Frames, Paradigms and Power: Global Health Policy-Making under Neoliberalism

Abstract

The study of global health governance has developed rapidly over recent years. That literature has identified a range of factors which help explain the ?failure? of global health governance, but it has largely neglected the global public policy processes which perpetuate that failure. In this paper we argue that there is such a thing as ?global health policy? and set out a new framework for analyzing the processes through which it is made, highlighting the mixture of power and ideas, agency and structure, which impact upon the policy cycle. The framework rests upon four pillars: framing; paradigms; power; and the ?deep core? of neoliberalism. Through integrating insights from a range of literatures, in particular from the global health governance and public policy analysis fields, we seek to enrich the conceptual basis of current work on global health governance.preprintPeer reviewe

The politics of researching global health politics Comment on "Knowledge, moral claims and the exercise of power in global health"

“…I would not disagree with any of those examples, but the list risks creating the impression that only a specific form of expertise -'health expertise' -confers power on actors in global health. Contrary to this, it seems clear that other forms of 'outside' expertise have become increasingly influential in global health over the past two decades -not least by virtue of the global reach of neoliberal ideology (12). Interestingly, this has not been the result of an externally-driven 'hostile takeover' of global health -quite the reverse: it has often been the result of global health actors consciously seeking to bring in new forms of knowledge and expertise which are thought to offer new approaches (and, in productive power terms, new concepts and categorizations).…”

The Ghost Is the Machine: How Can We Visibilize the Unseen Norms and Power of Global Health? Comment on "Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health"

“…The global dominance of neoliberal economic logics provides another case in point, forming a "deep normative core" in global health governance that profoundly influences the range of policy preferences and solutions deemed useful for solving problems and which effectively limit "what is sayable, doable, and even thinkable in global health governance. " 5 One visible outcome is a prioritization within global health governance, policy and research of technical and financial approaches to global health, which frame the imperative of global health intervention as a question of investment with 'impressive returns. ' 6 Certainly this approach contrasts with the traditional neoliberal view of health and social spending as an unproductive obstacle to free markets, animated most notoriously in the social spending restrictions of the structural adjustment programs of the 1980's and 1990's as well as in prevalent austerity policies adopted after the financial crises of the past decade.…”

Addressing trade policy as a macro-structural determinant of health: The role of institutions and ideas

“…(Scott-Samuel and Smith, 2015, Smith, 2013a, Lynch, 2017, Smith and Joyce, 2012), they can be attributed to institutionalised norms such as neoliberalism and a dominant biomedical approach to health that sit at odds with thinking about addressing broader social determinants of health. Neoliberalism, the prevailing economic paradigm since the 1980s, focuses on individual responsibility for health behaviours and outcomes, and fails to recognise the broader structural factors that have been shown to be crucial in explaining health outcomes (Navarro, 2007b, Rushton and Williams, 2012, Navarro, 2009, Navarro, 2007a, ScottSamuel and Smith, 2015, Smith, 2013b. Similarly, the biomedical approach looks for causes of illness proximal to the individual such as pathogens or individual behaviours rather than the broader structural factors that shape pathogen spread or influence the behaviour of individuals within a population (Glasgow and Schrecker, 2016, Bambra and Schrecker, 2015, Birn et al, 2009, Baum et al, 2013.…”