Polycystic ovary syndrome (PCOS), an endocrine disorder with no known cure that compromises fertility, is a lifestyle disease affecting a growing number of urban Indian women. Media accounts and medical practitioners have noted a recent rise in PCOS cases in urban India and attribute it to "Westernization," modernization, stress, and lifestyle changes following on the heels of economic liberalization in 1991, which opened up the country to processes of globalization. Discourse about PCOS has thus opened up a space for commentary indexing anxieties about larger social and political economic shifts in the country, and women with PCOS are individualized embodiments of the biosocial stresses caused by these shifts. Against the backdrop of a rapidly changing sociocultural landscape with potential for new opportunities for women, the syndrome also poses a challenge to women's traditional roles as wives and mothers, as its symptoms negatively affect reproduction and physical appearance. In this dissertation, I investigate aspects of public discourses about PCOS and lived realities of the syndrome in India as a lens into the interaction of processes of globalization with the local socioculturally embedded body.

In the United States, a growing proportion of the population is aged 65 and older. Associated with this demographic transition is a rise in the number of people who are aging with chronic disease. While there is a cultural ideal for older adults to remain in the community and out of institutional settings ("aging in place"), there is little recognition of the work and experience of trying to accomplish this. In the following papers, I draw on 12 months of ethnographic research in the Southwest US to describe the work of "aging in place." As a starting point, I use Medicare-funded home health care (HHC), which stands at the crossroads of acute-based institutional care and custodial, long-term care. In the first paper, using definitions of place from cultural geography, I explore the work of aging from the perspective of chronically ill older adult HHC users. I illustrate how bodies, practices, and places shift as processes of disease and medicalization inscribe them with risk, and the ways in which people accept, resist, and negotiate these changes. The second paper extends the work on audit culture to describe how Medicare's audit system has structured the organization and practice of HHC, and how this has reinforced the commodification of patients. I note how HHC nurses can draw on personal and professional logics in their documentation practices as a means of resisting rationalizing forces and opening up eligibility for care. The third paper uses case studies to push the literature on family caregiver burden to include the fraught, yet highly meaning-filled experience of caregiving. The cases show the difficulties and ambivalence in providing care to a chronically ill family member. Throughout these articles, underlying the tensions, uncertainties, and gaps I explore questions about what type of care is needed, who is worthy of care, and how responsibilities are distributed. I focus on how people's worlds and work are structured by larger scale social, cultural, and economic forces, and attend to the ways in which they reproduce, contend, and negotiate these forces from their unique positions, in effort to protect what they value.

With its oil wealth and an environment of abundant rivers, lakes, and the largest coastline in the United States, Alaska is one of the last places one would expect to find water insecurity. Yet approximately one third of households in remote Alaska Native villages lack in-home piped water and suffer the health consequences of poor sanitation and inadequate treated water. This problem has become particularly acute in the wake of surging energy prices and a concomitant shift in policies that increasingly require demonstrated economic sustainability before funding will be allocated for village water and sanitation projects. In response to increasing costs of living and the failure of development projects to foster the conditions under which they would be able to provide for their needs, many Iñupiat assert the importance of traditional values, practices and values that from their view constitute a path out of insecurity and into self-sufficiency. These Iñupiat point to modern technology as the source of what they call the spoiling of their communities. In this dissertation, I explore the disjuncture between how the state and the Iñupiat signify historical and contemporary issues and solutions around water, energy, and development. I suggest that the unintended consequences of decades of interventions to improve Iñupiaq health and well-being have been manufactured insecurity that is exacerbated by weakened social networks of reciprocity (the Iñupiaq traditional value of sharing), and rendered invisible by sustainability policies. I argue that these multifaceted processes of domination and suffering are all part of what many Iñupiat describe spoiling. In other words, when the Iñupiat talk about being spoiled by technology, they are talking about the historical domination by the state over their social reproduction in ways that produce and exacerbate the insecurities characterizing daily life in these remote villages.