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Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report
Abstract
The Lancet-University of Oslo Commission Report on Global Governance for Health provides an insightful analysis of the global health inequalities that result from transnational activities consequent on what the authors call contemporary "global social norms." Our critique is that the analysis and suggested reforms to prevailing institutions and practices are confined within the perspective of the dominant-although unsustainable and inequitable-market-oriented, neoliberal development model of global capitalism. Consequently, the report both elides critical discussion of many key forms of material and political power under conditions of neoliberal development and governance that shape the nature and priorities of the global governance for health, and fails to point to the extent of changes required to sustainably improve global health. We propose that an alternative concept of progress-one grounded in history, political economy, and ecologically responsible health ethics-is sorely needed to better address challenges of global health governance in the new millennium. This might be premised on global solidarity and the "development of sustainability." We argue that the prevailing market civilization model that lies at the heart of global capitalism is being, and will further need to be, contested to avoid contradictions and dislocations associated with the commodification and privatization of health.
... Widening disparities in health and wealth, despite massive economic growth and global ethical frameworks such as the Universal Declaration of Human Rights, questions the values that direct our actions today in global health. Global governance for health 40 has been critiqued on grounds inclusive of duty dumping 41 , exploitation 42 and incoherence 43,44 . The foundations of modern society's current approaches, based on economic liberalism, corporatism, managerialism, a focus on biomedical science, respect for human rights limited to civil and political rights, and healthcare services within an exploitative 'medical industrial complex', are distorted by power asymmetry and so-called 'global social norms' that limit the range of choice and constrain corrective action on health inequity. ...
... The foundations of modern society's current approaches, based on economic liberalism, corporatism, managerialism, a focus on biomedical science, respect for human rights limited to civil and political rights, and healthcare services within an exploitative 'medical industrial complex', are distorted by power asymmetry and so-called 'global social norms' that limit the range of choice and constrain corrective action on health inequity. 40,42,45 J.K. Galbraith's insights into the complacency of affluence and the need for a humane economic agenda 46,47 , as well as many cautions against being fooled by a window-dressing agenda in feel-good societies, remain relevant. Ignoring such advice while conditions of life remain desperate for the majority in the face of continuing exponential consumption of energy by a minority, without concern for the future, augurs poorly for achieving a secure world. ...
... 85 While the Commission made an accurate diagnosis of global health inequities, the solutions proposed were closely linked to the structures and processes that caused the problems, and failed to link into the structures of both the governance for global health and the global political economy as some of their root causes. 42,43 Most of the world's poor are people of colour, and the roots of structural racism and structural poverty are complex. [86][87][88] Honesty requires that the long-overdue attention now being paid to marginalised communities in the Global North should be extended to acknowledgement that impoverished lives in Africa and in the rest of the Global South also matter. ...
In the previous article in this issue (S Afr J Sci. 2022;118(11/12), Art. #13165), the emergence and spread of COVID-19 pari passu with climate change and planetary degradation were interpreted as late manifestations in the trend towards gradual decline into disorder (entropy) in an unstable and ecologically threatened planet. In this article, as we contemplate a post-COVID world, the question is whether new insights could generate courageous, prescient leadership towards new paradigms of health, politics, economics, society, and our relationship with nature. A gloomy prognosis is postulated because of the power of many impediments to such changes, both in an increasingly polarised world and in South Africa as a microcosm. Despite many squandered opportunities and a decline in local and global cooperation between all who have a stake in the future, some hope is retained for innovative shifts towards sustainable futures.
Significance:
Precarious local and global instabilities are vivid reminders of our interconnectedness with each other and with nature. Insights into local and global threats and opportunities, call for paradigm shifts in thinking about and taking action towards a potentially sustainable future in a country that has its own unique history and problems but is also a microcosm of the world. The impediments to making appropriately constructive paradigm shifts in many countries with their tendencies to authoritarianism that threaten peace and democracy, are even more complex in South Africa, where opportunities for dialogue and cooperation are diminishing. Retaining some hope, with vision and courage for innovative shifts towards a sustainable economic/ecological paradigm locally and globally, is arguably essential.
... The COVID-19 pandemic has revealed the dysfunctional system of global governance and exacerbated other barriers and bottlenecks to achieving the SDGs and the Paris Agreement, because the economic reforms to enable them come into conflict with powerful global actors pursuing their own economic goals, national security, and sovereignty. 6,14,15 Even before COVID-19, international support for the SDGs was tenuous, premised as it was on assumptions of rising economic growth and positive international cooperation, including wealthy countries contributing 0·7% of the gross domestic product for official development assistance. 15 COVID-19 and the priorities of some politicians have led to a further contraction in funding for development assistance, partly due to investment diversion to technological solutions (eg, vaccines, drugs, and therapeutics) and emergency preparedness and response. ...
... This shift should facilitate an inclusive and democratic global economy to counter the disproportionate political and economic power exerted by state and non-state actors in framing policies that perpetuate inequities in global health. 3,4,6,[14][15][16][17] The moral imagination-seeing the world from different stances to envision a wider spectrum of possibilities for a post-COVID-19 world-requires us to examine how problems and their solutions are framed. A gender or human rights lens, for example, enables us to focus on the multiple ways in which COVID-19 has particularly impacted on women and marginalised communities, and how they are elided in many national responses. ...
... 18 A political economy lens clarifies that inequalities in the distribution of power and wealth undermine efforts to develop a sustainable future for humans in their environments. 6,14 To drive our moral imagination, policy making should articulate diverse perspectives and avoid the too-early consensus or broad-brush solutions that can characterise expert panels. Influential idea-generators, multilateral agencies, advocacy coalitions, and philanthropists should incorporate clear articulation of the values that underpin the framing of problems, solutions, and challenges, and consciously seek out and present dissenting views. ...
... Movement beyond all these stages towards rapid acceptance is the prerequisite for appropriate action. 51 Whether or not we are able to take action to redress these morbid symptoms will depend on understanding the processes through which we have reached our current impasse. Given blind faith in the structure and functioning of the global political economy by those who have gained most from this, it would be a tough call to expect dramatic change. ...
... 69 Our intentions may be admirable, and we have the intellect and the material resources to achieve this goal, but the big question is whether we have the vision and political commitment to transform a fraudulent and corrupt global political economy. 51,70 Hope for such innovative social progress lies in the abundance of human ingenuity as reflected in innovative science. 71 Scientific and technical advances and moral aspirations must now be accompanied by the sociopolitical research and ethically appropriate actions required to reverse the shortcomings of our complex socially constructed world with its increasingly fragile economic and ecological systems. ...
... While it may be doubtful whether we are capable of adapting to a paradigm appropriate for innovatively addressing such 21st century challenges, we should at least attempt to do so through meaningful, crosscultural, trans-disciplinary dialogue and research 77 in pursuit of much needed, cosmopolitan political, moral and humanitarian leadership, in conjunction with activist social movements. 12,51,78,79 Ethical issues Not applicable. ...
Much current global debate – as well as a great deal of political rhetoric – about global health and healthcare is characterised by a renewed emphasis on the goal of universal access throughout the world. While this goal has been achieved to varying extents in the United Kingdom, Canada and many countries in Europe, even within those countries where national health systems have long been in place, the pervasive shift in emphasis from health as a social value to health as a commodity within a capitalist market civilization is eroding the commitment to equitable access to healthcare. Against this background the challenge is much greater in low- and middle-income countries that lag behind – especially if aspirations to universal access go beyond primary care. The challenges of achieving greater equity in access to health and in health outcomes, in a middle-income country like South Africa, illustrate the magnitude of the tensions and gaps that need to be traversed, given the vast differences between healthcare provided in the private and public sectors. Understandably the concept of National Health Insurance (NHI) in South Africa has widespread support. The strategies for how a successful and effective NHI could be implemented, over what time-frame and what it covers are, however, very controversial issues. What tends to be ignored is that sustainable improvement in health in South Africa, and elsewhere, is not determined merely by medical care but more especially by social structures intimately linked to deeply entrenched local and global social, economic and political forces and inequalities. While seldom openly addressed, some of these forces are explicated in this article to supplement views elsewhere, although most have elided emphasis on the pervasive effects of the global political economy on the provisioning and practising of health and healthcare everywhere on our planet.
... Structural acceleration in processes, underpinned most powerfully in recent decades by neoliberalism, that cause loss of biodiversity and adversely impinge on the health of populations and sustainability of the biosphere (Oreskes and Conway, 2013;Rockstrom et al., 2009;Schlossberg, 2017) include: '(1) intensification of the exploitation of human beings, social processes, and nature for purposes of; (2) incremental dispossession of communities of their basic and local means of subsistence and livelihood; (3) acceleration in the turnover time of the production and sale of commodities to generate quicker accumulation of profits for firms and investors; and (4) restructuring or privatization of previously public institutions and public goods, including provisions for healthcare and education' (Gill and Benatar, 2016). As both education and healthcare become increasingly subject to market forces and values, they are treated like commodities that can be simply bought and sold for reasons of profit at the expense of conditions for healthy living, and for delivery of healthcare (Gill and Benatar, 2016). ...
... Structural acceleration in processes, underpinned most powerfully in recent decades by neoliberalism, that cause loss of biodiversity and adversely impinge on the health of populations and sustainability of the biosphere (Oreskes and Conway, 2013;Rockstrom et al., 2009;Schlossberg, 2017) include: '(1) intensification of the exploitation of human beings, social processes, and nature for purposes of; (2) incremental dispossession of communities of their basic and local means of subsistence and livelihood; (3) acceleration in the turnover time of the production and sale of commodities to generate quicker accumulation of profits for firms and investors; and (4) restructuring or privatization of previously public institutions and public goods, including provisions for healthcare and education' (Gill and Benatar, 2016). As both education and healthcare become increasingly subject to market forces and values, they are treated like commodities that can be simply bought and sold for reasons of profit at the expense of conditions for healthy living, and for delivery of healthcare (Gill and Benatar, 2016). ...
... This perspective related to the interdependency of health for all, within an increasingly threated global ecological framework, has long remained beyond our horizons on health in an era of high technology medicine. It is also arguable that it is not possible to contemplate health or how it could be improved within this broadened perspective, without insight into the global political economy -how it is structured and controlled, its ideological and cultural underpinnings -and what should and could be changed Bakker, 2011a, 2011b;Gill and Benatar, 2016). ...
This article seeks to evaluate the ethical underpinnings of neoliberalism and its associated power relations, and to illustrate the influence of such relationships on the health of people and the planet in the so-called era of the Anthropocene. We seek to reveal the current ethical standing of neoliberalism, and to identify other ethical positions and power relations that could be more conducive to promoting peaceful progress in an era during which all future life on our planet will be increasingly threatened by several organically inter-linked, human-caused crises, including that of the Earth’s biosphere. We conclude that on a planet close to many tipping points, beyond which irreversible entropy may ensue, a shift is needed away from neoliberal and anthropocentric belief systems towards a more ecologically aware perspective on life. Fostering the ethics of greater cooperation, mutual respect, deeper democracy, solidarity and enhanced social justice could facilitate the development of sustainability as a maxim of wisdom and praxis. Ultimately however, such progress requires the transformation of political power, as well as policies that are grounded in new ethical commitments.
