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Pandemics, epidemics and food borne diseases are a major global challenge. Focusing on the food and farming sector, and mobilising social theory as well as empirical enquiry, Pathological Lives investigates current approaches to biosecurity and ask how Pathological Lives can be successfully 'regulated' without making life more dangerous as a result. * Uses empirical and social theoretical resources developed in the course of a 40-month research project entitled 'Biosecurity borderlands' * Focuses on the food and farming sector, where the generation and subsequent transmission of disease has the ability to reach pandemic proportions * Demonstrates the importance of a geographical and spatial analysis, drawing together social, material and biological approaches, as well as national and international examples * The book makes three main conceptual contributions, reconceptualising disease as situated matters, the spatial or topological analysis of situations and a reformulation of biopolitics * Uniquely brings together conceptual development with empirically and politically informed work on infectious and zoonotic disease, to produce a timely and important contribution to both social science and to policy debate

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Table of Contents


Title Page

List of Figures

Series Editors’ Preface




Reading Pathological Lives

Part I: Framing Pathological Lives

Chapter One: Pathological Lives – Disease, Space and Biopolitics

Introduction: The Emergency of Emergent Infectious Diseases

The Four Moves of Pathological Lives


Chapter Two: Biosecurity and the Diagramming of Disease

Disease Diagrams

The Disease Multiple: Germs and the Return of the Outside

Biosecurity and the Diagramming of Disease



Chapter Three: Reconfiguring Disease Situations

Disease Situations

Microbial Life and Contagion as Difference and Repetition

A Topological Disease Situation



Part II: Disease Situations

Chapter Four: ‘Just‐in‐Time’ Disease

Factory‐Farmed Chicken and Food‐borne Disease

Relational Economy of Disease

Powers of Life



Chapter Five: The De‐Pasteurisation of England

Birth of the Sty

Pigs in Practice – Fieldwork and Translations

Immunity, Attention and More‐than‐Human Responses



Chapter Six: Attending to Meat


Mapping the Current Landscape of Food Safety

A Failure of Coordination?

Inspection as Tending the Tensions of Food Safety

Being Stretched



Chapter Seven: A Surfeit of Disease

The Media Background to Disease Publics

Publicising Disease: From Public ‘Understanding’ to ‘Engagement’

Understanding and Engaging Disease Publics

Understanding the Surfeit

Conclusions: Making a Disease Public


Chapter Eight: Knowing Birds and Viruses – from Biopolitics to Cosmopolitics

Sensing Life

A Livelier Biopolitics and a Noisier Sentience

A Perceptual Ecology of Knowing Birds

Surveying Life

Knowing Viruses

The Significance of Observation



Chapter Nine: Conclusions – Living Pathological Lives

Time‐Space and Intra‐Actions

A livelier Politics of Life

A new Kind of Emergency?



End User License Agreement

List of Tables

Chapter 02

Table 2.1 Foucault’s three diagrams.

List of Illustrations

Chapter 01

Figure 1.1 How safe is your town? – US Public Health Poster, undated. The divisions between a contingent wild world and a domestic culture are clearly marked as spatially exclusive. The existence of a single non‐human on the right side of the wall, on two legs and with tail docked, is emblematic of this nature/culture binary that is in play.

Figure 1.2 Global livestock production: (a) number of chickens, carcass weight and egg production per animal from 1961 to 2008, global; (b) number of bovines (cattle and buffaloes), carcass weight and cattle milk production per animal from 1961 to 2008, global; (c) number of pigs and carcass weight from 1961 to 2008, global; (d) number of sheep, goats and carcass weights from 1961 to 2008, global. (Thornton,


, Used under CC BY 4.0

Chapter 02

Figure 2.1 A map of disease risk linked to air passenger movements and human population centres, an example of real‐time surveillance producing a catastrophic present.

Chapter 03

Figure 3.1 Maximum clade credibility tree of 31 H5 sequences derived from the haemagglutinin gene of avian influenza viruses (1,608 nt). Sampling dates and locations are included on the tip labels; where specific dates were unknown, ‘01’ was assigned. Node labels indicate significant posterior probabilities (>0.75). The dates for the most recent common ancestor (MRCA) of the currently circulating viruses circulating in Europe and Japan are indicated at the relevant nodes with 95% highest posterior density (HPD) levels. Sequences relate to H5N8 subtype, unless otherwise noted. The bold sequences relates to the Driffield ducks (Hanna et al.,



Chapter 04

Figure 4.1 This schematic representation of the broiler meat value chain in Great Britain includes a summary view of the component parts of the vertically integrated companies that make up the industry. These broiler integrator companies combine multiple activities from inputs upstream to processing downstream. More specifically this includes feed mills, compound feed, hatcheries, breeder parent flocks, hatching eggs, day‐old chick supply, transport, slaughter, further processing and supply of products to wholesale or retail markets. Flow in the reverse direction of the arrows represents the movement of money within the value chain.

Chapter 07

Figure 7.1 Catch it, Bin it, Kill it campaign poster (2009). (

Chapter 08

Figure 8.1 Scott's swan sensorium.



Table of Contents

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RGS‐IBG Book Series

For further information about the series and a full list of published and forthcoming titles please visit


Pathological Lives: Disease, Space and BiopoliticsSteve Hinchliffe, Nick Bingham, John Allen and Simon Carter

Smoking Geographies: Space, Place and TobaccoRoss Barnett, Graham Moon, Jamie Pearce, Lee Thompson and Liz Twigg

Rehearsing the State: The Political Practices of the Tibetan Government‐in‐ExileFiona McConnell

Nothing Personal? Geographies of Governing and Activism in the British Asylum SystemNick Gill

Articulations of Capital: Global Production Networks and Regional TransformationsJohn Pickles and Adrian Smith, with Robert Begg, Milan Buček, Poli Roukova and Rudolf Pástor

Metropolitan Preoccupations: The Spatial Politics of Squatting in BerlinAlexander Vasudevan

Everyday Peace? Politics, Citizenship and Muslim Lives in IndiaPhilippa Williams

Assembling Export Markets: The Making and Unmaking of Global Food Connections in West AfricaStefan Ouma

