Global health and the new world order

Historical and anthropological approaches to a changing regime of governance

Jean-Paul Gaudillière, Claire Beaudevin, Christoph Gradmann, Anne M. Lovell, Laurent Pordié, David Cantor

• Publisher: Manchester University Press
• Year: 2020
• Print ISBN: 9781526149671
• eBook ISBN: 9781526149664
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

The phrase 'global health' appears ubiquitously in contemporary medical spheres, from academic research programs to websites of pharmaceutical companies. In its most visible manifestation, global health refers to strategies addressing major epidemics and endemic conditions through philanthropy, and multilateral, private-public partnerships. This book explores the origins of global health, a new regime of health intervention in countries of the global South born around 1990, examining its assemblages of knowledge, practices and policies.The volume proposes an encompassing view of the transition from international public health to global health, bringing together historians and anthropologists to analyse why new modes of "interventions on the life of others" recently appeared and how they blur the classical divides between North and South. The contributors argue that not only does the global health enterprise signal a significant departure from the postwar targets and modes of operations typical of international public health, but that new configurations of action have moved global health beyond concerns with infectious diseases and state-based programs.The book will appeal to academics, students and health professionals interested in new discussions about the transnational circulation of drugs, bugs, therapies, biomedical technologies and people in the context of the "neo-liberal turn" in development practices.

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Global health and the new world order: introduction

Claire Beaudevin, Jean-Paul Gaudillière, Christoph Gradmann, Anne M. Lovell and Laurent Pordié

The phrase ‘global health’ appears ubiquitously in contemporary medical spheres, from academic research programmes to websites of pharmaceutical companies. In its most visible manifestation, global health refers to strategies addressing major epidemics and endemic conditions through philanthropy (e.g. the Bill and Melinda Gates Foundation) and multilateral, public-private partnerships (e.g. the Global Fund against AIDS, Tuberculosis and Malaria). Within this context, global health can be understood as a series of concerted responses to the perceived failure of decades-long struggles against major infectious diseases in non-industrialized countries, culminating in the post-Second World War era of international health and development. Global health efforts appeal for action in favour of ‘neglected’ populations by focusing on access to innovative and existing treatments, particularly drugs.

More recently, the scope of global health has expanded to include non-communicable diseases, including psychiatric and neurological conditions, injuries, cardiovascular disease and cancer, as well as innovative screening and treatments, such as medical genetics. In all areas, global health carries a series of assumptions – from the primacy of metrics and evidence-based practices to the incorporation of human-rights and poverty-eradication principles – that seem to oppose the earlier era of international health and development.

This volume moves beyond acknowledgements of the discursive prominence of global health to examine deep transformations regarding the actors, the targets and the tools involved in the governance of health at the international level. We argue not only that the global health enterprise signals a significant departure from the post-war targets and modes of operation that were typical of international public health (1940s–80s) but also that new configurations of action have moved it beyond concerns with infectious diseases and state-based programmes.

Governing health worldwide: history, anthropology and the problem of transition

Global health is of course not meant to be the birth of a governance of health at the international level. Historians have discussed previous waves of health globalization with various ideas about their dynamics and periodization. If the circulation of people, germs and remedies is taken as the main feature, global stories of health often start with the Early Modern period and the colonization of the Americas. In contrast, when considering the existence of institutions, programmes and tools to intervene on the health of others, then the late nineteenth century and the climax of European colonization come to the fore. Rather than focusing on the legacies of these early phases, this volume investigates the relationship of global health to a third wave of health globalization, namely the era of international public health and the regime of health governance that dominated the second half of the twentieth century.

The first use of the term ‘global health’, according to a Pubmed database search, appears in the1940s, but the expression does not really become frequent until the 1980s. By 2015, over 20,000 articles concerned with global health could be identified through the Web of Science. One interpretation of this growth may be that the term itself serves as what sociologists of science call a boundary object, linking heterogeneous and novel forms of knowledge, practices and actors involved in health interventions at a worldwide level (Weisz et al., 2017). This view of global health as a marker of recent and large transformations in the governance of health at the international level is not really new. Both historians and anthropologists of medicine have addressed the changes of the late twentieth century, although in very contrasting ways.

To remind us of what we owe to the former, one may recall the classic 2006 paper by Brown, Cueto and Fee from their project on the history of the World Health Organization (WHO) (Brown et al., 2006). In their paper global health is – to a large extent – a political phenomenon placed in the context of geopolitics, development strategies and rivalry between international organizations. Focusing on the WHO and the United Nations (UN) system of intergovernmental democracy, they point to the intimate relationship that international public health maintained with the Cold War. Other authors like Birn (2009) and Chorev (2012), as well as Cueto, Brown and Fee in their recent monograph (2019), have operated within comparable framings. Similarly, Packard, in his monograph (2016), has argued for more long-term continuity but seems to confirm the centrality of the 1980s–2000s as a period of change. To the historian, global health appears as both response and adaptation to a new situation dominated by a neoliberal agenda, associated with the rise of the World Bank alongside (and sometimes displacing) the WHO in the area of health, the quantification of health as an economic factor, the generalization of public-private partnerships and alliances independent from the UN system and the call for mobilizing ‘civil society’ rather than nation-states.

