Deconstructing the “Tropical” in Neglected Diseases

BY GAIL ROBSON

The WHO-approved term “Neglected Tropical Diseases,” is ubiquitous in the global health world, often shortened to its requisite public health abbreviation “NTDs”. There is a PLoS journal dedicated to NTDs, and many large NGOs and funding bodies have programs devoted to these diseases— from USAID’s Neglected Tropical Diseases Program to the Neglected Tropical Diseases NGDO Network. However, digging deeper into the issue, the definition of these diseases gets murkier and multiple categorizations emerge. The Gates foundation website describes their plan to combat “Neglected Infectious Diseases”. Other academic and development literature use the term “Diseases of Poverty” or even the shortened “Neglected Diseases” which overlap and expand on the original NTD framing.

If we think about neglect more broadly, and consider the interconnected economic, political and social systems throughout the world that affect patterns of disease, neglected diseases cease to be  just a tropical phenomenon. Neglect is at play at all scales— from here in Canada to those diseases that are on the official WHO “NTD” list.

So why is the “T” still there in most mainstream discussions? This question is actually more complex than it may seem. A Wikipedia search will give you the basic definition that: “tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions”. This sounds reasonable and relatively free from bias—these are real geographic regions. However, many of the ostensibly “tropical” diseases are not technically confined to those regions. Take malaria, for example; in the 1920s, a severe outbreak was recorded in Siberia, just under the Arctic circle, and you would be hard-pressed to call that “tropical”. Over the last two centuries, malaria gradually receded from the Northern hemisphere but remained endemic throughout colonial populations often concentrated in tropical regions. From the perspective of the European and American doctors “exploring” these new regions, it was identified as a disease of the “tropics”.  On the other hand, today, many so-called “neglected tropical diseases” can be found in marginalized populations in North America and Europe, disproportionately affecting people of colour and those living in poverty.  Even diseases in some tropical regions of the world, including Latin America, are not native to those areas but arrived with the Atlantic slave trade, and have continued as a legacy of European and American exploitation of African and indigenous populations.

The “tropical” in this case is less about the actual geographic location and acts more as a way of categorizing diseases that’s loaded with historic and political context. The word “tropical” has an even deeper history when you start looking at the entire field of “tropical medicine”, the phenomenon from the mid-19th to mid-20th that preceded today’s “international health” and “global health”. To delve into a history of tropical medicine here would be impossible, and there are many, many books that go in depth with these issues, but I’ll try to provide a bit of context. Tropical medicine was a central component of European and later American imperialism. The original school of tropical medicine- the London School of Hygiene and Tropical Medicine- was founded by the medical officer to England’s colonial office. This field was decidedly one-sided, almost exclusively practiced by European doctors and researchers looking at strange new medical phenomenon they “discovered” as imperialism infiltrated more regions of the world, but with little interaction with local medical practices. Much of this research was focused on protecting the colonizers rather than improving the lives of the indigenous populations of the “tropics”. This research is inextricable from the many other processes of domination throughout this era that shaped long-lasting patterns of global power relations still at play today.

The research and rhetoric in global health has certainly progressed, but the pattern of researchers and doctors in positions of power in high-income countries conducting research and coming up with “innovative” solutions to solve those diseases that are confined to the “tropics” has hardly gone away. A quick scan through the “NTD” literature will come up with an overwhelming number of academic papers written by privileged researchers in high-income countries trying to solve problems in low and middle-income countries. These researchers are coming up with progressive and important research, but without acknowledging imbalanced power relations and by ignoring the significance of the terms they use, they cannot provide a comprehensive understanding of the diseases they study.

The idea of neglect needs to be analyzed through the lens of many disciplines and to respectfully tackle, analyze, understand, and respond to these diseases, we must move away from the paternalistic framing of “tropical” diseases towards a framing that acknowledges history but is not complicit with its injustices.

A version of this article was first published in the REINVENT Blog.