... La segunda función es la gestión de las externalidades para prevenir o mitigar los efectos negativos para la salud que las situaciones o decisiones originadas en un país puedan tener en otros (90,91). La tercera función es la movilización de la solidaridad mundial, que ha sido el centro de atención predominante de los enfoques tradicionales de la salud global, principalmente mediante la prestación y distribución de ayudas (92,93). La cuarta función es un sistema de gobernanza mundial, que proporciona una dirección estratégica general a los sistemas universales de salud de modo que todas las demás funciones puedan desempeñarse adecuadamente. ...
... Sin embargo, existe una brecha de gobernanza entre el marco de derechos humanos y las prácticas internacionales de las políticas de salud global y desarrollo sostenible. Según estos autores, las manifestaciones actuales del derecho a la salud en la Agenda 2030 son insuficientes y superficiales, al no vincular explícitamente los compromisos o el discurso sobre el derecho a la salud con las obligaciones vinculantes de los tratados existentes en el marco de la cooperación para el desarrollo en materia de salud global (92,104). ...
El presente libro nace con el objetivo de aportar a la discusión
sobre los retos que el estudio de la Epidemiología tiene en un contexto global en el que 193 países miembros de la Organización de las
Naciones Unidas (ONU), organizaciones de la sociedad civil y otras
partes interesadas, acordaron “Transformar nuestro mundo: la Agenda 2030 para el Desarrollo Sostenible" (1), como un plan de acción
en favor de las personas, el planeta, la prosperidad, la paz y las
alianzas, mismo que entró en vigor el primer día de enero de 2016.
La Epidemiología en su origen, se concibió como una rama de
las ciencias médicas para tratar epidemias, o controlar enfermedades
epidémicas sumamente infecciosas (cólera, peste, viruela, y más) y,
con el tiempo, ha contribuido también a controlar enfermedades no
transmisibles como el cáncer, las enfermedades cardiovasculares y
los trastornos genéticos, entre otras. Su comprensión ha permitido
intervenir antes de que se declare la enfermedad, es decir, sonar
alarmas previo a que sea demasiado tarde y, ayudar a los altos funcionarios a formular estrategias para su solución (2).
No obstante, el avance progresivo del concepto de salud, ha
permitido pasar de no sólo la prevención de enfermedades infecciosas y no transmisibles, a considerar a la salud como un estado de
bienestar físico, mental y social integro. Más recientemente, la salud
se inscribe como un derecho humano, cuyo enfoque implica la no
discriminación, la disponibilidad de los bienes y servicios públicos
de salud, así como la accesibilidad, calidad, universalidad y rendición de cuentas (3), en un medio ambiente sano.
... 2 Unpacking the role of structural racism (the macro-level systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities faced by racialised communities) This shift should facilitate an inclusive and democratic global economy to counter the disproportionate political and economic power exerted by state and non-state actors in framing policies that perpetuate inequities in global health. 3,4,6,[14][15][16][17] The moral imagination-seeing the world from different stances to envision a wider spectrum of possibilities for a post-COVID-19 world-requires us to examine how problems and their solutions are framed. A gender or human rights lens, for example, enables us to focus on the multiple ways in which COVID-19 has particularly impacted on women and marginalised communities, and how they are elided in many national responses. ...
... 18 A political economy lens clarifies that inequalities in the distribution of power and wealth undermine efforts to develop a sustainable future for humans in their environments. 6,14 To drive our moral imagination, policy making should articulate diverse perspectives and avoid the too-early consensus or broad-brush solutions that can characterise expert panels. Influential idea-generators, multilateral agencies, advocacy coalitions, and philanthropists should incorporate clear articulation of the values that underpin the framing of problems, solutions, and challenges, and consciously seek out and present dissenting views. ...
... [7][8][9] Added to this is the chilling impact of self-censorship within a 'tyranny of silence' associated with political correctness, 10 and coercion through government bullying, as in Canada recently. 11 Labonté acknowledges that we agree on today's global crises being located within the pathology of our current global political economy and its supporting hegemonic discourse as discussed by others previously, [12][13][14][15][16][17] and explicated in more detail by Stephen Gill. 18 Labonté also avers that neither of us in our recent articles get sufficiently close to how change could be achieved. This point has merit, although it should be acknowledged that some suggestions have indeed been made for moving forward. ...
... So their recommendations, like those of the Lancet-Oslo Commission, remain weak. 17 David McCoy gets to the heart of the problem in concurring that a more critical approach to global health is requiredone that goes beyond the popularly accepted belief that progress and future solutions can be achieved merely through more neoliberal development, technological advancement and philanthropy. 34 I fully endorse his advocacy 'for the global health community to: (i) create more space for social and political sciences, within global health, (ii) be prepared to act politically and challenge power, and (iii) do more to bridge the global-local divide in recognition of the fact that progressive change requires mobilization from the bottom-up in conjunction with top down policy and legislative change. ...
... However, there is a governance gap between the human rights framework and international practices of global health and sustainable development policies. According to these authors, the current manifestations of the right to health in the 2030 Agenda are insufficient and superficial, as they do not explicitly link commitments or discourse on the right to health with the binding obligations of existing treaties in the framework of development cooperation on global health [46,47]. ...
This article discusses current challenges in the field of global health and the World Health Organization’s (WHO) strategies to address them. It highlights the importance of measuring the health impacts of global recession and globalization and the need for human-centered approaches to sustainable development. Emphasis is placed on commitment to health equity and the use of strategic partnerships for health at global, national, and local levels. Improving the health and well-being of populations, as well as public health equity, are core principles of the 2030 Agenda for the Sustainable Development Goals (SDGs). These principles are expressed in SDG 3, which promotes universal access to health services and systems and recognizes global health as a basic human right. It highlights the importance of strategic partnerships to combat emerging health crises, improve public health indices, and address the burden of chronic disease. These partnerships are contemplated in SDG 17 and are manifested in different modalities, such as network governance, cross-sector collaboration, public–private partnership, and social participation. This diversity of alliances has played an important role in scaling up and strengthening universal health systems around the world, including in Latin America and the Caribbean. The text concludes by presenting the essential characteristics of these inter-organizational and inter-institutional alliances in the field of global health.
... There is evidence in the literature that organizational leadership is a crucial element in stimulating, supporting, facilitating, supporting, and enhancing workers' performance (Lee et al., 2021). According to Gill and Benatar (2016), tackling global health concerns requires strong leadership. In any corporation, leadership plays a prominent role in achieving various corporate objectives (Grint et al., 2016). ...
Because of globalization and the ever-changing nature of businesses, particularly healthcare organizations, leaders need to determine the most effective method for bringing change that will help the organization achieve its objectives. Understanding how to encourage followers to reach organizational goals through leadership techniques adequately has become a concern for the healthcare business. Consequently, the significance of transformational leadership can be observed in bringing about that type of change in any business and understanding how to motivate followers to reach corporate goals effectively. As a result, the main objective of this study is to determine the influence of transformational leadership on healthcare workers’ innovative behavior in Jordan’s private hospitals as perceived by healthcare workers. This research employs a cross-sectional study design involving a quantitative method of data collection. In total, 412 healthcare workers from Jordanian private hospitals were included in the sample. Using simple linear regression analysis, the research findings revealed a significant transformational leadership impact on healthcare workers’ innovative behavior; the findings highlight the importance of hospital leaders adopting a transformational leadership style, which is crucial for motivating healthcare employees to engage in innovative behavior, In addition, Hospital leaders should focus on fostering a workplace that encourages innovation, motivates staff to gain new knowledge and skills and gives them chances to transfer their knowledge and skills into practice.
... In sum, these developments are central to understanding CPEH's causal pathways with links and synergies evidenced at multiple levels (Gill and Benatar 2016): via the global economic order driving extractivism; national policymaking facilitating Canada's role as home to mining TNCs; and the more proximal pathways of extraction's harms explored in the next section. Indeed, scholars and activists in Canada and LAC alike characterize the Canada-LAC mining nexus as a form of Canadian imperialism (Deneault and Sacher 2012;Gordon and Webber 2016;Tetreault 2013). ...
... Gill argued thus that a whole suite of transnational agreements, including those made by the signatory members of the WTO, NAFTA, and the EU, effectively served to entrench and expand neoliberal legality, thereby granting corporations quasi-constitutional protections from the perturbations of democratic discontent and anti-neoliberal policy plans (Gill 1995(Gill , 1998. Health scholars, including some collaborating with Gill himself, have since shown how consequential the neoliberal legal discipline of the New Constitutionalism has been in undermining health rights, straitjacketing the capacity of legislatures and government agencies to respond to health crises and make progress toward health for all globally (Benatar et al. 2018;Gill and Bakker 2011;Gill and Benatar 2016). Some have highlighted in this way how neoliberal trade rules limit the capacity of governments to regulate unhealthy foods and other internationally traded commodities, creating increasingly lower ceilings on standards while undermining democratic policy-making aimed at establishing better protections (Labonté and Schrecker 2007;Labonté et al. 2009;Labonté and Stuckler 2016). ...
This chapter deals with the Russian Federation’s management of the COVID-19 crisis in its foreign policy through health diplomacy. First, it looks at Russia’s strategy globally and then focuses on two case studies: Belarus and Italy. As shown by the analysis of the case studies, there have been at least two main phases in Russia’s external response to the pandemic. In the first phase, Russia used health diplomacy and helped other countries (e.g., Italy) struggling with the pandemic, seeking to rebrand itself as a benevolent actor and generous actor. In the second phase, Russia took part in the vaccine race. As a result, it became the first country to register a COVID-19 vaccine—despite accusations of disregarding scientific standards—to boast its scientific excellence internationally and boost national pride among its citizens. Finally, the chapter acknowledges the spillovers of Russia’s invasion of Ukraine for its health and vaccine diplomacy. Indeed, Russian companies and institutions must face the consequences of the war, which can further dilapidate the reputation built in the first phase of COVID-19 spreading.
... Gill argued thus that a whole suite of transnational agreements, including those made by the signatory members of the WTO, NAFTA, and the EU, effectively served to entrench and expand neoliberal legality, thereby granting corporations quasi-constitutional protections from the perturbations of democratic discontent and anti-neoliberal policy plans (Gill 1995(Gill , 1998. Health scholars, including some collaborating with Gill himself, have since shown how consequential the neoliberal legal discipline of the New Constitutionalism has been in undermining health rights, straitjacketing the capacity of legislatures and government agencies to respond to health crises and make progress toward health for all globally (Benatar et al. 2018;Gill and Bakker 2011;Gill and Benatar 2016). Some have highlighted in this way how neoliberal trade rules limit the capacity of governments to regulate unhealthy foods and other internationally traded commodities, creating increasingly lower ceilings on standards while undermining democratic policy-making aimed at establishing better protections (Labonté and Schrecker 2007;Labonté et al. 2009;Labonté and Stuckler 2016). ...
