The straw that breaks the camel's back. Redirecting health-seeking behavior studies on malaria and vulnerability

In the wake of the Millennium Development Goals, the focus on vulnerability and access to care has increasingly gained ground in the malaria social science literature. However, little emphasis has been given to the cumulative processes of vulnerability. In this article, we draw on ethnographic data, in particular on case studies, gathered in southeastern Tanzania in the 1990s and reexamine them in the context of vulnerability. We analyze the underpinnings of the cumulative dimension of vulnerability at three levels: (1) structural, that is, elements that determine access to material and social resources; (2) agent driven, that is, the consequences of coping strategies that enhance vulnerability; and (3) conjunctural, that is, periods characterized by the confluence of adverse circumstances. We argue that the analysis of cumulative processes of vulnerability paints a more comprehensive picture of people's struggle for health. This opens up a more systemic and dynamic perspective on access to care for disadvantaged populations.