Open Encyclopedia of Anthropology - Humanitarianism

Care

Rebecca Tishler — Tue, 14 Sep 2021 19:34:23 +0000

Initially published 14 Sep 2021

Abstract:

There are many universal assumptions about what care is and how it ought to be provided. Such assumptions are widely embedded in public debates, government policies, and institutional forms of support. This entry presents three areas of anthropological work on how care is practised around the world in order to challenge these assumptions and demonstrate how care varies in unexpected ways. First, the entry explores how care is structured and, in particular, how it is organised by contemporary states and global markets. Second, the entry provides an overview of how, in everyday relationships of support, the political, economic, and moral dimensions of care become entangled in one another. This demonstrates how ethnography offers a different way to approach ethical and practical questions about what makes care good or effective in different cultural contexts and in different settings—such as in medical institutions or in the relationships between carers and those for whom they care. Finally, the entry shows how the different ways that care works in families and in communities challenge taken-for-granted assumptions about what care ought to look like and where it should take place. Overall, the entry illustrates that care varies greatly across social contexts. Anthropology distinctively illuminates how deeply these variations change the experience and consequences of care in ways that require our detailed attention.

Introduction

Humans sustain each other’s lives through giving and receiving care. We often think of acts of care—such as a primary caregiver looking after a child—as central to what it means to be human. Such relationships of dependence, support, and sustenance are, indeed, universal—something we necessarily find in all societies. But precisely because care is a relationship, rather than a biological quality of individuals, this universal varies along with other forms of social variation. Societies imagine, structure, and practise caring relationships so differently as to create significant differences at the level of who has responsibility to provide care, who is seen to need and to deserve it, and what care aspires to do and be.

Policies, philosophies, and practices are often founded on universal assumptions about what care is and ought to be. States may cut welfare on the basis that it can and ought to be provided by families. Clinicians can care for patients with the idea that the best, even only, thing they can do for them is to cure them. Families may give women the responsibility to care on the basis that they are supposedly ‘naturally’ inclined to do so. Paying for care can be regarded suspiciously when people hold that care ought to emanate from personal and sentimental concerns, rather than instrumental ones. Informal care might be judged as inadequate on the basis that it lacks the expertise and rigour of professional forms of it. We have a panoply of ideas about what, where, how, and by whom care is to be provided—ideas that we often take to be natural, universal, and immovable.

This entry explores care in its different guises, in order to see more expansively what care means around the world, to illuminate its diversity and to question our assumptions. Anthropological work on care demonstrates how many dominant assumptions about care arise from specific ways that care is structured in contemporary Euro-American capitalist states. It shows that such assumptions do not help us understand how care appears in other societies, and risk blinding us to the complexity of caring relationships within Euro-American societies themselves. Anthropological studies of care thus illustrate that to understand the actual role of care in human life, we must expand our imagination about what, where, and how it is given.

Structures of care

Nation states and economic markets play a central role in distributing and regulating care in contemporary societies. They function to define who is worthy of care, who should be responsible for giving it, and the contexts in which it is given. Attending to these diverse ways of structuring care reveals how different they are from one another—and thus the significant effect they can have on the kind of care people receive and, in some cases, on the possibility of receiving care at all.

Capitalist economies typically connect care work and dependence with the private sphere as opposed to the public sphere of the market and politics. Relatedly, care is often held in these contexts to be a natural feminine activity while the independent ‘breadwinner’ is regarded as traditionally male (Ferguson 2015; Fineman 2005; Held 2006). A large amount of care work is thus performed by female kin within households and receives no fiscal compensation or legal recognition (Fraser & Gordon 2003). When care work is performed by non-kin in exchange for money, it is typically poorly compensated in contrast to jobs more closely associated with the centres of economic and political power (Folbre & Nelson 2000; Constable 2009; Zelizer 2009). Professional care receives little of the social status of other professions and those who perform informal care often occupy even lower statuses – their work receiving stigma and moral scrutiny for its conflation of the sentimental realm of care with economic modes of exchange (Ehrenreich & Hochschild 2004; Glenn 2012).

The structuring of societies according to the values of rationality, independence, individualism, and productive work thus shapes caring relationships in distinctive ways. It often obscures the time, expertise, effort, and costs of ‘women’s work’ and of ‘emotional labour’ in the home and beyond (Hochschild 1983; Abel & Nelson 1990). It also creates the impression that care work is only necessary for specific classes of ‘dependents’ and that it can be confined to specific social contexts (Ferguson 2015; Siebers 2007; Kittay 1999; Fineman 2005; Rivas 2004). Anthropological approaches to care challenge these assumptions by examining how it is actually practised and distributed in people’s daily lives. They also demonstrate that such socio-cultural and gendered assumptions about care nevertheless continue to determine how care is distributed in different societies (Zelizer 2009).

States and markets

No nation state has ever fully taken on the responsibility and fiscally compensated for all forms of care. Kinship, charity, community-based and privately financed care continue to play a vital role. Contemporary European welfare states, especially those in Scandinavia, have taken on probably the most responsibility for care within human history in their provision of expansive welfare payments for parental leave, child support, disability care, and elderly care as well as free healthcare. In such countries, kin are less often expected to provide care without state compensation, while the state also offers extensive alternatives for people to be professionally cared for by non-kin (Altermark 2018). This kind of expansive welfare government is accompanied by active intervention into the care of citizens through medical, psychiatric, and public health institutions (Foucault 2009b; 2009a; 1975). Such state intervention in turn generates classifications of certain classes of citizens as more ‘vulnerable’ than others.

Among developed capitalist countries, the US offers a stark contrast to Scandinavian states. The American state takes on far less responsibility for the care of its citizens, most notably in relation to healthcare and long-term nursing care. Organisations that provide long-term care for the elderly are typically owned and run privately, and are thus often beholden to logics of profit-making (Diamond 1995). Meanwhile, healthcare is largely funded through payments to private health insurance companies, who have ample legal room to evade the responsibility to actually provide care to many of those who would seem to need it. For example, when clinicians and potential patients claim to need support for eating disorders such as bulimia and anorexia, insurance companies can justify their refusal by reclassifying the very diagnostic symptoms such people initially use to make their claim to dependence as, instead, a wilful refusal of self-care (Lester 2019). Clinicians, operating within this mode of financing healthcare, can only obtain care for their patients by framing their conditions in the categories that insurance companies recognise as legitimate. Their clinical evaluations of patients thus become infused with insurance logics (Lester 2009; Brodwin 2013; see also Davis 2012; Biehl 2005).

In spite of this largely market-based approach to care, the American state is no less involved in its citizens’ lives. It makes ‘caring’ interventions through other institutions such as the military, justice, and carceral systems. War veterans, for instance, are entitled to kinds of healthcare assistance comparable to a comprehensive European welfare state (Wool 2015; Zogas 2021). Once someone with a mental-health disorder has committed a criminal offence, US courts can authorise otherwise-prohibited interventions in their lives to wean people off addiction or provide them with access to housing (Brodwin 2013; see also Cooper 2018). Prisons play a similarly unexpected role in providing healthcare to incarcerated pregnant mothers, making medical and emotional care simultaneously more available to some lower-income women of colour at the same time as entangling it with logics of incarceration (Sufrin 2017; see also Foucault 1995).

The opposite of this situation can also occur. States may attempt to maintain the idea that they are intervening to protect their citizens while, in reality, unburdening themselves of any responsibility to do so—often by bureaucratically distinguishing between supposedly legitimate and illegitimate forms of dependence (Foucault 2008). As Ukraine reeled from the Chernobyl explosion, the socialist and then post-socialist government was faced with unprecedented claims upon state assistance. It used biomedical institutions in order to reclassify people’s radiation damage as the result of an alternative condition that entitled citizens to nothing (Petryna 2013; see also Phillips 2011). When China introduced expansive new legislation to provide economic support to those with disabilities, the bureaucratic means for becoming certified as disabled turned out to be so complicated that few were able to claim it (Kohrman 2005).

A neoliberal logic, where governments redistribute responsibility to citizens by actively encouraging them to care for themselves (Foucault 2008), is present across many kinds of state intervention. This logic can make it easier for state institutions, and even families, to classify those who depend extensively on others, such as chronically ill or ‘unwanted’ populations, as ‘abnormal’—with the consequence that they may end up neglected in ‘zones of social abandonment’ (Biehl 2005; see also Marrow & Luhrmann 2012). Even the most well-meaning and charitable attempts to help those abandoned to these settings can unwittingly replicate the demands of neoliberal forms of government for citizens to take on more responsibility for their own care—rather than criticising the state for not providing it (Zigon 2010).

Humanitarianism and migrant care labour

Care is not confined to the borders of nation states, as humanitarian aid distributes it across regions in light of sharp global economic inequalities. States, together with non-profit organisations, make decisions about which populations in other parts of the world need, or are deserving of, humanitarian care. Much state-sponsored humanitarianism is shaped by ideals of a shared universal humanity that requires intervention to rescue and care for suffering victims. This logic can depoliticise the inequalities that produce such suffering in the first place (Beckett 2019; Feldman & Ticktin 2013; Ferguson 1994), creating unintended similarities between contemporary efforts and ideologies of benevolence underpinning colonial ‘civilising missions’ to reform those deemed vulnerable, deficient, suffering, or sick (Englund 2006). Lisa Malkki (1996) highlights how the category of ‘the refugee’ in programmes of humanitarian care for Hutus in East Africa reduces the complex identities and political subjectivities of those being ‘helped’ into a static, homogenous category of de-historicised victimhood. Similarly, children in conflict settings may come to be represented as fundamentally innocent and ‘needy’ through infantilising and at times futile ‘gifts of care’, such as hand-knitted toys (Malkki 2015).

A similar logic plays out when it comes to migrants and refugees at European state borders. The contemporary French state’s rhetoric of humanitarian care plays a role in categorising only certain undocumented migrants (sans-papiers) as vulnerable and ‘morally legitimate’ care-recipients—for instance, those who are sick or victims of sexual violence. This distinguishes them from migrants who might have been disenfranchised in other ways (Ticktin 2011). Such selective compassion by the state to care for specific bodies is a distinct political logic, one that may render issues of care apolitical and forecloses the possibility of contestation (see also Fassin 2011).

Global inequalities also shape, and are reinforced by, the international distribution of migrant care labour. Such labour is disproportionately performed by immigrant women from lower-income countries who move to engage in low-wage employment in the domestic and care work sectors of higher-income economies (Ehrenreich & Hochschild 2004; Glenn 2012; R. S. Parreñas 2015), such as from the Philippines to Hong Kong, Mexico and Central American countries to the US, and South Asia to the Gulf states. Precarious livelihoods in migrants’ countries of origin and aspirations to care for family futures often motivate these journeys abroad, while households in wealthier countries outsource care work to migrant women as sources of cheap labour.

Migrants may lack the legal rights of citizens in ways that are entangled with the marginalisation of care workers and care labour more widely. When migrant women enter into these already precarious and vulnerable forms of labour, their experience of this gendered devaluation of care intersects with their discrimination along the lines of class, race, and citizenship (Constable 1997; Rosenbaum 2017; Muehlebach 2012). This ‘global care chain’ has knock-on effects on women’s families in their country of origin, requiring them to find other kin or paid carers to take over caring responsibilities in their absence (Hochschild 2001).

The ethics of care

Political and economic logics distribute responsibility for care in such a way as to produce its presence or absence in different settings. How do people relate to one another within caring relationships themselves? What does care look like and involve in practice?

Ethics of care in professional settings

Many forms of health and social care now place a high value on autonomy, consent, and patient choice as they move away from paternalistic models. This ‘logic of choice’ (Mol 2008) limits many forms of caring intervention based on the authority of professional expertise. Social workers in the US bound by these values of autonomy cannot intervene in the lives of those with drug addictions and mental health problems, even when they find people sleeping in the snow without a blanket (Brodwin 2013). The logic of choice creates particular problems for those who need care when their mental capacity to choose is affected by conditions such as dementia, intellectual disability, or mental health problems (Driessen 2018b; Marrow & Luhrmann 2017). Many forms of care exist precisely because people are judged to be incapable of choosing for themselves—but strict adherence to a logic of choice leaves no room for this kind of intervention (Pols, Althoff & Bransen 2017).

Actual caring relationships tend to work in far more complex ways than the logic of choice, and its binary division of paternalism from autonomy, allows. In practice, many caring relationships work through constant intervention in the life of the care-recipient—some of which are paternalistic, and some of which can less easily be classified in this way (Mol, Moser & Pols 2010; see also Kittay 2007, 2019). Chinese parents, for instance, ‘tinker’ (Mol 2008) behind the scenes to create conditions that will be conducive to their children succeeding in a highly competitive economy, in order to avoid directly commanding their already stressed children (Kuan 2015). And many contemporary Euro-American forms of care try to combine intervention with freedom through different forms of pedagogy or persuasion (Pols 2006; Ochs & Izquierdo 2009; Driessen, van der Klift & Krause 2017; McKearney 2021).

Logics of care contrast, also, with another important standard within medical institutions: the goal-oriented focus of curing (Kleinman 2015; 2013). The role of such care comes into focus in settings where curing is not possible—such as in end-of life care (Kaufman 2014; Pols, Pasveer & Willems 2018; Shield 1988). Julie Livingston shows how, when doctors in resource-deprived hospitals in Botswana have little hope of curing their patients, they carefully attend to dressing wounds, managing pain, and providing emotional support (see also Kleinman 2009; Street 2014). They practise medicine as a form of solidarity with the sick—a care that exceeds standard biomedical forms of evaluation (Chambliss 1995). Medicine’s funding and regulation with the ideal of curing leads many in medical professions to miss the centrality of care to their own work, and to other people’s moral projects—as, for instance, when clinicians in the US misrecognise how parents pursue meaningful lives for their critically-ill children despite the improbability of curing them (Mattingly 2010; 2014).

The relational and hard-to-measure qualities of care often make it hard to justify in quantitative or economic terms. Interventions that work through the solidary logic of caring– such as long-term psychotherapy—often receive less funding (Lester 2019; Luhrmann 2001; Davis 2012). The impossibility of economically justifying long-term support for those with those mental disorders that incline them to reject care can lead clinicians to identify such patients as ‘incurable’—even when there is no strictly clinical reason to do so (Davis 2012; Lester 2009). A focus on such impersonal quantitative outcomes in the Canadian government’s response to a crisis of Inuit suicides ignored the sources of and the solutions to the crisis among the Inuit themselves, who see life as inherently bound up with relations of care with ancestors and relatives (Stevenson 2014).

Relations of care produce outcomes that the logics of choice and cure miss. A focus on autonomy can have the effect of wearing our relations thin, to the point that changes in cognitive capacity end up spelling social death (Biehl 2005; Cohen 2000; Marrow & Luhrmann 2012). Instead, a focus on relations of care can build sustaining ties between us as social beings (Taylor 2010). Athena McClean (2015) demonstrates the concrete effects of taking such hard-to-measure logics of care seriously by contrasting two long-term dementia care homes in the US: one which primarily treats care as an instrumental task, and the other as a relational form of solidarity. She demonstrates that the latter maintains not only the dignity but also the cognitive capacities of those in receipt of care—producing also far fewer incidents of conflict or distress.

It is for this reason that feminist scholars writing about the ‘ethics of care’ have long advocated for placing concerns about care at the centre of our moral imaginations and as integral to public and political life. They take care to be a relational practice that refers to all that people do to maintain, continue, and repair the world in which they live (Tronto & Fisher 1990; Tronto 2009).

Challenging moralities

Caring relationships that operate outside of the logics of cure, choice, and the market do not all look the same. Around the world, care takes many forms that challenge our moral intuitions about what it should look like—disrupting, in particular, the dichotomies we hold between good care and its opposites (Duclos & Criado 2020; McKearney 2020).

Professionalism, instrumentalism, and commodification are often set against the moral and emotional qualities we typically associate with care—of sentiment, connection, and warmth (see H. Brown 2010: 129). But, in practice, contractual relationships of care are frequently sites for human intimacy, connection, and flourishing. In the context of paid eldercare work in the US, precariously employed immigrant women who perform this work develop meaningful, if ambivalent, relationships with the older people they care for. Care is thus generative both of inequalities and of new forms of personhood, interdependence, and relatedness (Buch 2018) and thereby of moral engagement. Rather than telling a story about love or intimacy versus money, anthropologists have demonstrated how different ways of relating emerge in and through their very intersection. This has led them to question the assumption that a capitalist world is necessarily marked by a ‘lack’ of care (Constable 2009; Gutierrez Garza 2019; Zelizer 2009).

Some professional logics of care try to restrict these possibilities of intimacy. But other organisations deliberately use these possibilities to enable closer forms of personal connection for those whose dependence can deprive them of it (McKearney 2017; 2018; Marrow & Luhrmann 2017; Nakamura 2013; Kulick & Rydström 2015; Haeusermann 2018). These possibilities for human connection can also be important to care-givers, especially when their work is stigmatised and reproduces their social exclusion more widely (Muehlebach 2012; Rivas 2004). In Singapore, Filipino migrant nurses who might initially be rejected by their Chinese patients for being of ‘different skin’ can later find ways to connect with these patients through personal connections such as a shared religious orientations (Amrith 2017). Such everyday affective, intimate, and material exchanges within care work can constitute a form of political belonging for migrant carers, especially in the absence of formal citizenship rights (Coe 2019; see also T. M. Brown 2011).

