This study examines the cultural, social, environmental and political factors that shape the spread of diarrhoea. The case of Vietnam's Mekong Delta shows why the spread of disease is not merely an epidemiological problem, but an institutional one. Social inequalities, the dominance of central-state led discourse and the lack of participatory health education all contribute to a persistently high incidence of disease. This research calls for a re-politicization and contextualization of public health problems, in order to better understand why they occur and therefore be able to prevent them.