A Ghost in the Machine? Politics in Global Health Policy

In his recent commentary, Gorik Ooms argues that "denying that researchers, like all humans, have personal opinions … drives researchers' personal opinion underground, turning global health science into unconscious dogmatism or stealth advocacy, avoiding the crucial debate about the politics and underlying normative premises of global health. " These 'unconscious' dimensions of global health are as Ooms and others suggest, rooted in its unacknowledged normative, political and power aspects. But why would these aspects be either unconscious or unacknowledged? In this commentary, I argue that the 'unconscious' and 'unacknowledged' nature of the norms, politics and power that drive global health is a direct byproduct of the processes through which power operates, and a primary mechanism by which power sustains and reinforces itself. To identify what is unconscious and unacknowledged requires more than broadening the disciplinary base of global health research to those social sciences with deep traditions of thought in the domains of power, politics and norms, albeit that doing so is a fundamental first step. I argue that it also requires individual and institutional commitments to adopt reflexive, humble and above all else, equitable practices within global health research. Keywords: Global Health, Norms, Power, Interdisciplinarity, Reflexivity, Equity Copyright: © 2016 by Kerman University of Medical Sciences Citation: Forman L. 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.

Section: Resultsmentioning

confidence: 99%

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"

Forman

2015

“…These interviews were designed to follow-up on written responses to a larger survey, described below, and respondents were chosen randomly within seven different constituency groups that had made commitments (ie, governments, donors/foundations, UN/multilateral, NGOs, health professional associations, private sector, and academic and training institutions). The author was permitted by the Partnership to insert specific questions of relevance [3] for this research paper into the interview guide in order to probe perceptions and beliefs of the respondents about the construction of the Global Strategy and related commitments. The questions were meant to be the same for all key informants (40 in total, representing a third of the respondents who had submitted responses to the written survey); however, in practice, the questions on advocacy were listed at the end of the interview, and time did not always permit full and complete answers.…”

Section: 28mentioning

confidence: 99%

“…Therefore, policymaking is a fundamentally political and social process in the field of global health, despite the frequent assertion that global health policy should rest on a scientifically neutral, evidence-based foundation, marked by principled decisionmaking, rather than interest-based politics. 3 Indeed for some, evidence-based advocacy is seen as deliberately political in nature, projecting public health as an outcome of correctly applied technical and operational solutions, and downplaying the complexities of social and political change. 4 What is accepted as evidence-based in global public health areas often rests on the power of scientific and technical elites to determine the themes and terms of debate, which can exclude non-technical actors or non-elites from that process, creating a "de-democratising" effect in the policy-making process.…”

Section: Introductionmentioning

confidence: 99%

Power and Politics in the Global Health Landscape: Beliefs, Competition and Negotiation Among Global Advocacy Coalitions in the Policy-Making Process

McDougall¹

2016

Background: Advocacy coalitions play an increasingly prominent role within the global health landscape, linking actors and institutions to attract political attention and resources. This paper examines how coalitions negotiate among themselves and exercise hidden forms of power to produce policy on the basis of their beliefs and strategic interests. Methods: This paper examines the beliefs and behaviours of health advocacy coalitions using Sabatier's Advocacy Coalition Framework (ACF) as an informal theoretical lens. Coalitions are further explored in relation to the concept of transnational advocacy networks (Keck and Sikkink) and of productive power (Shiffman). The ACF focuses on explaining how policy change takes place when there is conflict concerning goals and technical approaches among different actors. This study uses participant observation methods, self-reported survey results and semistructured qualitative interviews to trace how a major policy project of the Millennium Development Goal (MDG) era, the Global Strategy for Women's and Children's Health, was constructed through negotiations among maternal, newborn, and child health (MNCH) and sexual and reproductive health and rights (SRHR) advocacy coalitions. Results:The Global Strategy represented a new opportunity for high-level political attention. Despite differing policy beliefs, MNCH and SRHR actors collaborated to produce this strategy because of anticipated gains in political attention. While core beliefs did not shift fundamentally and collaboration was primarily a short-term tactical response to a time-bound opportunity, MNCH actors began to focus more on human rights perspectives and SRHR actors adopted greater use of quantifiable indicators and economic argumentation. This shift emphasises the inherent importance of SRHR to maternal and child health survival. Conclusion: As opportunities arise, coalitions respond based on principles and policy beliefs, as well as to perceptions of advantage. Global health policy-making is an arena of contested interests, power and ideas, shaped by the interaction of coalitions. Although policy-making is often seen as a process that should be guided by evidence rather than interest-based politics, this study concludes that a participatory process of debate among different actorcoalitions is vital to progress and can lend greater legitimacy, accountability and transparency to the policy process. Implications for policy makers • The increase of global resources for reproductive, maternal, newborn, and child health (RMNCH) is a result of intensified coordination of actors in the effort to achieve the Millennium Development Goals (MDGs). • Understanding how transnational policy coalitions think, compete and negotiate with each other is vital to understanding how they have come to wield increasing influence in global health at a time of declining state dominance. • Global-level policy-making is legitimated and made more accountable by the participation of multi-constituency actor coalitions, including coal...

“…Today WHO has less financial power, in a world where funds are much more diffused, and where many organizations compete to access health resources and to influence the global health agenda. But also, WHO's moral authority has been undermined (partly because of the changed economic landscape), and its expertise is often challenged by other organizations (4,5). Shiffman points to the example of the International Health Metrics Institute (IHME) and the extent to which its expertise -measuring the global burden of disease -has impacted on discourse and priorities in the field of global health, leading to contention over global figures on malaria.…”

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confidence: 99%

Knowledge and networks – key sources of power in global health Comment on "Knowledge, moral claims and the exercise of power in global health"

Hanefeld

Walt

2015

Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today.