On May 19 this year, U.S. President Donald Trump threatened to permanently cancel U.S. payments to the World Health Organization (WHO). One month earlier, Trump had already announced that the U.S. would not honour its biannual 500 million USD commitment. The next day, the Bill and Melinda Gates Foundation stated that they would donate an additional 150 million to the WHO, on top of a previous 100 million USD. The Gates’ largesse precedes COVID19. Since 2000, their foundation has granted almost four billion USD to the WHO to support a gigantic program against polio, and additional hundreds of millions for other programs on malaria, HIV, and maternal health, and the escalated use of technology in health. The Gates Foundation is a crucial contributor to the WHO, second only to the U.S.
Despite its pre-existing involvement with the WHO, the Gates Foundation’s statement surprised many. The public wondered how it could be possible for a private actor to replace the contribution of a state to an international organization. In reality, there is nothing to be surprised about. For at least a century, philanthropic foundations have funded international organizations involved in health issues, including fighting pandemics, or even conducted what we call today global health policy. Actually, the continuities are so fundamental that the foundations from the early twentieth and the early twenty-first century seem to choose to globally fund health policies for similar reasons. Because the arguments are similar, and the means they used comparable, the criticisms raised against philanthropic foundations generally and their health policies also remain remarkably stable. The similarities between the past and the present suggest that the criticisms are here to stay. Indeed, certain observers would venture that older and newer philanthropic foundations are built upon the same questionable bases: unequal income distribution and lack of transparency and accountability.
Note: A shorter version of this post was published earlier on Duck of Minerva.
Politics, as famously defined by David Easton, is the “authoritative allocation of values”, such as welfare, security, and liberty. Politicians thus have to make decisions on hierarchies between these values – and they have to weigh values against each other in cases in which they collide. It is still too early for an in-depth analysis of the numerous norm collisions in the responses to the COVID-19 pandemic. And yet, we can already see how the previously found balance between the three aforementioned values, and the norms revolving around them, is destabilised.
In many countries around the world, the WHO is currently setting the agenda for a strategy to contain the Covid-19 pandemic. Its campaigns and recommendations on how to deal with Covid-19 are, though not entirely uncontroversial, widely distributed, while reaffirming one of its central roles: that of the epidemiological expert and crisis advisor, especially for poor countries.
Imagine the World Health Organization (WHO) had declared the outbreak of the mysterious lung ailment in the Chinese city of Wuhan a potential public health emergency of international concern already in late December 2019. Imagine it had immediately decreed a precautionary lockdown of the metropolitan area until the severity of the illness was assessed or the virus extinct. It might have been just in time to halt the spread of the disease which by now has become a supreme global emergency of unforeseen proportions.
Of course, this scenario was far from realistic given the WHO’s limited mandate and political authority. In reality, far from stopping the crisis dead in its tracks, its approach of appeasement and applause vis-à-vis China may have exacerbated the situation. The coronavirus crisis exposes deep gaps in the global governance of infectious diseases. Tragically, rectifying those problems would mean painful adaptations not only at the costs of national sovereignty, but also of democracy and constitutionalism.
As more and more people are voluntarily or forcefully retreating to their homes and isolating themselves from public life and social contact due to the ongoing global health crisis, it might be a good time to reflect on the circumstance that, according to estimates by WHO and UNICEF, in 2018 globally every five seconds a child or young person under 15 died of preventable infectious diseases, such as measles, or of complications in childbirth – many of them a consequence of unsafe births, lacking personnel, equipment, hygiene, infrastructure, and poor maternal health. A few days ago, I met an acquaintance, whose school-aged children have not been vaccinated against measles, carrying a stack of toilet paper packages in preparation for what was bound to come, the German-wide COVID-19 lockdown. The encounter made me aware of the imbalance between our plausible and humane concern for the safety and well-being of ourselves and those close to us on the one hand and a lack of awareness of our own role in preserving public health beyond COVID-19 on the other.
