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BIOETHNOGRAPHY: “Thus, instead of combining objects of inquiry (biology and culture), I conceived of bioethnography as combining two different methods for knowing the world (Mol 2002, 153)—ethnographic observation and biochemical sampling—in order to ask and answer research questions that could not be addressed through either method alone. This methodological focus involves exploring how our data collection and analysis might be shaped if we suspended the nature/culture binary” (Roberts, 2021, p. 2)

“bioethnography asks, what if we created numbers otherwise, upending the cooked data that reinforces inequality? In fact, bioethnography can enable us to identify structural forces, such as NAFTA and the global health apparatus itself, that are part of the bodily processes that make ill health. In other words, while we know that all data is cooked, it matters how it’s cooked.” (Roberts, 2021, p. 5)

Roberts describes their ongoing bioethnographic collaboration with a team of exposure scientists who are working in environmental engineering and health. Though ethnography is not easily enumerated, Roberts emphasizes that integrating it with quantitative data is worthwhile and makes for “better numbers”. As an example, Roberts describes 3 bioethnographic projects on neighborhoods, water distribution, and employment and chemical exposures. These projects were part of a longitudinal birth-cohort study in Mexico City called Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT), created to understand the effects of early-life nutrition and exposure to toxicants (such as lead and phenols). Overtime, this project was expanded to include the study of new toxins (e.g. BPAS, mercury, and fluoride) and new health concerns (e.g. obesity, meopause, sleep).

Roberts’ focus on neighborhoods was produced from the ethnographic observation that neighborhood characteristics might influence exposure levels. Following this observation, Roberts’ and ELEMENT researchers sorted participants by neighborhood and identified significant differences in blood-lead levels. Additionally, Roberts applied previous ethnographic observation and scholarship to argue that high levels of toxicants like lead correlate with the capacity of neighborhoods to withstand other dangers, such as police violence. These findings prompted the development of two new bioethnographic project centered on water and the effect of neighborhood dynamics on health.

“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

 The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).