Africa’s Information Revolution: Technical Regimes and Production Networks in South Africa and TanzaniaJames T. Murphy and Pádraig Carmody

Origination: The Geographies of Brands and BrandingAndy Pike

In the Nature of Landscape: Cultural Geography on the Norfolk BroadsDavid Matless

Geopolitics and Expertise: Knowledge and Authority in European DiplomacyMerje Kuus

Everyday Moral Economies: Food, Politics and Scale in CubaMarisa Wilson

Material Politics: Disputes Along the PipelineAndrew Barry

Fashioning Globalisation: New Zealand Design, Working Women and the Cultural EconomyMaureen Molloy and Wendy Larner

Working Lives – Gender, Migration and Employment in Britain, 1945–2007Linda McDowell

Dunes: Dynamics, Morphology and Geological HistoryAndrew Warren

Spatial Politics: Essays for Doreen MasseyEdited by David Featherstone and Joe Painter

The Improvised State: Sovereignty, Performance and Agency in Dayton BosniaAlex Jeffrey

Learning the City: Knowledge and Translocal AssemblageColin McFarlane

Aerial Life: Spaces, Mobilities, AffectsPeter Adey

Millionaire Migrants: Trans‐Pacific Life LinesDavid Ley

State, Science and the Skies: Governmentalities of the British AtmosphereMark Whitehead

Complex Locations: Women’s Geographical Work in the UK 1850–1970Avril Maddrell

Value Chain Struggles: Institutions and Governance in the Plantation Districts of South IndiaJeff Neilson and Bill Pritchard

Queer Visibilities: Space, Identity and Interaction in Cape TownAndrew Tucker

Arsenic Pollution: A Global SynthesisPeter Ravenscroft, Hugh Brammer and Keith Richards

Resistance, Space and Political Identities: The Making of Counter‐Global NetworksDavid Featherstone

Mental Health and Social Space: Towards Inclusionary Geographies?Hester Parr

Climate and Society in Colonial Mexico: A Study in VulnerabilityGeorgina H. Endfield

Geochemical Sediments and LandscapesEdited by David J. Nash and Sue J. McLaren

Driving Spaces: A Cultural‐Historical Geography of England’s M1 MotorwayPeter Merriman

Badlands of the Republic: Space, Politics and Urban PolicyMustafa Dikeç

Geomorphology of Upland Peat: Erosion, Form and Landscape ChangeMartin Evans and Jeff Warburton

Spaces of Colonialism: Delhi’s Urban GovernmentalitiesStephen Legg

People/States/TerritoriesRhys Jones

Publics and the CityKurt Iveson

After the Three Italies: Wealth, Inequality and Industrial ChangeMick Dunford and Lidia Greco

Putting Workfare in PlacePeter Sunley, Ron Martin and Corinne Nativel

Domicile and DiasporaAlison Blunt

Geographies and MoralitiesEdited by Roger Lee and David M. Smith

Military GeographiesRachel Woodward

A New Deal for Transport?Edited by Iain Docherty and Jon Shaw

Geographies of British ModernityEdited by David Gilbert, David Matless and Brian Short

Lost Geographies of PowerJohn Allen

Globalizing South ChinaCarolyn L. Cartier

Geomorphological Processes and Landscape Change: Britain in the Last 1000 YearsEdited by David L. Higgitt and E. Mark Lee

Pathological Lives

Disease, Space and Biopolitics

Steve Hinchliffe, Nick Bingham, John Allen and Simon Carter












This edition first published 2017© 2017 John Wiley & Sons, Ltd

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The right of Steve Hinchliffe, Nick Bingham, John Allen and Simon Carter to be identified as the authors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

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Library of Congress Cataloging‐in‐Publication Data

Names: Hinchliffe, Steve, 1967– author. | Bingham, Nick, author. | Allen, John, 1951– author. | Carter, Simon, 1960– author.Title: Pathological lives : disease, space and biopolitics / Steve Hinchliffe, Nick Bingham, John Allen, and Simon Carter.Description: Chichester, West Sussex ; Malden, MA : John Wiley & Sons Inc., 2017. | Includes bibliographical references and index.Identifiers: LCCN 2016028691 | ISBN 9781118997598 (hardback) | ISBN 9781118997604 (paperback) | ISBN 9781118997628 (epub) | ISBN 9781118997611 (Adobe PDF)Subjects: LCSH: Microbial ecology–Health aspects. | Bioethics. | Communicable diseases–Epidemiology. | Human‐animal relationships–Political aspects.Classification: LCC QR100 .H56 2017 | DDC 577.8–dc23LC record available at

A catalogue record for this book is available from the British Library.

Cover image: Photograph © Henry Buller, 2015





To the memory of Professor Doreen Massey

An infectious intellectual, colleague and friend

List of Figures

Figure 1.1

How safe is your town?

Figure 1.2

Global livestock production.

Figure 2.1

A map of disease risk linked to air passenger movements and human population centres.

Figure 3.1

Maximum clade credibility tree of 31 H5 sequences derived from the haemagglutinin gene of avian influenza viruses.

Figure 4.1

Schematic representation of the broiler meat value chain in Great Britain.

Figure 7.1

Catch it, Bin it, Kill it campaign poster (2009).

Figure 8.1

Scott’s swan sensorium.

Series Editors’ Preface

The RGS‐IBG Book Series only publishes work of the highest international standing. Its emphasis is on distinctive new developments in human and physical geography, although it is also open to contributions from cognate disciplines whose interests overlap with those of geographers. The Series places strong emphasis on theoretically‐informed and empirically‐strong texts. Reflecting the vibrant and diverse theoretical and empirical agendas that characterise the contemporary discipline, contributions are expected to inform, challenge and stimulate the reader. Overall, the RGS‐IBG Book Series seeks to promote scholarly publications that leave an intellectual mark and change the way readers think about particular issues, methods or theories.

For details on how to submit a proposal please

David FeatherstoneUniversity of Glasgow, UKTim AllottUniversity of Manchester, UKRGS‐IBG Book Series Editors


The work for this book was made possible with the generous support of the UK’s Economic and Social Research Council. Two awards, ‘Biosecurity Borderlands’ (RES‐062‐23‐1882) and ‘Contagion’ (ES/L003112/1) allowed us to conduct the field investigations and develop key conversations with actors in the field. The work has also benefitted from our co‐researchers in those projects, especially the contributions of Dr Stephanie Lavau and Dr Kim Ward. Their observations and work on this project while at Exeter University have been instrumental in the generation of this book.

