Stanford, CA: Stanford University Press, 2016. xiii, 252 pp. (Illustrations.) US$27.95, paper. ISBN 978-0-8047-9892-1.
Current scholarship on SARS (severe acute respiratory syndrome) mainly focuses on the political features reflected in the response towards this public health emergency, a nostalgic review of Mao’s government-led mass health campaign, and public policy studies of medical reforms before and after the pandemic. Katherine Mason’s Infectious Change analyzes the public health changes brought on by SARS based on over a year of fieldwork in Shenzhen (which she refers to using the pseudonym “Tianmai”). The book focuses on the transformation from a “grassroots, low-technology approach” to “a professionalized, biomedicalized, and globalized technological machine” (3) by analyzing how a group of medical professionals at the TM CDC (Tianmai Center for Disease Control) dedicated themselves to building and serving “an idealized world of modernity, science, and trust” at home and abroad (3–4), which Mason refers to as “the common.”
She breaks this object of study down into four groups: the civilized immigrant common, professional common, the transnational scientific common, the common of global health practitioners, and a global common of modern, civilized people around the world. Mason meticulously examines these four commons, starting with the bifurcated service-governance relationship between civilized immigrants and the floating population. She explores the logic of guanxi (connections), renqing (human feelings), and ganqing (emotion) in daily public health work and how newly recruited young professionals have challenged this logic. She further examines how ambitious young and highly educated professionals are eager to join the transnational scientific community because of increased funding and higher publication standards after SARS. She looks at how these professionals interacted with survey subjects, patients, and foreign collaborators. Based on a case study of the emergency response toward the H1N1 flu outbreak, she investigates how ordinary powerless bureaucrats felt betrayed by this process (178), motivated as they were by scientifically informed professionalism while working under the pressure of authoritarian mobilization. In the end, the book addresses how a few public health professionals tried to contribute to both the transnational scientific common, and the local professional common by promoting service to the most vulnerable population in the city: those living with HIV/AIDS.
As an anthropological work, the book dexterously interweaves the changes in public health after the SARS pandemic with major social and cultural phenomena in the dynamic migrant city of Shenzhen, including immigrants, migrants, guanxi, renqing, and ganqing. Shenzhen is located in the Pearl River Delta, where SARS first broke out in early 2003 before escalating into the first global pandemic of the new millennium. One of the four special economic zones designated by the Chinese government in the early 1980s, Shenzhen has attracted millions of highly educated young professionals and low-skilled factory workers. In this social context, as Mason vividly shows, traditional social and cultural principles like guanxi and renqing create intricate and multi-faceted relationships in public health work. She begins by examining the dichotomic relations between public health professionals and workers and employees at factories and service sectors, which she characterizes using categories such as civilized immigrants vs. the floating population, a beneficial group vs. a sacrificial group, and being served vs. being governed. According to the author, the former has dedicated itself to monitoring and controlling infectious diseases among the latter in order to protect the young, educated, and “high-quality” middle class that public health professionals themselves represent and which Mason defines as “civilized community.” However, the large number of migrants in the city becomes a form of biocapital for the use of public health professionals, who are eager to join the international scientific community with research based on first-hand data. Meanwhile, a smaller group of young scientifically minded public-health professionals set out to build a professional common that could serve the needs of the entire group (92). These professionals, represented in the book by Chu, have focused their efforts on providing care for the most vulnerable, marginalized, and stigmatized group among the floating population.
The book also vividly shows the changing and entrenched logic and practice of guanxi, renqing,and ganqing in the work of these public health professionals. As Mason argues, the success of the professional common lies in accurate biostatistics that reveal scientific truths about the population and a reliable means of sharing those statistics (70). Social gatherings, such as banquets and drinking wine, became commonplace as places where these relationships could be cultivated. However, newly graduated young professionals had little experience or interest in attending these sorts of occasions and cultivating connections through them. Notwithstanding, they still had to resort to these to obtain the large number of disease, placenta, and cancer samples for their scientific research projects. Guanxi and ganqing were also particularly important in follow-up work on populations with HIV/AIDS.
The book convincingly discloses and analyzes the features and deficiencies of some contemporary international scientific research projects in developing countries. As Mason shows, young public health researchers, their mentors, and foreign collaborators have their own motivations for carrying out their scientific research. Young researchers are under great pressure to publish and eagerly aspire to join the international community. To receive domestic and international funding, their mentors need to show how their administration has performed, including publication numbers and the ranking of these, and proof of the impact of their research. According to the text, foreign collaborators seem to benefit from this process, which results in a “division of ethical labor.” As Mason argues, these external collaborators “transfer ethical responsibility for the wellbeing of local people affected by global health interventions to local public health professionals alone” (201).
However, the book needs to elaborate on the continuity of some changes to Chinese public health after SARS. In fact, those changes took place following certain shifts in the macro environment that are linked with the motivations behind and changed orientations of scientific research in China. Nonetheless, this anthropological study has made a significant contribution to work on the professionalization of public health professionals, immigrant/migrant studies, scientific research ethics, theories of guanxi and renqing, and groups living with HIV/AIDS, issues it has examined from an interdisciplinary perspective in the changing, dynamic, and globalized context of Chinese society over the past decade.
Fang Xiaoping
Nanyang Technological University, Singapore
pp. 569-571