As anthropology departments face pressure from state legislation, university boards, and university administrators to justify their continued existence and/or make significant - and frequently drastic - changes, department leadership and anthropology faculty are strategizing how to bolster their programs, pedagogical approaches, and industry collaborations. In this article, we compile case studies from multiple, diverse anthropology programs and faculty to highlight concrete steps to take in response to these external pressures. We build on recent anthropological scholarship on this topic to identify and affirm action items in response as well as proactive safeguards to mitigate their effects.

Questions about the fairness, efficacy, and sustainability of volunteerism in community health have led some states and programs to attempt to scale back their reliance on "volunteer" labor. Such attempts demand theory-driven, comparative ethnographic research that makes sense of how such moves unfold and impact the lives of CHWs and the programs surrounding them. Guided by theory of the interaction of political and moral economies, this article comparatively analyzes two predominantly female community health workforces in Ethiopia, who worked as unpaid volunteers when their federal government was supposedly "moving away from volunteerism" in community health: (1) HIV/AIDS-focused, home-based caregivers in Addis Ababa (2007-9) organized by NGOs; and (2) primary health care-focused members of the Women's Development Army in rural Amhara (2012-16) organized by the state. Ethnographic and mixed methods, including surveys of volunteers' wellbeing (n = 110 in Addis Ababa; n = 73 in rural Amhara), were used to assemble each dataset. These data show 1) how exploitation of "volunteer" community health labor by states, NGOs, and partnerships between them is maintained through discourses of sacrifice and related notions; 2) what the deprivation, distress, and desires of community health workers reveal about the "voluntariness" of their labor; 3) how CHWs organize themselves into collectives seeking better working conditions; and 4) how these experiences and processes are gendered. In this post-COVID-19 era of persistent inequalities in health globally, comparative ethnographic research of efforts to move away from volunteerism can provide useful lessons for CHWs, policymakers, and advocates.

BACKGROUND:How do Northern Global Health scholars navigate authoritarian political contexts in their research in other countries? This question motivated the research project on which this article is based. Over ten months, we conducted in-depth qualitative interviews with sixteen European and North American scholars who were engaged in health-related research in an authoritarian country we refer to as Patria. RESULTS:All our interviewees recognized health as a political matter and acknowledged the importance of considering politics in Global Health research. Yet, they were reluctant to explicitly integrate politically sensitive topics and discuss questions related to local political context in their research. To gain and maintain access, and to protect themselves and their local collaborators in a politically sensitive and authoritarian context, the researchers employed practices of 'framing'. Such strategies included avoiding terms, scholarly references, and questions that were politically loaded; strategically conforming to the assumed apolitical language and methodologies of health research, and negotiating with and leaning on their local counterparts in processes of research dissemination and writing. CONCLUSION:Drawing on frame theory and literature on fieldwork and authoritarianism we discuss the implications our findings have, not only for Global Health research, but for healthcare sciences more broadly. While researchers who work in authoritarian regimes may be particularly prone to engage in practices of framing, the strategies our interviewees used are not limited to Global Health researchers working in such settings. As anthropologists with experience researching health in multiple countries, including in the United States, we recognize the strategies that our interlocutors used from our own research. By including a discussion of some of the ways political factors have shaped our research we make an argument for the value of political reflexivity in health research: the critical scrutiny of the taken-for-granted presuppositions and norms that guide our research, and of the political environments and power dynamics that shape and are shaped by our research. A turn to political reflexivity in health research can unravel some of the tacit assumptions, biases, norms and practices that are integral to the health care sciences and which students and researchers must critically think about.

•Frequency and perceived difficulty of water insecurity experiences were compared across two settings with different water landscapes.•Experiences among participants in Morogoro, Tanzania were qualitatively different than those in Amhara, Ethiopia.•Individuals who affirmed particular water-related challenges were more likely to rate them as being difficult.•Water problems associated with psycho-emotional and psychosocial stress were rated as being among the most difficult.•Models of water insecurity that combined frequency and perceived difficulty data had poor fit.

Agroecology is increasingly promoted as a way to create just and sustainable farm- and food systems. Although there are multiple initiatives to scale up agroecology, current socio-political structures often hinder its potential to transform food systems. This study uses participatory approaches to create paintings that envision agroecological futures in the context of increased farmer-pastoralist collaborations in Tanzania, how they would function, and what political action is needed to support such futures. The visions are based on focus group discussions with agroecological farmers and pastoralists, and a multi-stakeholder workshop with farmer and pastoralist representatives, innovative food system actors, and researchers. We find that the envisioned transformation of the food system would lead to positive effects on farmers' and pastoralists' income, autonomy, long-term planning, and producers' and consumers' health. We conclude that new policies and financial support systems are needed to enable the expansion of agroecological farming and food systems, by increasing the availability of organic markets, supporting domestic botanicals production, and by creating more inclusive and just food value chains.