This chapter deals with the Russian Federation’s management of the COVID-19 crisis in its foreign policy through health diplomacy. First, it looks at Russia’s strategy globally and then focuses on two case studies: Belarus and Italy. As shown by the analysis of the case studies, there have been at least two main phases in Russia’s external response to the pandemic. In the first phase, Russia used health diplomacy and helped other countries (e.g., Italy) struggling with the pandemic, seeking to rebrand itself as a benevolent actor and generous actor. In the second phase, Russia took part in the vaccine race. As a result, it became the first country to register a COVID-19 vaccine—despite accusations of disregarding scientific standards—to boast its scientific excellence internationally and boost national pride among its citizens. Finally, the chapter acknowledges the spillovers of Russia’s invasion of Ukraine for its health and vaccine diplomacy. Indeed, Russian companies and institutions must face the consequences of the war, which can further dilapidate the reputation built in the first phase of COVID-19 spreading.KeywordsRussiaForeign policyHealth diplomacyCOVID-19VaccinesBelarusItaly
... Gill argued thus that a whole suite of transnational agreements, including those made by the signatory members of the WTO, NAFTA, and the EU, effectively served to entrench and expand neoliberal legality, thereby granting corporations quasi-constitutional protections from the perturbations of democratic discontent and anti-neoliberal policy plans (Gill 1995(Gill , 1998. Health scholars, including some collaborating with Gill himself, have since shown how consequential the neoliberal legal discipline of the New Constitutionalism has been in undermining health rights, straitjacketing the capacity of legislatures and government agencies to respond to health crises and make progress toward health for all globally (Benatar et al. 2018;Gill and Bakker 2011;Gill and Benatar 2016). Some have highlighted in this way how neoliberal trade rules limit the capacity of governments to regulate unhealthy foods and other internationally traded commodities, creating increasingly lower ceilings on standards while undermining democratic policy-making aimed at establishing better protections (Labonté and Schrecker 2007;Labonté et al. 2009;Labonté and Stuckler 2016). ...
The United States management of the pandemic has been substantially worse than that of any other wealthy industrialized country. This chapter demonstrates the close connection between the agenda of right-wing populism and dysfunctional policies toward testing, provision of medical equipment, lockdowns, and vaccines. At the same time, a comprehensive explanation for the U.S. policy response and its transformative social impact must also account for the underlying neoliberal “pre-existing condition” and resultant serious inadequacies in public health in which the virus appeared. Fiscal and monetary policies designed ostensibly to cushion society from sickness and recession within a diminished public health environment also served to deepen inequality and impose a disproportionate share of the burden of adjustment on the poorest Americans.KeywordsPopulismNeoliberalismGovernancePublic healthMacro-economic policyFiscal policy
... The hegemonic tendencies effected by colonialism have also percolated into the area of Global Health Governance, to the detriment of countries in the Global South. Mainstream ideas of global health continue to reflect the hegemonial notions inherited from colonial medicine, including primary concerns such as retaining monopoly in trade of essential medicines, restrictions on intellectual property rights, focus on infectious diseases, and pushing the securitization of health 41 . Global health strategies that are led by the richer part of the world reproduce the exact same processes that have led to their original higher levels of development, aside from generating unequal global distribution of resources including, among other resources, medical/healthcare expertise and biomedical substances. ...
This essay attempts to piece together the main trajectories of climate change and global health governance starting with the historical connectedness of the idea of the global. While the Global South and the Global North constitute key concepts in the approach to global governance of key issues such as climate change and health governance, this essay attempts to locate the historical course undertaken by both concepts within the context of colonialism and postcolonialism in the unequal exchanges between these geopolitical entities. The essay argues that the hegemonic relationship between the Global North and South is traceable to colonialism and its epistemic vestiges (manifest, for instance, through state laws and concerns of security) that have an adverse impact on the countries of the Global South where health and climate change governance is concerned. The essay suggests that the majority of the socioeconomic issues currently plaguing the Global South can be attributed to colonialism and imperialism, which were supported in many parts of the world in the 19th and 20th centuries, as well as to the neocolonial and commercial strategies of extractive and exploitative capitalism of the 21st century. The costs of these changes must be considered in the context of a long-standing theme of the Global North's exploitation of the environment and the people of the Global South, particularly in terms of heritage loss, loss of biodiversity, extreme weather conditions, and even health emergencies like the COVID-19 pandemic. The essay concludes by advocating for a greater inclusion of the Global South in the governance of climate change through hybrid institutional complexes (HICs) in governing the global commons.
... 3 However, the selective nature of these policy initiatives ignored consideration of other closely intertwined system-based threats to global health and security. 44,45 COVID-19 has thus emerged and spread at a late stage in the trajectory of climate change, as one of many destructive outcomes of human behaviour. The role of laboratory manipulation of the virus remains unclear. ...
Despite massive global economic growth and advances in science and medicine with spectacular aggregate and individual improvements in health and life expectancy over the past century, the world has now become severely unstable in multiple domains – biological, sociological, political, ecological, economic, and health care. These pervasive instabilities are organically interactive within a complex world system that has reached crisis status at local, global, and planetary levels. Lying at the heart of this complex crisis are long-neglected disparities in health and well-being within and between countries, the refusal to face how these and climate change have arisen, and how economic considerations have fuelled the trend towards entropy (gradual decline of the planet into disorder). The critical point we have reached, starkly highlighted by the emergence of the COVID-19 pandemic pari passu with ongoing climate change and planetary degradation, reminds us of our global interconnectedness with each other and with nature. Comprehending and acknowledging the myriad, humanly constructed forces in each of these domains influencing all aspects of life, are the first steps towards effectively facing challenges to our health, our humanity (collectivity as humans) and our planet. Overcoming denial, acknowledging the magnitude and complexity of these challenges, prescient vision and dedicated action capable of fostering the cooperation for overcoming obstacles are now vital to seeking peaceful pathways towards more equitable and sustainable lives. South Africa is a microcosm of the world, with its local threats and challenges mirroring the global.
Significance:
Instabilities that pervade the world, highlighted by the COVID-19 pandemic, are especially significant for South Africa, where they manifest most starkly because of its apartheid legacy, its relative success economically on the African continent, and the implications of ongoing widening disparities and antagonism amongst South Africa’s diverse people. Belief in moving towards narrowing wide disparities through decolonisation and reversion to an ‘idyllic African heritage’ via a transformation that includes widespread corruption, and the ANC government’s perverse erosion of lives today and in the future through ‘state capture’, intensifies rather than ameliorates our predicament in an era when cooperation and a clear vision of current threats and future possibilities are desperately needed.
In an accompanying article, potential pathways towards a better future are offered through suggested shifts in paradigms of thought and action.
... Whilst transnational actors such as the WHO provide the much needed normative guidelines to shape policies, there is emphasis on how governments should strengthen technical determinants of ATM to progress towards globally conceived motivational frames such as UHC. This characterization rests on the notion of 'policy convergence' or the process by which knowledge about policies conceived in one jurisdiction influences policies in another jurisdiction [70]. Fundamentally, it assumes that once a country 'adopts' a global norm or 'commits' to an idea-in this case UHC-there would be synergistic action to align with that norm.This overly technocratic framing largely ignores the politics of transnational policy diffusion or how countries "mediate, filter, and refract the efforts by transnational actors and alliances to influence policies in the various issue-areas' [71]. ...
Background
Framing affects how issues are understood and portrayed. This profoundly shapes the construction of social problems and how policy options are considered. While access to essential medicines (ATM) in the World Health Organization (WHO) African Region is often framed as a societal problem, there is dominance of medical and technically oriented approaches to analyze and remedy the situation. Hence, the systematic application of social science approaches, such as framing theory, remains under-explored. Through a framing analysis of National Strategic Plans (NSPs) from eight countries, this study explores the applicability and potential usefulness of framing theory to analyze essential medicines policies.
Methods
We inductively coded the relevant NSP textual fragments using the qualitative content analysis software ATLAS.ti.22. Benford and Snow’s conceptualization of framing was used to organize the coded data into three frames: diagnostic (problems), prognostic (solutions) and motivational (values and ideological).
Results
The following five diagnostic frames were dominant or in-frame: medicine unavailability, ineffective regulation, weak supply chain management, proliferation of counterfeit (substandard or falsified) medicines and use of poor quality medicines. Diagnostic frames related to financing, affordability, efficiency and corruption were given limited coverage or out of frame. Prognostic frames corresponded with how these problems were framed. Whilst Universal Health Coverage (UHC) and its guiding principles was the dominant motivational frame, we identified some frame discordance between the global discourse and national level policies.
Conclusions
Social science approaches such as framing analysis are applicable and useful to systematically analyze essential medicine aspects. By applying framing theory, we revealed that ATM aspects in the eight countries we analyzed are more often characterized in relation to availability at the expense of affordability which undermines UHC. We conclude that whilst UHC is a strong motivational frame to guide ATM aspects, it is insufficient to inform a comprehensive approach to address the problems related to ATM at country level. To effectively advance ATM, concerned actors need to realize such limitation and endeavor to gain a deeper understanding of how problems are framed and agendas are set at country level, the processes through which ideas and knowledge become policies, including the political demands, incentives and trade-offs facing decision-makers in selecting policy priorities.
... Despite outstanding achievements in science and technological innovations in global public health outcomes since World War II [32], the growing disparities in health and wealth among countries make the current world situation more inequitable than it was prior to World War I [33]. Major advances in science and global health in the past decades have not correlated with the reduction of social inequalities and poverty, which are major structural determinants of TB and infectious diseases worldwide [34,35]. There is increasing evidence that the implementation of the End TB strategy alongside the SDGs may require a change in the interaction between health financing and healhcare [36], where current profit models of investment should be evaluated for transparency and effectiveness, and current oriented market and private health governance should shift to a more ecological and sustainable health-for-all model. ...
Purpose of review:
The alignment of sustainable development goals (SDGs) with the End Tuberculosis (TB) strategy provides an integrated roadmap to implement key approaches towards TB elimination. This review summarizes current social challenges for TB control, and yet, recent developments in TB diagnosis and vaccines in the context of the End TB strategy and SDGs to transform global health.
Recent findings:
Advances in non-sputum based TB biomarkers and whole genome sequencing technologies could revolutionize TB diagnostics. Moreover, synergistic novel technologies such as mRNA vaccination, nanovaccines and promising TB vaccine models are key promising developments for TB prevention and control.
Summary:
The End TB strategy depends on novel developments in point-of-care TB diagnostics and effective vaccines. However, despite outstanding technological developments in these fields, TB elimination will be unlikely achieved if TB social determinants are not fully addressed. Indeed, the End TB strategy and SDGs emphasize the importance of implementing sustainable universal health coverage and social protection.