The idea that care must take a particularly involved form of empathetic engagement does not hold everywhere (Otto & Keller 2018; Mezzenzana 2020). The warm and sentimental relationality we often associate with caring for another may be taken to get in the way of ‘good’ care. In Thailand, care is a matter of practical work, bodily ritual, and karmic morality. Here, care as the concrete, habituated, and mundane act of providing for others decentres more abstract, sentimentalised and morally loaded notions of care that have long dominated in Europe and America (Aulino 2016). Don Kulick and Jens Rydstrom (2015) demonstrate this in their study of carers in Denmark who support people with disabilities to have sexual encounters. These carers do not try, themselves, to be visible and involved. Instead, they aim to turn themselves into mere background influences—as do many carers supporting those who rely on extensive care throughout their daily lives (Rivas 2004; Stacey 2016; Buch 2018). At the other end of the spectrum, ‘warmth’ can arise in elderly care even when it is mediated by ‘cold’ objects like robots, as is the case in the Netherlands (Pols & Moser 2009; Mol, Moser & Pols 2010). Intimacy may similarly arise even in the apparent absence of human care relationships. Against the grain of popular discourses in Japan, which presume that elderly people living alone are socially abandoned, older adults can find their own ethical practices for living meaningfully in later life through daily rituals making offerings to departed ancestors (Danely 2015).

Control, confinement, and aggression are often imagined to stand in direct contrast to care. Anthropologists, by contrast, show how they can be central to the form that care takes in reality (Foucault 2009a; Johnson and Lindquist 2020; Mulla 2016). In many contexts, violence and deception do not compromise the purity of a more sentimental care but are instead central to how people imagine and practise good care (Brown 2010; Garcia 2015; Livingston 2012). In India, clinicians care for those with schizophrenia by hiding information about the diagnosis from these individuals, and enlisting the support of the family to regulate and control the care-recipient (Marrow & Luhrmann 2017; see also Luhrmann 2007). These paternalistic dynamics within and beyond the family may well be a key of part of the explanation as to why schizophrenia takes a far less severe form in this context. The line between abusive and affirming forms of care is thus much less clear, in practice, than our ideals of care may suggest (Garcia 2010; 2014). In these studies of alternative forms of professional care, hierarchy, paternalism, control, or detachment are not such grave dangers to the person as we often imagine. Rather, they are part of different ways of understanding what it means to be a person, to be cared for, and to be respected. These alternative caring ethics can have remarkably positive outcomes for conditions that mainstream Euro-American care struggles to handle, such as mental illness, dementia, intellectual disability, and addiction.

Care, kinship and communities

The majority of care around the world is still provided outside the direct purview and funding of the state and its institutions, within families and in communities. During the latter part of the twentieth century, many states closed long-stay institutions and shifted away from centralised hospitals on the idea that care is best provided in the ‘community’ (Horden Smith 2013). But this modernising narrative glosses over the fact that families and ‘communities’ rarely fit the imaginations of policy-makers and vary considerably in the way they distribute care.

Families are a primary site through which caring obligations are distributed—kinship roles themselves often being defined, in part, through one’s obligations to or entitlements to care at different life-stages (Goody 1971). But there are profound differences in normative cultural patterns about what families should look like, how care should be distributed within and beyond them, and what ought to constitute proper care. Children, in some contexts, may not have a single dedicated caregiver, nor any dedicated caregiver at all (Otto & Keller 2018), nor are they always regarded as the responsibility of parents in a concrete way, in no small part because they may not be defined as vulnerable to begin with (Lancy 2014). Children as young as five among the Runa of the Pastuza region in the Ecuadorian Amazon are left to look after themselves in very practical ways through building shelter and acquiring food on their own (Mezzenzana 2020). The Runa consider leaving children to their own devices as the best way to let them learn self-reliance, concern for others, and a capacity to manage themselves. This is connected to the self-reliant ‘obstinate individualism’ of the region, in which each person is their own responsibility and no one else’s (Mezzenzana 2020). Such alternative forms of childcare do not just challenge how childhood can be imagined; they also affect the extent to which adults are required to provide care and to which children can care for themselves (Ochs & Izquierdo 2009).

Kinship-care goes far beyond the nuclear family. There are many configurations of kinship that involve a different set of characters in providing care: grandparents, changing romantic partners (Zelizer 2009), or non-genetic close connections who may be described as kin (Edwards & Strathern 2000; Pande 2015). Domestic work by non-kin, more or less assumed into a family structure, has a long and continuous history (Delap 2011; Ray & Qayum 2009) as does the adoption of non-kin. In some societies, the very definition of a partner, parent, or child may not be a permanent genetic or legal bond (Sahlins 2013; Conklin & Morgan 1996). Kinship can also be created through acts of care; for instance, the day-to-day sharing of cooked meals in Langkawi in Malaysia (Carsten 1997; see also Parkes 2005). In these cases, kinship is often not defined at birth but rather is built between people through repeated transfers of care and exchanges of substances such as food or bodily fluids (Carsten 1989; 2000; Stasch 2009).

Kinship roles can also follow a more prescribed and structured set of normative expectations that concretely shape caring responsibilities. In rural Uganda, patrilineal family structures shape the different kinds of grandparental care that sons and daughters’ children receive (Whyte & Whyte 2004). In many South Asian families, one’s status as a child of one’s parents continues to define the care one receives and gives throughout the life course. Parents frequently refer to their adult children who have not yet married as bacche, ‘children’ in Hindi (Mody 2020a). Parental intervention in the sphere of marriage may also be seen as legitimate well into adulthood. The forms of pressure that it may take to make children conform to a parent’s decisions on suitable marriage partners are often expressed and justified through a language of care. Marriage-decisions gain part of their importance from the role that daughters-in-law play in providing care to their parents-in-law (Lamb 2000; Marrow & Luhrmann 2017).

These forms of kinship can give a stability, givenness, and intimacy to the kinship bond that makes the transfer of care obligatory and uncalculated. But that does not mean that care’s role in kinship is stable even in these contexts. One’s role shifts across the course of the lifetime with gendered transitions through childhood, adulthood, and elderhood (Goody 1971; Faubion 2001). The expectations of care that such transitions bring are negotiated and contested extensively. When kinship takes the burden of care, it is typically a weighty, complex, and fraught affair (Mody 2020b; Pinto 2014; Trawick 1990; Reece 2020).

Social and political changes brought about through processes of urbanisation and globalisation can also re-configure the role of kinship in caring relationships. Popular narratives in India lament the demise of the ‘Indian joint family’ to stress the importance of what they see as the legitimate way to look after elders: by caring for them within that familial context (Cohen 1992). But international migration from India has led to the growth of novel care arrangements: privatised eldercare homes and local care services as an alternative, or complement, to kinship care for elders who stay in India while their kin live abroad. A closer look at the lives of people living in these communities demonstrates that care homes are not merely impositions of Euro-American models but are culturally legitimate spaces for middle-class diasporic Indian families (Lamb 2009). In low-income settings in Sub-Saharan Africa, while the care of children, elders, and those with chronic health problems is often undertaken by family members, migration, urbanisation, and increasing inequalities constrain the capacities of households to care. Family care then becomes a dynamic space within which people do not only act according to emotional or moral obligations, but according to the resources available (Reece 2020; Read & van der Geest 2019; see also Han 2012 for an example from Chile). In Ghana, when family care becomes less viable on its own, other spaces such as church become important to providing health and social care, as well as acting as a form of ‘fictive’ family (Coe 2019b). Meanwhile, those living with HIV/AIDS in Uganda, may find new ‘(quasi) relatives’ among health workers, volunteers, and strangers who are seen to be more trustworthy than family members (van der Geest, Dapaah & Kwansa 2019).

Among families rendered transnational through global care chains, creative care arrangements challenge normative understandings of what a family should look like. Care amidst family separation can be mobilised as an intergenerational resource and form of solidarity. Nicaraguan transnational family life draws extensively on extended kinship networks, while grandmothers and grandchildren who care for each other in these contexts challenge constructions of those ‘left behind’ by migrants as passive care recipients (Yarris 2017). Care at a distance is increasingly mediated by digital technologies and expressed through remittances, gifts, and goods, while the ‘family’ itself may involve multiple actors, including paid care workers, distant relatives, and neighbours (Hromadžić & Palmberger 2018; Ahlin 2020; Baldassar and Wilding 2020). Transnational care challenges the distinctions between family, paid, informal, professional, communal, and state-based care, demonstrating the interconnection between all these categories.

The expectations within policy about where care is to be performed, and by whom, are influenced by and reproduce the legal recognition of only certain types of relatedness as legitimate. But care often exceeds these classifications. The narrow confines of kinship categories deployed by the state and the law are frequently rooted in biological or heteronormative assumptions and thus often exclude other forms of partnership, intimacy, and mutual care (Weston 1997; Dave 2012; see also Strathern 2005). Gay and lesbian relationships, for example, may not fit into many legal definitions of kinship precisely because they are founded upon the very idea of ‘caring and being cared for’ (Borneman 1997).

In other contexts, kinship’s importance can be exaggerated. Migrant care workers’ absences from their families are often framed by state and public discourses as having damaging impacts on heterosexual family structures (Manalansan 2008). However, this narrative overlooks the novel caring relationships based on love, intimacy, and friendship that migrants develop in communities abroad that go beyond kinship categories yet remain deeply significant to their experiences and identities (Johnson & Werbner 2010; Liebelt 2011).

Religious, political, and ethical movements also decentre kinship by structuring distributions of care beyond the family. Religious groups can create relationships of care and compassion between previously unrelated social groups and social concerns (Copeman 2009; Evans 2016; Kertzer 1980; Mair & Evans 2015). Christianity, for instance, created new forms of spiritual kinship within the church—most strikingly in monastic communities where people renounced existing relations and future marital prospects to form new kinds of brotherhood and sisterhood in Christ (Brown 1988; Banner 2014). These alternative moral imaginations created new categories of dependents worthy of care (such as children and the ‘poor’) as well as social practices and institutions to distribute care to them—many of which have decisively influenced the shape of contemporary forms of charity, healthcare, and education (Bakke 2005; Brown 1980, 2002; Scherz 2014).

Contemporary small-scale intentional communities can distribute responsibility for care within more limited and controlled environments—whether that be for those with dementia, intellectual disabilities, or the environment (Haeusermann 2018; McKearney 2017; Schiffer 2018). There is also increasing interest in how caring communities extend beyond the boundaries of humanity, both historically and in this age of climate change. One example is the relationship between orangutans, their local human caretakers, and the wider environment in rehabilitation centres in Sarawak (J. Parreñas 2018). Contrary to (post)colonial practices of conservation that are based on establishing control over other species and the environment, orangutans and their caretakers are embedded in a relationship of interdependence and shared vulnerability (through, for instance, land dispossession).

Volunteering can also be an important space for providing care and creating communities. In Greece, as people struggle to access national healthcare in times of economic crisis, networks of community-based clinics/pharmacies have emerged to redistribute donated medicines and provide care through networks of volunteers. These forms of care as social solidarity reanimate Greek citizenship, since it becomes a key location for caring relationships, instead of the family or the state (Cabot 2016). Similar kinds of solidarity can be found in Northern Italy in the context of austerity and diminishing state support. Here it is pensioners who take on the voluntary work of caring for each other, helping those more vulnerable in their neighbourhoods with their shopping, medical appointments and providing them with companionship. This unexpectedly correlates with a denigration of other forms of care, so that when migrant domestic workers in these regions provide similar kinds of care for little pay, their labours are ignored or stigmatised as profit-seeking (Muehlebach 2012). Such community-based caring solidarities are then bound up with questions around what kind of care is visible, and who or what is excluded from the moral framings of these movements.

Conclusion

Social relationships offer the possibility of sustaining another’s life, and of being sustained beyond what one is capable of. If these relationships are necessary for individuals and societies to survive, they are also as variable and open-ended as human life itself. When we attend to the vast diversity of meanings and practices of care around the world, many of our assumptions about it crumble. When care manifests as connection, asymmetric dependence, coercion, refusal, belonging, affirmation, desire, and neglect, all at the same time, we are forced to question what constitutes good care, and how clearly we can separate it from what we assume bad care to be. When we explore how care is structured by different social mechanisms, from kinship to the welfare state, we must take a much wider view about who provides care and in what settings. Within a globalised world of different economic regimes, we see how care is unequally distributed within and across societies, producing ambivalent and uncertain forms of intimacy and relatedness. In its everyday expressions, what care looks like in practice does not always fit in with the rigid pre-established normative ideals about how it ought to be. A detailed look at how care takes place outside of state and market overturns any easy or simple ideas about what care in the ‘community’ looks like and about how caring roles are taken on and negotiated. Care is a human universal. But humans universally structure, practise, and imagine it differently, creating vital differences to people’s lives.

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Note on contributors

Patrick McKearney is a Research Associate and Affiliated Lecturer at the University of Cambridge. He is editor of two special issues on cognitive disability in Medical Anthropology (2021) and The Cambridge Journal of Anthropology (2018), and writes, researches, and teaches on care, ethics, religion, disability, psychology, and personhood.

Dr. Patrick McKearney, Department of Social Anthropology, Free School Lane, Cambridge, CB23RF. pm419@cam.ac.uk

Megha Amrith leads the ‘Ageing in a Time of Mobility’ Research Group at the Max Planck Institute for the Study of Religious and Ethnic Diversity. She is the author of Caring for strangers: Filipino medical workers in Asia (2017, NIAS Press) and has research interests in migration and care work.

Dr. Megha Amrith, Max Planck Institute for the Study of Religious and Ethnic Diversity, Hermann-Föge-Weg 11, 37073 Göttingen, Germany. amrith@mmg.mpg.de

Global health

Felix Stein — Thu, 20 Jun 2019 20:40:13 +0000

Emily Yates-Doerr Kenneth Maes

Oregon State University and the University of Amsterdam; Oregon State University

Initially published 20 Jun 2019

http://doi.org/10.29164/19ghealth

Abstract:

Global health is a field of expertise that has emerged at the turn of the twenty-first century alongside changing disease profiles, health technologies, and governance structures. This entry provides an overview of the historical conditions that have given rise to the field. It illustrates the new political and financial transformations that have made global health 'global', in contrast to earlier work on international, world, or tropical health. It also charts new undertandings of wellness and disease, which have been shaped by global pandemics including HIV, the increase in non-communicable illnesses, and the recent concern for planetary sustainability. While anthropologists have played a central role in global health since its inception, the fields of anthropology and global health also operate in an 'awkward relation' (Strathern 1987) with one another. In the second part of the entry, we overview how anthropologists work within, against, and in-between the expertise of other global health practitioners. We suggest that insofar as the field of global health is emergent, so too are the ways that anthropologists engage with it.

Introduction: An awkward relation

Throughout the twentieth century, ‘global health’ was an uncommon term. The terms ‘world health’ or ‘international health’ were commonly used instead to discuss expansive supra-national health concerns, from epidemic diseases to political relations and financing. ‘Global health’ emerged to draw attention to the global connectedness of diseases and of the people and institutions that govern and respond to them, driven by the spread of new technologies that facilitate rapid global transit, exchange, and communication.

Global health has become codified as a field of expertise over the new millennium, and today the term is used widely. Global health centres exist at most major academic and health-focused institutes. The World Health Organization now issues a global health agenda^[1] and compiles its health-related statistics in a database called the Global Health Observatory.^[2] Numerous publications advance ‘global health science’. For example, the journal Global Public Health launched in 2006, and the medical journal The Lancet initiated a publication devoted entirely to global health in 2012. International conferences organised around the theme of global health draw thousands of professional and academic participants each year and news outlets commonly have global health sections as part of their broader health reporting.

As global health has exploded onto the scene of health scholarship, the field of anthropology has responded by taking it up as a set of practices within which to engage as well as a concept to study critically and ethnographically. Many anthropology departments now participate in multidisciplinary undergraduate and graduate programs focused on global health, and university partnerships between centres for global health and anthropology departments are common. Academic presses such as Duke University’s Critical Global Health series also connect the fields and several anthropologists have published review articles, readers, textbooks, and edited volumes on global health (e.g. Nichter 2008; Janes & Corbett 2009; Singer & Erickson 2013; Biehl & Petryna 2013; Adams & Biehl 2016; Brown & Closser 2018). Moreover, numerous meetings convened in recent years explore the rapidly transforming theories, policies, and practices produced through the intersections of these fields (e.g. de Klerk 2015).

Anthropologists have found diverse ways to engage with global health, and they have witnessed important frictions between the methods, orientations, and interests of different scholars and practitioners in these overlapping fields. In this sense, anthropology and global health are in ‘awkward relation’ to each other (Strathern 1987). This is to say that tensions arise when two differently-oriented and internally diverse fields meet and occasionally merge, and that the coming together of the fields will not be seamless. This entry will review the alternative orientations and praxes that have emerged in global health and anthropology’s intersections, and illustrate how this heterogeneity can be both productive and disruptive to efforts to address health problems around the world.

The entry is divided into two parts. The first shows that global health’s formations are both expansive and emergent. Its sprawling systems and organization of stakeholders include an exceedingly complex and dispersed set of interactions between microbes, carcinogens, billionaire donors, government officials, medical and pharmaceutical corporations, NGO workers, health care professionals, and publics. Moreover, the priorities, methods, and impacts of these multiple actors are rapidly transforming. That said, ‘rapid transformation’ is also a discursive strategy of some powerful players in the field of global health, and attention to the field’s historical formation shows that much of what is presented as ‘new’ echoes colonial-era patterns of consolidating wealth, exacerbating global inequality, and monitoring sickness and health for the sake of empire and/or corporate profit (Packard 2016; Trouillot 2003).

The second part of the entry shows that anthropologists over the past two decades have held a variety of dynamic positions in relation to the field of Global Health. It focuses on three positions, reviewing how anthropologists have worked within, against, and in-between dominant global health interests.

