Can the Sick Speak? Global Health Governance and Health Subalternity

Abstract

Global Health Governance (GHG) uses a set of financial, normative, and epistemic arguments to retain and amplify its influence. During the COVID-19 pandemic, the GHG regime used its own successes and failures to prescribe more of itself while demanding further resources. However, the consistent failures of this form governance and its appeasement to a dominant neoliberal ideology lead to the following question: Is the global health governance regime failing at its goal of improving health or succeeding at other political and ideological goals that necessitate such failures? Using concepts and ideas from social theory and post-colonial studies; I examine the definitions, epistemic basis, and drivers of GHG and propose certain conditions for the legitimacy of a global health governance system. Examining historical and current cases, I find that the GHG regime currently fails to fulfil such conditions of legitimacy and instead creates spaces that limit rather than help many populations it purports to serve. Those spaces of sickness confine people and reduce them into a state of health subalternity. In being health subalterns, people’s voices are neither sought nor heard in formulating the policies that determine their health. Finally, I argue that research and policymaking on global health should not be confined to the current accepted frameworks that assumes legitimacy and benevolence of GHG, and propose steps to establish an alternative, emancipatory model of understanding and governing global health.

Grandmother-inclusive intergenerational approaches: the missing piece of the puzzle for ending FGM/C by 2030?

“…We argue that youth-focused programmes and grandmother-exclusionary bias reflect several assumptions underpinned by coloniality of knowledge, namely when Euro-North-American-centric cultural norms shape academic research, theory, policy decisions, and intervention strategies (Khan et al, 2021 ; Aloudat, 2022 ; Newman, 2023 ).…”

“…Our evidence for grandmother-exclusionary bias derives from a critical discourse analysis of seven reports published between 2015 and 2021 by the UNFPA and UNICEF in relation to the JPEFGM, which made recommendations of which community members to engage as change agents in FGM/C programmes (Newman, 2023 ). Based on a review of secondary literature on health-related behavior strategies, we propose that grandmother-exclusionary bias reflects coloniality of knowledge in global health and gender and development, which is when Euro-North-American-centric cultural norms underpin academic research, theory, policy, and intervention strategies (Khan et al, 2021 ; Aloudat, 2022 ).…”

The WHO pandemic treaty: where are we on our scepticism?

“…This is a worthy objective and such a platform could strengthen access to medicines during emergencies as well as routine supplies, particularly, diseases that disproportionately affect the continent, as demand for COVID-19-related products recedes. However, building on lessons from ACT-A,19 it will be crucial to take cognisance of the existing gaps in governance that exist in many international organisations, by ensuring the needs and interests of communities are well represented in order to ensure accountability to the people whose lives it determines 20. As such, the design and operationalisation of the WHO-proposed framework and its mechanism of governance must be organised around national and regional ownership that engender locally and regionally driven solutions, adaptable to local health needs and context, with inclusion of national and regional stakeholders in decision-making, in order to stop epidemics when and wherever they occur 21…”

“…However, building on lessons from ACT-A, 19 it will be crucial to take cognisance of the existing gaps in governance that exist in many international organisations, by ensuring the needs and interests of communities are well represented in order to ensure accountability to the people whose lives it determines. 20 As such, the design and operationalisation of the WHO-proposed framework and its mechanism of governance must be organised around national and regional ownership that engender locally and regionally driven solutions, adaptable to local health needs and context, with inclusion of national and regional stakeholders in decision-making, in order to stop epidemics when and wherever they occur. 21 One way to do this is to consolidate regional efforts in Africa such as the Partnership for Africa Vaccine Manufacturing that aims to scale local vaccine manufacturing from 1% to 60% by 2040.…”

Antiracism in leading public health universities, journals and funders: commitments, accountability and the decision-makers

“…Public health is, in many respects, a field that centres human rights and justice for all. However, while these ethical values are embedded in the constitution of the WHO and enshrined in the mottos of many global public health organisations, in practice these decades-long commitments have sometimes been characterised as ‘lip service’,1 2 in the face of continued inequity—not only in health outcomes, but in how we get to those outcomes 3. In May 2020, as the world grappled with the first wave of the COVID-19 pandemic, the violent murder of George Floyd forced a greater reckoning with the systems and structures upholding racial oppression.…”