Season 2, Episode 5: Claire Decoteau on the COVID-19 Emergency and the Failure of Pandemic Response

In this podcast episode, Joseph Harris sits down with University of Illinois-Chicago Professor of Sociology Claire Decoteau. They discuss her latest book - Emergency: COVID-19 and the Uneven Valuation of Life - which explores how and why the city of Chicago failed to protect its most vulnerable citizens in its pandemic response. In the process, they explore the changing landscape of global health and sociology and the implications for democracy and health.

Transcript

Global Health Politics Podcast

Season 2, Episode 5: Claire Decoteau on the COVID-19 Emergency and the Failure of Pandemic Response

SPEAKERS

Claire Decoteau, Joseph Harris

Joseph Harris  00:00

Welcome to the Global Health politics podcast, where we go beyond the articles and books and have real intimate conversations with people working in the field of global health today. I'm your host. Joseph Harris. Today, I'm really pleased to be here with Dr Claire Decoteau, professor of sociology at the University of Illinois, Chicago. Dr Decoteau is one of the leading voices in the sociology of global health. Her first book, Ancestors and Antiretrovirals: Biopolitics of HIV/AIDS in Post Apartheid South Africa, examined how advanced western biomedicine failed to address the underlying causes of AIDS and the informal settlements of South Africa. Her most recent book, Emergency COVID-19 and the Uneven Valuation of Life, explores how the city's COVID response failed to protect even its most vulnerable residents, despite articulating a focus on equity and inclusion. Dr Decoteau, thanks for coming to join the global health politics podcast. 

Claire Decoteau  01:18

Thanks for having me. I appreciate it. 

Joseph Harris  01:20

How did you become interested in issues related to global health?

Claire Decoteau  01:27

After I graduated from college and before I did my PhD program, I lived in Paris for two years. I was working as a nanny and I was doing an MA in feminist theory, but I also volunteered for an organization that helped mostly female migrants from North Africa who are HIV positive access treatment programs in France, so they were able to access them as migrants. And I was struck by how uneven the distribution of illness is across the globe. That was sort of my first entry into understanding the uneven distribution of HIV cases across the globe, whereas the resources that can address illness, like treatments or preventions are, you know, hoarded by Western countries. So as I always tell my undergraduate sociology students, we can only understand these like global inequities in global health by studying the structures that actually create illness, and then, of course, the economic and political policies that sustain the unequal distribution of health resources. So this first sort of entry into volunteer work with African migrants in France really opened my eyes to the sociology of global health.

Joseph Harris  02:35

And what led you to work on South Africa and issues related to HIV/AIDS there? 

Claire Decoteau  02:40

When I was in graduate school, it was a really kind of exciting and turbulent time, I think, in the kind of history of HIV and AIDS, which I of course, had grown up watching, HIV sort of become the pandemic that it ended up becoming. And when I was in graduate school, it was when the Treatment Action Campaign in South Africa was really trying to bring global attention to the TRIPS Agreement, which is a global agreement that protects intellectual property rights for people for countries that are parts of the World Trade Organization, and basically it sets exorbitant prices on life saving drugs in ways that keep people living in countries with The highest rates of HIV from accessing things like antiretroviral treatment or other kinds of treatment for life saving, I mean, life saving treatment for infectious disease. And so that was happening when I was in graduate school, and I was very excited by what I was seeing the Treatment Action Campaign doing. And then when I arrived to conduct kind of preliminary research in South Africa, I started to get involved in some community movements of folks who were looking for non neoliberal approaches to water distribution and housing distribution in South Africa. And I was really struck by the disconnect between sort of struggles around healing and struggles around other forms of like neoliberal distribution in South Africa, like water and housing. And I was–so I was kind of intrigued by the split between different kinds of movements, those around health and those around my more like economic issues. But I was also really struck by the disconnect between how people in poor black communities in South Africa understand their health and the kind of debates that were happening in the public sphere. So a lot of the folks that I was involved with in community struggles were really reliant on indigenous healing, and indigenous healing was not very present in the kind of public conversations about HIV and treatment. And so both of those things really intrigued me. So I was very interested in kind of understanding how health is situated within a broader neoliberal kind of restructuring of South Africa, but also how everyday people came to understand their own healing in the context of the shifting kind of landscape of treatment around HIV. 

Joseph Harris  05:01

And you're known as both an ethnographer, but also a theorist. Could you talk a bit about those two roles, why they're important to you and what they offer the study of global health and social science more broadly?

