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Doctors in Africa, for example, have complained about the burden of providing AIDS statistics to first world countries. These statistics are of little use to them internally, in those (all too common) circumstances when they have no means to treat patients. The compilation, demanded by epidemiological agencies such as the WHO, takes up valuable medical and epidemiological resources. For them, AIDS is only one of a series of endemic causes of death. It is one that it will only be worth singling out for treatment once appropriate medical services are in place and general urban sanitary conditions are improved. Until then, the need that western doctors have to trace the detailed genesis and development of the disease is not felt so urgently. Thus the concern was raised in a conversation with the director of health statistics at the WHO in Geneva in 1989 that many of these statistics were being collected to further the careers of public health officials in the United States. (This is discussed further in the next chapter.) |
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A simple agonistic reading of the ICD is that the system was set up in an age of imperialism and helped impose an imperialist reading of disease from the West onto the rest of the world. There is truth in this, and many medical anthropologists and activists have ably told this story (Anderson 1996). Another, more subtle story can be told alongside this one. Management of the ICD played a part in the creation of the modern state, in many protocols for state-to-state negotiations, and in many international organizations. The degree to which it came to constitute medical knowledge is unknown, and that story is yet to be told. |
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This knowledge-creating role becomes clear when one looks at the highly complex bureaucratic work involved in developing and maintaining the ICD. Numerous groups use it for many different purposes. Medical insurance companies need a standard list of causes of death and of morbidity to work out standardized scales of payment for different treatments. They develop elaborate risk tables for different groups of subscribers (and thence modulate their premiums). Epidemiologists also use the ICD; to track down the causes of a given new disease, one needs a standard terminology and good records. Only with these in place can one determine that the disease only affects those who eat a certain kind of food, or have a certain genetic heritage or occupational history. Government health officials need good records to determine public health policy and services. For example, if tuberculosis is a major problem in a given area, then one might set up a clinic, or organize free x-rays there. |
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