The everyday political economy of health: community health workers and the response to the 2015 Zika outbreak in Brazil

Abstract

How is neoliberalism implicated in concrete health vulnerabilities? How do macrolevel political economy, policy and institutions translate into everyday experiences? Drawing on Marxist, feminist and International Political Economy critiques of everyday life, the article advances an everyday political economy of health focused on four key components: power, agency, intersectionality and the mutual implication of the global and the local. These components enable a nuanced investigation of concrete experiences of health and disease, and of the local implementation of health policies in the context of neoliberalism. The framework is applied to the case of the 2015 public health response to Zika in Brazil, and specifically to the role of community health workers, close-to-community healthcare providers tasked with bridging the health system and vulnerable groups. The everyday practice of these workers, and their working conditions overwhelmingly characterized by precarity and low pay, reveal the presence of global neoliberal dynamics pertaining to the reconfiguration of the Brazilian state as healthcare provider in a context of encroaching austerity, privatization and narrowly-defined cost-efficiency. These dynamics impacted detrimentally upon the effectiveness of the Zika response. KEYWORDS Everyday political economy; global health; community health workers; Zika; Brazil; neoliberalism In 2015, Brazil declared a war on mosquitoes. An outbreak of Zika virus disease, beginning in April in the northeast of the country, alarmed clinicians, researchers, policymakers, media and the public. Although Zika is a mild illness, causing fever, joint pain and headache, scientists puzzled over unprecedented symptoms in the most affected areas (Diniz, 2017). In November 2015, the Brazilian government declared a public health emergency based on the (then uncertain) association between Zika and neurological disorders. In February 2016, the World Health Organization declared Public Health Emergency of International Concern with a similar rationale (Heymann et al., 2016). Researchers later confirmed the link CONTACT João Nunes

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