Claire Decoteau  05:14

Sure, I think that theory done correctly helps to unveil hidden causal mechanisms, but also the conjunctures between intersecting systems of inequality. And so in all of my projects, from my first book on HIV to my most recent book on COVID and the intervening projects as well, I'm really interested in how health crises kind of pull back the curtains and allow us to see inequality in new ways, but also allow us to unpack scientific norms and practices. I also think that health crises force people to rethink some of their taken for granted approaches to knowledge and healing and so, you know, I'm very influenced by the writing of Michel Foucault, which, if you've ever read any of my work is pretty obvious. And like you know, his approaches to archeology and genealogy, I'm really interested in unveiling the subjugated knowledges that people use to navigate their worlds, but also give them critiques of prevailing systems of power, and I think that those subjugated knowledges are sometimes also most obvious in the midst of health crises. So I think that this approach of kind of focusing on health crises in this way really necessitates the kind of marrying of theory and ethnographic insight. I think theory allows us to explain complex systems, while ethnography unveils people's strategy for navigating and critiquing those systems.

Joseph Harris  06:46

Your first book, Ancestors and Antiretrovirals: The Biopolitics of HIV/AIDS in Post Apartheid South Africa explore the politics of HIV/AIDS in South Africa, examining how advanced western biomedicine failed to address the underlying causes of AIDS in the informal settlements of South Africa. Can you give readers a brief tour of that book and its main contributions?

Claire Decoteau  07:10

Sure. I think the book has three sort of main contributions. As I mentioned earlier, it puts the debates that were happening in the South African public sphere around treatment provision, in conversation with the country's adoption of neoliberalism and its efforts to sort of position itself geopolitically in both the continent of Africa and in its relationship to the west. So in the book, one of the arguments is that I suggest that the debates around HIV treatment, and at the time now, antiretroviral treatment is really widely available in well, we'll see, I suppose, with what's happening with Trump. But it has been widely available now for a while in the Global South and in South Africa. But at the time, it wasn't available, and the second president after democracy in South Africa, Thabo Mbeki, withheld treatment, really, he subscribed to what many have called AIDS denialism, and withheld the South Africa's adoption of antiretroviral treatment to the public sector. And so and then that policy shifted with the rise of the of the third President of the democratic South Africa. And so I sort of trace the shifts between those presidencies and illustrate that many of the debates that were happening around HIV treatment were really also about South Africa's gender politics, its approach to neoliberal restructuring and its efforts to position itself as a post colony in relation to the West. So I argue that the kind of debates that were happening around HIV in the public sphere, really redeployed these like tropes of tradition and modernity in an effort to manage what I call the post colonial paradox, which is basically that most post colonial countries had to figure out how they were going to position themselves with in relation to the Western world, join the global market, address the ravages of the colonial era and meet the needs of the most poor. And I suggest in the book that the contradictions that arise from nations attempting to manage all of this, at least in South Africa, really played out through the politics of AIDS. And in so doing, biomedical treatments like antiretrovirals and indigenous healing, which is why the book is called antiretroviral ancestors and antiretrovirals indigenous healing, which calls on ancestors to help us, sort of position our health in a more communal way, were really implicated in the skirmish over treatment and global positioning. And it had really significant implications for poor black populations, who really rely on indigenous healing extensively. So that's the first major argument, and I would say kind of the main kind of crux of the book. But I also show how when antiretrovirals were adopted in South Africa, there was a real effort to kind of biomedicalized citizenship rights. And so the book kind of traces the effects of those that massive shift in policy. And then the third thing is that the book is really situates this entire story within the squatter camp. So I did many, many years of ethnographic research in two squatter camps outside of Johannesburg, and the book attempts to make sense of how people were really dealing with all of these tremendous debates and bifurcations that were happening in the public sphere, when for them, the combination of biomedical and indigenous healing is very syncretic, and it has been for a very long time. So how did people sort of manage this, you know, really intense struggle at the public sphere, and how did it sort of impact their daily health strategies?

Joseph Harris  10:36

Can you talk a little bit about how the book was received, and also, in particular, in the informal settlements that you wrote about, and did it impact any kind of policy conversations there?

Claire Decoteau  10:53

Unfortunately. So I Yeah, it's really a shame. I wish that more policy makers read academic books, but I do think that the book was warmly received in a lot of academic circles, and helped scholars make sense of kind of subsequent shifts that were happening at both the state and sort of in health policy, and how shifting governmental regimes were kind of managing the ongoing kind of politics of health. I have returned to South Africa multiple times, and you know, been to those squatter camps where I conducted ethnography to visit my friends and interlocutors there. Unfortunately, many of them have passed away because of the poverty, violence and ongoing inequalities in health care in South Africa, but I'm still in very close contact with the ones that have managed to continue to survive. I did conduct another research project, kind of situated in the squatter camps and in some informal housing units in South Africa, where a lot of migrants from other parts of South Africa come and squat. And the project was comparing transactional sex and sex work in in South Africa. So it really was centered on women's lives. And I argue that women end up putting up sort of symbolic boundaries around their sexual practices and spatial boundaries around sort of feminized precarity in order to survive their economic conditions.