At the UK’s Animal and Plant Health Agency, Steve Hinchliffe would like to thank Drs Richard Irvine, Jill Banks, Andrew Breed and Professor Ian Brown who were all incredibly patient as he learned the language of influenza viruses and animal surveillance. At the Food Standards Agency, Steve Hinchliffe would like to thank the secretariat and colleagues in the Social Science Secretariat and Research Committee, especially Sian Thomas and Helen Atkinson.

At Exeter University we are indebted to conversations with a wide group of scholars – Michael Schillmeier, Henry Buller, Katie Ledingham, Gail Davies, Ann Kelly, John Dupré, Astrid Schrader, Elizabeth Johnson, Jo Little, Robbie MacDonald, Sarah Crawley, Jamie McCauley, Andrew Pickering, Sabina Leonelli, Krithika Srinivasan, Sam Kinsley, Regenia Gagnier among many others.

A host of others have commented upon or shared conversations around this work. They include Carlo Caduff, Ian Scoones, Paul Forster, Melissa Leach, Gareth Enticott, Ben Fine, Susan Craddock, Melanie Rock, Bruce Braun, Frederic Keck, John Law, Annemarie Mol, Beth Greenhough, Jamie Lorimer, Andrew Barry, Pierre‐Olivier Methot, Alex Nading, Rob Wallace, Andrew Donaldson, Kezia Barker, Stephan Price, Kristin Asdal, Linda Madsen and Ann Bruce.

We would also like to thank Dave Featherstone for his support and patience as editor of this series, and for the thoughtful comments of two anonymous referees whose comments were invaluable at the editing stage.

Chapters 4, 5 and 8 are substantial re‐workings of material that is published in the Journal of Cultural Economy, Geoforum and in the edited book Humans, Animals and Biopolitics: The More Than Human Condition (Kristin Asdal, Tone Druglitrø and Steve Hinchliffe).


Pandemics, epidemics, zoonoses and food‐borne diseases have, for some at least, become key challenges for contemporary global society. They threaten progress in global health, compromise food security, and, along with climate change and global terrorism, seem to usher in a state of emergency and a radically uncertain future. Just as importantly, they are associated with often painful and life altering illnesses that can exact suffering on the part of people and animals as well as social and economic hardship.

Many of these diseases are associated with what have become known as emerging and re‐emerging infections, a term that is often associated with a dynamic and unpredictable microbial world of recombinant viruses, resistant bacteria and mobile microbial genes. These microbes are testament, if any was needed, to the liveliness of the non‐human world.

And yet these diseases are more than a matter of microbes alone. They are instead a product of relations that involve microbes, their hosts and their social as well as physical environments. That is, they are the result of bio‐social clusters that involve and re‐format economies, social practices, living bodies and microbes.

So rather than disease being ‘out there’ or ‘to come’, in the form of a pathogen waiting to attack, we prefer to think of life as to greater or lesser extents pathological, or prone to disease. For us, it is the configuration of various matters and living processes that makes life more or less healthy.

This is not to say that all lives are equally diseased, or that disease is everywhere, or that it is somehow already present. Clearly there are disease and illness events that mark distinct and often irreversible ruptures in daily life. But it is to say that we can usefully identify some lives and ways of living as more pathological than others. How these pathological lives fare is dependent, we argue in this book, on the quality of the spatial relations from which they are made.

So, rather than focus on pathogens and their exclusion from everyday living spaces as a means to address the threat of emerging disease, we take a different tack. We use pathological lives as a means to understand how so many contemporary human and non‐human animal lives are living on a knife‐edge. In this view, the apparent stability of modern lives may, paradoxically perhaps, exhibit a form of fragility that is borne from their being lived at a threshold. It may take little, in other words, to push them over the precipice and into a pathogenic state.


The book addresses a puzzle of how best to understand and respond to the rise of interest in and concern over emerging infectious and food‐borne diseases. What is contributing to the recent growth of disease threats? How can we account for their persistent presence on political and public health agendas? In order to answer these questions we have mobilised some key terms that we will briefly introduce here before they are developed in detail in later chapters. These terms are not fixed in stone, but we hope they provide a handhold through the book’s chapters and to the issue of pathological lives.

The first key term is pathogenicity, a word we use to highlight that infectious disease is always more than a matter for pathogens alone. In its more scientific usage, the term refers to the potency or effectiveness of a particular pathogen (a bacteria, virus or other parasite for example). But here we mean to underline the relational ways in which infectious diseases are made. In the simplest of senses this can refer to the basic notion that diseases are made from host‐pathogen and environmental interactions. Pathogenicity is in this understanding borne out of the kinds of relations that hosts have with bacteria and viruses, their vectors and so on. A healthy host within a healthy population and environment is likely, for example, to reduce the pathogenicity of a microbe. In conditions of vulnerability, however, an otherwise inconsequential infection can take on life‐threatening qualities. In this book we supplement this epidemiological ‘matter of fact’ with other relations that contribute to pathogenicity. They include economic relations generated through markets for livestock and their produce, labour relations that format the interrelations between human and animal hosts, governmental relations that affect the ways in which diseases are monitored and so on. Our argument is that it is the intensities of these relations, their spatial interrelations, that constitute the pathogenicity of a disease. Pathogenicity, or the ability for diseases to amplify and reach new levels of intensity, is an outcome of these and many other spatial and socio‐material relations.

The second key term is disease diagrams. Diagrams refer to the ways in which diseases are understood and acted upon. For example, an infectious disease may be diagrammed as something to keep out through the installation of a barrier. Or it may be something to intervene in through the production of a vaccine, or other medicine. As might be obvious, there is often more than one of these diagrams in play at any one time, and the relative emphasis given to one diagram, or the specific mix of diagrams in play, can have effects on how a disease evolves, how it interrelates with other diseases, where authority lies in relation to disease and who is deemed as responsible for health. How people respond to this diagramming of disease becomes a critical issue for disease management.

