Global Health as a Field of Power Relations: A Response to Recent Commentaries

Abstract

Actors working in global health often portray it as an enterprise grounded in principled concerns, advanced by individuals and organizations who draw on scientific evidence to pursue health equity. This portrait is incomplete. It is also a field of power relations-a social arena in which actors claim and draw on expertise and moral authority to gain influence and pursue career, organizational and national interests. A clear understanding of how power operates in this field is necessary to ensure that it is used productively to serve the aims of health equity and improved population health. Responding to commentaries on an editorial published in this journal, I offer 3 ideas toward this end: (1) be skeptical of the global health rationality project-the effort to rescue the field from the alleged indignities of politics through the application of scientific methods; (2) analyze global health as a field of power relations, a concept developed by sociologist Pierre Bourdieu; and (3) elevate the place of input legitimacy-inclusive deliberation, fair process and transparency-to address legitimacy and knowledge deficits in this field.

Perspectives on power relations in human health and well-being

“…All human relationships thus incorporate power relations in different contexts (Bradbury-Jones, Sambrook, & Irvine, 2008; Kuokkanen & Leino- Kilpi, 2000). Global health—like the arts, law, and medicine—is a social arena with specific rules, but one where people hold unequal positions (Shiffman, 2015). In the area of healthcare, providers have more power and expertise than clients (Brown, 2016), and in contexts that incorporate older people, unequal power relations are common (Eliassen, 2016).…”

Key Ethical Issues Discussed at CDC-Sponsored International, Regional Meetings to Explore Cultural Perspectives and Contexts on Pandemic Influenza Preparedness and Response

“…Likewise, substantive ethical differences need not pose a serious impediment to pandemic preparedness efforts especially if more attention is paid to procedural ethics, that is, to procedures that ensure transparency, consistency, inclusiveness, and a fair hearing of concerns in a deliberative format. 45 If any lesson is learned from past pandemics, it is that each one informs our response to the next. Likewise, the ethical issues raised by past public health emergencies should serve to better prepare ourselves to effectively respond to the next emergency.…”

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

“…As Shiffman observes, power struggles are inextricably part of the global health landscape, including in relation to the important role of networks in governance reform. 62 Scientific evidence is vital to advancing progress, but normative questions of resource allocation and equitable provision of public goods require political and social debate that empirical methods alone cannot address. In this sense, this study of power relations among networks suggests that there is a highly productive role for politics in global public health.…”