Joseph Harris  12:18

You recently published a brand new book Emergency COVID-19 and the Uneven Valuation of Life. And this book explores how the city of Chicago's COVID response failed to protect its most vulnerable residents, despite having an explicit focus on equity and inclusion. Can you give readers a brief tour of that book and share with them a bit about what motivated you to write it?

Claire Decoteau  12:42

Sure. Obviously, like everyone across the world, I was my my family was very unmoored by the pandemic, and it was especially when, you know, everything shut down, and we didn't have masks and we didn't have any idea what was happening. And yet, at the same time, I was really struck by the fact that my race and class privilege really protected me from the worst impacts of the pandemic in ways that was not true for many of my neighbors, and so I think that's really what motivated me to work on this book. I also had never done research on Chicago itself as a Global Scholar just hadn't really focused on the global city of Chicago, and so it was an opportunity to really focus in on segregation and disinvestment in the city and how people were surviving the ravages of the pandemic. So yeah, so the city claimed that it was adopting a racial equity approach to the pandemic. And yet, the residents of the city that I talked to who lived in the neighborhoods that were targeted for additional resources by the city because of their because of the unequal impact that it was having on their lives. And yeah, so I mean, basically, I chose neighborhoods that had been the worst impacted by the pandemic, where the death rates and the hospitalization and the infection rates were the highest, and they were continuing to have really horrible–they were sorry, sorry. They were continuing to experience the pandemic and have some of the worst impacts despite the city's efforts to target resources toward them. But in addition to sort of having high rates of death and hospitalization, they also had extremely difficult stories to tell about their economic precarity and their housing insecurity. And so the book really explores why that would be so. Why when the city, you know, named equity in its mitigation strategies and targeted six neighborhoods that there were most impacted with additional resources for testing, and then once vaccines became available, targeted 15 very vulnerable neighborhoods with vaccine distribution, why did these efforts not really have much of an impact for those who lived in those neighborhoods. The book also looks a little bit at the US Government's kind of expansion of the social safety net to also explore why that didn't have more of an impact on vulnerable people's lives. And basically, I argue that it's in part because of the way that we approach crisis, the way that we approach emergency. And so I suggest that, in fact, COVID can be analyzed as a convergence of three emergencies. So first, the federal and local governments govern through emergency. That's the framework that I use, which entails enacting sort of temporally bounded, so time specific kinds of governmental strategies that presume scarcity and triage care, but they also naturalize structural inequality by de-linking the effects of racism, which is high rates of death and high rates of hospitalization from its causes, which are actually decades of racist policies of housing and education and healthcare. So that's kind of the first kind of set of emergencies that I focus on, is just the way that the city and the federal government governed through these emergencies in these temporally specific ways. And this approach really ignored two other what I call endemic emergencies that were already happening. So the slow emergencies that racially marginalized populations have faced for decades because of neoliberal restructuring and the fragmentation of care infrastructure and the sacrifice of low income frontline workers to death because in order to safeguard the economy and protect the middle class.

Joseph Harris  16:44

It's interesting that you mentioned this idea of governing through emergencies, and the different kinds that that stood out in that situation. We're standing at a moment now where the Trump administration is also governing through emergencies. Do you see some parallels there? How might these two cases be related? What can we learn from your case that might inform what we're experiencing now?

Claire Decoteau  17:13

Yeah, you know, I do think that Trump is using emergency in these really interesting, scary ways, where he's calling, you know, the border, an emergency in a particular kind of way in order to enact policies that are only allowable during times of war, he was looking for an illness that he might be able to use to declare a health Emergency on the border so that he could again enact policies that go beyond what's legally, you know, allowed. And I think of this in the book, I use both Foucault and Georgio Agamben, and Agamben really talks about the ways in which states of emergency really suspend the law and allow the state to kind of intervene directly on the population. But here, I think we see the the ways in which Agamben doesn't talk about race and class, because very clearly, Trump is using these emergency declarations to enact extremely white supremacist protection policies for for white people in the United States. And so I do think that it's, it's a scary time, obviously, and it's an but it's an important one to pay attention to the different ways in which emergency gates used. I mean, I think Trump did this a little bit during the pandemic as well, where once he realized that the pandemic was impacting lower income Black and Latinx people the most, he sort of withdrew his support for masking, for example. And so I think that we have to pay attention to the ways in which both the data about who is most impacted as well as the forms of emergency that you know the government uses can really be used strategically by those in power towards different ends. And so I think that what we saw in Chicago is a little bit different than what we're seeing with Trump. But both are ways in which emergency can be sort of weaponized by the government, to–to, you know, in ways that are extremely detrimental to everyday folks, but also to especially people who are marginalized by their race and class position. 

