What is the Boundary of Global Health?
By Manning Zhang
The challenge of defining global health is intricately linked to the ambiguity surrounding the term "global". Based on a definition in political sociology, the term globalization refers to the trend witnessed after World War II, where international governmental and nongovernmental organizations reorientated material benefits, identities, and rights (Moore et al., 2011). In the meantime, global financial institutions and multinational corporations mushroomed, which accelerated immigration and flows of economic and cultural resources (Moore et al., 2011). Although global health is closely related to the construct of globalization, the global interaction of health practices can be dated back to colonial times.
Koplan et al. (2009) compared the framework of public health, international health, and global health and found that the three fields shared concentrations on preventive medicine and underserved populations, and have similar perceptions that health is a public good to be maintained by public systems and structures . They argue that the term “global” refers to the commonality of health problems across national borders, as well as the determinants of health that do not reside in one single country (Koplan et al., 2009, p. 1994). Different from international health, Koplan et al (2009) contend that global health highlights the relationship and the exchange of knowledge and resources between developed and developing countries.
This definition illustrates the interconnectedness between health and international relations. However, there is still a need for a critical examination of how developed countries utilize health as a means to conduct surveillance and control in developing countries. This can reinforce the imbalances in economic and political order that exist within the global society. The history of global health began with colonial entanglements, and the transition from colonial health to international health to the emerging field of global health does not suggest that health resources and opportunities are distributed more equally globally but reflects that the political maneuvers are turned into less political and even apologetic terms in medicine and biomedicine in the postcolonial context.
This process is further complicated by the existence of various stakeholders including governments and non-governmental organizations. Packard (2016) discussed how the International Health Commission (IHC, with the previous name the International Health Board, or IHB) used the Hookworm campaign in the British Caribbean, South America, and East Asia to advance Western disease-control models in the first three decades of the twentieth century. He points out that the colonial roots of this organization and its campaigns deeply shaped their opinions toward developing countries. The belief that developing countries are incapable, less civilized, and scientifically backward renders their campaign top-down and ignorant of the local context of the countries and the communities with whom they are working (Packard, 2016, pp. 39–41).
As for international organizations, while it is hard to resist the urgency of the member states, they do not completely mirror these external demands (Chorev, 2012, pp. 1–3). Chorev uses the case of the World Health Organization (WHO) to illustrate that member states may utilize international organizations’ dependence on financial resources, vote on significant initiatives, and legitimacy support to leverage their ideal policy outcomes (Chorev, 2012, pp. 25–27). Nevertheless, it is not an uncommon practice for international organizations to yield passive compliance to create resistance to fulfill their independent goals, such as selectively adopting relatively radical requirements of developing countries (Chorev, 2012, p. 33). However, the WHO secretariat took two significantly iconoclastic steps respectively in the 1970s and the 1990s. The first practice is to draw on the New International Economic Order (principles) to safeguard its legitimacy when confronted with challenges from developed countries regarding its jurisdiction. (Chorev, 2012, p. 122). The second practice is to promote the concept of “new universalism” as a strategic response to the developed countries’ requirement to establish an international neoliberal order. Global health researchers apply the lenses from organization studies and international relationships to clarify the economic, political, and cultural forces intertwined with health issues in the international community.
Another perspective to scrutinize “global” in global health is to see the domestic response to the exogenous global health practices in the interventionist and non-interventionist forms. Medical science and knowledge provide an invisible but violent frontier to negotiate international socio-political orders. In the United States, the Bayh-Dole Act was created in 1980 to incentivize the commercialization of medical research. The steady increase in the US domestic academic patenting and related revenues, along with the passage of the WTO TRIPS agreement which extends the United States Intellectual Property Law to the rest of the world, accelerated the emulation of the Bayh-Dole model in the legislation of other countries. Murphy Halliburton (2017) examines how the patent law introduced in India as a result of World Trade Organization regulations is being utilized to restrict the exportation of affordable pharmaceutical products to the markets of developed countries and other middle-income nations. Thus, this law introduces an indirect impact on widening the disparity in health equity in other countries, that are dependent on Indian exported medications to treat HIV/AIDS, such as China, Brazil, and other middle-income countries in Latin America (Halliburton, 2017, p. 112). Halliburton’s research also suggests that practitioners of traditional Ayurvedic medicine in India do not have a consistent attitude in response to the challenge of the new patent law, which renders them vulnerable in the new environment (Halliburton, 2017, p. 147).