The third key term is disease situations. If we take the socio‐material intensities that generate pathogenicity along with the specific suite of disease diagrams that are mobilised to both understand and intervene in disease dynamics, then together they start to define what we are calling a disease situation. In using the term, we have the following intentions:

Situations are, first of all, meeting places, where numerous actors, bodies, species, pressures, flows, issues, decisions and so on are organised or brought together, or held apart or worked upon. They are heterogeneous (formed from their differences and relations), more than human, and dependent not only on what is meeting up but also how those meetings are spatially configured.

Situations, like pathogenicities, are relational – that is their properties or character are generated by and generative of social, spatial and material relations. They are not structures. They are grounded in practices and orderings and are as such more or less open to change. Situations clearly owe a debt to the relational geographies that precede this work (Murdoch, 2005; Whatmore, 1997) as well as to a more general interest in spatial analysis and thinking topologically.

Situations bear a family resemblance to the notion of assemblage, or the interrelations and co‐production of various ‘species’ or unlike kinds (diagrams, microbes, populations and so on). Assemblage in our view is a process, and differs from a whole or a system in that these unlike kinds need have nothing in common. No one in that sense can speak for the whole situation. Nevertheless, these ‘species’ inter‐mingle and can radically affect one another within their situation.

Finally, and in a way that takes us beyond some treatments of assemblage, situations are more than descriptions of the atmospheres generated by the convergence and divergence of various interrelating practices and matters. They are also, crucially, eventful and as such may offer the ingredients for change and intervention. When you are in a situation you are invited to act. In other words, situations have a potentiality that can generate events, prompt a shift in attention and foment new actions. Situations are in that sense real and existing manifestations of multiple processes that also have a power to force thought. To be clear, this power is always ‘a virtual one’ that ‘has to be actualised’ (Stengers, 2005b: 185). How this power can be realised (by, for example, those who attend to the more than human details of a situation) is a matter that is taken up in later chapters in the book.

Together these terms help us to offer original insights into the current disease predicament. Once we take a situational approach, with its pathogenicities and diagrams, we can identify the ways in which many current approaches to infectious and food‐borne diseases tend to miss some vital clues in terms of how to make life safe. Or, worse, how these same approaches may in fact, and paradoxically, make life even less safe. Our contention is that once we take disease situations seriously we can start to question the norms and assumptions that so often underline current re‐investments in life politics. Our argument is that we need to move away from a version of life politics (bio‐politics) where norms are policed and re‐enforced (often materially with a system of barriers and boundaries) to a lively politics (cosmopolitics) where we can use current disease situations to start to trace counter‐norms, to identify suppressed modes of existence and in doing so find possible ways out of the current predicament.

Reading Pathological Lives

In order to develop these arguments, we have divided the book into two main sections. In Part I (Chapters 1 to 3) we introduce the book’s approach and expand on the conceptual and methodological issues that relate to emergency diseases and pathological lives. We start by asking how emerging infections and food‐borne diseases have been conceptualised or framed, and how these have informed approaches to disease management. Working spatially, in Chapter 2 we adopt the term ‘disease diagram’ to chart the history of approaches to and interventions in infectious disease and follow this with an account of how and why current approaches to disease tend to involve a particular mix of disease diagrams. The particular mix of diagrams is, we argue, both a matter for empirical enquiry and a key feature of what we call a disease situation. In Chapter 3 our attention becomes more methodological as we expand on what we mean by ‘disease situations’ and ask how we might re‐configure conventional approaches to infectious disease. We outline some of the shifts required as we move from a geometry or topography of disease, with its focus on disease spread or extension over space, to one that is more attendant to the topologies of disease situations. The latter is concerned with the spatial intensities and relations that are generated in particular set ups and that make disease more or less likely.

Having set up diagrams and situations in Part I, in Part II we focus on a range of disease situations, or specific cuts through those situations. Following a short introduction to Part II, we start, in Chapter 4, in the hen house and look at the poultry industry as a main player in the re‐diagramming of avian and zoonotic diseases. We then move, in Chapter 5, to the pig sty, and chart not only the pressures that make a disease situation but also the efforts by farmers and others to patch and piece together healthy lives. Food‐borne diseases are our concern in Chapter 6, as we leave the farm and look at the ways in which food chains are understood and regulated. If Chapters 5 and 6 introduce the fraught politics of attention into pathological lives, Chapter 7 asks how likely this different politics of life might fare in what we call disease publics. Chapter 8 uses fieldwork on wild and domestic birds, and on viruses, to look for a different kind of life politics that may be developed from these situated knowledges. Finally, in the Conclusions, we spell out what a re‐oriented and spatialised politics of life means for the infectious disease issue.

It is of course possible to read the chapters individually, and to move between the situations that we trace in Part II, but they are not entirely stand‐alone. Our hope is that the narrative of the book will carry readers through the various arguments developed in Part I, to the more empirical treatments in Part II. Note however that we rarely treat the theoretical and empirical as distinct. The arguments in Part I are all empirically grounded, while the situations in Part II often involve conceptual development.

Part IFraming Pathological Lives

Chapter OnePathological Lives – Disease, Space and Biopolitics

The diversity and geographical distribution of influenza viruses currently circulating in wild and domestic birds are unprecedented since the advent of modern tools for virus detection and characterisation. The world needs to be concerned (WHO, 2015).

The number one risk on the [UK] Government’s national risk assessment for civil emergencies, ahead of both coastal flooding and a major terrorist incident, is the risk of pandemic influenza (House of Commons Committee of Public Accounts, 2013: 6).

We are left in the hands of the generations which, having heard of microbes much as St Thomas Aquinas heard of angels, suddenly concluded that the whole art of healing should be summed up in the formula: Find the microbe and kill it. And even that they did not know how to do (George Bernard Shaw, 1909: Preface to the Doctor’s Dilemma).

Introduction: The Emergency of Emergent Infectious Diseases

In Western states, at least, emerging infectious diseases have become emergencies in waiting. The threat of a widespread and acute malady affecting people, or indeed the plants and animals on which they rely (to say nothing of the technical infrastructures or other living and non‐living networks which sustain life), is a long‐standing one. But it is the imagined and to some extent experienced interdependencies and vulnerabilities that people share with each other and with other living bodies that seem to have raised the stakes in the last few decades. So much so that we are, for some at least, ‘teetering on the edge’ of a major disease event or catastrophe (Webster and Walker, 2003).