Joseph Harris  19:21

One of the really surprising things you highlight in the book was the degree of funding that went to police and fire departments, and this is, you know, for the COVID response, rather than to delivering direct care services that would, for example, help keep people protected fed in their homes. And that really just stuck with me. Can you talk a bit about that point?

Claire Decoteau  19:51

Yeah, so I do try to situate. I mean, I do think that Lightfoot used the discretionary funds, both from the Cares Act and then the ARPA funds, in particular ways that were detrimental, that really showed that she was prioritizing the sort of business interests in the city in addition to her lack of real care for essential workers. But I also think that these policies are also situated historically in the sense that, you know, lots of like in the 70s and the 80s, when Chicago was going through its kind of worst after effects of de industrialization, when federal funding was cut to cities. So this is, you know, an earlier period of a little bit what we're seeing now, although we're seeing it in a new way, you know, that really already impacted and made neighborhoods that were flourishing because they had access to factories and jobs. All of those jobs left the city and people didn't have places of employment that were close to their homes, and then the city retracted its social safety net, and all of that has had an impact then on how Chicago's landscape looks today, which then, of course, the disease came in and really ravaged the communities that were already disinvested. So I do think that that history is also important. But Lightfoot, then, with the Cares Act funding, spent over 60% of her discretionary funds on police personnel. And then during the ARPA, with the ARPA funds, the second kind of wave of federal grant money, she ended up using a lot of the money to pay back bank loans to balance the budget, and one of the ways she did that was by prioritizing particular kind of personnel, like fire personnel. And so these were really approaches that really illustrated that she was very invested in keeping the city's sort of rankings high so that they could still attract investment. And, you know, to some degree that's necessary. Cities have to manage their budgets in particular kinds of ways in order not to, you know, be in debt, but at the same time, she could have used some of those funds in different ways and really prioritize direct services to the poor. And so I think that one of the really telling moments in the pandemic was happened after George Floyd's murder, when there were these massive protests throughout the city and Lightfoot raised the bridges in Downtown Chicago, which are these iconic bridges that allow the boats to go through. But she did it so that the retail district downtown could not be looted, and meanwhile, the kind of poor neighborhoods that surround downtown were allowed to just burn. And the people, the residents that I spoke to, the people who I interviewed, all you know, talked about this moment as a very clarifying moment that illustrated precisely what she valued, which was wealth and not, you know, regular, everyday Black and Latinx folks.

Joseph Harris  22:56

Another shocking thing we learned in the book is that a full 72% of COVID deaths in Chicago were Black. And of course, those of us who who know the literature on the social determinants of health, you know this may not be a surprise for us, right? The most vulnerable are often the ones who get hit the hardest in a pandemic. And yet, the mayoral administration of Lori Lightfoot really approached the pandemic response in a data gathering kind of manner, trying to understand who exactly were being hit by this in a kind of reactive way, rather than proactively targeting those most vulnerable, who we would know already are most vulnerable. You know right away. Why did Mayor Lightfoot's team do that? 