... Kent Buse and Hawkes 2015; Lawrence O Gostin et al. 2015;Harmer and Buse 2014;Kickbusch 2016) This is all punctuated with a growing understanding that global health policies are shaped by political agendas, powerful interests and inter-linked transnational networks of agencies and structures sharing like-minded norms and worldviews.(Benatar 2016;Gill and Benatar 2016a; Ole Petter Ottersen et al. 2014;Shiffman 2014) After elaborating on why and how to arrive at a number of Sustainable Development Goal (SDG) priority goals for health, and in some cases modifying them, a crucial question is posed by Labonté in the concluding parts of the paper: "How can we tame capitalism and the predatory market logic to support human equity and (now) a livable planet? Or, if it cannot be tamed, how might capitalism be transformed into something better fit for human social and ecological survival into a 21 st century?"(Labonté 2016) ...
Over the last few decades, the global health workforce (HWF) gap has increased. This gap concerns the skilled HWF required for providing essential health care services across the world in an equitable manner. This thesis takes a cosmopolitan outlook, as coined by Ulrich Beck to describe a reflexive modernity, to study what is required to develop the global health workforce in an equitable manner. It looks into principles and policies of global health governance to assess what has been done to strengthen the health workforce. It also shows that there is a paradox in economic globalization, which leads to a structural problem to invest (sufficiently) in the health workforce at the national level. Via different methodologies, several levels of global health policy and health workforce development are studied. This includes a comparative policy analysis between countries as well as a specific study on health workforce investment in post –Ebola Guinea. Institutional reform of the WHO is studied alongside an analysis on the implementation of WHO’s Code of Practice on the international Recruitment of Health Personnel. The implications of the securitization of health policy on attacks against humanitarian health workers are researched. The thesis includes a critical analysis of the current resilience focus in health systems development. It analyses to what extent global health approaches in the Sustainable Development Goals are grounded in the Right to Health. The discussion then outlines the democratic space to reform and strengthen health workforce development across the different policy levels of global health governance. This is possible with a more cosmopolitan, transnational outlook to the health workforce challenge and international labour migration. This requires that countries take a shared sovereignty approach and find ways to regulate economic globalization so that it benefits the public good rather than the wealth of a few. However, current policy trends suggest that countries move away from these principles, instead of towards them. The thesis ends with suggestions on how to move beyond this ‘gridlock’ in global health workforce cooperation. It argues for moving beyond economic growth as a policy imperative, and instead take into account the planetary boundaries and social foundations as a basis for future global health workforce governance, known as the Doughnut Economics model.
... Health is a global political matter 17 and a public good for humanity. 18 The prevention of illness and promotion of health entail programmes that sometimes conflict with economic priorities. ...
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https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931298-8
... Yet, the political determinants of health and HI have been largely neglected and marginalised from mainstream public health debate and analyses [31,34,72,84], this includes an absence of questions related to politics and power dynamics within and between societies and countries [44]. As one study in Ethiopia highlights [85], if and when politics is referred to in mainstream public health research, it is often in regard to whether there is political commitment or not, rather than going deeper into the political context to consider how politics impacts health, HRS and the related research practices, or how internal power relations could be changed to achieve better health (and related research) outcomes [85,86]. This is thought to be due, in part, to what we mentioned previously about the two main models of health, disease and HI. ...
Background:
Despite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action.
Methods:
Through a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level.
Results:
Our model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities.
Conclusions:
This type of knowledge can assist researchers and decision-makers to identify any information gaps or barriers to be addressed, and establish new entry points to effectively strengthen these research capacities. This can lead to the production of a stronger evidence base, both locally and globally, which can be used to inform strategic efforts aimed at achieving health equity.
... However, further critical analysis is needed to advance understanding of political determinants of health, which are the "norms, policies and practices that arise from transnational interaction … that cause and maintain health inequities. " 3 The commentary contributes an NCD perspective to the existing literature on neoliberalism and health, which to date has been dominated by a focus on HIV, gender and trade agreements. The HIV epidemic, in particular, catalyzed critical analysis of how neoliberal policies exacerbated health inequities. ...
The recent perspective article "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention, " by Lencucha and Throw, interrogates how the dominant neoliberal paradigm restricts meaningful policy action to prevent non-communicable diseases (NCDs). It contributes an NCD perspective to the existing literature on neoliberalism and health, which to date has been dominated by a focus on HIV, gender and trade agreements. It further advances the emerging commercial determinants of health (CDoH) scholarship by calling for more nuanced analysis of how the governance of both health and the economy facilitates corporate influence in policy-making. In political science terms, Lencucha and Throw are calling for greater structural analysis. However, their focus on the pragmatic, as opposed to political, aspects of neoliberalism reflects a hesitancy within health scholarship to engage in political analysis. This depoliticization of health serves neoliberal interests by delegitimizing critical questions about who sustains and benefits from current institutional norms. Lencucha and Throw's call for greater interrogation of the structures of neoliberalism forms a basis from which to advance analysis of the political determinants of health.
... Underlying both are weighty questions about which norms, principles and power relations characterise and which should influence governance in the global order. Central questions are: how the world should be ordered; who is responsible for addressing global problems in various domains; are there alternatives to existing governance structures and how can change be managed; how can governance be organised so as to confer benefit on peoples across the globe equitably (Gill and Benatar 2006). This paper explores important conceptual and practical issues and contemporary challenges of global governance under the impact of the growing influence of the RPs alongside the retreat of the once pre-eminent US and European countries. ...
The idea of this paper is inspired by the dismal experience and lessons from the initially ineffective global (WHO-led) response to the 2014–2016 West African Ebola virus epidemic. It charts the evolution of global health policy and governance in the post-World War II international order to the current post-2015 UN Sustainable Development Goals era. In order to respond adequately existing and emerging health and development challenges across developing regions, the paper argues that global health governance and related structures and institutions must adapt to changing socio-economic circumstances at all levels of decision-making. Against the background of a changing world order characterised by the decline of US-led Western international liberalism and the rise of the emerging nations in the developing world, it identifies the ‘Rising Powers’ (RPs) among the emerging economies and their soft power diplomacy and international development cooperation strategy as important tools for responding to post-2015 global health challenges. Based on analysis of illustrative examples from the ‘BRICS’, a group of large emerging economies—Brazil, Russia, India, China and South Africa—the paper develops suggestions and recommendations for the RPs with respect to: (1) stimulating innovation in global health governance and (2) strengthening health systems and health security at country and regional levels. Observing that current deliberations on global health focus largely, but rather narrowly, on what resource inputs are needed to achieve the SDG health targets, this paper goes further and highlights the importance of the ‘how’ in terms of a leadership and driving role for the RPs: How can the RPs champion global governance reform and innovation aimed at producing strong, resilient and equitable global systems? How can the RPs use soft power diplomacy to enhance disease surveillance and detection capacities and to promote improved regional and international coordination in response to health threats? How can they provide incentives for investment in R&D and manufacturing of medicines to tackle neglected and poverty-related diseases in developing countries?
... En este aspecto, es importante enfatizar que las inequidades en salud entre e intra países son inaceptables y no pueden ser solucionadas con acciones restringidas a medidas técnicas del sector salud, o solamente circunscritas al ámbito nacional, una vez que requieren soluciones políticas globales. Actores estatales y no estatales deben estar más conectados por un diálogo político trasparente en los procesos de toma de decisiones que afectan a la salud 13 . Lo anterior también permite identificar la necesidad de que en la formación de los estudiantes de enfermería se enfatice cómo en el diagnóstico y planeación de intervenciones deberá considerarse el contexto, ya que éste se revela mutable, contradictorio, tensionado por las fuerzas sociales que representan, por un lado, un escenario conservador y, por otro, los cambios y las rupturas a favor de un nuevo proyecto para combatir las desigualdades. ...
Objetivo: El propósito de este estudio fue describir las percepciones de docentes de enfermería de habla hispana en América Latina, sobre las competencias relacionadas a la salud global que deben mostrar los estudiantes de enfermería del pregrado. Métodos: Este estudio descriptivo fue basado en una muestra de docentes de escuelas de enfermería miembros de la Asociación Latinoamericana de Escuelas y Facultades de Enfermería (ALADEFE) y de la Asociación de Escuelas de la Zona Centro Sur de México, las cuales recibieron un correo electrónico con una liga para responder una encuesta electrónica por Survey Monkey©. La encuesta incluyó una lista de 30 competencias en salud global dividida en seis dimensiones. Los docentes indicaron en una escala Likert de 4 puntos la relevancia de cada competencia para la educación de enfermería en el nivel de pregrado (1 = Completamente en desacuerdo; 2 = En desacuerdo; 3 = De acuerdo; 4 = Completamente de acuerdo). Resultados: En total, 110 profesores de nueve países respondieron a la encuesta. El promedio de cada ítem fue entre 3.0 - 4.0, esto indica que los profesores estuvieron de acuerdo en que todas las competencias son relevantes para la formación de estudiantes de enfermería a nivel de pregrado. Conclusiones: Los resultados de este estudio sugirieron que estas competencias deben ser incluidas en los currículos de enfermería a nivel de pregrado, para formar a los estudiantes en su labor como enfermeras y enfermeros en un mundo globalizado y prepararlos para contribuir a la Cobertura y el Acceso Universal a la Salud (Salud Universal).
... Buse and Lee (2005), for example, review the diverse roles of the 'commercial sector' in GHG. A rich literature has since emerged, documenting and interrogating how corporate influence is exerted in GHG (Gill and Benatar 2016). ...
... Unfortunately a comprehensive analysis of power dynamics, and how they impact upon learning, is beyond the scope of this paper [50,51]. However, it may be helpful to explore this dynamic through that lens moving forward. ...
Background: International health partnerships (IHPs) are changing, with an increased emphasis on mutual accountability and joint agenda setting for both the high-and the low-or middle-income country (LMIC) partners. There is now an important focus on the bi-directionality of learning however for the UK partners, this typically focuses on learning at the individual level, through personal and professional development. We sought to evaluate whether this learning also takes the shape of 'Reverse Innovation' –when an idea conceived in a low-income country is subsequently adopted in a higher-income country.
... Unfortunately a comprehensive analysis of power dynamics, and how they impact upon learning, is beyond the scope of this paper [50,51]. However, it may be helpful to explore this dynamic through that lens moving forward. ...
Background
International health partnerships (IHPs) are changing, with an increased emphasis on mutual accountability and joint agenda setting for both the high- and the low- or middle-income country (LMIC) partners. There is now an important focus on the bi-directionality of learning however for the UK partners, this typically focuses on learning at the individual level, through personal and professional development. We sought to evaluate whether this learning also takes the shape of ‘Reverse Innovation’ –when an idea conceived in a low-income country is subsequently adopted in a higher-income country.