Emergent transformations in global health

1. Responding ‘globally’

‘Global health’ has emerged in policy and development spaces that were, until recently, organised around ‘international’, ‘world’, or even ‘tropical’ public health concerns (Brown et al. 2006). It operates as both a collection or assemblage of individuals, organizations, and nation-states and as a discourse about health that travels beyond these institutions. The term has become so commonplace in public discourse that it may be easy to overlook that it is an invented, historically specific concept, which organises the world by prioritising some set of values over others (eg. charity over political justice, moral universalism over cultural specificity, global citizenship over Indigenous sovereignty, etc.) (Butt 2002).

Much anthropological work on the topic unpacks how global health has been constituted as a ‘global’ domain. It emphasises that the category ‘global’ is not an objective summation of all places in the world; rather, places and things that are considered to be global are produced out of specific historical and cultural milieus (Law 2004; Tsing 2000). And though ‘global’ purports to represent the entire world, the category often reinforces exclusions and absences. Current anthropological engagement and concern with global health can thus be seen as a continuation of anthropology’s awkward relation with state-making projects; indeed, medical anthropology itself has a root in the enlistment of anthropologists into twentieth century international health development projects (e.g., Foster 1976).

However, as Nolwazi Mkhwanazi (2016) points out, global health does not adhere to a single origin story. Doing global health well, she insists, entails searching out and listening to the stories that are often systematically erased alongside those which are commonplace. For example, the widespread interest in sexually transmitted disease and sexual violence in Africa on the part of global health organizations may foreclose attention to the fact that, for many, sex remains a source of thoroughly healthy pleasure (Hendriks & Spronk 2017). Or, the global health agenda focused on ‘maternal health’ may unfairly burden women with the responsibility for reproduction while silencing the experiences of domestic and caring fathers (Han 2009, Powis 2019). It is important to keep the power of stories in mind when reading the common histories of the field. Whether the explanation offered for the rise of global health focuses on transitioning disease profiles, changing governance structures, or something else entirely, it must be understood in terms of its narrative effect, which creates and reinforces the thing it purports to simply describe (Mattingly & Garro 2001).

One powerful story about the ascendance of global health emphasises the acceleration of contagions and potential pandemics whose vectors of transmission do not adhere to national boundaries (Caduff 2014). These epidemics involve viruses such as the human immunodeficiency virus (HIV), swine flu, or Ebola; bacteria such as tuberculosis or cholera; protozoa like the ones that cause malaria; and agents whose mechanisms of infection are not well understood. Many experts have responded to fears about the spread of illness by linking global health to national security. For example, the U.S.-based Centers for Disease Control (CDC) describes the basis for its commitment to global health as follows:

Disease knows no borders. In today’s interconnected world diseases can spread from an isolated, rural village to any major city in as little as 36 hours. The U.S. cannot protect its borders and the health of its citizens without addressing diseases elsewhere in the world. (2018)

The case made by the CDC and numerous other health agencies is that ‘local’ health and illness programs must be simultaneously global in outlook, since global monitoring is good for the nation. Of particular concern are countries or regions that health professionals frequently characterise as ‘resource-poor’.^[3]Global experts often positioned these countries as the containers of diseases – or people with diseases – which might, potentially, spread beyond their borders (Brada 2011). Experts typically talk about diseases moving from south to north or east to west. It is important to note, however, that many countries deemed ‘poor’ by the global health community are, in fact, resource-abundant and their apparent poverty is the result of Euro-American colonial expansion and extraction (Benton 2014) as well as on-going, deliberate efforts to maintain income and health inequalities on the part of exploitative global elites (Vasquez 2018).

In addition to categorising disease patterns and technologies, the ‘global’ of global health also references new structures of governance. The meteoric rise of global health in the past two decades speaks to the crucial role of non-governmental actors, including corporate and philanthropic foundations, in shaping health services today (McGoey et al. 2011; Nguyen 2005; Rottenburg 2009). The World Health Organization, founded in 1948, and the Latin American Health Organization, founded in 1902, once coordinated public and international health concerns among their ‘member states’. Now organizations headquartered in the Global North such as the Bill and Melinda Gates Foundation or Save the Children serve as ‘uneven partners’ of impoverished countries in the project of making health globally accessible (Crane 2010). Yet while the ‘single story’ of global health emphasises the emergence of non-state actors and disappearance of the state, other stories make clear that non-state actors were historical drivers of ‘international’ health, and that the involvement of the state remains central and on-going in global health practices today (Quirke & Gaudillière 2008; Vaughan 2007).

One especially common origin story of global health locates its roots in the strategic responses to the devastating effects of twentieth century HIV. In the US and Western Europe, infected people and their allies and advocates successfully pressured their governments to make therapeutic drugs more widely accessible in the 1980s and 1990s. Meanwhile, antiretroviral drugs (ARVs) and therapies remained prohibitively expensive for many people dying outside these countries, particularly in Sub-Saharan Africa, Brazil, and India. In fact, many health experts even argued against treating AIDS outside of Euro-America, framing prevention and treatment strategies as mutually exclusive, and arguing that AIDS should be prevented but not treated (Moyer 2015).

Grassroots movements connecting diverse global communities were instrumental in challenging the denial of ARVs to people outside the West. Activists demonstrated that successful treatment and high adherence rates were possible in resource-restricted settings and they leveraged pharmaceutical companies to make generic drugs available worldwide (Avirgan 2005). They also convinced donors to pay for the delivery of treatment and care, bringing foundations and non-governmental entities into the conversation. Bill Clinton, as President of the United States, initially supported Western pharmaceutical companies’ attempts to protect their patents on antiretroviral drugs abroad. In 1999, under pressure from global AIDS activists and members of the Congressional Black Caucus, Clinton announced that the United States government would not pressure sub-Saharan African countries to give up their rights to import or produce cheaper, generic ARVs (Messac & Prabhu 2013). In the early 2000s, the newly formed Clinton Foundation brokered a reciprocal investment/production deal between governments and generic drug producers in Africa and India. This was broadly described as a ‘win-win’, with profits made by drug companies and needy government purchasers securing drastic price reductions (Biehl 2006; see also Allen 2006; Erikson 2016).

The Clinton Foundation’s involvement in ARVs set the stage for other philanthropic organizations to join the emergent global health movement. In 2001, Amir Attaran and Jeffrey Sachs published an influential article in The Lancet, proposing a new funding structure dedicated to controlling the world’s three greatest infectious killers (Attaran & Sachs 2001). Later that year, leaders of the world’s eight largest economies launched the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. While the goal of universalising access to treatment has not been met, the Global Fund helped galvanise a massive increase in health financing that connected diverse non-state actors, including civil society groups, in the project of health governance. Speaking of health as ‘global’ and not ‘international’ was, in this sense, a strategic move to bring together actors whose interests extended beyond the wellbeing and security of single nations.

In addition to its unfolding against the backdrop of a worldwide mobilization against HIV, twenty-first century Global Health has also emerged as a response to the devastating global effects of structural adjustment programs, which dominated the international development agenda during the 1980s and 1990s. The World Bank and the International Monetary Fund had offered loans to low-income countries in exchange for various fiscal reforms. Some of the most crippling reforms involved government reductions in health care spending, leading to poorer quality and often non-existent public health care (Pfeiffer & Chapman 2010). During this period, the deregulation of global, transnational corporations led to the accumulation of massive wealth in the hands of the few, while also contributing to large-scale environmental degradation through resource extraction and the promotion of white middle/upper class consumption habits. Much of the work of global health today aims at righting the wrongs done by a previous era of experts who created widespread health inequity and illness in the name of global development. We explore how this is playing out further in the section below.

2. Transitions in ‘health’

Just as the ‘global’ in global health is emergent and under negotiation, so too is ‘health’. In the current era, it is often difficult to tease apart health as a biological condition of well-being from health as a risk factor, indicator, or proxy for development (Adams & Pigg 2005; Harper 2014). Global health professionals routinely use ‘health’ strategically, to reference both an immediate physiological state and a value-laden future aspiration. The following example of how health and health policy professionals are re-purposing the term ‘health’ illustrates the conceptual fluidity of the term.

‘“Health” has had its day’, Julio Frenk – then Dean of Public Health at Harvard University – declared at a 2013 conference held at the Institute of Health Metrics and Evaluation (IHME), an institute endowed by the Bill and Melinda Gates Foundation which has carried out much of its work under the banner of global health. Frenk was describing what he saw as a decline in the previous era of biomedicine, which had oriented public health toward body-focused and individual indicators for health such as maternal mortality, child morbidity, or average life expectancy. In its place was growing health-related interest in global development.

For Frenk, and many others at the IHME conference, this transition was linked to the Millennium Development Goals (MDGs). As Frenk explained, the assembly of these first UN development goals (in effect from 2000-2015) had been a small affair. Over three days, a relatively small number of politicians and policy experts had come up with eight global goals, giving themselves a 15-year window to meet them. Three MDGs (Goals 4, 5 & 6)^[4]were unquestionably related to biomedicine, seeking to reduce disease and mortality and to enhance health. Yet the goals also promoted a framework for thinking of health as a matter of global economic progress and planning. ‘No one expected the MDGs to be such a success’, Frenk told his audience. Crucially, the ‘success’ he referred to came about not because the MDG targets were achieved (most countries’ attempts to meet them fell far short) but because they significantly changed the conversation and influenced health funding allocations by channelling funding toward the elimination of specific, targeted diseases such as HIV and malaria (see also Hardon & Blume 2005). The merging of health and economic development can be seen clearly in MGD Goal 1, which coupled the eradication of extreme poverty and the eradication of hunger, bringing the experience of bodily suffering squarely into dialogue with economic concerns.

As the UN committee settled on ‘sustainability’ as the theme for their second set of development goals (named the Sustainable Development Goals or SDGs), health further shifted from being primarily a human body-based quality (i.e. the experience of wellness) to being a proxy for economic growth and development. While body-based health concerns such as morbidity and mortality remain key aspects of the SDGs, these operate alongside ‘health’ concerns of gross domestic product, human capital, and environmental sustainability. This result was not the contraction or disappearance of ‘health’ as Frenk had originally declared but rather its expansion: linking health tightly to global development makes health relevant far beyond biomedicine’s traditional focus on the individual body.

Changing disease pathways and illness profiles also fuel transformations in the conceptual underpinnings of twenty-first century health. New antibiotic technologies and the development of the field of nutrition in the early twentieth century ushered in major demographic population shifts. Today, people around the world are living longer and dying more commonly of non-infectious, chronic, and comorbid illnesses than in the past. Complementing conversations that aim to control contagion and limit the spread of illness vectors are conversations about ‘lifespan’ concerns, including metabolic disorders, tobacco prevention, mental health, and cognitive decline (Cousins 2015; Kalofonos 2010; Solomon 2016; Reubi 2012; Davis 2018). Aging, once a given part of life, is becoming a medical condition that is financially lucrative for the health industry precisely because it is not curable (Manderson & Smith-Morris 2010; Danely 2019).

Rising temperatures and sea levels also shape the manifestation of afflictions such as diabetes and kidney disease (Nading 2016; Moran-Thomas 2019). Hygiene has likewise extended beyond the discourse of personal medicine, which often exacerbates racism and sexism by blaming and shaming individuals for system-wide failures (Briggs & Mantini-Briggs 2003; Saldaña-Tejada 2017). It now encompass ‘dirty’ atmospheric airstreams and construction technologies and their related – and still racially and gender-stratified – afflictions (Kenner 2013; Whitmarsh 2008). Concern about the immediate effects of microbial infection broadens to slower disasters, such as absorption of carcinogens or heavy metals. Illness, once defined as a feeling of being sick and suffering, has come to encompass that which accumulates in the body all but unnoticed, as in the case where the victim of a heart attack ‘suffers’ without longterm awareness of the disease. In many conditions of chronic illness, health may not pertain to patient perception but to diagnostic capacity and the anticipation of a future manifestation of illness yet to come (Lynch & Cohn 2016; Weaver & Mendenhall 2014). At the inception of the SDGs, The Lancet released a report on planetary health which expanded the concept of illness even further by drawing climate change, microbial environments, water security, and ecosystem diversity into global health’s terrain (Horton & Lo 2015).

The question of which – or whose – health is targeted by global health institutions has been a central concern for anthropologists (see Yates-Doerr 2018). As discussed further below, global health institutions have been widely critiqued for transforming culturally sensitive and locally attuned responses to complex diseases into ‘magic bullet’, short-term solutions. The field of global health has frequently ignored or devalued structural underpinnings of health and disease including access to food, employment, and high-quality primary health care (Closser 2010; Maes & Kalofonos 2013; Maes 2017). Yet in some important ways, the emergent focus on sustainable development among many key actors in global health may be helping to link health to structures of poverty, the violence of colonialism and deregulated capitalism, and climate vulnerabilities. Some suggest that on-going shifts in global health resonate with the social justice spirit of the Alma Ata Declaration of 1978, in which societal concerns for primary care were strengthened (Fee & Brown 2015). Exemplifying these shifts are movements to expand universal health care and ensure basic income. However, anthropologists caution that optimism about how these movements are unfolding should be tempered (Prince 2017; Berliner & Kenworthy 2017). There is clear empirical support for concern, for instance, that the cash transfer programs championed by behavioural economists and the World Bank may unfairly burden marginalised women’s lives or that turning health into a measure of poverty may have a dangerous ‘hidden cost’, by upholding gendered and racist inequalities (Cookson 2018).

The Global Burden of Disease (GBD) study, commissioned by the World Bank in 1990, did much to make global health a household term by quantifying the economic cost of more than 100 diseases across eight world regions. This study gave diverse and previously incommensurate illnesses a measurable standard through which they could be compared. The Lancet editor Richard Horton noted at a conference at the IHME celebrating the twenty-year anniversary of the study that ‘before the GBD there was not a science of health metrics’. Today, econometrics is central to global health, which makes use of disability adjusted life-years (DALYs), quality adjusted life-years (QALYs), and inequality measures called Gini Coefficients to transform diverse kinds of health into a single health metric to be defined by big data computing technologies. ‘Big data’ has brought health to policies previously focused on development while giving global health a decidedly economic flavour (Adams 2016; Yates-Doerr 2014).

At the GBD retrospective there was widespread celebration of the large number of lives saved by statistical analysis and its related ‘evidence-based policy’ (Adams 2013; Fan & Uretsky 2017). Several in attendance argued that the GBD study was a clarion call for investing more in health information systems. A speaker on an all-male panel noted that if the global community really ‘wanted nurses to save lives, we’d arm them with data collection tools’. This sentiment that data collection is more important than on-the-ground care is popular in many global health circles, whose participants seek distance from intimate patient-centred care practices and strive to improve health through the aggregation and analysis of (presumably neutral) data. A book celebrating one of the GBD’s founders is titled Epic measures: one doctor: seven billion patients, implying that better health data will have universal, global benefits. But data are not value-free, as those who study their assembly have shown (Geissler et al. 2016; Beisel & Schneider 2012; Sanabria 2016; Kelly 2012; Biruk 2018). Cultural and political orientations shape which questions are asked and how they are investigated. Framing health problems in some ways over others, in turn, shapes their solutions. For example, if the global increase in diabetes is framed as a biomedical problem, treatment strategies will address medication and diets; if it is framed as a problem of unjust food systems, responses may seek to bolster community-based food sovereignty and hold predatory food corporations to account (Carney et al.2019).

Sometimes anthropologists and global health practitioners may agree on how health problems and their solutions are constructed, finding each other at points of convergence and adding synergistically to the others’ perspectives. However, the person-centred, participant-observation, and ethnographic methods of much anthropological research are frequently at odds with the metric-centred methods of global health. Anthropologists and global health professionals may additionally take different positions with regard to their critique of colonialism or their embrace (or not) of capitalism, and they very often have differently imagined end-goals when carrying out research and subsequent interventions. The result is an awkward relation between the fields. In the next section, we address the different and dynamic positions that anthropologists hold in relation to the field of global health.

Anthropological engagements with global health

Anthropological engagement with global health can be characterised more by its diversity than by any uniform mode of relating. However, three broad positions of anthropologists with regard to global health can be identified: working within, in-between, and against other global health professionals. Additionally, the idea of an ‘awkward relation’ between anthropology and global health emphasises that different positions can be held by the same actor even while positions are in tension (see also Vernooij 2017).

1. Working within

While the field of medicine pre-dates anthropology by millennia, anthropologists have been centrally engaged in global health for as long as ‘global health’ has been recognised as a field. Some key anthropologists are well-known public health figures, such as the World Bank’s former Director Jim Yong Kim and his long-time collaborator Paul Farmer, co-founders of the NGO Partners in Health, which seeks to simultaneously treat individual illness and address the structural violence that devastates poor communities (2004). Kim and Farmer have been among several prominent anthropologists involved in the formulation and execution of health policies and intervention projects. As such, they are positioned to make a powerful case to the global health community to target the cultures of elite privilege that enable systemic health inequities in addition to – or even instead of – the cultures and behaviours of impoverished people when designing health projects (but see Shaffer 2018).

Other global health anthropologists hold valuable positions on the ground – often with little public visibility – where they work to improve local acceptability of global interventions or ensure projects are run in ways that matter to the people whose lives they are intended to shape (de Klerk 2013; Pell et al. 2019). Anthropological methods are embraced by several global health projects, which have found ethnography, and qualitative research more generally, crucial to their long-term success (Campbell 2011).