Simplifying somewhat, this apparent emergency‐to‐come has two core elements. First, it is socio‐ecological and based on the sciences of ‘emerging and re‐emerging diseases’. Here the focus tends to be on mutable microorganisms and the potential for those organisms to wreak havoc in a highly ‘infectable’ and densely interconnected modern world (Braun, 2007). Previously, and in the main, microorganisms had been understood as more or less fixed entities that would inevitably run their evolutionary course, becoming less significant over time (Methot and Fantini, 2014). The emergence of new infectious diseases, like AIDS (Acquired Immune Deficiency Syndrome) and SARS (Severe Acute Respiratory Syndrome), and the re‐emergence of newly virulent scourges (like influenza and tuberculosis) in the later part of the twentieth century suggested that life, and microbial life in particular, was less fixed and so less predictable than we might have countenanced.

These new agents of concern could mutate and recombine, jump species, take advantage of new environmental conditions, and could move through the dense and rapid transit routes that circled the planet. Instead of being on the wane, microbes were back on the agenda. Along with climate change and global terrorism, they formed a raft of ‘agents’ that were regarded as mutable, indeterminate and generative of catastrophic events. For some at least, global connectivity and molecular mutability had combined to usher in a new age of plagues, epidemics and pandemics (Garret, 1994). Arguably, emerging diseases suggested that the world was now more ‘infectable’ than ever.

Second, this emergency‐to‐come is governmental. Here, emergency relates to a form of anticipatory or future‐oriented government that seeks to highlight (even give greater emphasis to) potential breakdowns in social order. In this style of governance of and through emergencies – which has arguably become dominant in recent decades (Amoore, 2013) – the role of public and private institutions is to organise for events that are of sufficient magnitude that they demand foresight and preparation (Anderson, 2010; Collier and Lakoff, 2008b).

Pandemics, infectious animal diseases and food contamination events, for example, can all exact such far‐reaching challenges to social and economic life that they constitute security issues, necessitating some kind of civil emergency planning in order to prepare for or mitigate their worst effects. Infectious disease, in this sense, has become part and parcel of a logic and practice of security. Indeed, the term biosecurity is often used in relation to the threat of emerging infectious diseases, and refers to the raft of measures and policies that governments, commercial and other organisations seek to put in place in order to reduce the risk of a disease event and/or prepare for the consequences of such an event in terms of emergency response. Whether the resulting biosecurity practices are effective or make matters more prone to go wrong is a major question that we will return to throughout this book.

These socio‐ecological and governmental aspects of emerging infectious diseases may well be mutually re‐affirming. First, and most obviously, changes to the ‘infectability’ of the planet may be accompanied by shifts in approaches to infectious disease control, leading to the rise of biosecurity as a discourse and material practice. Second, the rise of a form of anticipatory governance clearly requires its own set of justifications. Mutable microbes form a convenient ontology or cause under which new kinds of human authority and control can be justified and normalised (King, 2002). For some commentators, a mode of life (a modus vivendi (Sloterdijk, 2013)) emerges in which control is predicated on accentuating certain threats. This may be more than ideological. Perhaps what is most interesting here is the possibility that, third, these forms of human control can in turn produce new microbial environments that may inadvertently be even more challenging. Spiralling efforts to counter microbial threats, or a hypertrophic approach to security, can seed further changes to rapidly evolving microbiomes (Landecker, 2015). So much so that a belief in human authority and control may well be part of the problem.

Pathological Lives engages with the disease emergency, its rise up scientific and political agenda, its formatting through biosecurity and, crucially, the extent to which the resulting foci of attention may well be making matters worse rather than better. We focus on the particular ways in which emergency diseases are constituted – how they are understood, marshalled, measured, generated and even ignored. Our method is at once geographical and based within science and technology studies. In taking these approaches, with their legacy of fieldwork and ‘theorising empirically’ (Mol, 2002), we are interested in the practical ‘doings’ of disease rather than the grand stories that are told about them. Only by investigating practices (what is done as well as what is said) can we assess the extent to which these doings may play a part in bringing about the emergency they seek to mitigate – or, indeed, may offer new openings for doing things otherwise.

This book is empirically grounded, and in being so it can make some claim to a better understanding of how communicable diseases are being managed and mismanaged and will aim to make some concrete suggestions about what it takes to do health and disease in ways that are better suited to the current predicament. It is based on fieldwork that we undertook across a range of sites and involving all manner of species (from farms to restaurants, from wildlife reserves to virological laboratories, and from factories to living rooms). Our methods are varied, though mostly ethnographic in character and sensibility, and our aim has been to allow the practices that we have observed, written down and questioned, to surprise us, to put our concepts at risk and to force us to think carefully and critically about the disease emergency.

Pathological Lives is also conceptual. In working across numerous sites and species, and in linking together those sites and species, our argument pulls together key geographical or spatial insights on the relations between people, animals, microbes, infrastructures and ways of governing disease. Rather than focusing on one part of the disease system, we are interested in what happens when you take the changing relations between hosts, microbes and their environments, as well as the emerging regimes of control or governance, as the key concern for investigation. Infectious disease in this instance, and for us, is not only a result of microorganisms infecting a host, but the multi‐faceted outcome of the changing relations that make microbes more or less likely to be effective in generating disease.

The key question becomes, in this sense, how various matters (including not only microbes) combine with other conditions to produce disease. We make a distinction, then, between those approaches that focus on disease as a matter of discrete causative agents and those that view disease as a more relational phenomenon. In the first instance, approaches to infectious disease management or control that focus on microbes as pathogens tend to emphasise their absence and exclusion. They involve constructing and maintaining real as well as metaphorical walls (see Figure 1.1).

Figure 1.1 How safe is your town? – US Public Health Poster, undated. The divisions between a contingent wild world and a domestic culture are clearly marked as spatially exclusive. The existence of a single non‐human on the right side of the wall, on two legs and with tail docked, is emblematic of this nature/culture binary that is in play.

(Virginia Health Bulletin, 1908: 216).