Methods
This mixed methods study used an initial scoping survey of all the UK-leads of the Tropical Health Education Trust (THET)-supported International Health Partnerships (n = 114) to ascertain the extent to which the IHPs are or have been vehicles for Reverse Innovation. The survey formed the sampling frame for further deep-dive interviews to focus on volunteers’ experiences and attitudes to learning from LMICs. Interviews of IHP leads (n = 12) were audio-recorded and transcribed verbatim. Survey data was analysed descriptively. Interview transcripts were coded thematically, using an inductive approach.
Results
Survey response rate was 27% (n = 34). The majority (70%) strongly agreed that supporting LMIC partners best described the mission of the partnership but only 13% of respondents strongly agreed that learning about new innovations and models was a primary mission of their partnership. Although more than half of respondents reported having observed innovative practice in the LMIC, only one IHP respondent indicated that this has led to Reverse Innovation. Interviews with a sample of survey respondents revealed themes primarily around how learning is conceptualised, but also a central power imbalance between the UK and LMIC partners. Paternalistic notions of knowledge could be traced to partnership power dynamics and latent attitudes to LMICs.
Conclusions
Given the global flow of innovation, if High-income countries (HICs) are to benefit from LMIC practices, it is paramount to keep an open mind about where such learning can come from. Making the potential for learning more explicit and facilitating innovation dissemination upon return will ultimately underpin the success of adoption.
... These figures probably represent a fraction of those living in very difficult circumstances as most people in such circumstances do not migrate. It has furthermore been argued that international policies and practices, such as neoliberalism, continue to create conditions under which people lead very precarious lives (Gill & Benatar, 2016). In addition, even in so-called post-conflict societies -it is commonly not accurate to speak of people living in a calm 'post'-trauma situation. ...
Post Traumatic Stress Disorder (PTSD) and chronic pain have been identified as global health challenges for health professionals, and there is a robust literature linking PTSD and chronic pain. Much of the research is focused on high-income countries, leaving a serious gap when chronic pain is considered globally. Using the concept of Continuous Traumatic Stress (CTS), we look at how broader social conditions impact on the experience of chronic pain. We review the relevant literature on chronic pain, PTSD, and CTS, and suggest a research agenda for a more globally relevant and contextual understanding of chronic pain.
Objective
Globally, 5 billion people lack access to safe surgery and annually, only 6% of surgeries occur in low-income countries. Surgical frugal innovations can reduce cost and optimise the function for the context; however, there is limited evidence about what enables success.
Design
A systematic literature review (SLR) was performed to understand the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries (LMICs).
Data sources
Web of Science, PubMed, Embase at Ovid, Google Scholar and EThOs were searched.
Eligibility criteria for selecting studies
Inclusion criteria were original research in English containing a frugal surgical innovation. Research must be focused on LMICs. Studies were excluded if the content was not focused on LMICs or did not pertain to barriers and facilitators. 26 studies from 2006 to 2021 were included. The GRADE tool was used to assess overall review quality.
Results
Results were analysed using the modified consolidated framework for implementation research. The lack of formal evidence regarding frugal innovation in LMICs was the most reported barrier. The adaptability of frugal innovations to the context was the most reported facilitator. The limitations of this study were that most frugal innovations are not included in formal literature and that only English studies were included.
Conclusion
Frugal surgical innovations that are highly adaptable to the local context hold significant potential to scale and positively affect healthcare access and outcomes. Furthermore, supporting formal research about frugal innovations is important when aiming to innovate for health equity.
The COVID pandemic represents something far more than the deadly global aggregation of experiences of infection in individual bodies. Instead, reconsidered in terms of social co-infection, disruption, and dysregulation, it presents a picture of political and economic pathologies that are examined in this chapter as a form of pandemic co-pathogenesis. What stands out most in this global pandemic picture are vulnerabilities created by neoliberal policies co-acting with a novel viral pathogen to inflict harm across the global body politic. The resulting vectors of COVID as a neoliberal disease are surveyed thus in the terms of: (i) neoliberal neocoloniality; (ii) neoliberal inequality; (iii) neoliberal austerity; and (iv) neoliberal legality. Considered in terms of co-pathogenesis, each of these vectors also evidences additional co-acting pathologies ranging from other systemic social forces such as racism to other infectious diseases such as AIDS. The resulting outcomes have in turn included not just the outgrowth of new viral variants of SARS-CoV-2, but also new variations in associated social, political, and economic pathologies, including not least of all in the evolution of the neoliberal policy regimes and political-economic structures that did so much to contribute to pandemic co-pathogenesis in the first place. Most striking among these neoliberal variants are new forms of reactionary and illiberal neoliberalism linked to the rise of authoritarian anti-globalists. Yet other emergent post-neoliberal possibilities connected to ‘building-back better’ call out for attention too. Examining COVID with a radically re-socialized concept of co-pathogenesis thereby provides a useful way for scholars of International Political Economy to come to terms with both (a) the central enabling role that neoliberal vectors played alongside other causes as enablers of the pandemic, and (b) with the subsequent variants of neoliberal norms and practices that have evolved out of the pandemic alongside new viral variants of SARS-CoV-2 itself.KeywordsCo-pathogenesisDisaster capitalismDouble movementGlobalizationNeoliberalism
This thesis aims to understand how methodological and conceptual approaches to complexity in quantitative analysis can improve evidence and decision-making, specifically for schistosomiasis control in Uganda and more broadly within global health. Engaging directly with the complexity through methodological choices provided new insights into policies and practices in global health. In Paper 1, I provided an overview of actors and power dynamics in global health, by describing the changing landscape of global health actors as it relates to relative shifts in power over time. This is accomplished by capturing the emergent, dynamic network structure of development aid for health in the period encompassing the ‘MDG era’, between 1990 and 2015. This paper was published in the Journal of Health Policy and Planning (https://doi.org/10.1093/heapol/czac025). Paper 2 aimed to develop evidence for decision-making in response to the needs of policymakers and practitioners, with a focus on schistosomiasis transmission and control activities in Uganda. This was accomplished by (1) capturing the perspectives of national and sub-national decision-makers on schistosomiasis transmission using participatory modelling, and (2) using the participatory modelling outputs to inform mathematical model simulations in response to the evidence needs. The implementation of this approach challenged the balance of power between international and domestic actors in the development of evidence and decisions regarding the delivery of global health interventions. This paper was published in BMJ Global Health (http://dx.doi.org/10.1136/bmjgh-2021-007113). Paper 3 used the outcomes of the participatory systems mapping workshops and individual-based simulations to guide the scope and content of economic evaluations of schistosomiasis interventions. The results indicated that the most cost-effective scenario is a system of implementation reliant on volunteers from within communities and donated drugs. As anticipated, when all else is held equal, including these costs result in lower cost-effectiveness ratios relative to other interventions. Further, the results bring into question the purpose of continuing interventions which are not predicted to achieve the desired targets within the 30-year time horizon. This paper highlighted potential opportunities for schistosomiasis intervention design and implementation which is more aligned with the aims of equitable, country-led sustainable development. Paper 4 shifted the focus within the discussion of evidence for decision-making in global health to consider one particular type, peer-reviewed publications, which is most often considered as ‘best practice’ in evidence-based decision-making. A systematic review captured the network of authors who had published on MDA. These results constituted the sampling frame for a remote survey to elucidate perspectives on their roles in policy and practice related to MDA. The findings highlighted the ongoing structural disparities in research leadership and found broad concern about opportunities and about disconnects that limit engagement between researchers and decision-makers for use of primary research in policy and decision-making processes. Paper 4 was published in the Journal of Public Health Policy (https://doi.org/10.1057/s41271-021-00294-x). Broadly speaking, the papers in this thesis have shown that while reductionist, linear perspectives may be part of the reason for the continuation of ineffectual policies and practices, the confluence of politics, power relations, and economies in the context of a complex system of actors and processes also plays a significant role with regards to policy and practice decision making. This was observed in relation to schistosomiasis in Uganda and more broadly in global health at the system level. This thesis uses language and methods common in health sciences to communicate critiques in a way that can be engaged with by health policy-makers, practitioners, and many public health researchers. Finally, this thesis showed the possibilities for using network-based and computational models for understanding complexity within the global health 'system'.
The social determinants of health framework provides a framework to conceptualize, measure, monitor, and evaluate the progress of social indicators that are instrumental to health, and potentially holds promise in positively impacting global public health outcomes. Nevertheless, there are limitations to this approach. This chapter begins by discussing the social determinants of health framework and charting the shift across varying approaches and paradigms in the determinants of health that have led to the acknowledgment of social factors and determinants as instrumental to health outcomes. Next, it attempts to delineate the development of a global public health framework, discuss its potential contributions and shortcomings, as well as its alignment with social determinants of health framework. It then posits how the social determinants of health framework can contribute to global public health goals. Finally, it reflects on the remaining gaps in the research on the social determinants of health in the context of global public health and articulate the way forward for research in the field.
In times of a public health emergency, lawyers and ethicists play a key role in ensuring that government responses, such as travel restrictions, are both legally and ethically justified. However, when travel bans were imposed in a broadly discriminatory manner against southern African countries in response to the Omicron SARS-CoV-2 variant in late 2021, considerations of law, ethics or science did not appear to guide politicians’ decisions. Rather, these bans appeared to be driven by fear of contagion and electoral blowback, economic motivations and inherently racist assumptions about low-income and middle-income countries (LMICs). With a new pandemic treaty and amendments to the WHO’s International Health Regulations (IHR) on the near-term horizon, ethics and international law are at a key inflection point in global health governance. Drawing on examples of bordering practices to contain contagion in the current pandemic and in the distant past, we argue that the current IHR is not adequately constructed for a just and equitable international response to pandemics. Countries impose travel restrictions irrespective of their need or of the health and economic impact of such measures on LMICs. While the strengthening and reform of international laws and norms are worthy pursuits, we remain apprehensive about the transformative potential of such initiatives in the absence of collective political will, and suggest that in the interim, LMICs are justified in seeking strategic opportunities to play the same stark self-interested hardball as powerful states.
Public health researchers concerned with the commercial industry's influence over health policy have contributed to the development of a new field of inquiry, Corporative Political Activity (CPA). While the CPA literature has improved our understanding of the tactics that industries use to influence health policy and outcomes, ironically, this literature appears to have fallen short of thoroughly engaging those social science disciplines focusing on the relationship between industry and government in the policymaking process, such as political science. The purpose of this article is to reveal how political science theory and method can generate new research questions for CPA scholars; propose alternative qualitative methodological approaches to causal inference, with a focus on historical and temporal analysis; and establish adequacy in causal mechanisms. The application of political science theories and methods may assist CPA researchers in their efforts to explain the durability and efficacy of CPA political tactics at the domestic government level, which of these tactics are more important, while providing greater depth into explaining how and why industries continue to obstruct policymaking. The author(s) then propose an alternative political science analytical framework, Political Analysis of Corporate Political Activity (PACPA), that may provide a more thorough understanding of the politics of the commercial sector's policy influence. This framework integrates the political science literature highlighting the political and institutional contexts shaping interest group activities and policymaking influence along with the CPA literature discussing these issues, through a historically-based qualitative case study approach emphasizing the causal mechanisms behind industry's political activities. With respect to methodology, this article relied on an analysis of qualitative documents through a variety of on-line search engines and the author(s)'s extensive knowledge of the topic. Select case studies were used as illustrations supporting the author(s)'s claims. This research began in November 2020 and concluded in June 2021.