This work can be perspective-driven, addressing questions such as: what are local beliefs about vaccinations (Larson et al. 2016; Closser et al. 2016), food supplementations (Trapp 2016), microbiocides used in STD prevention (Pool et al. 2010), or regionally specific understandings of health, wellness, illness, or dying more generally? Their work can also be practice-driven, with anthropologists seeking to learn about how people receive vaccinations so as to make vaccination campaigns more effective (Sullivan 2017), to help experts design dietary interventions to better respond to people’s needs (Warin & Zivkovic 2019), or to impact midwifery policy to bring locally-accepted techniques for childbirth into public health systems (Kennedy et al. 2018; Berry 2010).

The anthropological project of ‘working within’ global health can entail the work of transforming how both experimental trials and their resultant interventions are carried out. Hardon and Pool, for example, call for ‘strategic collaboration’, in which anthropologists team up with biomedical allies to break the hegemony of many existing global health technologies (2016). One strategic collaboration entails multi-authored research projects drawing together experts from a range of regions and disciplines. For example, the book Second chances: surviving AIDS in Uganda, was based on collaborative writing between African and Western scholars to encourage global health’s polyvocality (Whyte 2014). Another example is the Ebola Response Anthropology Network, which formed in response to the 2013-2015 Ebola pandemic, and which aims to enable social scientists and outbreak control teams working for NGOs and governmental and international agencies to interact and engage in more appropriate and effective practices of containment of the epidemic and care for those affected.^[5]

Anthropologists have also noted that for all the talk of its global reach, ‘global health’ remains an English word with British colonial histories – as seen clearly in the outsized presence of global health institutions in former British colonies (and a less active presence in Latin America and China) and in the absence or looseness of regulations that exist for clinical trials and medical experimentation outside of Euro-America (Petryna 2009; Cerón 2011), clinical medical-tourism (Wendland 2012), and family planning policies that continue colonial-era practices of population control (Kuumba 2001).

At the same time, to foreclose global health as an inevitably colonialist project risks another erasure given that scholars located in the so-called Global South have been busy using – while simultaneously remaking – global health’s infrastructures in powerful ways (Brijnath and Antoniades 2018; Lasco & Curato 2019; de-Graft Aikins et al. 2010; Mishra 2013). Anthropologists Michael Tan^[6]and Gideon Lasco^[7], for example, each write a popular editorial column for the Philippines Daily Inquirer, amplifying while also repositioning the sciences of global health. Much like medical anthropologists today operate in the shadow of colonial history while also marking a departure from this history through their critiques of colonialism, so too might anthropologists work from within the apparatus of global health to initiate decolonial transformations in how global health work unfolds today (see Benton, Sangaramoorthy & Kalofonos 2017).

2. Working against

Anthropologists also hold themselves at a distance from global health, critiquing its frequently reductive myopic strategies for ‘doing good’. Rather than leverage capitalist-bound structures that often dominate global health care delivery systems, these anthropologists seek to refuse – or at least destabilise – these pathways for action. This emergent domain of ‘Critical Global Health’ (Adams & Biehl 2016) or ‘Critical Health Ethnography’ (Storeng & Mishra 2014) has vocalised a powerful challenge to how the activities of global health exacerbate deeply entrenched social and political-economic hierarchies. For example, in different ways, Liisa Maalki (2015), Miriam Ticktin (2011), and Elizabeth Dunn (2012) demonstrate how humanitarian calls for charity and compassion individualise suffering and occlude the political and structural determinants of suffering, undermining substantive challenges to capitalism and biomedicine. Numerous anthropologists similarly draw attention to how global health locks its participants into cycles of emergency and crisis which ignore – and thereby perpetuate – deep structural violences and their inequities (Benton 2015; Redfield 2013).

The global health inclination to ‘scale up’ treatment interventions has also received sustained anthropological criticism. Anthropologists showed how the scale up of ARVs in sub-Saharan Africa (Pfeiffer & Chapman 2010) and the response to Haiti’s 2010 earthquake (Schuller 2012) undermined public healthcare systems, contributing to the rise of NGOs and privatised care and leading to immiseration and intensified suffering. Yates-Doerr has critiqued the movement to ‘scale up nutrition’, pointing out that pathways that shape eating and satiety differ from those shaping pathogenic or viral infection, which tend to dominate global health frameworks of biosecurity. This work argues against the common global health paradigm of ‘one health’, which treats health as a singular global entity, by highlighting the diversity in forms of health and forms of health-care that matter in people’s lives (Yates-Doerr 2015a; Yates-Doerr 2015b).

Many involved in Critical Global Health see informed critique as a means of improving the lives of people throughout the globe, yet their critiques also unsettle the very language of ‘improvement’ (Li 2017; Wendland, Erikson & Sullivan 2016). Global health is frequently driven by a call for immediate response to urgent or imminent health crises. By contrast, a critical global health anthropology is likely to frame this as a discursive tactic that too often privileges the scalable, magic-bullet solutions that consistently fail as they move from theory to practice (Erikson 2012; Storeng & Béhague 2017). Here, anthropologists refuse global health’s logics by asking for patience, locality, and slowness (Adams, Burke & Whitmarsh 2014), and even radical inaction. These are posed as difficult but necessary tactics for refusing the capitalist logic of relentless innovation that drives many global health projects, and as a way to transform deep historical inequalities.

3. Working in-between

A final mode of relating involves the work of moving in-between different communities of practice. Anthropologists who study the unfolding of global health programs frequently serve as cultural brokers who mediate between experts and the people affected by experts’ visions for global health. Taking a biographical approach that tracks how health technologies transform as they are implemented, these anthropologists foreground that health practices have ‘social lives’ (Whyte, Geest & Hardon 2002), or what Ramah McKay (2018a) has called ‘afterlives’ in reference to how medical projects live on after official experts withdraw.

Anthropologists who move in between ‘everyday’ and ‘expert’ sites might find themselves translating information held by global health experts into an idiom understood by those whom experts hope to reach. They might also work in the other direction to bring knowledge gained through long-term, grounded engagement with everyday life to spaces of global expertise so as to improve health experts’ practices of design and dissemination. They might also do both (Vernooij et al. 2016; Manderson 1998; Hardin 2018). Moving in-between registers of practice can help to illuminate the expertise that lies in the so-called every day – for example, in the every day practices of community health workers who often refashion projects as they roll them out (Nading 2013; Maes 2014; Kalofonos 2014; Swartz & Colvin 2014) – while also showing how policy spaces are guided by their own cultures (Napier et al. 2017; Taylor 2003; Yates-Doerr 2018).

Global health anthropologists frequently find (or place) themselves amid controversies and disjunctures: spaces where conflicting normativities arise. One technique entails the explicit study of ethical disjuncture. For example, Jenna Grant unpacks the presumed universality of experimental research ethics by illustrating how different logics of ‘the good’ compete in an HIV pre-exposure prophylaxis trial (2016). Anthropologists who work with policy makers even as they study policy-making practices routinely draw attention to the frictions and even failures that happen when policy agendas are taken up in everyday life. In doing so, anthropologists do not simply emphasise the need to adjust interventions and pedagogies to be site-specific, but urge policy makers to learn to account for this adaptiveness in the design of their policies. The goal here is not to further Global Health in its own terms, but to illuminate the shortcomings or successes of its strategies.

Conclusion

At a 2009 Yale-based conference organised to celebrate fifty years of medical anthropology, Didier Fassin noted in a keynote lecture that ‘the obscure object of global health’ had rarely been problematised (2013: 96). Anthropologists would soon redress this. In fact, that very year an annual review on ‘Anthropology and global health’ (Janes & Corbett 2009) overviewed the work of more than 100 anthropologists engaged in a critical analysis of the globalization of bioscience. His lecture has served as a call for anthropology to critically unpack globality (asking, for whom is global health global?) as well as the need to open up the black box of ‘health’. Farmer, Kleinman, and Kim, in a similar vein, have pointed to how global health has existed as a collection of problems rather than a discipline (2013: xiii). And McKay (2018b) describes teaching global health as a ‘critical entanglement’, in the sense that anthropologists frequently critique global health interventions even as they use anthropological methods to participate in the work of global health.

This entry has suggested that global health and anthropology connect through an awkward relation. If global health is an ‘obscure object’ (Fassin 2013), so too is its anthropology. Indeed, one of the methodological approaches taken by anthropologists is to explicitly not know with confidence what is meant by global health but to instead follow, empirically, how global health is brought about in practices. As we’ve shown above, these practices include those of the anthropologists who work to shape, even as they might oppose, the terrain of the field.

While many economists and statisticians make use of the supposed objectivity of big data econometrics to make a strong claim to global health, Stacy Pigg (2013) notes that anthropologists might make a claim to global health themselves. That anthropologists use data that are typically not easily quantified – that anthropologists’ metrics are often lively and social (Verran 2001) – is, in fact, taken by many global health practitioners as a strength. The widespread failure of many global health projects has resulted in an appreciation and uptake of anthropological techniques in and beyond the centres of the field. The ‘awkward relations’ that are therein produced remain emergent and dynamic.

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Note on contributors

Emily Yates-Doerr is Assistant Professor at Oregon State University and the University of Amsterdam, where she holds a European Research Council Starting Grant for the project ‘Global future health: a multi-sited ethnography of an adaptive intervention’. She is the author of The weight of obesity: hunger and global health in postwar Guatemala (University of California Press, 2015). Follow her on Twitter at @eyatesd.

Emily Yates-Doerr, Faculty of Social and Behavioural Sciences, Universiteit van Amsterdam, Postbus 15509, 1001 NA Amsterdam, The Netherlands. e.j.f.yates-doerr@uva.nl

Kenneth Maes is Associate Professor at Oregon State University. He is carrying out collaborative research on the challenges and opportunities posed by community health work. He is the author of The lives of community health workers: local labor and global health in urban Ethiopia (Routledge, 2016).

Kenneth Maes, School of Language, Culture and Society, Oregon State University, 238 Waldo Hall, 2250 SW Jefferson Way, Corvallis OR 97331, United States. kenneth.maes@oregonstate.edu

[1] Available on-line: https://www.who.int/about/vision/global_health_agenda/en/

[2] Available on-line: https://www.who.int/gho/en/

[3] The terms ‘resource poor’ or ‘Global South’ have begun to take the place of earlier framings of ‘developing’ or ‘third world’. Each of these terms has problems (Fernholz 2016), reflecting the inherent difficulty of categorising diverse world regions through a shared ‘global’ agenda.

[4] Available on-line: https://www.un.org/millenniumgoals/bkgd.shtml

[5] Information can be found at http://www.ebola-anthropology.net/about-the-network/.

[6] https://opinion.inquirer.net/column/pinoy-kasi

[7] https://opinion.inquirer.net/byline/gideon-lasco

Charité

Felix Stein — Fri, 17 Aug 2018 18:35:27 +0000

Jonathan Benthall

University College London

Initially published 17 Aug 2018

http://doi.org/10.29164/18charite

Abstract:

Cet article aborde la charité comme un terme «étique» qui facilite la comparaison entre des traditions différentes. Les bases théoriques en ont été posées par deux grands anthropologues au début du XXe siècle: Marcel Mauss, dont L’essai sur le don a suscité des interprétations très variées sur le thème de l’échange et de la réciprocité; et Edvard Westermarck, chez lequel, derrière les préjugés sur une hiérarchie des «races», on peut discerner quelques idées durables au sujet de la relation entre charité et religion. Le simple avis selon lequel tout don charitable est simplement une avance sur des bénéfices à percevoir ultérieurement (dans ce monde ou dans l’au-delà) doit être nuancé par le fait que la «mutualité» est un aspect de la coexistence humaine complémentaire à la réciprocité.

Vers la fin du XXe siècle, certains anthropologues ont jeté un regard critique sur les agences d’aide occidentales. Mais la réflexion sur la charité a été en grande partie laissée aux historiens. Une fois l’intérêt anthropologique pour la charité retombé, ce sont d’abord les religions dharmiques du sous-continent indien, puis l’Islam qui l’ont ravivé et ont stimulé le processus de «déprovincialisation» de l’opinion courante selon laquelle la charité est un monopole de la tradition euro-américaine. Si les anthropologues sociaux ont étudié de nombreuses autres manifestations de la charité, nous prêterons ici une attention particulière aux prescriptions coraniques relatives aux bonnes œuvres et aux différentes manières par lesquelles elles ont renforcé la formation d’organisations caritatives islamiques, dont l’efficacité pratique et potentielle a été compromise par une réaction vraisemblablement excessive aux attaques du 11 septembre 2001 contre les États-Unis.

Les anthropologues ont contribué à la critique de l’humanitarisme en tant qu’idéologie et nous donnons ici des exemples de projets de recherche de terrain productifs qui en ont tiré parti. Enfin, une synthèse d’aide méthodologique holistique pourra être utile afin de structurer l’étude de la charité et il est rappelé que la nature problématique de la charité que les anthropologues tentent de résoudre aujourd’hui a été soulevée par l’auteur de la Bhagavad Gita, plusieurs siècles avant notre ère.

Introduction

Le terme «charité»^[1] désigne l’aumône et l’offrande volontaire, mais il possède aussi des connotations d’amour spirituel, la première vertu chrétienne. Il a été utilisé dans certaines versions de la Bible pour traduire, via le latin caritas, le terme grec du Nouveau Testament, agapè. Certains défenseurs du Christianisme, par exemple dans la Catholic Encyclopedia, confondent les deux sens de ce terme. Dans l’Angleterre élisabéthaine, «charité» acquiert aussi une définition juridique restrictive qui reste essentielle dans le droit britannique et américain. Une distinction est souvent opérée dans les langues européennes entre «charité» et «philanthropie». Pour les Grecs de l’Antiquité, la «philanthropie» était «l’amour du principe d’humanité». Mais elle s’est confondue, pendant le siècle des Lumières, avec l’idée de bienfait public dépouillé de connotation religieuse et, aujourd’hui, elle est particulièrement associée à la générosité des riches et au patronage de la culture savante (et, plus récemment, à la promesse de financement du développement d’une grande partie des pays du Sud).

Jusqu’à présent, toutes les tentatives d’étude comparative de notre sujet se sont dispensées de cette distinction entre charité et philanthropie, notamment du fait qu’il n’existe pas de parallèle dans les langues majeures non européennes, comme l’arabe ou le hindi. Un autre terme largement utilisé, «l’action humanitaire» pose problème, parce que le mot «humanitaire» peut être couramment interprété comme englobant toutes formes d’action philanthropique ou altruiste; mais l’humanitarisme en tant que mouvement peut être défini comme une idéologie qui remonte au XIXe siècle (Davies 2012). (Plus précisément, le droit humanitaire international est l’ensemble des mesures visant à limiter les effets d’un conflit armé, et n’entre pas dans le cadre de cet article.) Si nous recherchons un point de comparaison, c’est-à-dire un terme «étique», par opposition aux catégories dépendant d’un ancrage culturel (ou «émiques»), alors le terme de «bonnes œuvres» est tout à fait convenable; mais dans cet article, le terme de «charité» sera utilisé au sens inclusif.

Fondements théoriques

Deux géants de l’anthropologie ont posé les bases, au début du XXe siècle, de notre compréhension théorique de la charité. Le premier est Marcel Mauss, dans son essai sur la réciprocité et la solidarité sociale, Essai sur le don (2016 [1925]^[2]). L’argument de Mauss selon lequel le principe d’échange touche tous les aspects de la vie sociale, dans une «atmosphère du don, de l’obligation et de la liberté mêlées» (2016: 177), a stimulé un débat productif mais parfois confus (Testart 1998; Guyer 2016). L’autre pionnier, peut-être moins largement reconnu en la matière, était Edvard Westermarck. Il adhérait aux idées victoriennes sur l’existence d’une hiérarchie entre les «races» civilisées et sauvages, mais sa comparaison globale des traditions de charité (1909), toujours impressionnante à ce jour, explique comment l’aide mutuelle est couramment influencée par des motifs égoïstes et, de façon plus surprenante, comment la charité dans toutes les «religions supérieures» est associée au sacrifice.

On peut se demander pourquoi l’anthropologie socio-culturelle n’a pas tiré parti des points de vue de Mauss et de Westermarck sur la charité avant le dernier quart du siècle. L’explication vient peut-être du fait que la plupart des anthropologues se sont positionnés politiquement sur un spectre situé entre un réformisme social qui dénigrait la charité comme une solution tentant de soigner les symptômes plutôt que le mal, légitimant les privilèges des riches, et un marxisme rigoureux, fermement opposé à la charité, frein à l’inévitable révolution prolétarienne. Mais la conséquence du rejet de la charité privée est le placement de tout le pouvoir entre les mains de l’État. L’hostilité pure et simple envers la charité, complément aux droits acquis par le paiement de l’impôt, est beaucoup moins fréquemment exprimée par les sociologues aujourd’hui, notamment du fait de la prévalence des accords de partenariat entre les organisations caritatives et les gouvernements. De plus, le rôle de la charité privée pour compenser le recul de l’État-providence, avec les conséquences particulièrement désastreuses que cela entraîne dans les anciens pays communistes comme la Russie (Caldwell, 2016), est un thème fréquent dans les travaux de recherche récents.

Le commentaire de Jonathan Parry sur l’Essai sur le don de Mauss (1986) a provoqué trente ans de débat académique sur ce texte. L’argument quelque peu provocateur de Parry consistait à présenter le don pur ou gratuit, associé aux religions de salut (renoncement volontaire à des ressources sans rien attendre en retour) comme une sorte de complément dialectique à la marchandisation des biens qui domine les sociétés industrielles occidentales. Peu après, Mary Douglas (1990), sans faire aucune référence à Parry dans son introduction à une traduction en anglais de l’Essai sur le don, dénigrait la notion même de don gratuit. Pour ce qui nous concerne aujourd’hui, nous pouvons extraire deux suggestions liées de l’essai de Mauss.