This so‐called ‘ontological’ approach to disease, with microbiological organisms as agents of causation, is often in tension with the second, relational or more ‘physiological’ and ‘ecological’ understandings of disease (Anderson and MacKay, 2014). In the latter, microbes may be just one component of a complex of matters that conspire to produce disease. Here, understanding disease is less likely to focus on a single agent and pathway to the host, but on a suite of issues, on biographical details (a patient or host’s propensity to develop symptoms) and on the patient’s social and ecological setting (relating to a population, its density, levels of immunity and so on). It may even stretch to consider the role of disease management and governance in the shaping of the disease.

In these ecological approaches, the focus may be less concerned with keeping matters out and more attentive to the multiple relations that make disease. How these relations are configured, spatially, becomes the key matter of concern. It is the constellation of matters that twist and turn bodies of all shapes and sizes into diseased relations that grab our attention. All life in that sense is more or less pathological. It is the quality of the relations that make those lives more or less liveable.

In order to make these spatial arguments we employ some key terms. First, in Chapter 2, we introduce disease diagrams, which we take to be ways of understanding and acting upon disease and health threats. For example, if disease is understood as a germ‐borne menace, then exclusion is the spatial practice of choice. Conversely, if a more ecological or biographical approach is taken, then disease may be diagrammed as a matter of social inclusion and public health campaigns (perhaps by improving health services, availability of vaccines and so on). Diagrams then are the ways that disease is grasped and governed. They are spatialisations that affect the ways in which disease and health are understood and treated. For sure, these and other disease diagrams may co‐exist and be in tension with one another. How one or other gains ascendancy or how they are mobilised at the same time and in the same place becomes a key resource for the interrogation of disease in practice.

The second term we adopt is disease situation (Chapter 3). This refers to the ways in which a specific combination of disease diagrams, as well as the suite of issues that make disease more or less likely (including, for example, host population characteristics, forms of governance, market pressures and so on), generate the conditions for living. This, in short, is an ecology or assemblage – a spatial arrangement or meeting of ideas, practices and materials. But more than this, a situation also alerts us to the possibility that this configuration or assemblage has a ‘virtual power’ to force thought, to make us think again about disease and health (Stengers, 2005b: 185). This power has to be realised, and one of the jobs of analysts is to help to bring that forcing of thought into being.

To be clear, in using the term ecology in this context we do not mean to signal a science of functions, or simply an adding together of ‘factors’. The components of a situation will combine together in ways that are not easy to predict and cannot be assumed to be simple additions. This is because, in the terms of Karen Barad (2007), matters will intra‐act rather than simply interact. That is, they are relational and may alter each other as they go. So, the situations we describe are close to what Isabelle Stengers has described as an ecology as ‘a science of multiplicities, disparate causalities, and unintentional creations of meaning’ (Stengers, 2010a: 34). This space of crossings, folds and missed opportunities may, we argue, open up new ways of imagining and enacting the politics of disease and the definition of what counts as the disease emergency. It may, we suggest, help to empower the disease situation by redefining what counts as the emergency of emerging infections.

These terms and the approach to disease situations as possible sources for redoing pathological lives course through the book in its conceptual framing (Part I), its more empirically focused chapters (Part II), and in the conclusion. To spell out some of these possibilities and the approaches on which they are based, we next draw out four key moves that distinguish the approach that we take to the spatial politics of disease.

The Four Moves of Pathological Lives

There are four key moves that we make in this book that distinguish our approach to emergency disease. First, we revisit the emergent infectious disease thesis and justify the book’s shift in focus from forest edge to socio‐technical diseases. Infectious disease becomes, on this account, a networked matter involving markets, sciences, governments and so on. Second, we note how this refocusing of attention on socio‐technical set‐ups requires a rather different spatial imagination, as we move from disease sites to disease situations. Third, from pathogens to pathogenicities, we add to this spatial reconfiguration by expanding on a distinction between a pathogen‐focused understanding of disease and one that is more interested in diseases as relationally produced. Finally, in a politics of life, we briefly discuss biopolitics, one of the key means through which the management of emergency diseases has been organised and conceptualised, and in doing so open up a conceptual frame that provides some resources for generating a new or different politics of life.

From Forest Edge to Socio‐Technical Diseases

In the early 1990s, communicable and infectious diseases were back on the political agenda. They had been somewhat marginalised following the triumphant post‐war pronouncements that the world was on the brink of an epidemiological transition. Communicable diseases would be relegated, so the optimists argued, to a relatively minor component of human morbidity and mortality through the use of antimicrobial medicines, improved hygiene and other modern technologies (Omran, 1971). This technological and medical optimism was ‘flanked by a belief in the natural decline of virulence’ (Methot and Fantini, 2014: 218), or the gradual co‐evolution of microorganisms and their hosts resulting in better adaptations or a shift from pathogenic to commensal relations. Yet, as the century neared its end, a raft of diseases started to unsettle the progressive narrative of continuous medical advance and infectious disease decline. Some of these diseases were new, while others had been persistent scourges for people in the Global South and were now threatening to infect the North (Farmer, 1999).

These new and neglected infectious diseases owed some of their rise to prominence in the Global North to a renewed fear that emerging infectious diseases had the potential to produce global pandemics. The concerns seemed to restage a rather ancient fear of contagion and connectivity in which certain parts of the world, certain social groups and certain practices are pathologised and demonised (King, 2002). The ‘virtuous’ Global North and the under‐regulated and therefore contingent Global South seemed, in disease terms, closer than ever. The alarming rhetoric of cosmopolitan life out of control, common in international organisations (World Health Organisation, 2007) and popular science writing (Garret, 1994; Garrett, 2013; Quamenn, 2012; Wolfe, 2011) made use of familiar spatial imaginaries where ‘modern’ society is threatened by poorly governed, exotic, other‐worldly, sexualised and often naturalised lives. The enemy figures of mutating, slippery, re‐assorting pathogens, of free‐roaming super‐spreaders and patient zeros, of (largely non‐Western) human‐animal practices or interspecies intimacy (Shukin, 2009: 46) and of rogue practitioners in an otherwise ‘orderly’ system, are all portrayed as ‘outsiders’ in need of excommunication.

