I am concerned empirically and theoretically with how social and structural factors interact to shape risk, risk engagement, and health outcomes.

I have modeled the interplay of individual, social and structure factors on health vulnerabilities and outcomes as it relates to youth HIV risk in rural and urban spaces in Lesotho based on over a decade of ethnographic work, water insecurity and enteric disease risk in rural South Africa, and educational attainment, fertility and life expectancy globally. Health interventions, health systems, and health services perpetuate social and structural inequities, complicating and exacerbating poor health outcomes.

My work on HIV prevention in Lesotho came during the roll out and heavy promotion of Voluntary Medical Male Circumcision. Extensive ethnographic work revealed significant hesitancy to this prevention strategy, as it threatened long-standing rites traditions and reflected growing tensions between urban/rural, modern/traditional living. The hesitancy offered another example of public health’s failure to consider how social and structural factors interact to shape risk, risk and prevention engagement, and health outcomes. No regard was given to existing circumcision practices and traditional leaders were not considered as important stakeholders in rollout and mobilization efforts. This work is published as journal articles and as an edited collection on resistance to global public health interventions. Thinking through Resistance examines a diverse range of case studies of opposition to biomedical public health policies to assess the root causes of opposition and argues for alternatives to the current technocratic approach to global public health including the expansion of basic health services and infrastructure.

Select publications:

BULLED, N. (2015). Prescribing HIV Prevention: Bringing Culture into Global Health Communication. Left Coast Press.

BULLED, N. (Editor). (2017). Thinking Through Resistance: Case studies of opposition to contemporary global health practices. Routledge.

BULLED, N. (2019) Public health’s social contract: An obstacle in the advancement of effective HIV technologies. Global Public Health. DOI: 10.1080/17441692.2019.1585468

BULLED, N. (2016). The Effects of Water Insecurity and Emotional Distress on Civic Action for Improved Water Infrastructure in Rural South Africa. Medical Anthropology Quarterly. 31(1):133-154. doi: 10.1111/maq.12270

BULLED, N. & Green, E.C. (2015). Making voluntary medical male circumcision a viable HIV prevention strategy in high prevalence countries by engaging the traditional sector. Critical Public Health, 26(3):258-268, doi: 10.1080/09581596.2015.1055319.

BULLED, N. (2015). Social Models of Youth HIV Risk in Lesotho: Accounting for multiple dimensions of high risk environments. African Journal of AIDS Research, 14(3):239-254.

BULLED, N. (2015). Conceptualizing Biopolitics: Citizen-state interactions in the securing of water services in South Africa. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 34(6):533-50, doi: 10.1080/01459740.2015.1050490.

BULLED, N. (2015). Hesitance towards Voluntary Medical Male Circumcision in Lesotho: Reconfiguring global health governance. Global Public Health. 10(5-6): 757-772, doi:10.1080/17441692.2014.962559.

Kenworthy, N. & BULLED, N. (2013). From modeling to morals: Imagining the future of HIV PrEP in Lesotho. Developing World Bioethics, 13(2): 70-78, doi:10.1111/dewb.12029.

BULLED, N. (2013). (Re)distribution of Blame: Examining the Politics of Biomedical HIV Knowledge in Lesotho. Critical Arts, 27(3): 267-287.

BULLED, N. (2013). New Lives for Old: Modernity, Biomedicine, Traditional Culture and HIV prevention in Lesotho. Global Discourse, 1-16. doi:10.1080/23269995.2013.804700.

BULLED, N. & Sosis, R. (2010). Examining the influence of life expectancy of reproductive timing, total fertility, and education attainment. Human Nature, 21(3):269-289.