D’abord, lorsqu’un don ne peut pas être réciproque, le donateur bénéficie d’un crédit moral, mais le bénéficiaire s’en trouve offensé. D’où la réputation de «froideur» souvent attribuée à la charité organisée en Europe depuis le XIXe siècle, notamment lorsqu’elle évite les relations en face-à-face entre donateurs et bénéficiaires. Les réformateurs sociaux ont cherché à la remplacer par l’État-providence. L’ethnographie indienne révèle une interprétation du don charitable particulièrement sinistre: les dons non réciproques faits aux prêtres et aux renonçants peuvent porter malheur et transmettre ce mauvais sort du donateur au bénéficiaire si de soigneuses précautions ne sont pas prises.

Ensuite, un «don gratuit» ne peut admettre aucune dimension de réciprocité. Lorsque je fais un don, je dois le faire de façon à ce que personne (moi y compris) n’y voie aucun aspect transactionnel ou ne s’attende à ce que j’en sois récompensé, dans ce monde ou dans «l’économie céleste» de l’au-delà. Bien que ce paradoxe soit marquant dans les trois religions abrahamiques, c’est en Inde qu’il est le plus élaboré. La Bhagavad Gita (17.20-22, voir aussi Bornstein 2009: 624-5, 644) distingue la «charité en signe de bonté» (le don sans rien attendre en retour), la «charité en signe de passion» (avec intention de récompense, ou le don à contrecœur) et la «charité en signe de noirceur» (un don effectué au mauvais moment ou au mauvais endroit, à un bénéficiaire indigne ou avec mépris). James Laidlaw décrit comment, dans la secte Shvetambar («vêtus de blanc») du jaïnisme indien, lorsque les renonçants célibataires itinérants font l’aumône de nourriture auprès des familles laïques, ils affichent une «indifférence revêche» plutôt que leur gratitude ou leur appréciation, le but étant de ne pas créer de relation sociale et d’atteindre une perfection spirituelle éternelle (Laidlaw 2000: 632). D’après Hilal Alkan-Zeybek (2012), le bénévolat islamique des femmes des classes moyennes et supérieures auprès des pauvres dans une ville d’Anatolie centrale, poursuit un objectif exactement contraire: renforcer la solidarité par le contact physique et la «transformation éthique» du donateur, afin que les hiérarchies de classe soient atténuées. La monographie d’Erica Bornstein basée sur son travail de terrain à Delhi montre en quoi les croyances et pratiques regroupées dans un «hindouisme» moderne interagissent avec les traditions séculières, bouddhistes, islamiques et chrétiennes, pour former un paysage caritatif diversifié, à la fois au plan international et en Inde (Bornstein 2012).

Les interprétations de Mauss sont compliquées par le fait qu’il considérait tous les dons comme impliquant métaphoriquement un sacrifice: lorsque je fais un don, je donne une part de moi-même. Westermarck soulignait pour sa part que, dans les enseignements chrétien et juif, l’aumône venait remplacer les offrandes sacrificielles à Dieu. La charité en général est habituellement saluée comme une expression d’empathie ou, à l’inverse, dénigrée comme apaisant la conscience des donateurs et maintenant le statu quo. Mais Westermarck suggère une troisième voie dans la façon de la concevoir: il l’envisage comme un acte de dévotion. Les prières adressées par les bénéficiaires sont, dans les traditions abrahamiques, une manière d’offrir en retour (le revers étant les malédictions murmurées par ceux qui sont injustement traités). Ilana Silber affirme que de subtils «échos» des idéologies et pratiques sacrificielles perdurent au fil du temps, comme le commandement chrétien selon lequel le don charitable est un moyen pour les fidèles d’imiter le don de Dieu que constitue le sacrifice de Jésus (Silber 2000: 305, 310). Elle affirme que trois types de don religieux doivent être distingués dans l’Ancien Testament: les dons à Dieu, ceux aux représentants religieux et ceux aux nécessiteux. La doctrine chrétienne de la diakonia, ou service, insiste toutefois sur le fait que tout acte au profit des affamés, des assoiffés, des sans-abri, des démunis, des malades ou des prisonniers équivaut à rendre le même service à Dieu (Mathieu 25: 31-46). Amira Mittermaier, dans un article sur le bénévolat islamique en Égypte (2014) suivant Fassin (2012), associe étroitement la tradition chrétienne et post-chrétienne de la charité avec la compassion, contrairement à l’obéissance religieuse qu’elle avait observée dans la pratique de certains de ses interlocuteurs musulmans du Caire. Mais l’histoire des institutions caritatives, parmi les nombreuses institutions et dénominations chrétiennes, est si variée qu’il existe un risque de généralisation abusive au sujet de leurs motivations, qui incluent la renonciation, l’abnégation et l’expiation, ainsi que la compassion.

Dans la droite ligne d’une tendance générale des sciences sociales à reconnaître la porosité de la distinction entre le religieux et le «séculier», un caractère «quasi-religieux» peut être attribué à certaines des agences humanitaires et de développement séculières les plus performantes (Barnett et Stein 2012), dans la mesure où elles sont guidées par des principes moraux fortement internalisés, un respect pour leurs fondateurs charismatiques et un engagement pour le monde dans son ensemble. Philip Fountain, motivé par son étude ethnographique auprès du Mennonite Central Committee, une agence de développement chrétienne d’Amérique du Nord, s’est intéressé à ce problème conceptuel, en partant de la réflexion selon laquelle tout développement, qu’il soit marqué comme religieux ou non, est peut-être inévitablement prosélyte en ce qu’il cherche à modifier les pratiques sociales d’autrui (Fountain 2015).

Réciprocité et mutualité

Des études ethnographiques suggèrent que l’analyse de la charité limitée aux équations de l’offre et de la récompense est peut-être trop monodimensionnelle. Elles nous renvoient aux débats anthropologiques non résolus sur la relation entre réciprocité et mutualité et sur la nature de l’altruisme.

Mittermaier, dans un autre article (2013), en se basant sur son travail de terrain en Égypte en 2011-2012, met une économie de la grâce (baraka), qui insiste sur la générosité, en contraste avec une économie de la récompense (thawab) qui vise à s’assurer une place au paradis: ce dernier modèle, selon elle, a été accentué par la marche du capitalisme dans les sociétés arabes. Emanuel Schaeublin, dans son étude de l’aumône à Naplouse en Cisjordanie palestinienne (2016) avance, suite à un article riche mais difficile à saisir de Paul Dresch (1998: 114-16), que pour ses interlocuteurs musulmans, la richesse est l’expression d’une abondante générosité divine (en arabe, rizq) et qu’avec Dieu, il ne peut pas y avoir de réciprocité. Mittermaier comme Schaeublin dans leurs ethnographies fines nous renvoient à la théologie islamique et s’abstiennent de toute comparaison «étique». Mais en avançant la primauté du don, ils nous indiquent un nexus de concepts qu’on pourrait qualifier de contre-sujet en musique, complémentaire au thème de la réciprocité. Julian Pitt-Rivers (1992) a proposé le concept de grâce non seulement comme fondement du christianisme, mais aussi comme un terme «étique» associé à l’idée de charité: «La grâce est toujours quelque chose de plus, au-dessus de "ce qui compte", de ce qui est obligatoire ou prévisible».

Meyer Fortes affirmait (2004 [1969]: 231-2) que la parenté trouve ses racines dans un principe de «concorde» («amity») ou «d’altruisme prescriptif», qui s’étend au-delà de la famille dans des domaines plus larges. Pour James Woodburn (1998), spécialiste des sociétés de chasseurs-cueilleurs, la réciprocité n’est pas universelle à tous les groupes humains: les Hadza de Tanzanie ne comprennent pas le concept de générosité ou de charité car ils sont profondément et fermement engagés dans le partage égalitaire. David Maybury-Lewis cite un ancien du peuple Gabra, des nomades du nord du Kenya: «Même le lait de nos propres animaux ne nous appartient pas. Nous devons le donner à ceux qui en ont besoin, parce qu’un homme pauvre est une honte pour nous tous» (Maybury-Lewis 1992: 85, d’après le travail de terrain d’Aneesa Kassam).

Les anthropologues sociaux s’intéressent aux valeurs ou principes conduisant à l’altruisme. Les biologistes, à l’inverse, classent un comportement comme altruiste dans la mesure où il réduit le succès de reproduction d’un organisme A en augmentant celui d’un organisme B. Le paradoxe de l’altruisme, l’une des plus grandes énigmes de l’évolution, a été exprimé pour la première fois par Darwin dans ses réflexions sur l’existence d’insectes stériles, et a suscité une vaste littérature scientifique (largement évitée par les anthropologues sociaux). Marshall Sahlins, cependant, s’appuyant sur les travaux du psychologue cognitif et développemental Michael Tomasello, déduit que «l’intentionnalité partagée» ou intersubjectivité est une capacité à la mutualité propre à l’être humain, non discernable chez les primates non humains (Sahlins 2001, Tomasello 2009). Dans la mesure où la science post-darwinienne a détrôné pratiquement tout autre indicateur présumé d’unicité humaine flagrante, le débat semble rester ouvert. La biographie d’un excentrique génie, George R. Price (1922-75), collègue du célèbre sociobiologiste W.D. Hamilton), explique comment il a tenté de démontrer mathématiquement qu’un comportement ostensiblement altruiste respecte en fait une échelle précisément calibrée d’intérêt personnel dépendant du degré de proximité entre le bienfaiteur et le bénéficiaire (Harman 2010).

Pour le primatologue Frans de Waal, cependant, l’altruisme humain n’est pas un problème théorique. N’en déplaise à Tomasello, il fait remonter son évolution au moment où les femelles mammifères ont commencé à nourrir leurs petits. L’empathie est associée à la libération de l’hormone ocytocine: de Waal et ses collaborateurs ont même émis le postulat que les humains et les campagnols des prairies ont en commun les mécanismes biologiques du comportement de consolation (Burkett et al. 2016). Parce que l’ocytocine nous fait nous sentir bien, la distinction entre le soin des autres et l’amour-propre, de ce point de vue, s’évanouit.

Étude de la charité avant 2000

Au cours des années 1970 et 1980, l’essor des organisations non gouvernementales (ONG) (terme non satisfaisant qui pourtant perdure) a progressivement provoqué une vague de projets d’étude dans lesquels les anthropologues ont joué un rôle significatif. L’ouvrage Imposing aid (1986) de Barbara Harrell-Bond a marqué un tournant: il s’agit d’une monographie iconoclaste sur le travail des agences d’aide internationale, basée sur son travail de terrain avec les réfugiés ougandais dans le sud du Soudan. Les institutions occidentales étaient de plus en plus dépendantes des financements gouvernementaux et soumises à la pression du respect des politiques étrangères des gouvernements; leurs idéaux caritatifs élevés les avaient largement immunisées contre la critique. Elle leur reprochait notamment le fait qu’elles ne s’efforçaient pas de donner aux «victimes» les moyens de prendre le contrôle de leur propre vie. Les critiques d’Alex de Waal (1989) étaient elles aussi très dures à l’encontre de la réponse des organisations de secours à la famine dans la Corne de l’Afrique, qui évitaient le dialogue avec les pauvres des régions rurales qu’elles étaient censées servir; quelques années plus tard, il s’attaqua à la complaisance reproduite par ce qu’il appelait «l’Internationale humanitaire». Parmi les autres ouvrages marquants d’anthropologie publiés à la même époque, on trouve The anti-politics machine de James Ferguson (1990), qui expose l’incapacité des bureaucraties de l’aide à fournir de véritables avancées aux supposés bénéficiaires du «développement».

Certains publications se sont concentrées sur l’élément marketing du travail des agences d’aide internationale, et sur le processus par lequel les catastrophes sont «érigées» en produits consommables par un oligopole d’organisations médiatiques à des fins de publicité et de collecte de fonds caritatives, afin qu’aux représentations de la souffrance de la périphérie du globe réponde constamment un flux d’aide (p. ex. Benthall 1993, Lidchi 1999). Mais la réflexion sur la charité en elle-même a été largement absente de la littérature de recherche florissante sur le développement et l’aide humanitaire. Les historiens ont comblé cette lacune: Paul Veyne sur la munificence des particuliers de la période gréco-romaine env. 300 av. J.-C. (1990 [1976]); Frank Prochaska sur la «philanthropie des pauvres envers les pauvres» en Grande-Bretagne et la «générosité royale» qui permet à la monarchie britannique de rester crédible (1988); et nombre des contributeurs au premier recueil d’essais comparatifs sur la charité à paraître (Ilchman et al., 1998), dont aucun des vingt-deux auteurs n’est anthropologue.

Il apparaît que le stimulus qui a conduit les anthropologues à réfléchir sur la charité est venu des traditions non chrétiennes, avant qu’ils commencent à se tourner vers ses manifestations chrétiennes et séculières. Cela reste cohérent avec le retard plus général de l’anthropologie à étudier le christianisme, à l’exception de l’Afrique (comme l’affirmait Cannell 2006: 1-14). Parmi les quelques exceptions trouvées avant la fin du siècle dernier, on peut citer un essai de Claudia Fonseca (1986) basé sur son travail de terrain dans un petit centre caritatif à Paris qui distribuait gratuitement des vêtements aux sans-abri. Elle y décrit le «pacte implicite» de bienveillance et de politesse établi entre certaines dames bénévoles et leurs «clients», et la transition entre l’ancienne aspiration chrétienne à gagner sa place au paradis par la charité et l’objectif plus moderne de réinsertion des pauvres dans la vie active. L’étude d’Erica Bornstein sur les ONG protestantes transnationales au Zimbabwe a rapidement rattrapé le retard et elle fut le premier chercheur sur les organisations caritatives à suivre le «traffic in meaning», la contradiction entre les attentes d’un donateur transnational individuel et les réactions des bénéficiaires finals (en l’occurrence, par l’intermédiaire du programme international de parrainage d’enfants World Vision) (Bornstein 2005).

Décentrage de la charité via l’Islam

Les réflexions susmentionnées de Jonathan Parry sur le «don gratuit» ont été inspirées par les religions dharmiques du sous-continent indien; et Katherine A. Bowie a publié un premier article sur la charité bouddhiste dans le nord de la Thaïlande, qualifiant le paradigme prévalant de «gain de mérite» bouddhiste en insistant sur la stratification des classes (1998). Mais le principal élan vers la déprovincialisation des hypothèses «occidentales» au sujet de la charité en tant que monopole euro-américain est venu de l’étude du monde musulman et de son abondant héritage de commandements religieux à la générosité, ainsi que de ses institutions caritatives. Une fois encore, les historiens ont été en première ligne (Arjomand 1998, Kozlowski 1998, Weiss (éd.) 2002, Bonner et al. 2003, Singer 2008, Fauzia 2013).

Christian Décobert, historien de l’Islam ancien, a eu l’originalité de faire le lien entre le terme coranique clé de zakat (aumône obligatoire comme la dîme hébraïque, et l’un des cinq «piliers» de l’Islam) et la théorisation de la pureté de Mary Douglas (son premier ouvrage Purity and danger de 1966,^[3] plutôt que son travail ultérieur sur la Bible), le terme zakat ayant des origines communes avec l’hébreu-araméen zakut, qui a des connotations de pureté, de rectitude et d’épanouissement, mais pas d’aumône (Décobert 1991: 198ss). Il existe aussi un chevauchement sémantique clair entre l’idée d’aumône et celle de rectitude via le mot ṣadaqa (aumône volontaire). Décobert a aussi tiré des conclusions (1991: 196) sur l’autoreprésentation et les systèmes de parenté des premières sociétés musulmanes à partir des règles établies dans le Coran à propos de la distribution de la zakat, et leur huit catégories de bénéficiaires possibles (Coran 9.60), et il a proposé un lien avec la tradition agricole d’offrande des prémices à Dieu, ouvrant ainsi des possibilités d’étude comparative qui restent à explorer plus avant (Benthall 1999, Benthall et Bellion-Jourdan 2003: 19-25).

Le lien entre le don à Dieu et le don aux nécessiteux ne s’est jamais distendu dans le monde musulman où les sacrifices d’animaux sont encore couramment pratiqués, la viande étant donnée aux pauvres (bien que dans les pays industrialisés il s’agisse souvent de viande en conserve importées commercialement des élevages de moutons néo-zélandais). Dans le Coran, les sacrifices majeurs de chameaux et de bétail retenus dans l’Islam sont représentés non seulement comme des cérémonies, mais aussi comme des moyens pratiques de nourrir les personnes dans le besoin. Les sacrifices comme la zakat sont associés à la prière et à l’affirmation de l’unicité de Dieu et de l’Islam. La pratique de la zakat a connu de nombreuses variations au cours de l’histoire de l’Islam, allant d’un contrôle total par les gouvernements, jusqu’aux dons informels par des connaissances privées pendant le mois saint du Ramadan, avec de nombreux cas intermédiaires. Mais le domaine discursif auquel elle appartient reste une réalité pour les musulmans pratiquants.

L’étude des traditions caritatives de l’Islam est particulièrement intéressante pour deux raisons. La première est que, dans pratiquement tous les pays, on trouve soit des donateurs soit des bénéficiaires musulmans, soit les deux, ce qui révèle des pratiques religieuses aussi variées que dans le monde chrétien. Ceci revêt une importance pratique en matière de politiques d’aide et de développement.