Claire Decoteau  23:50

Yeah, that's a good question. I mean, I think that it is important, and many people have said this about the book, that we have to remember back and remember that people wanted to see the data right, like everybody was terrified. Nobody knew what was going on. And there were all of these calls to collect data and figure out what was happening, especially because it was very clear that, from early on, that black and Latinx folks were being hit very the hardest by the pandemic. And so I do think that in part, Lightfoot and her team were responding to that call for data, and Chicago was one of the first cities to illustrate the sort of inequality in the impact of the pandemic with racial disparities data. But in the end, collecting data itself doesn't address racism, it's just collecting data, and so it can't be an end in itself. And I think that that's really the issue with Lightfoot, was that the data was sort of the point for her, and it did allow her to allocate some resources, but those resources were so minimal that they had very little impact on. Neighborhoods themselves, whereas, if she had, you know, paid attention to the social determinants of poor health, which sociologists, of course, know the map of Chicago. We've all seen that map. Everybody who's ever looked at a map of Chicago recognizes the social determinants of health. You know, she could have kind of proactively allocated some direct services, some services to some additional resources to safety net hospitals, cash assistance and rental assistance early on, in addition to protecting workers. So there could have been really stronger, you know, worker protections that were put in place from the outset, as opposed to sort of waiting to collect this massive amounts of data. The other thing that the data really did so she ended up collecting all of this data from across the city on hospitalization and death rates and infection rates, and those are things that people could track throughout the pandemic, but at the same time on a zip code level, but at the same time, using that data to then allocate scarce resources meant that if one part of the city had high infection rates, she would allocate some testing resources to that area until those rates fell, but once those rates fell, those resources were retracted and sent elsewhere. So I've sort of described this as like a whack a mole approach to the pandemic, which doesn't actually make very much sense, because, one It pits neighborhoods against one another, where they're competing for these scarce resources by allowing but and then if they succeed, their resources get retracted. And so several people were saying, you know, we had these extra resources, and then suddenly they disappeared, and we had worked really hard to, you know, get vaccines out to our community, and then as soon as our vaccine rates were high enough, the city took those vaccine resources away. And so using resources in this way, using the data to kind of allocate resources in this way, ended up being really problematic, and a lot of folks who had even received the resources were extremely critical of the way that the mayor did this.

Joseph Harris  27:04

It's so interesting. I think what you share really underscores the power of metrics. And I can't help but think about Vincanne Adams's great book, Metrics: what Counts in Global Health. But there, of course, the I think real focus is on global health and thinking about poorer countries and the power that donors have right over resources and organizations like the Bill Gates Foundation and others demanding metrics of people on the ground in different countries. And those dynamics don't seem to be sort of happening here in Chicago in the same way the donors are clamoring for it. And yet those metrics that call for metrics still seem so powerful. And is there anything more you want to say about that? Because it just it's there, but it's almost, it's a paradox, why that should be so powerful.

Claire Decoteau  28:07

Yeah. Well, I think for her, it was a way to show that she was being racially equitable. And so I think that there was this, you know, she's a Black mayor in a city that is 30% Black and 30% Latinx. It's a, you know, majority minority city, and lots of people were, you know, really struggling during the pandemic. And I think that she needed to address the, you know, racial inequalities of the pandemic. And she, you know, to her credit, really recognized that that was super important. But the way that she did that was not by allocating resources differently or thinking differently about how to allocate resources. She created this, you know, these metrics. And I think the metrics, because they were the end in itself, and they cost a lot of money to, you know, create, they allowed her to sort of play a political game. I mean, it's not all that different from what happens in the Global South, just it's a slightly different framing, but it allows her to sort of claim political capital by saying, I am addressing racial inequality. See, look at all of this. You know, all, look at all of these statistics that I'm gathering. But the statistics themselves are a story that she can tell, of course, but they don't, you know, they can't be the end in the end of the of the project, right? The project has to be that the you that the you know, that we do something with the data. And I feel like, if the you know, data is not necessarily not a bad thing if it's in the right hands, and I think that if, like, community groups have been able to use that data themselves to and then been given these resources and said, like, Here are some ways that you could, you know, like, sort of they got to be part of the conversation about what was happening. That could have been better. But I also think that recognizing that some early efforts to sort of provide rental assistance, provide cash assistance, I just think. That there were different ways she could have thought about it, and I think that the metrics became her whole game, and that's when they become problematic.

Joseph Harris  30:07

So fascinating in the midst of crisis as well. What can other cities learn from Chicago's response to COVID and what other cities had, in your view, more effective COVID responses?

Claire Decoteau  30:22

I you know, nobody did it perfectly. Of course, I do think that Seattle, for example, did some quite robust protections for workers. So they had sort of mandates around what businesses had to do in order to protect their workers. There was more PPE that was not just given to hospitals, but given to, you know, factories and sort of frontline workers. And there were also sick leave protections that were kind of put into place and so and then there were cities like Austin and certain areas of California where hotels were used to house essential workers when they had tested positive for the Coronavirus, and so they wouldn't have to return home and infect their families. And so those are just some examples. I mean, those are not like holistic approaches that you know totally changed the direction of the pandemic, but they're just examples of things that you know, that our Chicago could have done a little bit better. The other thing that the book and then some subsequent articles I've talked quite a bit about is housing. The Rental Assistance Program really didn't get kicked off in many cities until December, and by then, a lot of lower income homes. They were people were months behind on rent, and in Chicago, lower income folks, affordable housing is basically found through informal agreements, and people were really worried about getting informally evicted, so there were eviction moratoria in place, but that doesn't protect people who don't have formal leases. And so a lot of the folks that I talked to had already moved because they were so worried about getting evicted in the midst of a pandemic, and then once rental assistance become available, they weren't eligible for it because they'd already sort of made moves to try to protect themselves from becoming evicted. And so I just think that the rental like the issue around housing, especially with something like the like the Coronavirus, where your house matters so much to protecting yourself, really was an oversight that really needed to have happened much earlier.

