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研究生:張瀠之
研究生(外文):Ying-tzu Ena Chang
論文名稱:Rethinking Indigenous pathways to health in eastern Taiwan: Negotiating the complex terrains of local sociality, cultural sovereignty, and biomedical governmentality
論文名稱(外文):Rethinking Indigenous pathways to health in eastern Taiwan: Negotiating the complex terrains of local sociality, cultural sovereignty, and biomedical governmentality
指導教授:傅可恩傅可恩引用關係
指導教授(外文):Kerim Friedman
口試委員:蔡友月林益仁陳毅峰日宏煜 (Umin˙Itei)
口試委員(外文):Yu-Yueh TsaiYih-Ren LinYi-Fong ChenHung-Yu Ru
口試日期:2020-06-23
學位類別:博士
校院名稱:國立東華大學
系所名稱:族群關係與文化學系
學門:社會及行為科學學門
學類:民族學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:英文
論文頁數:343
中文關鍵詞:原住民族研究原住民健康文化主權社會性生醫治理性原民性
外文關鍵詞:Taiwan Indigenous studiesIndigenous Healthcultural sovereigntysocialitybiomedical governmentalityIndigeneity
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本論文將東台灣的原住民族的健康之路視為在地社會性、文化主權與生物醫學治理之間的複雜協商。透過觀察原住民本位的健康促進活動,探究兩個部落如何挑戰政府偏好的生醫模式霸權。本論文中,民族誌結合了台灣和紐西蘭健康工作者和決策者的訪談以及文本分析,批判台灣政府以缺陷模式(deficit-based)的生醫途徑來治理原住民族健康,將原住民族健康建構在原住民與一般人口間的數據比較,並將原住民族文化和健康實踐問題化,以至於需要被「改善」。政府對原住民族簡單劃一的想像,忽略了原住民族的多樣與韌性,遂產生各種與部落現實有巨大落差的政策。此外,本論文透過田野浸染的文獻探討(field-informed literature review)之研究法,綜觀紐西蘭毛利本位的家族健康(Whānau Ora)計畫,並將其成功歸結為對自決、優勢為本的思考(strength-based thinking),以及對關係性的強調。此分析看見台灣應跳脫慣用思維——將健康視為線性、個人化和風險規避的概念,並提出另一種思考方式——將之視為裝配(assemblage),由跨越物質、文化、社會、心理、制度和論述範疇的關係組成,強調健康的異質性、關聯性和未定性。此外,研究者綜合在部落經驗與學習到的啟示,提出將原民性(Indigeneity)概念化為銜接(articulating)空間、時間及族群等界線,以適切理解當代原住民族生活的複雜性。鑑於此對生醫化的原住民族健康的反思,本論文認為健康策略應以原住民族的世界觀與價值為中心發展,而非利用原住民族文化形式來達成政府設定的健康標準。因此,本論文提出以原住民族知識為基礎,並展向未來的文化主權論述,主張將健康之路視為原住民族本位的文化主權伸張,以及與生醫治理和在地社會性間的複雜協商,藉此更貼近當代原住民族雜揉的生活面貌。
This thesis explores Indigenous pathways to health in eastern Taiwan as negotiation between local sociality, cultural sovereignty, and biomedical governmentality. It examines how Indigenous-centered health initiatives in two communities are challenging the hegemony of the biomedical models favored by the state. These ethnographies are paired with textual research and interviews with policy makers and health professionals in both Taiwan and New Zealand. The thesis considers how the Taiwanese state governs Indigenous health through dominant deficit-based biomedical approaches. It critiques the state’s imaginary of a homogenous framing of the Indigenous population and the multiple ways in which the state (mis)understands Indigenous cultures. Identifying significant disjunctures between Taiwan state policies and community realities, it suggests a conceptualization of health that avoids the linear, individualistic, and risk averse approaches of the state. It proposes an approach based on the view of health as an ‘assemblage’ made up of sets of relations cutting across material, cultural, social, emotional, institutional, and discursive categories highlighting heterogeneity, sociality, and indeterminacy of health circumstances. Further, based on the stories learned from the communities, it also suggests conceptualizing Indigeneity as articulating across spatial, temporal, and ethnic boundaries as a way to address the intricacy of contemporary Indigenous cultures. Through a field-informed literature review, the thesis draws insights from Whānau Ora, a Māori health initiative in Aotearoa / New Zealand. The robustness of Whānau Ora to demonstrates the importance of self-determination, strength-based thinking/resourcefulness, and relationality in addressing Indigenous health issues and offer useful points of reflection for Taiwan. Building on these insights, the thesis argues that biomedicalized approaches to Indigenous health based on statistical comparisons between Indigenous and the general populations, with the former seen as less-than and in need of ‘improvement’, require careful reconsideration. Indigenous peoples, their ontologies, and aspirations should be normalized and the center of health programs where Indigenous cultural elements are not only means to health outcome goals set by the state. Instead, this thesis offers a reframing of pathways to wellbeing based on cultural sovereignty. As an alternative to externally defined political sovereignty, it is grounded upon Indigenous knowledges and oriented towards the future− validating hybrid cultures of everyday experience as legitimately Indigenous.