La deuxième raison est plus intellectuelle, mettant en question la prétention européenne à un universalisme séculier. D’autres traditions de charité et d’humanitarisme ont été largement ignorées. Toutes les traditions religieuses incluent des commandements de «bonnes œuvres» et on peut penser à l’essence de la charité comme à un acte physique, comme le bon Samaritain tendant la main à un voyageur en détresse ou, dans la tradition islamique, même sourire à un voisin. Mais il existe des différences subtiles. La charité chrétienne, associée à l’agapè, ne se confond pas exactement avec le champ lexical islamique, qui inclut zakat, ṣadaqa et waqf (la fondation caritative islamique). Les règles de distribution de la zakat ont attiré l’attention des érudits de l’Islam et peuvent être considérées historiquement comme ayant posé les principes d’un proto-Trésor public. Elles ont, par exemple, été interprétées comme autorisant le financement du djihad militaire. Mais le soutien aux pauvres est aujourd’hui couramment considéré comme la priorité de la zakat, voire son objet exclusif, et elle est devenue un outil de financement extrêmement efficace pour les organisations caritatives islamiques contemporaines, qui ont notamment actualisé l’insistance du Coran sur les droits des enfants orphelins.

Les auteurs d’une analyse rétrospective remarquablement approfondie d’un épisode de famine et de l’inadaptation de la réponse internationale, Famine in Somalia: competing imperatives, collectives failures, 2011-12, en arrivent à la conclusion suivante:

«Depuis la fin des années 1990, il est devenu à la mode dans la communauté de l’aide humanitaire occidentale de promouvoir les droits et d’écarter la charité en tant que solution paternaliste et avilissante. Les acteurs non occidentaux (notamment islamiques) replacent la question de la charité et de l’action volontaire au centre de l’action humanitaire, au moins en termes d’intentions» (Maxwell et Majid 2016: 196).

Ces auteurs ont été impressionnés par leur observation de la solidarité du personnel humanitaire islamique avec la communauté touchée. Les anthropologues peuvent bien convenir qu'attendre de ceux qui souffrent de la famine qu'ils comptent sur l'application de leurs droits alors qu'ils ne bénéficient d'aucun cadre juridique, n'est rien de plus qu'un trope rhétorique.

Les études basées sur des données ethnographiques de la charité islamique sunnite se sont multipliées ces dernières années. Comme les études sur les sociétés arabes menées par Mittermaier et Schaeublin (auxquelles on peut ajouter celles de Harmsen en 2008, Roy en 2011, Atia en 2013, Challand en 2014 et Juul Petersen en 2015), un ensemble de travaux sur l’Afrique de l’Ouest a émergé (Kaag en 2007, de Bruijn et van Dijk en 2009, LeBlanc et Gosselin en 2016). Les centres d’intérêt de ces études reflètent la croissance des ONG islamiques, qui remonte aux années 1980, en partie dans le sillage de la croissance des ONG en général, et en partie en conséquence de la «résurgence islamique», un effort international pour rétablir les valeurs et les pratiques islamiques. L’un des sujets qui a des implications pratiques est la question de la «proximité culturelle»: dans quelle mesure une organisation confessionnelle peut-elle améliorer son efficacité par un accès privilégié aux bénéficiaires de l’aide qui partagent les mêmes traditions religieuses (de Cordier 2009, Palmer 2011)? La réponse à cette question est globalement positive si l’on considère le travail des agences d’aide chrétiennes parmi les populations chrétiennes en Afrique et en Amérique latine. Mais ce qui aurait pu être une augmentation constante de l’acceptation et de l’influence des organisations caritatives islamiques dans le monde a été sérieusement compromis par l’ombre qui plane sur elles: les allégations persistantes d’implication dans des activités «terroristes». Une certaine responsabilité limitée des organisations caritatives du Golfe dans les années qui ont précédé le 11 septembre 2001 ne peut pas être niée, mais l’une des racines du problème remonte à la détermination des puissances occidentales à soutenir les moudjahidin pendant la guerre entre l’Union soviétique et l’Afghanistan dans les années 1980, quand l’aide humanitaire était ouvertement mêlée au soutien militaire des États-Unis à travers l’Arabie saoudite et le Pakistan (Benthall 2010: 115-18). En conséquence de quoi, de nombreuses ONG islamiques ont été blacklistées par le gouvernement américain, qui a une grande influence mondiale, ou obligées de fermer, et même celles qui présentaient un dossier irréprochable ont dû faire face à des obstacles juridiques et financiers. Malgré la publication d’avis contraires, la domination des experts du «contre-terrorisme» aux États-Unis reste forte, et ils semblent souvent (ainsi que raisonnent Schaeublin en 2008, James en 2010, 2011, de Goede en 2012, Benthall en 2016) s’attendre au pire de la part des donateurs caritatifs musulmans. Des présomptions défavorables sont aussi diffusées sur tous les musulmans «pas à leur place», ces volontaires exprimant une solidarité musulmane transnationale qui voyagent dans des régions lointaines et troublées (Li en 2010, Kassem en 2010-11).

À l’inverse, au Royaume-Uni, une autorité régulatrice ouverte aux organisations caritatives des diasporas de toutes sortes, la Charity Commission, a encouragé le développement du secteur caritatif islamique qui a établi des relations de coopération fructueuses avec l’establishment dans le domaine de l’aide, notamment en adoptant le principe de non-discrimination en raison de la religion. Le seul autre pays dans lequel les organisations caritatives islamiques se développent vigoureusement avec relativement peu d’intervention politique est l’Indonésie, qui a une longue tradition d’institutions d’assistance sociale confessionnelles (Latief 2012, Fauzia 2013). Organisation islamique majeure, la Muhammadiyah, fondée en 1912 à Yogyakarta, avait adopté explicitement le principe de non-discrimination dans ses œuvres caritatives. Mais elle est devenue plus religieusement exclusive pendant la période de libération du régime néerlandais, et son engagement à l’inclusivité n’a pas encore été formellement réaffirmé (Fauzia 2017).

Dans son ethnographie aux nombreuses facettes sur les musulmans Hui en Chine, Matthew S. Erie explore en quoi les principes islamiques traditionnels du don charitable sont négociés dans une sorte de «compétition de valeur» avec les pratiques de don dominantes des Han et avec les anxiétés sécuritaires du parti-État officiellement athée (Erie 2016). Le terme désignant le don volontaire musulman, nietie, est dérivé du terme coranique niyyah, intention ou motivation, sans distinction en chinois entre l’objet du don et l’acte de don. Conformément à la pratique Taoïste, mais contrairement au commandement coranique selon lequel le don charitable confère un mérite supplémentaire lorsqu’il est effectué en toute discrétion, les dons individuels et familiaux du nietie sont affichés nommément sur les murs des mosquées. Des collectes de nietie sont organisées pour les secours soutenus par le gouvernement après les tremblements de terre (Erie 2016: 276-9).

Le débat au sein du monde islamique sur l’éthique du don charitable s’est notamment concentré sur les règles de la zakat. Le point de vue traditionnel de la plupart des oulémas était que seuls des musulmans pouvaient en être les bénéficiaires. Libérées de cette restriction, certaines organisations caritatives islamiques ont pu faire cause commune avec les principales ONG séculières et chrétiennes. Cette différence d’interprétation des règles de la zakat, comme d’autres (telles que la mesure dans laquelle elles autorisent le prosélytisme) peuvent être vues comme intégrant des concepts qui sont au cœur des débats actuels plus larges au sein de l’Islam aujourd’hui (Benthall 2016: 18). Elles ont aussi un certain rapport avec la réflexion anthropologique sur la charité en général, dans la mesure où l’Islam, avec son histoire missionnaire et expansionniste, présente un universalisme alternatif à celui souvent pris pour acquis du Christianisme et de son héritier, l’universalisme séculier post-Lumières.

La critique de l’humanitarisme

L’étude de la charité par les anthropologues sociaux du monde entier s’est étendue ces dernières années. Ils ne s’intéressent pas tous aux mêmes questions. Par exemple, la monographie de C. Julia Huang sur le mouvement d’assistance sociale internationale Tzu Chi (fondé par une modeste nonne bouddhiste taïwanaise, la vénérable Cheng Yen – née en 1937 – et qui compte aujourd’hui des millions de sympathisants) est principalement axée sur le thème wébérien du charisme et de sa bureaucratisation (Huang 2009). Ce modèle peut notamment être applicable aux institutions caritatives de toute sorte lorsqu’elles s’étendent, du fait qu’elles sont chargées de valeurs morales fortes tout en étant obligées d’entrer en concurrence comme des entreprises. L’engagement séculaire spécifique des organisations caritatives chrétiennes dans les soins aux personnes atteintes de la lèpre (et plus récemment, dans la lutte contre leur stigmatisation) a attiré l’attention (Gussow 1989, Staples 2007). Mais ces approches semblent marginales par rapport à la tendance actuelle d’analyse des agences humanitaires.

Les professionnels des secours et du développement (parfois affublés du sobriquet de «citoyens d’Aideland») contestent souvent le fait que leur action ait quoi que ce soit à voir avec la charité. Leur position pourrait bien être un exemple de déformation professionnelle. Des initiatives multinationales ambitieuses ont appelé l’entreprise humanitaire à passer de la motivation charitable à une motivation poussée par l’impératif de «solidarité mondiale» (World Humanitarian Summit 2016: 13). Mais ce concept noble est confronté à l’évidence des inégalités internationales flagrantes, au mieux légèrement atténuées par l’action humanitaire, et manque de soutien dans la tradition usuelle. Les récents travaux des anthropologues et autres se sont ralliés à interroger l’idéologie de l’humanitarisme (p. ex. Bornstein at Redfield (éds) 2010).

Le concept de «raison humanitaire» exprimé par Didier Fassin a eu une large influence (Fassin 2011). Il entend par là une idéologique omniprésente dans le monde, moralement intouchable. En la confrontant, il cherche à faire se chevaucher les deux sens normalement contradictoires de l’idéologie: d’un côté un voile insidieux masquant des intérêts économiques brutaux (comme dans les travaux de Karl Marx) et, de l’autre côté, un système culturel qui donne un sens aux relations sociales (comme dans les travaux de Clifford Geertz). Renforcé par une ethnographie rigoureuse (il a une formation de médecin et a été vice-président de Médecins Sans Frontières) son argument selon lequel l’humanitarisme est une forme de gouvernance occidentale, dépendant de l’existence illusoire d’une «communauté internationale», apparaît comme une application de la science sociale dans toute sa splendeur. Sans aucun doute (et Fassin s’inscrit dans la droite ligne de la critique beaucoup plus ancienne de la «charité»), l’humanitarisme présente des aspects nettement conservateurs et peut même déshumaniser, en réduisant les survivants à la «vie nue» ce qu’Agamben (1995) a diagnostiqué, par exemple dans de nombreux camps de réfugiés (Agier 2014). L’ethnographie remarquable de Peter Redfield sur Médecins Sans Frontières s’appuie sur la critique d’Agamben et de Fassin tout en détaillant les réussites uniques de cette agence et en la reconnaissant comme l’une des ONG les plus autocritiques (Redfield 2013), même s’il remet par ailleurs en question l’argument excentrique de MSF selon lequel elle n’est pas une organisation «caritative», malgré le succès de ses collectes de fonds publiques (Redfield 2012: 454-7).

Entre les mains d’analystes en chambre, une approche revenant sur le concept de «biopouvoir» de Foucault (la subjugation des corps et le contrôle des populations) peut être exagérée, notamment lorsque la brutalité de nombreux régimes non occidentaux aussi bien que occidentaux est sous-estimée. Mais la critique de la «gouvernance humanitaire» a animé de nombreuses publications fondées sur l’ethnographie et portant sur la charité. Les occupants des camps de réfugiés (estimés à environ six millions de personnes en 2014 et dont le nombre a rapidement augmenté depuis) peuvent être considérés comme des objets de charité (même lorsque les administrateurs sont des agences gouvernementales ou internationales) dans la mesure ou leurs droits en tant que citoyens sont suspendus dans des espaces qui sont «hors limites» et régis par des règlements spéciaux (Agier 2014). Edward Simpson dresse le portrait intense, quoique impressionniste, des conséquences d’un tremblement de terre majeur dans l’État du Gujarat, en Inde, en 2001: dégradation du tissu social avec la complicité d’organisations philanthropiques de toute sorte (le pire exemple étant celui d’une école pour orphelins montée par un pédophile britannique). Simpson innove en y incluant des organisations indiennes locales et de la diaspora du Gujarat, de sorte que les organisations caritatives qu’il critique ne sont pas seulement celles d’origine occidentale (Simpson 2013). Maurizio Albahari a publié son ouvrage complet sur la crise des migrants en Méditerranée (2015) juste avant qu’elle n’atteigne son point d’ébullition. Même si Albahari est sensible à tous les autres aspects de la crise après une décennie de recherches, c’est son travail bénévole en 2005 dans un centre de demandeurs d’asile dans une petite ville côtière du talon de la botte italienne qui confère à son livre toute son autorité. Albahari y montre comment une myriade d’organisations caritatives religieuses et séculières, soi-disant indépendantes, ont assumé de facto un rôle de gendarme. Sa monographie soutient l’argument selon lequel les critiques les plus approfondies des efforts caritatifs restent aujourd’hui celles renforcées par l’observation participante, comme dans les premiers travaux d’Harrell-Bond et Alex de Waal. Liisa H. Malkki (2015) diagnostique un «besoin» chez les professionnels de la Croix Rouge finlandaise qui ont servi à l’étranger: ils sont frustrés par la routine de la vie de classe moyenne, rendue plus difficile à supporter par les longs hivers, et recherchent une sorte d’épanouissement personnel qu’ils ne peuvent pas obtenir chez eux. Les anthropologues de l’hémisphère Nord reconnaîtront peut-être ce sentiment.

Un modèle holistique

L’école germano-néerlandaise d’anthropologie présente un modèle méthodologique dans lequel l’étude des initiatives caritatives peut être insérée. Ce modèle s’appuie sur un concept étendu de sécurité sociale, décrit par Franz et Keebet von Benda-Beckman comme la «dimension de l’organisation sociale s’agissant de tous les aspects de sécurité non considérés comme dépendant exclusivement de la responsabilité individuelle» (Thelan et al. 2009). L’un des mérites de cette démarche méthodologique est qu’elle prête totalement attention aux points de vue des bénéficiaires de la charité et à la question de l’évaluation de son efficacité. Cinq «couches» de description sont identifiées: les notions idéologiques et culturelles de risque et de soin; la prise en charge institutionnelle, basée sur des droits clairement définis; les relations sociales existant entre les fournisseurs et les bénéficiaires; les actions concrètes telles que l’assistance de personne à personne, et le transfert de ressources; et enfin, les conséquences des interventions pour les fournisseurs comme pour les bénéficiaires. Carolin Leutloff-Grandits (2009) applique cette méthode dans un article sur le changement des réponses caritatives face à l’effondrement des structures étatiques en ex-Yougoslavie. Dans la ville croate ethniquement mixte de Knin en 2001, au lendemain de la guerre serbo-croate, la branche locale de l’organisation catholique Caritas a lancé une campagne caritative émouvante pour les «Croates affamés» de la ville, adoptant ce que Leutloff-Grandits appelle une «politique offensive d’ingénierie ethnique» par d’autres moyens. Une préférence a été affichée pour les Croates nouvellement arrivés de Bosnie, causant un ressentiment à la fois parmi les catholiques croates et les orthodoxes serbes de retour. Parmi les quelques publications détaillées qui prennent en compte toutes les «couches» de l’analyse émise par les von Benda-Beckman (même si elles ne se rangent pas à leurs suggestions), on peut distinguer Famine in Somalia (2016) de Maxwell et Majid et Crimes of peace (2015) d’Albahari, toutes deux déjà mentionnées.

Conclusion: du progrès dans la charité?

Au cours de la parenthèse de la moitié du XXe siècle susmentionnée, entre les écrits de Mauss et Westermarck et les contributions innovantes d’Harrell-Bond, Alex de Waal et Parry, un anthropologue a fait figure d’exception en portant un intérêt soutenu au thème de la charité: R.R. Marett. Il écrit ainsi: «le vrai progrès est le progrès de la charité, toutes les autres avancées lui étant secondaires» (Marett 1935: 40). Il considérait les soins maternels comme la source première de la charité (Marett 1939: 141, 147). Même si son style peut sembler sentimental aux lecteurs d’aujourd’hui, il peut être considéré comme annonciateur de Fortes sur la concorde et Frans de Waal sur l’ocytocine. Cependant, une réflexion sur la charité ne peut ignorer la présence de la réciprocité qui plane et menace toujours la pureté du don gratuit. La Bhagavad Gita reconnaissait ce dilemme moral il y a plus de deux millénaires.

La phrase de Marett sur le progrès résonne aujourd’hui et nous invite à nous questionner sur ce que nous devrions considérer comme le progrès. Depuis les années 1960, un mouvement informe connu sous le nom de «responsabilité sociale d’entreprise» peut être considéré comme une variante moderne de la charité, et ses manifestations font l’objet d’une attention ethnographique, par exemple en Afrique du Sud (Rajak 2011) et en Arabie saoudite (Derbal 2014: 146-53). Parmi les innovations plus récentes méritant d’être étudiées, on peut citer l’apparition de cabinets de consultants qui donnent aux jeunes héritiers des conseils sur la meilleure façon de devenir des donateurs philanthropes.