As a result, an ‘Out of Africa’ and or ‘Out of Asia’ mapping of emerging infections is common (Leach and Dry, 2010). Indeed, the emergence of the Human Immunodeficiency Virus (HIV) in the late 1970s was followed by the identification of an infective pathway that implicated initial human contact with non‐human primates. Forest edges within central African states, and the hunting and consumption of bush meat, became key sites for virological research (Wolfe et al., 2007). Simian immunodeficiency viruses (SIVs) and Ebola Haemorrhagic Fever (EHF) provided similar geographies of emergence, with unregulated primate contact as the disease transfer event or first cause. Moreover, other diseases, including Japanese Encephalites, Nipah and Hendra, often with bats as wild hosts, tended to draw researchers to the newly opening borderlands between wildlife and human society.

These emergence and transmission narratives repeated a familiar story of human encroachment, ecological change and intensifying interactions with and/or disturbances to wildlife that together produced the conditions of possibility for the transfer of microorganisms from wildlife to people. While not new, these transfers now had more chance of circulating beyond the confines of the forest edge as a result of new transport infrastructures that were often associated with military conflict, science, intensive forestry, mining or agriculture. Stephen Morse, the virologist who did much to popularise this etiology, coined the term ‘viral traffic’ as a means to capture the direction, increased reach and accelerating speed of viral movement (Morse, 1993). He also coined the terms ‘emerging infectious diseases’ and ‘emerging viruses’ to relay the sense of the effects of a combination of human‐induced environmental changes, shifts in human–non‐human animal interactions and increased transport and communications on the evolution and disease‐producing capacity of microbial life.

The promiscuity of human and non‐human lives, their mixing, movement and co‐dependencies, seemed to drive a continuous ‘spill‐over’ (Quamenn, 2012), where microbes that were once restricted to non‐human species were able to transmute and transmit to people. The evidence was arresting. Roughly three‐quarters of the emerging diseases of the last three decades were judged to be ‘zoonotic’ (infectious diseases that jump between human and non‐human animals (Taylor et al., 2001)) and 60% of all known human communicable diseases were ‘due to multi‐host pathogens characterised by their movement across species lines’ (AVMA, 2008: 3). At the turn of the new century, a wave of zoonotic respiratory diseases increased the stakes further (at least in the West and Global North), giving the emergency in waiting further credence. Severe Acute and Middle East Respiratory Syndromes (SARS and MERS) in 2002 and 2013, as well as Avian and Swine Influenzas throughout the 2000s and in 2009, seemed to testify to this upturn in infectious and often viral diseases that had multiple non‐human hosts and or vectors and were associated with high mortality rates in people.

In terms of the geographies of infectious disease, these diseases started to shift the epidemiological gaze away from the forest edge. SARS seemed to be more urban and peri‐urban in terms of its epicentre (Harris Ali and Keil, 2008; Schillmeier, 2013). The new wave of zoonotic influenzas like avian and swine flu were clearly related to socio‐economic conditions and even to industrial practices (Wallace, 2009). Certainly, the geography of emergence and spread outwards from a hot spot in the Global South was always questionable to social scientists interested in the relations that make disease possible, but these epidemic and pandemic events made this geography even less convincing. The 2009 swine flu pandemic strain virus seemed, for example, to emerge within intensive pig raising facilities in North America and Mexico. Meanwhile, highly pathogenic avian influenza (HPAI) viruses seem to have both wild and domestic birds to thank for their emergence and continuing evolution. The focus of attention has therefore somewhat shifted from forest edges and wildlife to semi‐domesticated and domesticated non‐human animal hosts that are more centrally linked to food and farming practices as well as to the laboratory and regulatory practices that are associated with securing safe life.

This refocusing attention on the socio‐technical disease set‐up is further justified when we consider other disease emergencies. For alongside zoonotic infections, there are also diseases that affect often large and vulnerable domestic animal populations, with devastating effects on animals, economies and the people who work with those animals. The disease pathways and mechanisms may be similar, often with wildlife hosts acting as ‘reservoirs’ for microorganisms and playing a key role in the cycling and recycling of disease. However, of equal concern here are the growing size and scale of domestic animal populations and holdings. In the last few decades the rise of both global livestock animal numbers, particularly for chicken, cattle and pigs, and a continuing growth in average carcass weights, amount to a ballooning global domestic animal biomass (see Figure 1.2). In terms of disease risk, this expansion of mass increases the magnitude, if not the frequency, of the risks of epizootic events, or widespread non‐human animal diseases. The implications for animal welfare, food security and livelihoods are clear. Again, recent disease events that have affected national herds like Bovine Spongiform Encephalopathy (BSE), foot and mouth disease, Bovine Tuberculosis, Brucellosis, Porcine epidemic diarrhoea and others, are indicative of the kinds of vulnerabilities that these livestock operations face.

Figure 1.2 Global livestock production: (a) number of chickens, carcass weight and egg production per animal from 1961 to 2008, global; (b) number of bovines (cattle and buffaloes), carcass weight and cattle milk production per animal from 1961 to 2008, global; (c) number of pigs and carcass weight from 1961 to 2008, global; (d) number of sheep, goats and carcass weights from 1961 to 2008, global. (Thornton, 2010, Used under CC BY 4.0

To add two more concerns, there are also food‐borne diseases and the emergence of anti‐microbial resistance. Food‐borne diseases can develop within living animals or on animal products that support a diversity of life, and travel with those products through a convoluted pathway and complex food industry to reach consumers in forms that are difficult to monitor and control. The food industry itself becomes the site of emergence, so much so that microbiological life can flourish and mutate within its fabric and generate new forms of disease. BSE, Campylobacter (a bacteria associated with food poisoning) and Escherichia Coli 0157, all seem to have opportunistically combined rapid microbiological change with a complex and high‐pressure food chain to produce new challenges to public health.

Finally, there is the spectre of anti‐microbial resistance (AMR). The rise of antibiotic treatments has enabled highly successful control of bacterial infections in humans and non‐human animals. But resistance to the effects of these naturally occurring and synthetic medicines is an inevitable part of microbial evolution. This process is accelerated by the misuse or poor stewardship of those medicines. The result is that there are now strains of bacteria associated with food and farming (E. Coli, Methicillin‐resistant Staphylococcus aureus (MRSA) and Campylobacter) that are resistant to first‐line treatments and broad‐spectrum antibiotics. The circulation of resistant microbes and their mobile genes through the food and farming system and into the wider environment via human and animal wastes is a key concern (Wellington et al., 2013).