Anthropologists bring a different perspective to this transition, by stressing heterogeneity within global health and the specificities of local realities. One of the most widely read ethnographies of global health, Julie Livingston's monograph on the only cancer ward in Botswana, illustrates this approach (Livingston, 2012). The improvised medicine which she describes challenges notions of universality by revealing global health to be a matter of practices under constraint. Oncology at the periphery, as opposed to, say, in New York, inevitably involves a cancer epidemic, which does not fit the global agenda of oncology research and treatment. The nature of this epidemic challenges the once-dominant idea of an epidemiological transition from infectious to chronic disease according to which low-income countries would eventually exhibit the same patterns found earlier in the industrialized North. Cancer cases in Botswana tend to develop from almost-forgotten viruses and are often poly-morbid with AIDS and tuberculosis (TB). Furthermore, patients exhibit critical advanced stages of the disease rarely seen in wealthier settings.

Yet, this oncology at the periphery is simultaneously global. In Botswana as in many places in Africa, the 1980s–90s turn away from international health and development was less about new responses than the destruction of old ones. The debt crisis and structural adjustment policies, with their parade of reduced public funding for health, tightening cost management and experimental introduction of patients’ fees, have left deep traces on an already ruined landscape that resonates with historical studies. The global percolates into the local with new forms of circulation linked to drug access, the interventions of public-private partnerships and philanthropic actors, from the Bill and Melinda Gates Foundation to pharmaceutical companies like Novartis.

What is at stake here is not the incompatibility of such historical and anthropological approaches. On the contrary, their combination has generated important insights in recent historical work about global health, for instance in explorations of medical experiments in East Africa (Graboyes, 2015), of mass therapeutic campaigns in French colonial Africa (Lachenal, 2014; Tousignant, 2012) or of the vestiges of medical research in West and East Africa (Geissler et al., 2016). Several anthropologists have also recently combined ethnographies of globalized health with historical approaches when attending, for instance, to HIV/AIDS, leprosy and malaria in Africa (Geissler, 2015), to traditional healing and its role in Tanzania (Langwick, 2015) or to the meaning of past ‘African science’ in a Ghanaian laboratory (Droney, 2014). However, this scholarship is characterized both by its scarcity and by its predominantly African focus, where historians and anthropologists have long and parallel experience in using oral histories.

As a consequence, the prevailing disconnection between historical and anthropological approaches in studies of international/global health has created a vast body of literature and two formidable gaps. The first is a temporal gap between the historiography of international public health through the 1970s and the numerous anthropological studies of global health in the present. In between the two periods lies the far less commonly analysed transition beginning in the 1980s–2000s. The second gap originates in problems of scale. Macro-inquiries of institutions and politics abound, as do micro-investigations of local configurations. Taken together, they omit intermediate spaces through which these levels might be linked, such as local and regional non-governmental organizations (NGOs), as well as objects and actors that circulate: experts, pharmaceuticals, tools and policies. With this book we contribute to filling these gaps through a stronger engagement between history and anthropology, an attention to the history of the present and a harnessing of concepts (circulation, scale, transnationalism) that cross the two disciplines.

Bringing historians and anthropologists into a closer conversation, at times based on integrated research, the book thus allows knowledge, practices and policies to be linked, while bridging the macro-history of post-war international health and the local anthropology of the present. We identify crucial and differentiated moments in the post-war trajectory of transnational health interventions. We define them in terms of diseases targeted, actors involved, expertise mobilized, tools employed and – given their importance in the turn to global – the relations between health, development and economy. The periodization, in which a sea-change occurs between the mid-1980s and the late 1990s, rests on our hypothesis that multiple practices of health globalization were already in existence by, or first appeared at, the end of the Second World War. The consequence is that one can, for analytical purposes, con...

Table of contents

• Cover
• Half-title page
• Series page
• Title page
• Copyright page
• Contents
• Contributors
• Acknowledgements
• Abbreviations
• 1 Global health and the new world order: introduction
• 2 Standardization and localization in tuberculosis control
• 3 The not-so-distant past, tuberculosis and the DOTS challenge
• 4 Decolonizing, nationalizing and globalizing the history of psychiatry: from colonial to cross-cultural psychiatry in Nigeria
• 5 ‘Clearing the streets’: enacting human rights in mental health care in Ghana
• 6 You’ve got the point? Acupuncture and the techno-politics of bodyscape
• 7 Finding the global in the local: constructing population in the search for disease genes
• 8 Rare genetic disease, global health and genomics: the case of R337h in Brazil
• 9 The World Health Organization’s response to Ebola in historical perspective
• 10 Epilogue: in search of global health
• Index