Not much is known about higher technical education in England, but current education policy looks positively at it to improve labour productivity and social mobility. We provide updated estimates of individual earnings differentials associated with such education, compared to achieving degrees, for all secondary school leavers in 2003. We find an early advantage of higher technical education, which erode over time. By age 30, most degree holders earn more. However, for men with higher technical education in STEM, earnings remain significantly above those of many degree holders. For women, such differences were not found.
Introduction
The integration of more diverse perspectives into the development of evidence for decision-making has been elusive, despite years of rhetoric to the contrary. This has led to cycles of population-based health interventions which have not delivered the promised results. The WHO most recently set a target for schistosomiasis elimination by 2030 and called for cross-cutting approaches to be driven by endemic countries themselves. The extent to which elimination is feasible within the time frame has been a subject of debate.
Methods
Systems maps were developed through participatory modelling activities with individuals working on schistosomiasis control and elimination activities from the village through national levels in Uganda. These maps were first synthesised, then used to frame the form and content of subsequent mathematical modelling activities, and finally explicitly informed model parameter specifications for simulations, using the open-source SCHISTOX model, driven by the participants.
Results
Based on the outputs of the participatory modelling, the simulation activities centred around reductions in water contact. The results of the simulations showed that mass drug administration, at either the current or target levels of coverage, combined with water contact reduction activities, achieved morbidity control in high prevalence Schistosoma mansoni settings, while both morbidity control and elimination were achieved in high prevalence S. haematobium settings within the 10-year time period.
Conclusion
The combination of participatory systems mapping and individual-based modelling was a rich strategy which explicitly integrated the perspectives of national and subnational policymakers and practitioners into the development of evidence. This strategy can serve as a method by which individuals who have not been traditionally included in modelling activities, and do not hold positions or work in traditional centres of power, may be heard and truly integrated into the development of evidence for decision-making in global health.
Addressing global health is one of the largest challenges facing humanity in the 21st century, however, this task is becoming even more formidable with the accelerated destruction of the planet. Building on the success of the previous edition, the book outlines how progress towards improving global health relies on understanding its core social, economic, political, environmental and ideological aspects. A multi-disciplinary group of authors suggest not only theoretically compelling arguments for what we must do, but also provide practical recommendations as to how we can promote global health despite contemporary constraints. The importance of cross-cultural dialogue and utilisation of ethical tools in tackling global health problems is emphasised. Thoroughly updated, new or expanded topics include: mass displacement of people; novel threats, including new infectious diseases; global justice; and ecological ethics and planetary sustainability. Offering a diverse range of perspectives, this volume is essential for bioethicists, public health practitioners and philosophers.
Addressing global health is one of the largest challenges facing humanity in the 21st century, however, this task is becoming even more formidable with the accelerated destruction of the planet. Building on the success of the previous edition, the book outlines how progress towards improving global health relies on understanding its core social, economic, political, environmental and ideological aspects. A multi-disciplinary group of authors suggest not only theoretically compelling arguments for what we must do, but also provide practical recommendations as to how we can promote global health despite contemporary constraints. The importance of cross-cultural dialogue and utilisation of ethical tools in tackling global health problems is emphasised. Thoroughly updated, new or expanded topics include: mass displacement of people; novel threats, including new infectious diseases; global justice; and ecological ethics and planetary sustainability. Offering a diverse range of perspectives, this volume is essential for bioethicists, public health practitioners and philosophers.
Addressing global health is one of the largest challenges facing humanity in the 21st century, however, this task is becoming even more formidable with the accelerated destruction of the planet. Building on the success of the previous edition, the book outlines how progress towards improving global health relies on understanding its core social, economic, political, environmental and ideological aspects. A multi-disciplinary group of authors suggest not only theoretically compelling arguments for what we must do, but also provide practical recommendations as to how we can promote global health despite contemporary constraints. The importance of cross-cultural dialogue and utilisation of ethical tools in tackling global health problems is emphasised. Thoroughly updated, new or expanded topics include: mass displacement of people; novel threats, including new infectious diseases; global justice; and ecological ethics and planetary sustainability. Offering a diverse range of perspectives, this volume is essential for bioethicists, public health practitioners and philosophers.
Despite the rapid growth of the global health field over the past few decades, consensus on what qualifies as global health scholarship or practice remains elusive. We conducted a meta-knowledge analysis of the titles and abstracts of articles published in 25 journals labelled as global health journals between 2001 and 2019. We identified the major topics in these journals by creating clusters based on terms co-occurrence over time. We also conducted a review of global health definitions during the same period.
The analysis included 16 413 articles. The number of journals, labelled as global health, and articles published in these journals, increased dramatically during the study period. The majority of global health publications focused on topics prevalent in low-resource settings. Governance, infectious diseases, and maternal and child health were major topics throughout the analysis period. Surveillance and disease outcomes appeared during the 2006–2010 epoch and continued, with increasing complexity, until the 2016–2019 epoch. Malaria, sexual and reproductive health, and research methodology appeared for only one epoch as major topics. We included 11 relevant definitions in this analysis. Definitions of global health were not aligned with the major topics identified in the analysis of articles published in global health journals.
These results highlight a lack of alignment between what is published as global health scholarship and global health definitions, which often advocate taking a global perspective to population health. Our analysis suggests that global health has not truly moved beyond its predecessor, international health. There is a need to define the parameters of the discipline and investigate the disconnect between what is published in global health versus how the field is defined.
The influence of for-profit businesses in collective action across countries to protect and
promote population health dates from the first International Sanitary Conferences of the
nineteenth century. The restructuring of the world economy since the late twentieth
century and the growth of large transnational corporations have led the business sector
to become a key feature of global health politics. The business sector has subsequently
moved from being a commercial producer of health-related goods and services,
contractor, and charitable donor, to being a major shaper of, and even participant in,
global health policymaking bodies. This chapter discusses three sites where this has
occurred: collective action to regulate health-harming industries, activities to provide for
public interest needs, and participation in decision-making within global health
institutions. These changing forms of engagement by the business sector have elicited
scholarly and policy debate regarding the appropriate relationship between public and
private interests in global health.
A new context for ethics and ethics education is evident in a rapidly changing world and our threatened planet. The current focus on considerations of inter-personal ethics within an anthropocentric perspective on life should be extended to embrace considerations of global and ecological ethics within an eco-centric perspective on global and planetary health. The pathway to understanding and adapting to this new context includes promoting shifts in life styles from selfish hyper-individualism and wasteful consumerism towards cautious use of limited resources within an increasingly interdependent world in which the equal moral worth of all and sustainability are valued. Critical scholarly approaches to global politics and to the global political economy could facilitate such change and encourage iterative interactive processes instead of seeking conclusive definitive ‘scientific’ solutions to all problems. Hopefully this shift in perspective could be achieved firstly through sensitization to new and increasingly challenging ethical dilemmas, and then by encouraging rational thinking and action based on global and ecological considerations rather than on false economic dogma and the distorted workings of a market civilization. Moving ahead with these activities must begin with promotion of education, learning and self-reflection to foster the widespread development of a global state of mind. Such a shift would require an expanded ethical discourse, with consideration of ethical dilemmas beyond human inter-personal relationships. These should include intra-institutional and inter-institutional relationships, as well as relational ethics between nations in a post-Westphalian world, and between humans and nature in an era now called the Anthropocene, to ensure survival on a planet undergoing entropy.
A systematic and theoretically informed analysis of how extractive industries affect health outcomes and health inequities is overdue. Informed by the work of Saskia Sassen on "logics of extraction," we adopt an expansive definition of extractive industries to include (for example) large-scale foreign acquisitions of agricultural land for export production. To ground our analysis in concrete place-based evidence, we begin with a brief review of four case examples of major extractive activities. We then analyze the political economy of extractivism, focusing on the societal structures, processes, and relationships of power that drive and enable extraction. Next, we examine how this global order shapes and interacts with politics, institutions, and policies at the state/national level contextualizing extractive activity. Having provided necessary context, we posit a set of pathways that link the global political economy and national politics and institutional practices surrounding extraction to health outcomes and their distribution. These pathways involve both direct health effects, such as toxic work and environmental exposures and assassination of activists, and indirect effects, including sustained impoverishment, water insecurity, and stress-related ailments. We conclude with some reflections on the need for future research on the health and health equity implications of the global extractive order. URL: https://authors.elsevier.com/sd/article/S1353829217311966
Human security denotes a human-denominated, as opposed to State, focus for security. It highlights the duality of individual, universal—universalizable—human rights. This duality is central to the notion of human rights tied to human security. The idea of human security beyond borders is fundamentally an exercise in reimagining the traditionally State-based loci of responsibility for those individual but also universal human rights. This chapter introduces the challenges of geopolitical shifts compounded by unprecedented impacts of climate change, migration, and pandemic (potential). It makes a case for rethinking human security of citizens and non-citizens alike—beyond borders.
Successive global health crises - from HIV and AIDS to SARS and H5N1 to Ebola - highlight one of the most pressing challenges to global health security: the GAP - the governance accountability problem. Introduced in 2014 in the book entitled, HIV/AIDS and the South African state: The responsibility to respond, this article takes up Alan Whiteside's challenges, in a book review in these pages, to offer a more comprehensive analysis of the GAP. The GAP [Šehović, A. B. (2014). HIV/AIDS and the South African state: The responsibility to respond. Ashgate Global Health.] posits that there is a disconnect between ad hoc, state and non-state interventions to respond to an epidemic crisis, and the ultimate guarantee for health (security), which remains legally vested with the state. The existence and expansion of such ad hoc solutions result in a negligence: a failure of re-ordering of health rights and responsibilities for health between such actors and the accountable state. The GAP aims to highlight this disjunction. This article first defines the GAP. Second, it asks two questions: First, what is the contribution of the GAP thesis to understanding the emerging health security landscape? Second, what can the GAP offer in terms of practical insight into viable solutions to the re-ordering of state/non-state-based responsibility and accountability for global health security?
As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA)-based processes including ‘evidence-informed deliberative processes.’ However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like ‘evidence-informed deliberative processes’ could be one way of achieving this laudable goal.
The 2011 high-level meeting of the United Nations General Assembly on non-communicable diseases (NCDs), and subsequent developments in global public policy on NCDs can be seen as a contemporary case study in global health governance. As the debate on what constitutes appropriate and desirable governance continues, highly contrasting models are being compared as starting points. We define these as the global health initiative model and the convention/strategy model. Each has a different strategy at its core and represents a different response to key normative challenges that are said to plague global health governance – participation, scope of action, balancing power, legitimacy and effectiveness. As the current structure of the Global Coordinating Mechanism for NCDs within the WHO emerges as a possible new model, we argue that these normative challenges need to be addressed to safeguard against potential policy ineffectiveness.