Introduction Across a variety of settings, women in tenuous financial circumstances are drawn to community health work as a way to advance themselves in the context of limited employment options. Female Community Health Workers (CHWs) are often preferred because they can more easily access mothers and children; at the same time, gender norms are at the heart of many of the challenges and inequities that these workers encounter. Here, we explore how these gender roles and a lack of formal worker protections leave CHWs vulnerable to violence and sexual harassment, common occurrences that are frequently downplayed or silenced.Methods We are a group of researchers who work on CHW programmes in a variety of contexts globally. The examples here are drawn from our ethnographic research (participant observation and in-depth interviews).Results CHW work creates job opportunities for women in contexts where such opportunities are extremely rare. These jobs can be a lifeline for women with few other options. Yet the threat of violence can be very real: women may face violence from the community, and some experience harassment from supervisors within health programmes.Conclusion Taking gendered harassment and violence seriously in CHW programmes is critical for research and practice. Fulfilling CHWs’ vision of health programmes that value them, support them and give them opportunities may be a way for CHW programmes to lead the way in gender-transformative labour practices.

Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security—one that addresses myriad transmission pathways and co-occurring diseases—that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.

Despite progress in documenting the outcomes of Community Health Worker interventions, the lack of standardized measures to assess CHW practice has made it difficult for programs to conduct reliable evaluations, and impossible to aggregate data across programs and regions, impeding commitment to sustainable, long-term financing of CHW programs. In addition, while CHWs have sometimes been involved as data collectors, they have seldom been engaged as full partners in all stages of evaluation and research. This manuscript details the current work being done by the CI Project, demonstrating how CHWs are able to contribute to the integrity, sustainability, and viability of CHW programs through the collaborative development and adoption of a set of common process and outcome constructs and indicators for CHW practice and CHW program implementation.

Background: Substantial evidence supports community health workers' (CHWs) contributions to improving health and reducing inequities. Common evaluation indicators can strengthen the evidence base and support the profession. Objectives: We describe the development of a 6-year community-academic partnership to identify common CHW process and outcome indicators. Methods: Methods include interviews, focus groups and a survey conducted in Michigan, a Summit in Oregon, consultations at national conferences, and regular conference calls. Results: Using popular education as a primary strategy, we have honed our original goal, identified a set of 20 recommended constructs, developed a national constituency with international connections, and obtained dedicated funding. Conclusions: Participatory identification, development, and uptake of a set of common indicators (CI) for CHW practice will allow data to be aggregated at multiple levels, potentially leading to more sustainable financing of CHW programs. Given that measurement drives practice, a set of common CHW indicators can help to preserve the flexibility and integrity of the CHW role.

Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool.

The 2010 Affordable Care Act provided new impetus and funding opportunities for state Medicaid agencies to integrate community health workers (CHWs) into their health systems. Community health workers are trusted community members who participate in training so they can promote health in their own communities. This qualitative study shares lessons and strategies from Oregon's early efforts to integrate CHWs into Medicaid with concomitant financing, policy, and infrastructure issues. Key informant interviews were conducted with 16 Coordinated care organizations (CCO) and analyzed using an iterative, immersion-crystallization approach. Coordinated care organizations found CHW integration a supportive factor for Medicaid-enrolled members navigating health and social services, educating members about disease conditions, and facilitating member engagement in primary care. Barriers to CHW integration included a lack of understanding about CHW roles and their benefits to health systems, as well as a need for more intensive guidance and support on financing and integrating CHW services.

Little empirical research exists on the effects of health work on Community Health Workers' (CHWs') social relationships and status, yet these factors are important in understanding the broad social and behavioral drivers and impacts of CHW programs. This is particularly true for unpaid CHWs. Engaging with others as a CHW might help a worker to embody a valued role in society as a selfless, caring individual; or it might strengthen bonds with others and improve social networks and social capital. By combining qualitative, ethnographic, and survey data collected in rural Amhara, Ethiopia from 2013 to 2016, we evaluated the extent to which unpaid female workers in Ethiopia's Women's Development Army (WDA) were better able than their peers to achieve cultural consonance by building desired social connections or fulfilling locally salient models of virtuous womanhood. We conducted a cultural consensus survey (n = 74) and measured cultural consonance in a larger survey of adult women, including WDA leaders (n = 422). We also conducted participant observation and interviews with health officials, local health staff, and WDA leaders. In our study site, WDA leaders were more able than other women to fulfill the cultural ideal of having connections to various government officials. Yet these connections often did not lead to the benefits that WDA leaders hoped for. Also, in contrast to the findings of many other studies, achieving greater cultural consonance was not significantly associated with reduced psychological distress in this population. For women in this rural context, meanwhile, psychological distress is strongly associated with food and water insecurity, stressful life events, and social support. These findings point to the importance of social, economic and psychological support for rural women in Amhara, and specifically for unpaid CHWs.