Medical science and knowledge can also impact global health through body surveillance. For instance, biomedical and biotechnological research on stem cells is faced with excessive licensing fees and censorship (Benjamin, 2013; So et al., 2008). But in California, the influential stem cell advocacy led to the passage of Proposition 71, which provided financial and administrative support for stem cell research. However, through the lens of bioconstitutionism, Ruha Benjamin found out that the populist language used in stem cell advocacy created an exclusive “public”, which simplified the Deafness identity, entrenched the exclusion of African American people from both donating tissue and receiving treatment, and ignored the increasing uncertainties for socially subordinate women to be coerced into egg donation both within and beyond the US borders (Benjamin, 2013).
These risks have been evident in the case of global stem cell tourism. Stem cell tourism refers to the unethical practice of supplying patients with untested cellular products, and the majority of these clinics are located in low- and middle-income countries, even though the US is the biggest stem cell tourism destination (Connolly et al., 2014; Julian et al., 2018; Lyons et al., 2022). The relatively lower cost and the perceived high quality of treatment, as well as the wide spectrum of target diseases advertised, have motivated patients in developing countries to travel abroad and pursue such unguaranteed services, despite the effects of COVID-19 (Connolly et al., 2014; Turner, 2020). However, in countries where stem cell clinics are prevalent, oversight agencies cannot provide de facto restrictions over these businesses, and the deadly consequences of medical malpractice are difficult to hold accountable (Julian et al., 2018).
Different from other scholars who portray the patients as blind risk-takers, Alan Petersen and his colleagues refer to stem cell tourism as “hopeful travails”, and examine how different stakeholders such as public investors, governments, and scientists in the field of stem cell treatment construct hope and optimism surrounding the industry and practices (Petersen et al., 2014, 2017). Among all the conditions claimed to be treatable by stem cell therapies, the most marketable ones are chronic diseases and biogerontological measures, such as anti-aging procedures, Multiple Sclerosis, Parkinson’s disease, and stroke (Connolly et al., 2014; Julian et al., 2018; Lyons et al., 2022). The imagined future outcomes are essential for people who are plagued by these incurable problems. Petersen et al. also use the perspective “political economy of hope” introduced by Nicolas Rose and Carlos Novas to describe the various forms people use to influence the direction of science (Petersen et al., 2014; Rose & Novas, 2005, p. 451). Both their frame of hope and Ruha Benjamin’s frame of bioconstitutionalism, contribute to the discussion on individuals’ agency in front of the order of medical knowledge and technology in the global context. While global health is commonly framed as a region-level, or country-level construct, where economic and political maneuvers are led by elites, researchers must recognize the importance of individual self-determination and the grassroots movements that can effect change in the prevailing system.
Critical scholarly works on global health may have diverse focal points, but they converge on a common central question: Who’s interest comes first? The examination of how health research, campaigns, and education have been utilized to exclude marginalized populations’ benefits and to exacerbate the global disparities in economic and health outcomes, challenges Koplan et al.’s (2009) definition of global health as a public good. Seye Abimbola and Madhukar Pai (2020) raised a critical question in their Lancet paper: Will global health survive its decolonization? They contend that the pervasive supremacist remnants of colonization exist in different aspects of global health, including displays of class, caste, religious, racial, and ethnic superiority (Abimbola & Pai, 2020). They underscore the importance of mutual learning instead of reinforcing dependence between the high-income countries, and low-income and middle-income countries (Abimbola & Pai, 2020). How can sociology studies, with its strength in theoretical establishments, contribute to the decolonization of global health?
References:
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