Taken together, these zoonotic, epizootic, food‐borne and AMR emergencies not only shift attention from the forest edges towards socio‐technical disease set‐ups, they also suggest a shift in the role of social science (Janes et al., 2012). To put it simply, these set‐ups involve a broader set of relations with non‐human animals than might be found at the forest edge. The issue may no longer be the encroachment of people into wild spaces, but quite the reverse, the increasingly obvious encroachment of non‐human animal ecologies on people (Nading, 2013). In other words, there is a pressing need to focus on the effects of an expanding domestic animal ecology, and to give more attention to the human‐animal and material ecologies that are being reformatted in current iterations of agriculture, food provision, regulation and science.

As a result we primarily deal here with the socio‐technical aspects of infectious disease as they relate to food and farming, where the generation, amplification and subsequent transmission of disease can produce catastrophic effects, and where the control of disease risk can, we argue, make matters both better and worse. In making this our focus we nevertheless take a multi‐sited approach, one that includes farms, laboratories, factories, wildlife reserves, restaurants and kitchens, government offices and public meetings. How to tie these various sites together requires us to say a little more about what we call disease situations.

From Disease Sites to Disease Situations

The responses of food, farming and policy sectors as well as scientific research to emerging infectious and food‐borne disease are of key concern for future global health. Crucially, these responses are coloured by the operation of a raft of other pressures on food and farming. These include economic, environmental and regulatory pressures. We will run through some examples here before outlining how and why this matters for studying disease.

Responding to emerging diseases takes place against a backdrop of growing demands on the food and farming sectors to produce food for more people, at prices and with margins that are agreeable to consumers and producers. The production of animal protein is a huge growth area for many economies, and this growth is driving and responding to changing diets and lifestyle expectations. Increased livestock productivity is part and parcel of the new but somewhat familiar aims of sustainable intensification (Garnett and Godfray, 2012). Domestic livestock populations are estimated to have grown at around 2.4% per annum, with carcass weight per animal increasing year on year (Alexandratos and Bruinsma, 2012). Globally, 52 billion chickens are consumed annually (FAO, 2013). Worldwide pig production is struggling to match growing demand for pork in Asia in particular. Food networks are increasingly international and global financiers are investing in concentrated animal feeding operations (CAFOs) and livestock infrastructure on an unprecedented scale (Pew Commission, 2008; Wallace, 2009) as a means to meet this demand and of course to secure steady returns on investment.

This expansion of agri‐food has numerous benefits, it is often argued, in terms of providing affordable food for a growing and developing human population in ways that might be expected to meet clear standards of production (McCloskey et al., 2014). Yet, it also faces large challenges, including ones that relate to environmental externalities (not least greenhouse gas emissions, the throughput of finite resources and nitrate pollution) and animal welfare concerns. In terms of health and disease, the issues are not straightforward. On the one hand, there are arguments that increased concentration and enclosure (or modernisation) increases the ability of the food and farming system to exclude pathogenic materials. On the other, logistical and health challenges of a densely interconnected system look ever more difficult and prone to catastrophic failure. As global animal mass grows, as wildlife is simultaneously displaced and competes with agriculture for habitat, and as food systems increase in terms of network length and connectivity, the potential for devastating zoonotic, animal and food related diseases may well have grown. All of these concerns bear down on an industry that is increasingly under pressure to produce plentiful food, at low cost and in ways that are environmentally sustainable and healthy. The result is that there are often tensions that exist between safety and profits, biosecurity and food security, biodiversity and risk, consumer demands for affordable goods and food safety.

Expansion and internationalisation of the food and farming system also poses governance challenges at a time of widespread crises in terms of resourcing, organising and generating and maintaining trust in public and private institutions. Internationalisation may well be accompanied by a reduction rather than rising of standards as conglomerates and corporate bodies aim to improve margins by taking advantage of low‐cost labour, cheaper inputs and less stringent regulation. At the same time, a general tendency to reduce the ‘regulatory burden’ on businesses and offset the public cost of dealing with disease events has led to a ‘neo‐liberal’ style reorganisation of state and local state regulatory infrastructures (from veterinary services to food inspection, and from government‐led science to national health provision) (Maye et al., 2012).

More specifically, there have been attempts to redistribute responsibility onto private actors so that they take charge of their disease risk. Farmers for example, in the UK and New Zealand, have been encouraged to form (albeit highly subsidised) limited liability companies in order to control Bovine Tuberculosis through culling of wildlife. There have even been attempts to make compensation for disease breakdowns dependent upon farmers having taken necessary steps to improve the biosecurity of their premises (Donaldson, 2008; Mason, 2014). In the US, following the avian influenza outbreaks of 2015, farmers are required to meet certain biosecurity standards in order to be eligible for compensation following future outbreaks. Meanwhile, under the same rubric of neoliberal approaches to governing, there are attempts to develop market opportunities in health and disease abatement.

This is an area where disease (as emergency in waiting) chimes with the prospect and marketing of scientific innovation and pharmaceuticals. The always inevitable and imminent emergency is a useful means to implore governments and businesses to invest in security, in frontline broad spectrum drugs, in disease resistant genetically modified or edited animals and so on. The market opportunity of security adds another pressure onto the mix of issues that surround disease management and control.

The broader point is that the intensification and extension of international food supply chains has been accompanied by re‐arrangements to public budgets, an increase in private health and security providers, a reformatting of animal and human health related sciences, and, arguably, an atmosphere of scepticism and mistrust of both public and private authorities.

Given these material, social, ecological and political tensions, how should emergency diseases be studied? We are interested in the interfaces between the regulation or management of disease and other concerns (costs, labour dynamics, food safety concerns, ecology, issues of countryside and wildlife), an interest that requires us to broaden the spatial vocabulary through which diseases are normally studied. Here we make a distinction between a site (or a location on a map like a specific forest, or a farm, or a factory) and a situation in which various processes, diagrams, materials and actors of all shapes and sizes that make that place are brought into view (Chapter 3