Joseph Harris  32:31

Moving beyond COVID, we're obviously living in a really challenging moment right now, attacks on higher education, public health, diversity, equity and inclusion. What do you consider some of the most pressing issues we're dealing with today, especially for global health?

Claire Decoteau  32:51

So, so many. There's so many challenging things happening. I mean, I think that one of the things that the people in the US often forget, but that the COVID pandemic and the AIDS pandemic have really illustrated is that we're all connected to one another across the globe and across cities, and when we disinfect, when we disinvest and retract funding from the most vulnerable, there are reverberations for all of us, and not just should we care about the most vulnerable, because it's an ethical and justice issue, but we also should care, because entrenched inequality has negative consequences for the spread of infectious disease. And then, of course, we're seeing the retractions of us support for USA ID, for PEPFAR, for reproductive health care, and in the United States for Medicaid. And this is going to have long term, devastating effects for people across the world. It's going to mean lots, millions and millions of people lose their lives and face tremendous precarity, and then with cutbacks to universities and research funding, you know, we as social scientists are less capable of tracking these, you know, impacts, and that's also really scary that we're not going to be able to do our jobs of sort of recording and auditing what's happening because our funding is getting cut. So I would just say that, you know, my writing is often critical of policies that are well intentioned but have unforeseen kind of negative impacts because of racist or colonial presumptions that are sort of inherent in their logic. But here, I think we're seeing blatant racist and colonialist and classist logics at work, and we need to find ways to fight back, both big and small, and I think that that means organizing within our communities to help one another, but also using our privilege as much as possible to push back.

Joseph Harris  34:41

I appreciate you offering some concrete suggestions there. That's, that's great. Can you tell us a little bit about your current projects?

Claire Decoteau  34:51

Sure, I am currently conducting research about what's happened with abortion in the post Dobbs, moment. In the United States. So I'm doing interviews with women who live in states with abortion bans, who are using different means to access abortions. So some of them are traveling out of state to get abortions at clinics in states where abortions are illegal. Some of them are using telehealth to order medication abortion through the mail, and some of them are doing self managed abortions in their homes with pills that they got from community networks. And then I'm also interviewing abortion providers and lawyers and movement activists. So I think there's several fascinating things in this project as well. Of course, it's again, like analyzing the impact of a health crisis on marginalized folks. One of the things that I think is really interesting is that abortion is very exceptionalized and all and has been throughout history in the United States, so it sort of exists in this medical, legal borderland, which means that basically, abortion is kept separate from health care, but also highly criminalized, and this, both of these things have been heightened since the Supreme Court ended federal protections for abortion with the Dobbs decision. And yet, for the women that I'm interviewing, abortion is necessary to them because they live in economic precarity without sufficient welfare. They experience violence in their lives. They experience violence from medical and prison systems. They don't have access to health care. Many of them experience chronic and chronic mental and physical illnesses. And so I think that their experiences of all of the precarity that kind of intersects in their lives really illustrates the broader failure of the US welfare state to protect lower income women of color in the south, and they need abortions because of this failure of the US state to protect them. But on the other hand, their abortion is actually something that they can do to help themselves and their families, and so it actually is kind of a empowering moment for them, where they get to make a choice and and do something that that helps their families. The other thing that I'm really interested in with this project is that many of these women have very little education, and they're very disconnected from like, national news sources. Many of them didn't even know that abortion was illegal in their state until they needed one. So I'm also interested in, if that's the case, how do you figure out how to get an abortion, and who do you decide to trust? Especially because abortion often means people are isolated from their closest kin, and they can't, you know, talk to their medical professionals for fear of surveillance. So how do they figure out what to do? And I think that that's a really other really interesting thing about the project.

Joseph Harris  37:48

That sounds like an extraordinarily powerful project. Can't wait to read it. Thank you. Are there particular researchers whose work you closely follow today, or activist profit organizations whose work you particularly admire?