Recently developed scales aim to advance understanding of household water insecurity and inform interventions to address this critical global problem. The relative severity of items included in household water insecurity scales has been established as an inverse of the proportion of the population that reports experiencing the item. Here, we assess subjective perceptions of scale item severity among people who experience household water insecurity. In 2017, we surveyed 259 women in Amhara, Ethiopia, assessing both experiences of water insecurity and perceptions of item severity using a pictorial scale. The mean subjective severity of most items was at the high end of our pictorial scale. Subjective severity of items was not associated with whether or not a participant experienced the item in the last thirty days, with a participant's summary household water insecurity score, or with rural versus peri-urban residence, but was consistently associated with community of residence. Item severity as defined by the proportion of the population experiencing the item aligned with average perceptions of item severity, with one exception: drinking water that might not be safe. We discuss these findings' implications for water insecurity measurement, evaluation of interventions, and studies of the relationship between water insecurity and psychological distress.

Global health is a field of expertise that has emerged at the turn of the twenty-first century alongside changing disease profiles, health technologies, and governance structures.This entry provides an overview of the historical conditions that have given rise to the field.It illustrates the new political and financial transformations that have made global health 'global', in contrast to earlier work on international, world, or tropical health.It also charts new undertandings of wellness and disease, which have been shaped by global pandemics including HIV, the increase in non-communicable illnesses, and the recent concern for planetary sustainability.While anthropologists have played a central role in global health since its inception, the fields of anthropology and global health also operate in an 'awkward relation' (Strathern 1987) with one another.In the second part of the entry, we overview how anthropologists work within, against, and in-between the expertise of other global health practitioners.We suggest that insofar as the field of global health is emergent, so too are the ways that anthropologists engage with it. Introduction: an awkward relationThroughout the twentieth century, 'global health' was an uncommon term.The terms 'world health' or 'international health' were commonly used instead to discuss expansive supra-national health concerns, from epidemic diseases to political relations and financing.'Global health' emerged to draw attention to the global connectedness of diseases and of the people and institutions that govern and respond to them, driven by the spread of new technologies that facilitate rapid global transit, exchange, and communication.Global health has become codified as a field of expertise over the new millennium, and today the term is used widely.Global health centres exist at most major academic and health-focused institutes.The World Health Organization now issues a global health agenda [1] and compiles its health-related statistics in a database called the Global Health Observatory.[2] Numerous publications advance 'global health science'.For example, the journal Global Public Health launched in 2006, and the medical journal The Lancet initiated a publication devoted entirely to global health in 2012.International conferences organised around the theme of global health draw thousands of professional and academic participants each year and news outlets commonly have global health sections as part of their broader health reporting.

Of the millions of Community Health Workers (CHWs) serving their communities across the world, there are approximately twice as many female CHWs as there are male. Hiring women has in many cases become an ethical expectation, in part because working as a CHW is often seen as empowering the CHW herself to enact positive change in her community. This article draws on interviews, participant observation, document review and a survey carried out in rural Amhara, Ethiopia from 2013 to 2016 to explore discourses and experiences of empowerment among unpaid female CHWs in Ethiopia's Women's Development Army (WDA). This programme was designed to encourage women to leave the house and gain decision-making power vis-à-vis their husbands-and to use this power to achieve specific, state-mandated, domestically centred goals. Some women discovered new opportunities for mobility and self-actualization through this work, and some made positive contributions to the health system. At the same time, by design, women in the WDA had limited ability to exercise political power or gain authority within the structures that employed them, and they were taken away from tending to their individual work demands without compensation. The official rhetoric of the WDA-that women's empowerment can happen by rearranging village-level social relations, without offering poor women opportunities like paid employment, job advancement or the ability to shape government policy-allowed the Ethiopian government and its donors to pursue 'empowerment' without investments in pay for lower-level health workers, or fundamental freedoms introduced into state-society relations.