Intercultural Health in Ecuador: A Critical Evaluation of the Case For Affirmative Biopolitics

This research examines the prospect of affirmative biopolitics through Intercultural Health policies in Ecuador. Spurred by radical demands for decolonization by the indigenous uprising, Interculturality became a political platform for the recognition of indigenous groups and alternate forms of development such as Sumak Kawsay and Buen Vivir during the administration of President Correa. Part of expansive healthcare reforms, Intercultural Health policies attempted to recognize traditional indigenous medicines within the public universal healthcare system. Based on ethnographic research at a Ministry of Public Health clinic housing indigenous midwives and biomedical practitioners, I examine the biopolitical implications of enacting Interculturality through national healthcare policies. I argue Intercultural Health policies provide a critical case study for a nuanced theory of affirmative biopolitics. Through detailed examination of policy in-action, I examine the complex negotiations behind adjusting biopolitical agendas to include diverse ways of life. Across multiple levels of policy design and implementation, I analyze the frictions between the hegemonic forces of biopolitical agendas such as the Buen Vivir objectives, and expanding the biolegitimacy of diverse ways of life through Interculturality. Despite attempts to incorporate traditional medicines, the push to achieve statistical health outcomes ultimately reinforced the dominance of biomedicine. At all levels, individuals questioned what forms of inclusion are truly legitimizing. However, instead of resisting biopolitical control outright, many sought more inclusive forms of biopower. Building upon proposals for affirmative biopolitics, I propose an analytical framework for examining how biopolitical agendas can incorporate diverse ways of life. I argue that affirmative biopolitics are defined by a plurality of lifeways, networks of change, participatory governance, and political and structural adjustment. Through my analysis of Intercultural Health policies, I demonstrate how these components interact in complex ways to both support and undermine affirmative biopolitical goals. In doing so, I argue against theorizing biopower as predominantly neoliberal or as a monolithic agenda of the state. I demonstrate how Ecuadorian neo-socialist policies established a co-responsibility between citizens, communities, and the state. Likewise, activist and indigenous involvement in political structures creates challenges from within state institutions. Ultimately, biopolitical controls limit radical paradigms to incremental affirmative change