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ground factor that has had a great impact has been the convergence of international bureaucracy. Throughout this century, in general, people have become more and more used to being counted and classified. Public organizations have become increasingly adept at the necessary procedures. Inhabitants of rural areas and of developing countries are less likely to slip through the net now than fifty years ago. It is much less likely anywhere that it is the village priest who determines the cause of death. WHO resolved in the 1970s to cooperate with developing countries "in their endeavor to establish or to expand the system of collection of morality and morbidity statistics through lay and paramedical personnel" (Kupka 1978). WHO is attempting to achieve this through working with trained lay personnel on a modified, simplified version of the ICD. |
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We introduce this factor as a reminder of the historical and contingent nature of universally applicable lists. In a related domain, Alain Desrosières (1988) has shown how census breakdowns of the populations of Germany, France, and England have remained closely tied to the history of work, trade unions, and government intervention in those countries. As the ICD "naturally" becomes more universally applicable, this is partly the result of the (often-tacit) spread of western values through the application of modernist bureaucratic techniques. These techniques appear rational, natural, and general to citizens of western states, but when looked at in detail prove highly contingent. Just how contingent comes out clearly when we look at an alternative. Thomas McKeown wrote a thoughtful essay for the British Medical Journal in which he proposed "A classification of disease that distinguishes diseases determined at fertilization from thosethe large majoritynot so determined and manifested only in an appropriate environment. Whereas the latter are in principle preventable, contraception, abortion, treatment must deal with the former, or, some would add, modification of genes or chromosomes" (McKeown 1983, 594). This new classification would be threefold, divided into diseases determined before birth, and those arising subsequently from either "deficiencies and hazards" or ''maladaption.'' Hazards would include, from above and below, predation and parasites. Maladaption would include western diseases associated with technology, for example, diabetes, rare in Kenya in the 1930s and now rampant (McKeown 1983, 595). Of course, this can easily obscure and inscribe the deepest of ethical problems such as the importation of smallpox to Native Americans through the process of conquest. Maladaption appears to be an obscenely mild term for the resulting devastation. Monica Casper |
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