The Ebola epidemic in West Africa is not merely a biomedical problem that can be seen in isolation and dealt with only through emergency medical rescue processes. The ethical dilemmas surfaced by this epidemic are also not confined to the usual micro-ethical problems associated with medical care and medical research. The pandemic, as one of many manifestations of failed human and social development that has brought the world to dangerous ‘tipping points’, requires deep introspection and action to address upstream causal processes.
The planetary boundaries framework defines a safe operating space for humanity based on the intrinsic biophysical processes
that regulate the stability of the Earth system. Here, we revise and update the planetary boundary framework, with a focus
on the underpinning biophysical science, based on targeted input from expert research communities and on more general scientific
advances over the past 5 years. Several of the boundaries now have a two-tier approach, reflecting the importance of cross-scale
interactions and the regional-level heterogeneity of the processes that underpin the boundaries. Two core boundaries—climate
change and biosphere integrity—have been identified, each of which has the potential on its own to drive the Earth system
into a new state should they be substantially and persistently transgressed.
Despite large gains in health over the past few decades, the distribution of health risks worldwide remains extremely and unacceptably uneven. Although the health sector has a crucial role in addressing health inequalities, its efforts often come into conflict with powerful global actors in pursuit of other interests such as protection of national security, safeguarding of sovereignty, or economic goals. This is the starting point of The Lancet-University of Oslo Commission on Global Governance for Health. With globalisation, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power: states, transnational corporations, civil society, and others. The decisions, policies, and actions of such actors are, in turn, founded on global social norms. Their actions are not designed to harm health, but can have negative side-effects that create health inequities. The norms, policies, and practices that arise from global political interaction across all sectors that affect health are what we call global political determinants of health. The Commission argues that global political determinants that unfavourably affect the health of some groups of people relative to others are unfair, and that at least some harms could be avoided by improving how global governance works. There is an urgent need to understand how public health can be better protected and promoted in the realm of global governance, but this issue is a complex and politically sensitive one. Global governance processes involve the distribution of economic, intellectual, normative, and political resources, and to assess their effect on health requires an analysis of power. This report examines power disparities and dynamics across a range of policy areas that aff ect health and that require improved global governance: economic crises and austerity measures, knowledge and intellectual property, foreign investment treaties, food security, transnational corporate activity, irregular migration, and violent conflict. The case analyses show that in the contemporary global governance landscape, power asymmetries between actors with conflicting interests shape political determinants of health. We identified five dysfunctions of the global governance system that allow adverse eff ects of global political determinants of health to persist. First, participation and representation of some actors, such as civil society, health experts, and marginalised groups, are insufficient in decision-making processes (democratic deficit). Second, inadequate means to constrain power and poor transparency make it difficult to hold actors to account for their actions (weak accountability mechanisms). Third, norms, rules, and decision-making procedures are often impervious to changing needs and can sustain entrenched power disparities, with adverse eff ects on the distribution of health (institutional stickiness). Fourth, inadequate means exist at both national and global levels to protect health in global policy-making arenas outside of the health sector, such that health can be subordinated under other objectives (inadequate policy space for health). Lastly, in a range of policy-making areas, there is a total or near absence of international institutions (eg, treaties, funds, courts, and softer forms of regulation such as norms and guidelines) to protect and promote health (missing or nascent institutions). Recognising that major drivers of ill health lie beyond the control of national governments and, in many instances, also outside of the health sector, we assert that some of the root causes of health inequity must be addressed within global governance processes. For the continued success of the global health system, its initiatives must not be thwarted by political decisions in other arenas. Rather, global governance processes outside the health arena must be made to work better for health. The Commission calls for stronger cross-sectoral global action for health. We propose for consideration a Multistakeholder Platform on Governance for Health, which would serve as a policy forum to provide space for diverse stakeholders to frame issues, set agendas, examine and debate policies in the making that would have an eff ect on health and health equity, and identify barriers and propose solutions for concrete policy processes. Additionally, we call for the independent monitoring of how global governance processes aff ect health equity to be institutionalised through an Independent Scientific Monitoring Panel and mandated health equity impact assessments within international organisations. The Commission also calls for measures to better harness the global political determinants of health. We call for strengthened use of human rights instruments for health, such as the Special Rapporteurs, and stronger sanctions against a broader range of violations by nonstate actors through the international judicial system. We recognise that global governance for health must be rooted in commitments to global solidarity and shared responsibility through rights-based approaches and new frameworks for international financing that go beyond traditional development assistance, such as for research and social protection. We want to send a strong message to the international community and to all actors that exert influence in processes of global governance: we must no longer regard health only as a technical biomedical issue, but acknowledge the need for global cross-sectoral action and justice in our eff orts to address health inequity.
The final report of the WHO Commission on the Social Determinants of Health is the culmination of a huge analytical effort to review the evidence and produce clear policy measures for achieving health equity. Further consideration needs to be given to an effective political strategy for taking forward these measures. Framing health equity in relation to global health, linking it to other key policy priorities, recognising that normative differences rather than lack of evidence lies at the heart of the problem, creating an appropriate institutional form for taking forward the Commission's recommendations, being prepared to challenge the status quo in global governance, and reflecting on the strengths and limitations of WHO's role in global governance should be part of such a strategy.
The structure of the control network of transnational corporations affects global market competition and financial stability. So far, only small national samples were studied and there was no appropriate methodology to assess control globally. We present the first investigation of the architecture of the international ownership network, along with the computation of the control held by each global player. We find that transnational corporations form a giant bow-tie structure and that a large portion of control flows to a small tightly-knit core of financial institutions. This core can be seen as an economic "super-entity" that raises new important issues both for researchers and policy makers.
The term social suffering describes collective and individual human suffering associated with life conditions shaped by powerful social forces.1 Unlike physical suffering or mental illness, it is largely unrecorded. New measures such as disability adjusted life years, designed to document the global distribution of morbidity in economic and individualistic terms, only barely represent a much more complex concept of suffering as a social experience and neglect most of what is at stake for people globally.2 Yet more than ever social suffering requires scholarly attention to facilitate cross cultural discourse and peaceful development in an increasingly interdependent world.1 2 3
Social suffering has evolved from the state of ignorance, vulnerability to nature, and terror associated with naked tyrannical power in the dark ages to the diverse suffering associated with wealth creating progress since the Enlightenment.2 In 16th century Europe enclosure of common land dispossessed the poor. A century later the industrial revolution generated abysmal working conditions in European factories. Pervasive forces in the 20th century continue to inflict suffering worldwide.
Since the Enlightenment demands for respecting human dignity have progressively ameliorated indignities suffered under oppressive rulers, industrialists, and slave owners. The Universal …
The importance of public policy as a determinant of health is routinely acknowledged, but there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin public policy influence people's health. This paper explores the possible reasons behind the absence of a politics of health and demonstrates how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategy and policy, and to more realistic and evidence-based public health and health promotion practice.
Is essential if we want to abolish poverty
Benatar explores the underlying reasons for our failure to make adequate progress in improving global health.
We are challenged to develop a public health approach that responds to the globalized world. The present global health crisis is not primarily one of disease, but of governance: its key characteristic is a weakening of public policy and interstate mechanisms as a consequence of global restructuring. The response needs to focus on the political determinants of health, in particular on mechanisms that help ensure the global public goods that are required for a more equitable and secure development. A first step in this direction would be to take up the proposal from the recent 6th Global Conference on Health Promotion to explore the possibility of a new type of global health treaty which would help to establish the new parameters of global health governance. National public health associations should take the lead to establish health as a global public good and organize "National Global Health Summits" to discuss the possible mechanisms for the necessary political process. This means putting global health governance issues onto the agenda of other sectors such as foreign policy, as health is critical not only for poverty reduction but for human security as a whole.
It is important to re-emphasize in conclusion that it was never the purpose of this volume to offer a single perspective or voice on questions of global governance. Rather it seeks to offer a continuum of perspectives encompassing not only critical theory (as opposed to problem-solving theory) but also what I call ‘critical problem-solving’. So what follows is my review of some of the new imaginaries and forms of praxis that may have a transformative impact on global governance at what might be suggested, is an historical crossroads in world order. They seek changes in the direction of historical forces so as to transform prevailing structures of subordination, exploitation and dispossession and associated tendencies towards health crises and despoliation of the biosphere. Such novel, radical paths towards the making of history can be related to new forms of political agency in the emerging figure of what I call the ‘post modern Prince’ (Gill 2000b).
Chapter 2 posed issues concerning the security of capital, the security of states (national or state security) and human security, with the latter understood as a basic condition of existence for not only sustainable but also progressive forms of social reproduction that allow human beings to express their species-being as defined in Chapter 2. So in Chapters 10 and 11, I address the question: What type of security and what institutions for social reproduction are being most protected in the emerging world order, by what and for whom?
In the 12 years since publication of the previous issue of this volume, the world has changed significantly. In addition to further widening of many of the disparities in health previously described, the impact and implications of the still evolving global economic crisis and of climate change have led to increasing recognition of how the ‘development’ agenda has failed, and that global health is one of the major challenges for the twenty-first century (Benatar and Brock, 2011). World population has increased to 7 billion people, half of whom continue to live in severe poverty (on less than US$2–3 a day), most in constant hunger and under squalid conditions, with little prospect of significant improvement unless new solutions are envisaged. This article discusses the health of citizens of very poor countries and the global interdependence of the health of all peoples, including the privileged.
What can be done about the poor state of global health? How are global health challenges intimately linked to the global political economy and to issues of social justice? What are our responsibilities and how can we improve global health? Global Health and Global Health Ethics addresses these questions from the perspective of a range of disciplines, including medicine, philosophy and the social sciences. Topics covered range from infectious diseases, climate change and the environment to trade, foreign aid, food security and biotechnology. Each chapter identifies the ways in which we exacerbate poor global health and discusses what we should do to remedy the factors identified. Together, they contribute to a deeper understanding of the challenges we face, and propose new national and global policies. Offering a wealth of empirical data and both practical and theoretical guidance, this is a key resource for bioethicists, public health practitioners and philosophers.
Summary Global health is arguably the most pressing moral challenge for human security and well-being in the twenty-first century. In seeking solutions to this, I begin by suggesting the need to acknowledge that the world is in a state of entropy. This is reflected in widening disparities in health across the planet (despite major advances in science and medicine and spectacular economic growth), the emergence and spread of many new infectious diseases, climate change and the recently evolving global economic crisis – all of which are already having devastating effects on population health. These trends will continue if we fail to take appropriate action, and they reveal the need for new paradigms of thinking and action that require a shift in the spectrum of our value system from one dominated by a highly individualistic, competitive, scientific, market approach to health and well-being to an orientation that, while retaining the best of these values, is more inclusive of solidarity, cooperation and socio-economic and ecological sustainability considerations. A thrust towards making such progress could be promoted by expanding the discourses on ethics and human rights, and by developing the global state of mind essential for progress in an increasingly interdependent world. Introduction It is becoming apparent to some scholars that global health is the most pressing moral challenge for human security and social well-being in the twenty-first century (Benatar 2005). If this is an accurate diagnosis (and I do not intend to provide the evidence or rationale for this here, as there is already a voluminous literature on this topic), then the next step towards seeking solutions is to achieve widespread acceptance of this diagnosis. Only then can we begin to consider and take appropriate action.