Acknowledgements i
致謝(Acknowledgements in Mandarin) v
Abstract ix
摘要(Abstract in Mandarin) xi
Table of contents xiii
Detailed table of contents xv
List of figures xix
List of table. xxi
List of acronyms xxii
List of Indigenous terminology xxiii
Preface: Navigating in/between worlds without maps xxv
Chapter 1 Introduction 1
1.1 Indigenous health as political: Indigenous peoples, Taiwan, and contested sovereignty 8
1.2 Thesis aim, questions, and argument 12
1.3 Setting the scene: Kanahcian and Karoroan 13
1.3.1 Kanahcian and the Senior Association 16
1.3.2 Karoroan and the Physical Rehabilitation Center 21
1.4 Thesis structure 26
Chapter 2 Iteration: As method, concept, and challenge 29
2.1 Circuits of iteration: Spatiotemporal, conceptual, and methodological 30
2.2 Learning and Unlearning – a dialectics of method 34
Entry Point # 1: What underlies the distinction of ‘Indigenous’ in health? 34
Entry Point # 2: Contemporary Indigenous culture as complex embodiments of tradition, personal contingency, and state intervention 36
2.3 Ethical positionality as methodological framing of the research 38
2.4 Methodological choices and their implications 43
2.4.1 Ethnographic observation & multi-sited ethnography 43
2.4.2 Studying-up, studying-with, and studying-in-between 45
2.5 Taiwan field sites: Karoroan and Kanahcian 47
2.5.1 Karoroan 48
2.5.2 Kanahcian 51
2.6 Iteration as method and theory 53
2.7 State policy and biomedical discourses 54
2.8 Whānau Ora in Aotearoa 56
2.8.1 Creating links 56
2.8.2 Field-informed literature review as an appropriate method 57
2.9 Spiraling between places, peoples, and paradigms 59
Chapter 3 Shifting conceptualizations: Governmentality, assemblage/articulation theories, and Indigenous cultural sovereignty 61
3.1 Indigenous health 62
3.1.1 Approaches to Indigenous health studies 62
Indigenous approaches 64
Biomedical approaches and their critiques 65
Social determinants of health approaches and their critiques 66
Social science approaches 67
3.1.2 Indigenous health in Taiwan 68
3.2 Governmentality and the will to ‘improve’ Indigenous lives 71
3.2.1 Governmentality and biomedicine 71
3.2.2 The will to improve 74
3.3 On assemblage 75
3.4 On culture 81
3.4.1 Debates of the ‘culture’ concept 81
3.4.2 Problems with ‘cultural’ sensitivity 83
3.4.3 Indigeneity as ‘articulated’ 84
3.5 Indigenous conceptions of sovereignty 85
3.5.1 Critique of sovereignty 86
3.5.2 Cultural Sovereignty 88
3.6 From deficit-thinking to strength-based approaches 90
Chapter 4 Governing Indigenous lives: State perspectives of Indigenous health 93
4.1 The politics of Indigenous health 94
4.1.1 Historical development and colonial roots 95
4.1.2 Current political context 99
4.2 How the state sees Indigenous health: Projects and policies 102
4.2.1 The Improvement Project 102
4.2.1.1 Rural region and off-shore island medical resource advancement project 105
4.2.1.2. Indigenous regions and off-shore island public-funding supported medical personnel training project 105
4.2.1.3. Indigenous community health promotion project (ICHPP) 107
4.2.2 Other Indigenous health initiatives 109
4.2.2.1 Indigenous community cultural health station (ICCHS) 109
4.2.2.2 Long-Term Care 2.0 110
4.2.2.3 Indigenous Health Bill 112
4.3 Singular Indigeneity and bureaucratic contingency 113
4.3.1 An imagined homogenous Indigeneity 113
4.3.2 Bureaucratic contingency and exclusion of Indigenous participation 117
4.4 ‘Culture’ as othering and relief of structural responsibility 123
4.5 A liberal multiculturalist’s dilemma: Celebrate difference or eliminate it? 128
Chapter 5 Whānau Ora: Wellbeing as exercise of Māori and family self-determination 131
5.1 Contextualizing Māori health: colonization, self-determination, and neoliberal turn 136
5.2 Whānau ora: A philosophy, model of practice, and outcome 139
5.3 The development, structure, and operation of Whānau Ora 141
5.3.1 Two phases of Whānau Ora and key developments 142
5.3.1.1 Phase one 142