Claire Decoteau 38:08

Yeah, I'm a big fan of Vinh-Kim Nguyen's work, which, if you've read some of my work, I use him in almost everything. I really appreciate his approach to thinking about global health and the ways in which it operates also through metrics. I mean, he talks about that some as well. And I'm very interested, maybe in a related way, to the work of Médecins Sans Frontières, so the Doctors Without Borders, I think they are doing incredibly important work around the world. I'm also really influenced right now with the framework of reproductive justice. So what's interesting about reproductive justice is that it's not just focused on reproductive health care. So the whole premise of the approach is that we can't understand just like abortion is exceptionalized, but we can't understand it unless we situate reproduction at the intersection of all of the different sort of like structures, so structures of healthcare, structures of welfare, but also structures of policing. So the promise of reproductive justice is that women should have the right to choose to have children, choose not to have children, and to be able to raise their children in safety and security. And so it kind of really does talk about criminalization within a broader framework, so not just the criminalization of pregnancy or healthcare, but also the criminalization of just women's bodies and autonomy in general. And it also really situates marginalized women's voices and experiences at the center of the analytic frame to kind of then widen the lens out to see how all of these intersecting structures work, and so I think that it could be a really useful analytic frame for a lot of sociological questions. So that's something I'm thinking about today.

Joseph Harris  39:51

Great. The next few questions I'll ask are aimed at helping the listener understand how you think about the research project, process. What would you say are the most meaningful parts of the research process to you?

Claire Decoteau  40:10

I'm never really sure how to answer these questions, so I'll just say a little bit about my own process. I'm very influenced epistemologically by critical realism and extended case method, both in that my ethnographic approach or qualitative approach to understanding people's lives is very situated in understanding the broader systems in which they take part and that determine sort of their options. For whatever it is that they're dealing with. So, um, I always kind of situate the stories that I'm hearing from people within an analysis of the social, economic and political policies, their histories, and sort of what that means for the landscapes of care that they're trying to navigate. I also think that it's interesting to use stories as a means of auditing policies. So with the COVID project, this was very much a very concerted effort where we really wanted to know how people who lived in communities that were being allocated additional resources by the city. Thought about the city's policies, so what did they think, and did they find them useful, and how did they understand them and navigate them in their everyday lives? And so I think that sometimes tacking back and forth between people's stories and what they think and how they're experiencing things and then the policy realm is really useful, and I do it in that way, like tacking back and forth, because I find that kind of dialectical process throughout the research process really useful and helpful and, like, empowering to me as I'm trying to figure out what's going on. I also would say that I am a I read very widely. I think that reading is a major part of the research process, and not just the sort of like canonical research of whatever it is that you're studying, but really allowing the project to kind of send you down like pathways towards like satellite literatures that you didn't really consider in the beginning. Because that's where the case kind of takes you. And so I would say that one of the things to think about in research is to just be, like, omnivorous in your reading practices. Because I think it is really important for like, figuring out what's happening and understanding how to, how to, how to write about it.

Joseph Harris  42:39

I was just in a conversation yesterday with Leo Bucha, and we were talking about the importance of slow research having a chance to, you know, let ideas marinate and to, you know, put ideas into conversation with other ideas, and the idea that, you know, research gets better with time, often, and I think that what you share there really connects to that idea in reading widely, you know, there's so many different kinds of nutritional sources for our ideas, that I've certainly found that reading widely contributes to better research, at least in my own view, as well. 

Claire Decoteau  43:24

Yeah, definitely.

Joseph Harris  43:27

 Are there any practices or habits you've found indispensable in helping you in the process of conducting research and writing?

Claire Decoteau  43:40

I guess memoing is sort of the best answer to that question. I memo extensively all the time. I feel like it kind of helps me, like in an ongoing processing way. So even if the memos are not useful later on, or I read them later and I'm like, Oh, I don't know what I was thinking. You know, they i i Find memoing Like a, yeah, it's like a process that I do as I as I go through all of the different stages, both the like data collection and the reading and the connecting it to once you get to the coding phase. And so, yeah, I'm a huge fan of memoing constantly. And I'm always telling my students that make sure that you're kind of memoing about what you're thinking and memoing about the themes that are emerging, and meming about something that you've read and how that might relate to what you're doing. And so I think for me, what you know, whether you call it a memo or whatever it is, I think that it helps me to do that work of the time, kind of tacking back and forth between these different levels.

Joseph Harris  44:40

Yeah, yeah, and it sounds like again, connecting this idea of marinating helping to process the information for beginning researchers. I think this idea of memo writing is a little bit abstract. It conjures this idea of. Uh, from, you know, SO and SO to SO and SO with the subject line, you know, as a formal sort of corporate or policy advisor type memo, can you say something about what your memos look like? Is it? Is it just a paragraph or a stream of consciousness? Is it more a formal memo? What help help a beginning researcher understand what a memo looks like. 

