Douglas (1992) describes how understanding disease emergence often comes in the form of blame. One such view is moralistic where the individual victim is blamed for becoming infected (Douglas, 1992). As conveyed in the Acholi example above some cultures may interpret sudden illness as a result that a community or individual has disobeyed the god(s), spirits or ancestors and therefore that individual or group are being cursed or punished. A
literal understanding of this belief from an external perspective may interpret it as
backward or ignorant. The underlying meaning however may act as an empirical warning to the wider community that if one disobeys the laws of that society misfortune may ensue. Jones (2011) comments on this perspective as a culturally determined epidemiology that has become exaggerated and exoticised in western consciousness through a globalised media.
Ebola has been exoticised, associated with traditional practices, local customs, and cultural beliefs, and insinuated to be a result of African ignorance and
backwardness. (2011, N.p, Ghjournal.org)
Going on to argue that a hyper focus around EVD and culture is a “rhetorical racialization of the disease”, framing African culture as a “risk factor” that hinders modern control efforts (Jones, 2011). The prolonged West African outbreak (2013-2016) provided an opportunity to develop more informed understandings of EVD outbreaks. Despite this, however the West African outbreak displayed a cultural epidemiology within the popular and scientific literature. The following excerpt was taken from a paper written by “the WHO Ebola response team” consisting of over 60 authors.
“We infer that the present epidemic is exceptionally large, not principally because of the biological characteristics of the virus, but rather because of the attributes of the affected populations and because control efforts have been insufficient to halt the spread of infection” (Aylward et al., 2014, p.1487).
Reference to the “attributes of the affected population” suggests a culturally determined epidemiology regarding the scope of transmission. The comment supports Byron Good’s (1994) argument that “while new explanatory models may be introduced, it is clear that changes in medical rationality seldom follow quickly”, (1994).
A second form of blame for the explanation of disease emergence explored by Douglas (1992) is to fault an adversary. The moral of framing a disease as an adversary is that everyone needs to be smart and protect one’s self-interest in order to survive. The
adversary could be the threat of a bite from an infected reservoir host such as a mosquito in the case of malaria. It is therefore understood that to protect oneself a potential victim must ensure to employ precautionary measures such as using a mosquito net.
Throughout history, illness and disease have been presented in the form of an adversary using metaphors. Sontag (2001) specifically explores the punitive impact of cancer,
tuberculosis, and HIV as something other than a disease. She highlights how cancer was sometimes framed as “an evil invisible predator”, TB as a disease “of thin garments, thin bodies, unheated rooms, poor hygiene and inadequate food”. Metaphors are sometimes used to construct narratives and imagery in order to influence public opinion and support government policies. Sontag refers to the “language of political paranoia” evidenced through the use of metaphors such as “alien take-overs” and “invaders” was used to describe the pathophysiology of HIV in the 1980’s. She argues how such language was used to construct “an ideally comprehensive illness in the era of Star Wars and Space Invaders” (Sontag, 2001). Similarities exist between this type of imagery and the EVD narratives sometimes expressed in popular literature. Prior to the more recent West African outbreak, Ebola Virus Disease had received much publicity and media attention in
westernized countries where its ‘enemy’ status can be attributed to imagery facilitated by fiction and media hype (Farmer, 1999a). Ebola Virus Disease gained considerable
international attention through exaggerated accounts of blood oozing from body orifices and sensationalised newspaper headlines that humanized the virus as “a killer virus” or “a killing ghost, like Jack the Ripper” (BBC, 2014; CNN, 2014). The potent virulence of the virus into western consciousness was also portrayed through a number of Hollywood productions such as Outbreak (1995) based on Richard Preston’s novel, The Hot Zone
(1994) and Contagion (2011)directed by Peter Soderbergh that portrayed EVD as an imminent pandemic threat.
The third understanding of disease and illness is to blame a higher force. The outside enemy may refer to larger causal factors or structural determinants of disease and represent views frequently held in the social, ecological and political sciences. Blame for the
emergence of disease among a given population may be attributed to government policies on land use changes or a conflict situation that displaces populations and disrupts
livelihoods. The socio- ecological model also argues that prevailing structural inequalities have led to increasingly unsustainable patterns of consumption and production and
emerging infectious diseases are a symptom of this (Lee & Dodgson, 2000). This is sometimes referred to as political ecology.While the area of research into the social and environmental dimensions of human health has been investigated to a certain degree, the role of political ecology in increasing vulnerability to disease and shaping health decision- making is less common (Lee & Dodgson, 2000). According to King (2010) health is structured by the political and economic systems, which can create the conditions that influence the transmission of disease.