5.3.1.2 Phase two 144
5.3.2 Holistic and cross-sector 148
5.3 3 From whānau ora to Whānau Ora: The politicization of an Indigenous philosophy 149
5.3.4 Relational approach to management and funding 151
5.4 Indigenous-centered health programs: Self-determination, strength-based thinking / resroucefulness, and relationality 152
5.4.1 Self-determination 152
5.4.2 Strength-based thinking/Resourcefulness 154
5.4.3 Relationality/Sociality 155
5.5 Normalizing Indigenous health practices 156
Chapter 6 Living the lives behind the statistics: Health as assemblage 157
6.1 Disjunctive health outcomes: ‘We are Bunun, we should have a different standard for waistline!’ 160
6.1.1 ‘Bunun fought the Japanese but lost to the state-owned liquor corporation.’ 162
6.1.2 ‘Should you have rice after having yam?’: Public health education demonstration 163
6.2 Poverty as social suffering and structural violence 166
6.2.1 Niun’s Story: Loss, hurt, and healing through connecting 167
6.2.2 Cina Buni’s Story: ‘I have to be optimistic, otherwise I can’t continue to live’ 171
6.3 Drastic changes: ‘Fixing’ a mobile people 175
6.4 Local conceptions and practices of health 180
6.4.1 Customary healing methods and situhu 180
6.4.2 Encountering western medicine 182
6.5 Wellbeing as social and cultural: Kanahcian Senior Association gatherings 184
6.5.1 Collective decision-making at Kanahcian Senior Association 190
6.5.1.1 Independence from government funding 190
6.5.1.2 ‘The fish is too big for me!’ 193
6.5.2 Utilization of Bunun knowledge at Kanahcian 195
6.5.3 Bunun conceptions of wellbeing as socially constituted 197
6.6 Health as assemblage: Rethinking alcohol and weight control 199
6.6.1 ‘Cholesterols [and alcohol] are bad!’ 199
6.6.2 Assembling body weight 201
6.7 Health as relations: Complex, dynamic, and contingent 203
Chapter 7 Living contemporary Indigenous cultures: Indigeneity as articulated 205
7.1 Routing/rooting identity and wellbeing 208
7.2 Karoroan: ‘Peripheral’ but proud and healthy 212
7.2.1 ‘We rarely got sick before’ 215
7.2.2 ‘We were so poor we had only lobsters.’ 217
7.2.3 Mobility and resilience 220
7.2.4 The Sakizaya Name Rectification Campaign 223
7.3 History and development of Karoroan: Multi-ethnicity and hybrid identities 226
7.3.1 Migration history and development 226
7.3.2 Karoroan: A ‘Sakizaya’ community 229
7.3.3 An old house: Embodying techniques of different people at different points of time 231
7.4 Regenerating traditional knowledge as lifestyle 233
7.4.1 Retracing the old trail to Fenglin 234
7.4.2 Collecting wild plant 238
7.5 Wellbeing through articulating place, people, and culture: Karoroan rehabilitation center 240
7.5.1 Karoroan’s strategic development 240
7.5.2 Utilization of local resources at Karoroan 243
7.5.3 Karoroan Rehabilitation center as site of building and rebuilding relationships 245
7.6 Pathways to health as negotiating sociality, cultural sovereignty, and biomedical governmentality 247
Chapter 8 Rebuilding Indigenous governance 253
8.1 Thesis summary 254
8.2 Learnings: Revisiting the research questions 257
8.3 Unlearnings: Methodological and conceptual reflections 259
Interview interruption as practice of sociality 260
Difficulty to talk health as reflective of holism and interconnectedness 260
Formal and informal interviews 261
Real relationships as messy and non-oppositional 262
Reflecting on ethics working with community elders (80 years old and above) 262
Resisting deep-colonizing 264
I and thou: Claiming dispersed author-ity 265
8.4 Future directions 266
8.5 Implications and contribution 268
Appendix 1 List of interviewees 273
Appendix 2 Macquarie Human Research Ethics Committee approval 275
Appendix 3 Information and consent form (English) 279
Appendix 4 Information and consent form (Mandarin) 281
Appendix 5 Participant information sheet (English) 283
Appendix 6 Participant information sheet (Mandarin) 285
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