Tax struggle is the oldest form of class struggle. (Karl Marx, 1967, cited in O'Connor 1973, p. 10) Introduction In our earlier chapter we outlined a reading of the present global conjuncture which we characterized as one of “organic crisis.” The term was meant to invoke a paradoxical situation, one pregnant with possibilities for alternative ways in which global health might be improved, yet nevertheless a situation in which new alternatives have yet to emerge, or indeed to be born. We also noted how the broad-ranging nature of the organic crisis was characterized by a number of “morbid symptoms” such as deterioration in global health and global nutrition associated with the way in which capitalist social forces have come to determine increasingly not only whether we have access to useful and affordable health care, but also what we eat and whether we are actually able to eat. More broadly the deepening and extension of the power of capital – since capitalism is a system of power relations and power structures – has come to determine increasing aspects of social reproduction, our health and indeed the very means of survival for a large proportion of the inhabitants of the planet. We noted therefore that the global organic crisis involves a global crisis of accumulation, the dominant governmental responses to that crisis which have so far been one-sided, lean in favor of financial interests and big corporations, and how capitalism in crisis and its mode of relentless accumulation intersect with deepening and long-term threats to our social and ecological reproduction.
In previous work I have argued that reasonable indicators of our progress towards global justice include the extent to which: (1) all are enabled to meet their basic needs; (2) people's basic liberties are protected; and (3) social and political arrangements are in place to support these two goals, that is, that enable us to meet our basic needs and protect our basic liberties (Brock, 2005, 2009). How do we get from where we are now to where we should be? The issue of transitioning to any of our ideals of global justice has not received as much attention as it should. In this chapter I examine some measures that would close the gap between our current state of affairs and better enabling people to meet their basic needs. Current global poverty must be one of the most pressing obstacles to realizing global justice. The way in which we are depleting and destroying the global commons is another pressing and related issue. Failing to protect the global commons has a bearing not only on current and future global poverty, but indeed, on the capacity of the planet to provide a life-sustaining environment, and thus on everyone's ability to meet their basic needs. In the second part of the chapter I discuss how concern in this area can also ground a case for global taxation reforms.
This groundbreaking collection on global leadership features innovative and critical perspectives by scholars from international relations, political economy, medicine, law and philosophy, from North and South. The book's novel theorization of global leadership is situated historically within the classics of modern political theory and sociology, relating it to the crisis of global capitalism today. Contributors reflect on the multiple political, economic, social, ecological and ethical crises that constitute our current global predicament. The book suggests that there is an overarching condition of global organic crisis, which shapes the political and organizational responses of the dominant global leadership and of various subaltern forces. Contributors argue that to meaningfully address the challenges of the global crisis will require far more effective, inclusive and legitimate forms of global leadership and global governance than have characterized the neoliberal era.
The exercise of identifying lessons in the aftermath of a major public health emergency is of immense importance for the improvement
of global public health emergency preparedness and response. Despite the persistence of the Ebola Virus Disease (EVD) outbreak
in West Africa, it seems that the Ebola ‘lessons learned’ exercise is now in full swing. On our assessment, a significant
shortcoming plagues recent articulations of lessons learned, particularly among those emerging from organizational reflections.
In this article we argue that, despite not being recognized as such, the vast majority of lessons proffered in this literature
should be understood as ethical lessons stemming from moral failures, and that any improvements in future global public health emergency preparedness and response are in large part
dependent on acknowledging this fact and adjusting priorities, policies and practices accordingly such that they align with
values that better ensure these moral failures are not repeated and that new moral failures do not arise. We cannot continue
to fiddle at the margins without critically reflecting on our repeated moral failings and committing ourselves to a set of
values that engenders an approach to global public health emergencies that embodies a sense of solidarity and global justice.
While the current Ebola epidemic spiraled out of control to become the biggest in history, the global public health response has been criticized as "too little, too late." Many, like the World Health Organization, are asking what lessons have been learned from this epidemic. We present an analysis of the political economy of this Ebola outbreak that reveals the importance of addressing the social determinants that facilitated the exposure of populations, previously unaffected by Ebola Virus Disease, to infection and restricted the capacity for an effective medical response. To prevent further such crises, the global public health community has a responsibility to advocate for health system investment and development and for fundamental pro-poor changes to economic and power relations in the region.
This article argues for a radical conception of praxis in international relations. By praxis is meant those forms of critical theoretical and practical activity that are not only linked to understanding, explaining and acting in international relations but also transforming those relations to help constitute a more ethical, just and sustainable world order. The argument is developed as follows: (1) discussion of theoretical perspectives, and how they constitute dominant paradigms of International Relations in the West, particularly in the USA. Such dominant paradigms are shaped by a liberal ontology, opposed to Marxism and critical theory. (2) A critique of ‘imperial common sense’ that is bound up with US supremacy in an unjust world of deepening crises, growing inequality, social dislocations and unsustainable accumulation. Here my argument involves a dialectical strategy that critically addresses the nature, self-evidence and global influence of mainstream American International Relations. (3) A discussion of how new forms of praxis are emerging, seeking to develop radical alternatives that are sober, imaginative, sustainable and politically and ethically credible – in the multiple, diverse and new forms of political agency reflected in the figure of the ‘post-modern Prince’. The article concludes by outlining elements of a radical research agenda to address significant intellectual, ethical and public policy issues in the emerging world order.
Contradictions associated with the growth in the power of capital suggest that the prevailing discourse and forces of globalising neoliberalism may have failed to gain more than temporary dominance or supremacy. A period of global recomposition of social forces may be emerging to reconfigure world order. A central task of global political economy is to theorise possibilities for a democratic transformation of world order, in the context of consciousness, culture, and material life, so as to transcend the oxymoron of neoliberal 'market civilisation'.
Constitutional revision is a feature of the 1990s. Specifically, this involves initiatives to politically ‘lock in’ neo‐liberal reforms. These initiatives serve to secure investor freedoms and property rights for transnational enterprises. Yet students of international political economy have paid surprisingly little attention to the constitutional aspects of global restructuring. Thus this essay analyses the new constitutionalism of disciplinary neo‐liberalism, understood as the discourse of governance that informs this pattern of change. It is reflected in the World Bank's World Development Report 1997: The State in a Changing World. New constitutionalism operates to confer privileged rights of citizenship and representation to corporate capital and large investors. What is emerging within state forms (state & endash civil society complexes) is a pattern of authority in which capital has greater weight and representation, restraining the democratisation process that has involved centuries of struggle for representation—a development that is contested and contradictory.
This article takes the state of health in the world today as the starting point for a backward look at the trajectory that has led to our current position and speculation about prospects for improved global health in the future. Our model of social development and its dominant value system, which has promoted scientific progress but has also brought about great social, economic and health instability, is interrogated. This leads to questions such as what it means to be healthy and what the practice of medicine is about. Three potential scenarios for global health in the future are outlined. It is suggested that deep introspection about our current value system is required to achieve a paradigm shift that could reverse current trends and lead both to improvements in health globally and to less human insecurity. The authors conclude that while we have the material resources to achieve ambitious goals we may lack the moral and political will to do so. An expanded discourse on ethics and human rights—as well as on the limits of what is politically possible— may provide the impetus to drive change towards an improved global economic system and better health globally.
The megacities arising around the planet are like the Internet where many events are taking place simultaneously. The urban scape today is becoming more a space of flows—migrants, trade, capital, information, microbes—than a space of places rooted in an historical identity.
The megaurban condition today encompasses many realities, from the glittering generic city-state of Singapore to the slums climbing up the hillsides around Mexico City or Sao Paulo. In these spaces we work, love and live out the intimate moments of our lives. In these spaces we consume and spew out climate warming gases.
In this section, two of the world's “star architects”—Rem Koolhaas and Frank Gehry—the visionary “arcologist” Paolo Soleri and the Turkish novelist and Nobel laureate, Orhan Pamuk, grasp at chronicling the reality of where we live.
In the 60 years since the Universal Declaration of Human Rights was promulgated, the promise of achieving respect for the human rights, health and well being of all is becoming an ever more distant prospect. We have not even remotely met the challenge of improving health for a large proportion of the world's population, and the prospects for improving global health seem to be receding in the current deteriorating economic and political climate. As global health remains one of the most pressing problems of our time, we must question the values that direct our actions and current approaches, which proclaim 'human rights to health' but which subsume these rights to a broader paradigm of unregulated global market economics and national politics, rather than working to make these oft-contradictory goals mutually compatible through justifiable and accountable global governance processes. We suggest that a new balance of values and new ways of thinking and acting are needed. These must transcend national and institutional boundaries and recognise that health in the most privileged nations is closely linked to health and disease in impoverished countries. Sustainable development of health and well-being is a necessity for all, and values for health should permeate every area of social and economic activity.
There are two perspectives on the problem of human rights abuses: the perpetrator perspective and the system perspective. The perpetrator perspective focuses on the shortcomings of persons, blaming them for neglect, cruelty, or moral weakness, and it attempts correction through education, activism, and judicial intervention. The system perspective acknowledges that the social circumstances within which individuals live can surreptitiously co-opt otherwise good people into participating in human rights abuses. Here, the corrective approach needs to focus on the complex task of altering structures and functions of systems in order to overcome structurally propelled abuses of human rights, while at the same time recognizing the moral and legal importance of allocating individual blame for the violation of such rights.
In this paper, we propose a new model for development, one that transcends the North-South dichotomy and goes beyond a narrow conception of development as an economic process. This model requires a paradigm shift toward a new metaphor that develops sustainability, rather than sustains development. We conclude by defending a 'report card on development' as a means for evaluating how countries perform within this new paradigm.
The Lancet-University of Oslo commission on global governance for health. The political origins of health inequity: prospects for change
- Op Ottersen
- J Dasgupta
- C Blouin
Tackling the political origins of health inequality
- C Clift
On the lancet commission
- D Mccoy
Annual Human Rights Lecture
- S R Benatar
Fear’s Empire: War Terrorism and Democracy
- B Barber
Canada’s “maple spring” from the Québec student strike to the movement against neoliberalism
- I Solty
Let Them Eat Junk: How Capitalism Creates Hunger and Obesity
- Rr Albritton
85 richest people as wealthy as poorest half of the world
- Oxfam
Capitalism’s Achilles Heel: Dirty Money and How to Renew the Free-Market System
- Rw Baker
Ebola and lessons learned from moral failures: who cares about ethics? [published online ahead of print
- Mj Smith
- Reg Upshur