Quoi qu’il en soit, ce qui fut qualifié avec condescendance «d’anthropologie appliquée» semble aujourd’hui reprendre de la vigueur au sein de la discipline. Les opportunités sont nombreuses pour les anthropologues de s’appuyer sur les travaux précédents en matière de charité d’une façon à la fois utile sur le plan pratique et sophistiquée sur le plan théorique, à un moment où la demande de don volontaire et de bénévolat est plus importante que jamais.

Notes de l’auteur

Cet article utilise du matériel déjà publié par l’auteur dans trois autres articles de synthèse: ‘Charity’ dans Fassin, D. (éd.) 2012. A companion to moral anthropology (Chichester: Wiley-Blackwell); ‘Religion and humanitarianism’, dans MacGinty R. & J.H. Peterson (éds) 2015. The Routledge companion to humanitarian action (London: Routledge); ‘Humanitarianism as ideology and practice’ dans Callan H. (éd.) 2018. The Wiley-Blackwell encyclopedia of anthropology. Je présente mes remerciements aux éditeurs pour les opportunités de réflexion qu’ils m’ont données. Cet article doit beaucoup à Felix Stein comme éditeur de mise en service, et à deux examinateurs anonymes.

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Les publications qui sont possiblement les plus utiles comme lecture introductoire sont marquées avec un astérisque.

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Auteur

Jonathan Benthall est chercheur honoraire affilié au département d’anthropologie du University College London et directeur émérite de l’Institut Royal d’Anthropologie de Grande-Bretagne. Son livre le plus récent s’appelle Islamic charities and Islamic humanism in troubled times (2016).

Jonathan Benthall, Downingbury Farmhouse, Pembury, Tunbridge Wells, Kent TN2 4AD, United Kingdom. jonathanbenthall@hotmail.com

[1] Cet article est une traduction de l’original intitulé “Charity” (Benthall 2017)

[2] Traduction anglaise, The Gift. Texte original français en version numérique: http://classiques.uqac.ca/classiques/mauss_marcel/socio_et_anthropo/2_essai_sur_le_don/essai_sur_le_don.html

[3] Traduction française: De la souillure: Essai sur les notions de pollution et de tabou (Paris: Maspéro, 1971).

Charity

Felix Stein — Fri, 22 Dec 2017 16:34:20 +0000

Jonathan Benthall

University College London

Initially published 22 Dec 2017

http://doi.org/10.29164/17charity

Abstract:

This entry considers charity as an ‘etic’ term that facilitates comparison between different traditions. Theoretical foundations were laid by two great anthropologists at the beginning of the twentieth century: Marcel Mauss, whose The gift has elicited a wealth of varied interpretations on the theme of exchange and reciprocity; and Edvard Westermarck, behind whose dated assumptions about a hierarchy of ‘races’ we may discern some lasting insights into the relationship between charity and religion. The simple view that all charitable giving is merely a down payment on benefits to be received later (in this world or in the hereafter) has to be qualified by evidence of ‘mutuality’ as an aspect of human coexistence complementary to reciprocity.

Towards the end of the twentieth century, some anthropologists turned a critical eye on the work of Western aid agencies. But it was largely left to historians to reflect on charity per se. After the cooling of anthropological interest in charity, it was first the dharmic religions of the Indian subcontinent and then Islam that reignited it and stimulated the process of ‘deprovincialising’ the common assumption that charity is a monopoly of the Euro-American tradition. Though social anthropologists have studied many other manifestations of charity, detailed attention is given here to the Qur’anic prescriptions relating to good works and to the ways in which they have empowered the formation of organised Islamic charities, whose practical and potential efficacy has been thwarted by an arguably excessive political reaction since the 11^th September 2001 attacks on the United States.

Anthropologists have contributed to the critique of humanitarianism as an ideology, and examples are given here of productive field-based research projects that have drawn on this critique. Finally, a holistic methodological aid is summarised which may be helpful in structuring research on charity, and it is recalled that the problematic nature of charity which anthropologists try to resolve today was noticed by the author of the Bhagavad Gita some centuries before the contemporary era.

Introduction

The word ‘charity’ in English refers to almsgiving and freewill offerings, but it also has connotations of spiritual love, the highest Christian virtue. It was used in some Bibles to translate, via the Latin caritas, the Greek New Testament word agapē. Some Christian apologists, for instance in the Catholic Encyclopedia, conflate the two senses of the word. In Elizabethan England, ‘charity’ also acquired a restrictive legal definition that is still an essential part of British and American law. A distinction is often made in European languages between ‘charity’ and ‘philanthropy’. For the ancient Greeks, ‘philanthropy’ was ‘love of the principle of humanity’. But it became fused, during the century of the Enlightenment, with the idea of public benefactions shorn of religious connotations, and today it has come to be associated particularly with the munificence of the rich, and patronage of high culture (also more recently with the promise of funding for development in much of the Global South).

All attempts so far to study our subject comparatively have dispensed with the charity/philanthropy distinction, one good reason being that it has no parallels in major non-European languages such as Arabic or Hindi. Another widely used term, ‘humanitarian action’, is problematic because the word ‘humanitarian’ can be taken colloquially to encompass all forms of philanthropic or altruistic action; but humanitarianism as a movement can be defined as an ideology traceable back to the nineteenth century (Davies 2012). (More tightly, International Humanitarian Law is the body of measures intended to limit the effects of armed conflict, and is outside the scope of this entry). If we look for a comparative, i.e. ‘etic’ term, as opposed to the above culturally embedded or ‘emic’ categories, then ‘good works’ is as serviceable as any; but in this entry, the term ‘charity’ will be used in an inclusive sense.

Theoretical foundations

Two giants of anthropology laid the foundations, at the beginning of the twentieth century, for our discipline’s theoretical understanding of charity. Foremost has been Marcel Mauss’s essay on reciprocity and social solidarity, The gift (2016 [1925]). Mauss’s claim that the principle of exchange penetrates every aspect of social life, in the ‘atmosphere of the gift …, of obligation and of liberty mixed together’ (2016: 177), has stimulated productive but sometimes confusing debate (Testart 1998; Guyer 2016). The other pioneer, though less widely remembered in this field, was Edvard Westermarck. He adhered to Victorian assumptions about a hierarchy of savage and civilised ‘races’, but his global comparison of charitable traditions (1909), still impressive today, explains how mutual aid is commonly influenced by egoistic motives, and, more arrestingly, how charity in all the ‘higher religions’ has been associated with sacrifice.

It may be asked why social-cultural anthropology failed to build on Mauss’s and Westermarck’s insights on charity until the last quarter of the century. The explanation may be that most anthropologists positioned themselves politically on a spectrum between a social reformism that disparaged charity as addressing symptoms rather than causes, legitimating the privileges of the rich, and strict Marxism, firmly opposed to charity as a brake on the inevitable proletarian revolution. But the consequence of rejecting private charity is to place all power in the hands of the state. Out-and-out hostility to charity, as an adjunct to entitlements paid for by taxation, is much less frequently expressed by social researchers today, especially because of the prevalence of partnership arrangements between charitable organizations and governments. Moreover, a frequent theme in recent research literature is the role of private charity in compensating for the retreat of the welfare state, most damagingly in former communist countries such as Russia (Caldwell 2016).

Jonathan Parry’s commentary on Mauss’s The gift (1986) sparked three decades of academic debate about this text. Parry’s somewhat provocative argument was that the pure or free gift, associated with salvation religions – a voluntary surrender of resources without expectation of return – is a kind of dialectical complement to the commodification of goods that dominates Western industrial societies. Shortly afterwards, Mary Douglas (1990), making no reference to Parry in her introduction to an English translation of The gift, deprecated the very notion of a free gift. For our present purpose, we may extract two linked suggestions from Mauss’s essay.

First, when a gift cannot be reciprocated, moral credit accrues to the donor but the recipient suffers a wound. Hence the reputation for ‘coldness’ that organised charity in Europe has often acquired since the nineteenth century, especially when it evacuates face-to-face relationships between donors and recipients. Social reformers sought to replace it with the welfare state. Some Indian ethnography reveals an interpretation of charitable giving as especially sinister: unreciprocated gifts made to priests and renouncers can bring misfortune that migrates from donor to recipient unless careful precautions are taken.

Second, a ‘free’ gift cannot admit any dimension of reciprocity. When I make a gift, I must do so in such a way as to deny to others – and indeed, to myself – that it has a transactional aspect or that I will be rewarded, whether in this world or in the ‘celestial economy’ of the hereafter. Though this paradox is salient in all the three Abrahamic religions, it is in India that it is worked through with most sophistication. The Bhagavad Gita (17.20-22, see also Bornstein 2009: 624-5, 644) distinguishes ‘charity in the mode of goodness’ (given with no expectation of reward) from ‘charity in the mode of passion’ (with intent of recompense, or given grudgingly) and ‘charity in the mode of darkness’ (given at the wrong place or time, to an unworthy recipient, or with disrespect). James Laidlaw describes how in the Shvetambar (‘white-clad’) sect of Indian Jainism, when itinerant celibate renouncers collect food in alms bowls from lay families, they show ‘surly indifference’ rather than showing thanks or appreciation – their aim being not to create social relations but to achieve a timeless spiritual perfection (Laidlaw 2000: 632). According to Hilal Alkan-Zeybek (2012), Islamic volunteering by middle and upper class women to assist poor people in a city in central Anatolia aims at exactly the opposite: enhancing solidarity through bodily contact, and ‘ethical transformation’ of the giver, so that class hierarchies are mitigated. Erica Bornstein’s monograph based on fieldwork in Delhi shows how the beliefs and practices aggregated as modern ‘Hinduism’ interact with Buddhist, Islamic, Christian and secular traditions to form a diversified charitable landscape, both international and intra-Indian (Bornstein 2012).

Interpretations of Mauss are complicated by the fact that he saw all gifts as metaphorically entailing sacrifice: when I make a gift, I give a part of myself. Westermarck stressed that in both Jewish and Christian teaching, almsgiving came to replace sacrificial offerings to God. Charity in general is habitually either praised as an expression of empathy or else depreciated as appeasing the conscience of donors and maintaining the status quo, but Westermarck suggests a third way of conceiving it: as an act of devotion. The prayers offered by beneficiaries are, in the Abrahamic traditions, one way in which they can offer a return – the obverse being curses uttered by those who are unjustly treated. Ilana Silber has argued that subtle ‘echoes’ of sacrificial ideologies and practices still reverberate across long stretches of time, as in the Christian injunction that charitable giving is one way for the faithful to emulate God’s free gift of Jesus’s self-sacrifice (Silber 305, 310). She argues for the need to distinguish three kinds of religious giving in the Hebrew Testament: gifts to the gods, to religious officials, and to the needy. The Christian doctrine of diakonīa or service, however, insists that anything done to benefit the hungry, thirsty, homeless, naked, sick or imprisoned is equivalent to performing the same service for God (Matthew 25: 31-46). Amira Mittermaier, in an article on Islamic voluntarism in Egypt (2014) following Fassin (2012), strongly associates the Christian and post-Christian tradition of charity with compassion, as opposed to religious dutifulness such as she observed in the practice of some of her Cairene Muslim interlocutors. But the history of charitable institutions across all Christian denominations and institutions is so varied that there is a danger here of over-generalization about their motivations, which include renunciation, self-denial and expiation, as well as compassion.

In keeping with a general trend in the social sciences towards recognising the porosity of the distinction between the religious and the ‘secular’, a ‘quasi-religious’ character may be attributed to some of the most successful secular humanitarian and development agencies (Barnett & Stein 2012), inasmuch as they are empowered by strongly internalised moral principles, reverence for charismatic founders, and an engagement with the world as a whole. Philip Fountain, stimulated by his ethnographic research with the Mennonite Central Committee, a North American Christian development agency, has pursued this conceptual problem, starting from the reflection that maybe ‘all development, whether labelled religious or otherwise, is incurably proselytizing’ in that it sets out to rework the social practices of others (Fountain 2015).

Reciprocity versus mutuality

Some ethnographic studies suggest that analysis of charity confined to equations of offerings and rewards may be too one-dimensional; and they point us to unresolved anthropological debates about the relationship between reciprocity and mutuality, and the nature of altruism.

Mittermaier, in another article (2013), draws a contrast, based on her fieldwork in Egypt in 2011–12, between an economy of blessing (baraka), which stresses generosity, and an economy of recompense (thawāb) aimed at securing a place in paradise: the latter model, according to her, has been accentuated by the march of capitalism in Arab societies. Emanuel Schaeublin, in his study of almsgiving in Nablus in the Palestinian West Bank (2016), argues, following a rich but elusive article by Paul Dresch (1998: 114-16), that for his Muslim interlocutors wealth is an expression of abundant divine provision (in Arabic, rizq), and with God there can be no reciprocity. Both Mittermaier and Schaeublin in their fine-grained ethnographies refer us to Islamic theology and abstain from ‘etic’ comparison. But in arguing for the primacy of giving they point us to a nexus of concepts that may be thought of as like a countersubject in music, complementary to the theme of reciprocity. Julian Pitt-Rivers (1992) proposed the concept of grace not only as fundamental to Christianity but also as an ‘etic’ term associated with the idea of charity: ‘Grace is always something extra, over and above “what counts”, what is obligatory or predictable’.

Meyer Fortes argued ([1969] 2004, 231-2) that kinship is rooted in a principle of ‘amity’ or ‘prescriptive altruism’, which is extended outside the family into wider domains. For James Woodburn (1998), an authority on hunter-gatherer societies, reciprocity is not universal to all human groups: the Hadza of Tanzania would not understand the concept of generosity or charity, being profoundly and assertively committed to egalitarian sharing. David Maybury-Lewis quotes from an elder of the Gabra people, pastoral nomads in northern Kenya: ‘Even the milk from our own animals does not belong to us. We must give to those who need it, for a poor man shames us all’ (Maybury-Lewis 1992: 85, based on fieldwork by Aneesa Kassam).

Social anthropologists are concerned with values or principles conducing to altruism. Biologists, by contrast, categorise behaviour as altruistic insofar as it decreases the reproductive success of organism A while increasing that of organism B. The paradox of altruism, one of evolution’s greatest riddles, was first articulated by Darwin in his reflections on the existence of sterile insects, and has elicited a vast scientific literature – largely bypassed by social anthropologists. Marshall Sahlins, however, drawing on the work of the developmental and comparative psychologist Michael Tomasello, deduces that ‘shared intentionality’ or intersubjectivity is a uniquely human capacity for mutuality, not discernable among non-human primates (Sahlins 2011, Tomasello 2009). Inasmuch as post-Darwinian science has dethroned almost every other presumed indicator of stark human uniqueness, the debate should be assumed to be still open. The biography of an eccentric genius, George R. Price (1922–75, a colleague of the more famous sociobiologist W. D. Hamilton), explains how he set out to prove mathematically that ostensibly altruistic behaviour actually conforms to a precisely calibrated scale of self-interest depending on the benefactor’s degree of relatedness to the beneficiary (Harman 2010). For the primatologist Frans de Waal, however, human altruism is not a theoretical problem. Pace Tomasello, he sees it as having evolved when female mammals began to nurture their young. Empathy is associated with the release of the hormone oxytocin: de Waal and his co-workers have even postulated that biological mechanisms for consolation behaviour are conserved between prairie voles and humans (Burkett et al. 2016). Because oxytocin makes us feel good, the sharp line between care for others and self-love, according to this view, falls away.

Research on charity pre-2000

During the 1970s and 1980s, the rise of Non-Governmental Organizations (NGOs) – an unsatisfactory term which has nonetheless stuck – gradually provoked a spate of research projects in which anthropologists played a significant role. Barbara Harrell-Bond’s Imposing aid (1986) was a landmark: an iconoclastic monograph on the work of international aid agencies, based on her fieldwork with Ugandan refugees in southern Sudan. Western institutions were increasingly dependent on government funding and pressured to comply with government foreign policies; their high charitable ideals had largely immunised them from criticism. She faulted them specially for failing to make the effort to empower ‘victims’ to take control of their own lives. Equally hard-hitting was Alex de Waal’s criticism (1989) of relief organizations’ response to famine in the Horn of Africa, which avoided dialogue with the rural poor whom they were supposed to serve; a few years later he attacked the self-reproducing complacency of what he called the ‘Humanitarian International’. Among other influential books by anthropologists published at about the same time was James Ferguson’s The anti-politics machine (1990), which exposed the failure of aid bureaucracies to deliver real benefits to the supposed beneficiaries of ‘development’.

Some publications focussed on the element of marketing in the work of overseas aid agencies, and on the process whereby disasters are ‘constructed’ as consumables via an oligopoly of media organizations for the purpose of campaigning and charitable fundraising, so that the flow of representations of suffering from the global periphery is continuously reciprocated by aid flows (e.g. Benthall 1993, Lidchi 1999). But reflection on charity per se was largely absent from the burgeoning research literature on development and disaster relief. Historians made up for this gap: Paul Veyne on munificence by private individuals in the Greco-Roman period from c. 300 BC ([1976] 1990); Frank Prochaska on the ‘philanthropy of the poor to the poor’ in Britain, and the ‘royal bounty’ that enables the modern British monarchy to remain credible (1988); many of the contributors to the first collection of comparative essays on charity to be published (Ilchman et al., 1998), with not a single anthropologist among its twenty-two authors.