Claire Decoteau  45:21

I mean, I don't have any rules about it. I, for me, I sort of, I have some ongoing memos that I like to kind of collect and then go back to so some of them, and I sort of separate them out from, like, my empirical memos and my, like, theoretical or analytic memos. And so they're not formalized in any way. There's no structure to them. It is sort of more stream of consciousness. But there are sometimes like themes, right? So like, maybe this theme emerges across these two separate memos, and that allows me to kind of link a, you know, an emergent code of the data, but also to like something that I'm thinking about theoretically. And so, yeah, they're sort of organized topically or substantively, but really, quite, quite stream of consciousness. And no, no rules apply. Really, it's just a process of, like, thinking through what, what you're reading, what you're thinking about, what some things somebody said, like, made you really, you know, inspired, and you wanted to make sure you didn't forget and come back to that idea later. Because I think it's also helpful in that sense, that you kind of go back and look through the different substantive like thoughts that you had across time. So it allows you to kind of go back and forth historically to in your kind of thought process.

Joseph Harris  46:36

And I'm curious, do you find that the writing in the memos. Does it ultimately, most of it get used, or is it mostly more about the processing, the helping you process?

Claire Decoteau  46:49

It's more, for me, about the processing. I wouldn't, I would, generally wouldn't use that. I mean, I might like, one of those ideas might inspire some like more formal writing, but for me, it's just a processing tool.

Joseph Harris  46:59

It's so interesting, because I think, you know, some of us might fear, you know, particularly if you're a graduate student and you are on the tenure track, you you you only have, you have a scarcity of time, right? And, you know, wasting a lot of time writing stuff that you might not use. But what you're saying is, no, this is really valuable, even if it doesn't wind up in a manuscript. It helped you get the manuscript to where it needed to be. Is that right?

Claire Decoteau  47:28

Yeah, that is right. And it's funny, because when I first, like, started my official job on the tenure track, you know, people would talk about writing in this way, that was like, Oh, I have to write so many, you know, minutes per day, or something like, to get into it. And I was like, What do you mean? I can't, like, formally write something until I'm ready to write, and it takes a lot to get there, but I am like writing along the way. It's just not the, like, formal writing. So I think it depends on what you mean by writing. But yeah, for me, it's all about processing. I guess I process through writing.

Claire Decoteau  47:57

Well, one of the things that's always struck me about you is, I mean, you're clearly a really highly productive scholar. You know, the sort of quality of the contributions aside, which are extremely high quality. You know, you've written book after book after book, for example, and article after article after article. And it's, it's so interesting to hear. You know, processing in this way, what some might think of as inefficient writing being so important to being highly efficient productive. So, yeah, I really appreciate you sharing that Sure. Yeah, yeah, if you could give first year PhD students doing work on global health one piece of advice, what would it be? 

Claire Decoteau  48:45

Yeah, I think it's hard to do global research right now for so many reasons. I mean the attack on funding, of course, being one of the primary ones. And of course, like the, you know, boundaries around national you know, borders is also going to be difficult for folks to navigate.But I guess just in general, I would say that global work takes a lot of patience, but also a lot of connections. So I think that, you know, for me, getting really involved in community organizations and community struggles was key. It made me feel like I was connected to what was happening and allowed me to understand what was going on before even, you know, doing any, like, formal research. But it also, you know, made me feel like I had, like a family that I could kind of talk to about what was happening, and I had both a sort of organized organizing, or more like, yeah, community organizing family. And then I had an academic family, and sometimes those you know related to one another. So the other piece of advice, besides sort of getting involved in community organizations of whatever kind, depending on what you're you're studying, was to have kind of an academic home away from home. So having a university where you're involved in conversations, you can get advice from local scholars, but you can also make sure that you are using local knowledge. I think it's really unfortunate that we often in the United States are engaged in debates in the US that we have to do for you know, writing for publication purposes, but we really should be using and benefiting from the knowledge of folks who are in the countries that were, that were studying so, so, I would say, like those kinds of connections, like community connections, academic connections, and then, you know, once you're back in the US, if you are a US based scholar, getting involved in things like the Global Health Network or the global and transnational sociology section, I think is also important for making connections, because it allows you to be around other people who are struggling with some of the same dynamics. I mean both like intellectually and like practically, that you are. And so I think getting help from folks who've done done it already or in the midst of it is also really useful. 

Joseph Harris  51:06

That community is just so important. I love that. we've been talking today with Dr Claire Decoteau, Professor of Sociology at the University of Illinois, Chicago. Her latest book is Emergency COVID-19 and the Uneven Valuation of Life. Claire, I'd like to thank you for joining us here on the podcast.

Claire Decoteau  51:26

Thank you so much for having me. It's been really fun. Thank you.

This transcript was edited with the assistance of Juliana Zraick.