Zur Jahrtausendwende besaß Frankreich nach Angaben der WHO eines der besten Gesundheitssysteme weltweit. Zwei Jahrzehnte später sieht das Land dem Verlust seiner Führungsrolle in der Gesundheitspolitik entgegen, wie sowohl die abnehmende Beteiligung französischer Experten in internationalen Einsatzfeldern als auch der wachsende Druck auf den nationalen Gesundheitssektor durch Personalmangel und Beschäftigtenstreiks zeigen. Diese Phänomene können nicht getrennt voneinander analysiert, sondern müssen als Teil derselben Entwicklung begriffen werden, wie Claire Galesne in ihrem neuen Blogpost schreibt. Zu lange hätten sich die Politik wie auch die Fachliteratur nur auf den Globalen Süden konzentriert und dabei entwickelte Industrienationen aus den Augen verloren, wo in den letzten Jahren Probleme wie Unterfinanzierung, regionale Unterschiede in der Lebenserwartung sowie ein Anstieg nichtübertragbarer Krankheiten eine zunehmende Belastung darstellen. Das Beispiel Frankreichs zeigt, dass Expert*innen gut darin beraten wären, sich in Ländern mit hohem Einkommen nicht nur um die öffentliche Gesundheitsversorgung zu fördern und sich in Niedriglohnländern nicht nur um Medikamentenpreise zu kümmern. Mehr dazu gibt es im gesamten Artikel auf Englisch hier.
At the turn of the millennium, France had the best healthcare system in the world, according to the World Health Organisation (WHO), and it became a Global Health leader by contributing to setting up and funding key Global Health initiatives, such as UNITAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Almost two decades later, the government faces an unprecedented strike in the emergency services, while experts worried about the decrease in French expertise and influence in Global Health. France’s health leadership thus seems to be challenged both at the national and international level. This parallel is quite striking because, traditionally, the Global Health literature is blind to health development in donors’ countries. Rather it studies primarily interventions by high-income countries in the Global South. In this blog post, I want to understand how these domestic and foreign health issues can be related through an analysis of the French case.
Wo staatliche Gesundheitsversorgung nicht garantiert ist, muss das Bestehen einer Grundabdeckung anderweitig sichergestellt werden. Zahnärztliche Therapeut*innen in entlegenen Gegenden sind das Musterbeispiel für die Bereitstellung solcher Dienstleistungen. Was in den 1920er Jahren in Neuseeland begann, findet sich mittlerweile in über 53 Ländern von Australien bis Simbabwe. Doch nicht nur das – die weltweite Verbreitung dieses Berufsfeldes zeigt überdies die erstaunliche Dynamik peripherer Diffusion in einer globalisierten Welt. In gängigen (Imperialismus-) Theorien wird Diffusion normalerweise als Prozess verstanden, der die globalen Machtzentren miteinander verbindet. Die Bewegung der zahnärztlichen Therapeut*innen zeigt allerdings, dass die Verbreitung von Wissen auch entlang der Ränder geschieht und diese vernetzt. In den USA begannen die ersten sechs Dentaltherapeut*innen ihre Arbeit 2004 in Alaska. Mittlerweile gibt es hierzu Gesetzesinitiativen in 10 weiteren Bundesstaaten, und Praktizierende treffen sich regelmäßig auf Konferenzen, um neue Kooperationsplattformen zu schaffen. Ihre Aktivitäten werden durch zahlreiche Stiftungen gefördert, die sich auf die Finanzierung neuer Modelle der Gesundheitsfürsorge spezialisieren und oftmals für die Ausbildung der Therapeut*innen aufkommen. Warum dies klassischen Zahnarztverbänden ein Dorn im Auge ist und dieses relativ neue Berufsfeld ein zweischneidiges Schwert darstellt, können Sie auf Englisch in unserem neuen Blogpost von Luis Aue und Tine Hanrieder lesen.
Diffusion is known as a process that ties together the centers of the world ever more closely. Once the privatization of water supply made it on the international agenda, privatization soon became a topic in capitals all over the world. Once it becomes the world standard to have a ministry for digital affairs, governments around the world will establish such an organization. Still, there is another and more hidden network of diffusion: diffusion that connects the world’s peripheries – sites of marginalized populations both in the Global South and the Global North. Here, an innovation does not move between the centers of power; it moves between the peripheries forgotten by the centers.
Dental therapists in the US are a case in point of such peripheral diffusion. They deliver basic dental services to underserved populations in peripheries, services that are normally delivered by dentists. Dental therapists work around the world in sites that are considered underserved. The profession was first established for dental services to schoolchildren in New Zealand in the 1920s, following bad health status of recruits. Now, there are dental therapists in 53 countries, from Australia to Zimbabwe. In the US, they were introduced for the first time in Alaskan Native communities. Currently, the dental therapist movement is introducing this profession in peripheries all over the US.
This movement and the spread of dental therapists in the US draw attention to important features of peripheral diffusion in a globalized world.