It appears that the stimulus for anthropologists to reflect on charity came from non-Christian traditions, before they began to turn to its Christian and secular manifestations. This would be in keeping with anthropology’s more general tardiness in studying Christianity, except in Africa (as argued by Cannell 2006: 1-14). Among the few exceptions to be found before the end of the last century is an essay by Claudia Fonseca (1986) based on her fieldwork in a small charitable centre in Paris that distributed free clothing to down-and-outs. She describes the ‘implicit pact’ of goodwill and politeness established between some of the lady volunteers and their ‘clients’, and the transition between the older Christian aspiration of gaining a path to paradise through charity and the more modern aim of reinserting poor people into the workforce. Erica Bornstein’s study of transnational Protestant NGOs in Zimbabwe made up quickly for lost ground, and she was the first researcher on charities to follow through the ‘traffic in meaning’ arising at cross purposes between the expectations of an individual transnational donor and the reactions of eventual recipients – in this case through World Vision’s global child sponsorship programme (Bornstein 2005).

Decentring of charity via Islam

Jonathan Parry’s aforementioned reflections on the ‘free gift’ were inspired by the dharmic religions of the Indian subcontinent; and Katherine A. Bowie published an early article on Buddhist charity in northern Thailand, qualifying the prevailing paradigm of Buddhist merit-making with her stress on class stratification (1998). But the main impetus towards deprovincialising ‘Western’ assumptions about charity as a Euro-American monopoly came from studying the Muslim world and its abundant legacy of religious injunctions to generosity, as well as actual charitable institutions. Again, historians have been well to the fore (Arjomand 1998, Kozlowski 1998, Weiss (ed.) 2002, Bonner et al. 2003, Singer 2008, Fauzia 2013).

One historian of early Islam, Christian Décobert, had the originality to make a connection between the key Qur’anic term zakat – mandatory almsgiving, like the Hebraic tithe, and one of the five ‘pillars’ of Islam – and Mary Douglas’s theorising on purity (her early Purity and danger (1966) rather than her later work on the Bible). For zakat has common origins with the Hebrew-Aramaic zakut, which had connotations of purity, rectitude and thriving, but not of almsgiving (Décobert 1991: 198ff). There is also a clear semantic overlap between the idea of alms and that of rectitude via the word ṣadaqa (voluntary almsgiving). Décobert also drew inferences (1991: 196) about the self-representation and kinship systems of early Muslim societies from the rules laid down in the Qur’an about the distribution of zakat, with their eight categories of eligible beneficiaries (Qur’an 9.60), and he proposed a link with the agricultural tradition of offering firstfruits to God, thus opening up opportunities for comparative study which have yet to be fully explored (Benthall 1999, Benthall & Bellion-Jourdan 2003: 19-25).

The connection between giving to God and giving to the needy has never slackened throughout the Muslim world, in many parts whereof animal sacrifice is still routinely practised, with the meat given to the poor (though in industrialised countries it is as likely today to be canned meat imported commercially from New Zealand sheep farms). In the Qur’an, the major sacrifices of camels and cattle that were retained in Islam are represented as not only ceremonies but also a practical means of feeding the needy. Both sacrifice and zakat are associated with prayer and with affirming the oneness of God and Islam. The practice of zakat has undergone many variations during the history of Islam – ranging between, on the one hand, complete control by governments, and, on the other, informal gifts through private connections during the holy month of Ramadan, with many intermediate cases. But the discursive field to which it belongs remains a reality for devout Muslims.

Studying Islamic charitable traditions is of particular interest for two reasons. First, in almost all countries there are either Muslim donors or Muslim recipients or both – revealing as much variety of religious practices as may be found within Christendom. This is of practical importance for aid and development policies.

The second reason is more intellectual, calling into question European claims to secular universalism. Other traditions of charity and humanitarianism were generally disregarded. All religious traditions embody injunctions to ‘good works’, and we may think of the essence of charity as a bodily act, such as reaching out with a hand like the Good Samaritan to a traveller in distress, or, in the Islamic tradition, even smiling at a neighbour. But there are subtle differences. Christian charity, with its association with agapē, does not overlap exactly with the Islamic lexical field, which includes zakat, ṣadaqa and waqf (the Islamic charitable foundation). The rules for the distribution of zakat have been given much attention by Islamic scholars, and may be seen historically as having set out the principles of a proto-state treasury. They have, for instance, been interpreted as authorising finance for military jihad. But support for the poor is usually today regarded as zakat’s primary or even exclusive purpose, and it has been turned into a highly effective fundraising tool by contemporary Islamic charities, especially in actualising the Qur’an’s insistence on the rights of orphaned children.

The authors of a remarkably thorough retrospective analysis of a famine and the inadequate global response to it, Famine in Somalia: competing imperatives, collective failures, 2011–12, conclude:

‘Since the late 1990s, it has become fashionable in the Western humanitarian aid community to promote rights, and to dismiss charity as paternalistic and demeaning. Non-Western actors – particularly Islamic actors – put the issues of charity and of voluntary action squarely back in the centre of humanitarian action, at least in terms of intentions’ (Maxwell & Majid 2016: 196).

These authors were impressed by their observation of Islamic aid workers’ ‘solidarity with the affected community’. Anthropologists may well concur that it is no more than a rhetorical trope to expect those suffering from famine to rely on their rights when they have no juridical entitlements.

Ethnographically grounded research on Sunni Islamic charity has accelerated in recent years. As well as studies on Arab societies by Mittermaier and Schaeublin – to which may be added Harmsen 2008, Roy 2011, Atia 2013, Challand 2014, and Juul Petersen 2015 – a body of work on West Africa has emerged (Kaag 2007, de Bruijn & van Dijk 2009, LeBlanc & Gosselin 2016). Research interest has reflected the growth of Islamic NGOs, which took off in the 1980s partly in line with the growth of NGOs in general, and partly as a result of the ‘Islamic resurgence’ – the worldwide endeavour to re-establish Islamic values and practices. One topic with practical implications is the question of ‘cultural proximity’: to what extent can an international faith-based organization improve its effectiveness through privileged access to aid recipients who share the same religious tradition (de Cordier 2009, Palmer 2011)? The answer to the question is mainly positive when we consider the work of Christian aid agencies among Christian populations in Africa and Latin America. But what could otherwise have been a steady increase in the acceptance and influence of Islamic charities worldwide has been seriously compromised by a shadow hanging over it: persistent allegations of implication in ‘terrorist’ activities. Some limited culpability on the part of Gulf-based charities in the years leading up to 11^th September 2001 cannot be denied, but one root of the problem goes back to the determination of the Western powers to back the mujahideen during the Soviet–Afghan war of the 1980s, when humanitarian aid was blatantly mixed with military support by the USA through Saudi Arabia and Pakistan (Benthall 2010: 115-8). The outcome is that many Islamic NGOs have been blacklisted by the US Government with its global reach, or forced to close down, and even those with an impeccable record have had to face legal and financial obstacles. The dominance of ‘counter-terrorist’ experts in the USA remains strong despite the publication of contrary views, and often seems (as argued by Schaeublin 2008, James 2010–11, de Goede 2012, Benthall 2016) to assume the worst of Muslim charitable donors. Adverse presumptions are also disseminated about all ‘Muslims out of place’, volunteers expressing transnational Muslim solidarity who travel in distant and troubled regions (Li 2010, Kassem 2010–11).

By contrast, in the United Kingdom a government regulator sympathetic to diaspora charities of all kinds, the Charity Commission, has encouraged the growth of an Islamic charity sector that has established fruitful cooperative relations with the mainstream aid establishment – especially by embracing the principle of non-discrimination with regard to religion. The only other country where Islamic charities can be said to flourish vigorously with relatively little political intervention is Indonesia, which has a long tradition of faith-based welfare institutions (Latief 2012, Fauzia 2013). A major Islamic organization, the Muhammadiyah, founded in 1912 in Yogyakarta, came to adopt explicitly the principle of non-discrimination in its charitable works. But it became more religiously exclusive during the period of liberation from Dutch rule, and the commitment to inclusivity has not yet been formally reaffirmed (Fauzia 2017).

In his many-faceted ethnography of Hui Muslims in China, Matthew S. Erie explores how traditional Islamic principles of charitable giving are negotiated in a kind of ‘value competition’ with mainstream Han Chinese gift practices and with the security anxieties of the officially atheist Party-State (Erie 2016). The term for Muslim voluntary giving, nietie, is derived from the Qur’anic term niyyah, intent or motivation, without distinction in Chinese between the thing given and the act of giving. In conformity with Daoist practice, but contrary to the Qur’anic injunction that charitable giving gains extra merit when it is given discreetly, individual and family donations of nietie are posted on walls in mosques by name. Collections of nietie are organised for government-sponsored relief aid after earthquakes (Erie 2016: 276-9).

Debate within the Islamic world about the ethics of charitable giving has focused especially on the rules of zakat. The traditional view of most ulama was that only Muslims could be beneficiaries. When released from this restriction, Islamic charities have found common cause with the mainstream of secular and Christian NGOs. This and other differences on how to interpret the zakat rules – such as to what extent they authorise proselytism – may be seen as encapsulating concepts that go to the heart of wider current debates within Islam today (Benthall 2016: 18). They also have a bearing on anthropological reflection about charity in general, in that Islam, with its missionary and expansionary history, presents an alternative universalism to the often taken-for-granted universalism of Christianity and its legatee, post-Enlightenment secular universalism.

The critique of humanitarianism

Research by social anthropologists on charity all over the world has expanded in recent years. They are not all interested in the same questions. For instance, C. Julia Huang’s monograph on the international Tzu Chi social welfare movement – founded by an unassuming Taiwanese Buddhist nun, the Venerable Cheng Yen (b. 1937) and now numbering millions of supporters – is primarily concerned with the Weberian theme of charisma and its bureaucratization (Huang 2009). This model may be specially applicable to charitable institutions of every kind as they expand, in that they are empowered by strongly held moral values while also obliged to compete as corporate bodies. The specific centuries-old commitment of Christian charities to the care and healing of leprosy sufferers – and latterly to opposing their stigmatization – has attracted attention (Gussow 1989, Staples 2007). But these approaches seem marginal to the current trend in the analysis of humanitarian agencies.

Practitioners in relief and development – sometimes mocked as citizens of ‘aidland’ – habitually deny that what they are doing has anything to do with charity. This may be an instance of déformation professionnelle. Ambitious multinational initiatives have called for the humanitarian enterprise to change from one driven by charity to one driven by the imperative of ‘global solidarity’ (World Humanitarian Summit 2016: 13). But this high-minded concept is at odds with the actual evidence of gross global inequalities, never more than slightly mitigated by humanitarian action, and it lacks the underpinning of any vernacular tradition. Recent work by anthropologists and others has turned to holding the ideology of humanitarianism up to the light (e.g. Bornstein & Redfield (eds) 2010).

Didier Fassin’s concept of ‘humanitarian reason’ has been widely influential (Fassin 2011). By this he means a globally pervasive, morally untouchable idéologique, in confronting which he seeks to straddle the two normally contradictory senses of ideology: on the one hand, an insidious veil obscuring brutal economic interests (as in the works of Karl Marx), and, on the other hand, a cultural system that makes sense of social relations (as in the works of Clifford Geertz). Complemented by careful ethnography – he was trained as a physician and served as a vice-president of Médecins Sans Frontières (MSF, aka Doctors Without Borders) – his contention that humanitarianism is a form of Western governance, dependent on the fantasy that an ‘international community’ exists, seems an application of social science at its best. Without doubt – and this follows on from the much older critique of ‘charity’ – humanitarianism has markedly conservative aspects and can even dehumanise, reducing survivors to the ‘bare life’ diagnosed by Agamben (1995) as in many refugee camps (Agier 2014). An impressive ethnography, Peter Redfield’s monograph on MSF, draws on the Agamben–Fassin critique while also recognising and detailing this agency’s unique achievements as one of the most effective and most self-critical NGOs (Redfield 2013), though he has incidentally questioned MSF’s eccentric contention that it is not a ‘charity’ despite its famous successes in public fundraising (Redfield 2012: 454-7).

In the hands of armchair social scientists, an approach dwelling on Foucault’s concept of ‘biopower’ – the subjugation of bodies and control of populations – can be overdone, especially when the brutality of many non-Western as well as Western regimes is underestimated. But the critique of ‘humanitarian governance’ has animated many recent ethnographically grounded publications bearing on charity. The occupants of refugee camps – estimated at about six million persons in 2014, and fast growing in numbers since then – may be seen as objects of charity (even when the administrators are state or interstate agencies) in that their rights of citizenship are suspended in spaces that are ‘off limits’ and governed by special regulations (Agier 2014). Edward Simpson provides a searing, if impressionistic, study of the aftermath of a major earthquake in Guajarat, India, in 2001: a degradation of the social fabric in which philanthropic organizations of all kinds connived – the worst case being a school for boy orphans set up by a British paedophile. Simpson breaks new ground by including coverage of local Indian organizations and Gujarati diasporas, so that the charities that he criticises are not only those of Western origin (Simpson 2013). Maurizio Albahari went to press with his comprehensive book on the Mediterranean migrant crisis (2015) just before it reached boiling point. Though Albahari is sensitive to all other aspects of the crisis after a decade of research, it is his voluntary work in 2005 at a reception centre for asylum seekers in a small coastal town on the heel of Italy that gives his book a first-hand authority. Albahari shows how a myriad of religious and secular charities, nominally independent, assumed a de facto policing role. His monograph supports the contention that the most searching critiques of charitable endeavours are still today those that are fortified by participant observation, as in the earlier work of Harrell-Bond and Alex de Waal. Liisa H. Malkki (2015) diagnoses a ‘neediness’ among Finnish Red Cross professional staff who have served abroad: they are frustrated by the routines of middle-class life, made less bearable by the long winters, and look for a kind of personal fulfilment unobtainable at home. Anthropologists from the Global North may recognise the feeling.

A holistic template

The German–Dutch school of anthropology contributes a methodological template into which research on charitable initiatives may be inserted. The template relies on an expanded concept of social security, described by Franz and Keebet von Benda-Beckman as ‘the dimension of social organization dealing with the provision of security not considered to be an exclusive matter of individual responsibility’ (Thelan et al. 2009). One merit of this methodological démarche is that it pays full attention to the viewpoints of the recipients of charity and to the question of evaluating efficacy. Five ‘layers’ of description are identified: ideological and cultural notions of risk and caring; institutional provision, based on clearly defined rights; actual social relationships between providers and recipients; concrete actions such as person-to-person assistance, and the transfer of resources; and finally the consequences of interventions for both providers and recipients. Carolin Leutloff-Grandits (2009) applies this method in an article on changing charitable responses in the face of the breakdown of state structures in former Yugoslavia. In the ethnically mixed Croatian town of Knin in 2001 during the aftermath of the Croat–Serb war, the local branch of the Catholic Caritas organization launched an emotive charity campaign for ‘hungry Croats’ in the town, adopting what Leutloff-Grandits calls a ‘war policy of ethnic engineering’ by other means. Preference was shown to Croatian settlers from Bosnia, causing resentment among both the Catholic Croat and the Orthodox Serb returnees. From the few full-length published studies that do justice to all the ‘layers’ of analysis specified by the von Benda-Beckmans (though independently of their suggestions), we may single out Maxwell and Majid’s Famine in Somalia (2016) and Albahari’s Crimes of peace (2015), both mentioned above.

Conclusion: progress in charity?

During the mid-twentieth century hiatus, noted above, between Mauss’s and Westermarck’s writings and the innovative contributions by Harrell-Bond, Alex de Waal, and Parry, one anthropologist was exceptional in taking a sustained interest in the theme of charity: R. R. Marett. He wrote: ‘real progress is progress in charity, all other advance being secondary thereto’ (Marett 1935: 40). He saw maternal nurturing as the fountainhead of charity (Marett 1939: 141, 147). Though his phrasing will strike readers today as sentimental, it might be seen as adumbrating Fortes on amity and Frans de Waal on oxytocin. Yet no reflection on charity can ignore the lurking presence of reciprocity, which always threatens the purity of the free gift. The Bhagavad Gita recognised the moral dilemma over two millennia ago.

Marett’s dictum about progress has resonance today, and it prompts questions as to what should be recognised as progress. Since the 1960s, an amorphous movement known as Corporate Social Responsibility may be seen as one modern variant of charity, and ethnographic attention has been given to its manifestations, for instance in South Africa (Rajak 2011) and Saudi Arabia (Derbal 2014: 146-53). Among more recent innovations deserving of study is the formation of commercial consultancy firms to advise young people who have inherited wealth on how best to become philanthropic donors.

In any case, what used to be condescended to as ‘applied anthropology’ seems to be gathering some strength within the discipline. There are many opportunities for anthropologists to build on previous work relating to charity in ways that are practically useful as well as theoretically sophisticated, at a time of unprecedented demands on voluntary giving and volunteering.

Notes

This entry makes some use of material already published by the author in three other overview articles: ‘Charity’ in Fassin, D. (ed.) 2012. A companion to moral anthropology (Chichester: Wiley-Blackwell); ‘Religion and humanitarianism’, in MacGinty, R. & J.H. Peterson (eds) 2015. The Routledge companion to humanitarian action (London: Routledge); ‘Humanitarianism as ideology and practice’ in Callan H. (ed.) forthcoming. The Wiley-Blackwell encyclopedia of anthropology. Gratitude is due to all these editors for the opportunities they have given for reflection. The present article owes much to Felix Stein as commissioning editor, and to two anonymous referees. Expert copy-editing was provided by Rebecca Tishler.

References

Publications that may be found specially helpful for introductory reading are indicated with a *.

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Note on contributor

Jonathan Benthall is an Honorary Research Associate in the Department of Anthropology, University College London, and Director Emeritus, Royal Anthropological Institute. His most recently published book is Islamic charities and Islamic humanism in troubled times (2016).

Jonathan Benthall, Downingbury Farmhouse, Pembury, Tunbridge Wells, Kent TN2 4AD, United Kingdom. jonathanbenthall@hotmail.com