Health for Some: The Political Economy of Global Health Governance
Ideally the only influence on a person's health should be his or her personal choices, such as whether or not to eat fast food, exercise, drink alcohol, or smoke. In reality, health is also determined by researchers, politicians, and bankers, because they develop health policies and determine what type of care is available to whom, and when. Health For Some assembles 13 essays which collectively aim to identify the 'impact of health on political economy changes associated with globalisation' and 'emerging forms of health governance', by establishing the identities of the major players in the development of frameworks and the control of global health (p. 4).
According to MacLean and Brown, one goal of this book was to provoke discussion on 'undertheorized [sic] areas' of global health (p. 4). Although not every chapter will appeal to every reader, the chapters vary, and at least one should be useful to anyone interested in the future of public-health provision. 'Transitional norm-building in global health: the important role of non-state actors in post-Westphelian politics', by Wolfgang Hein and Lars Kohlmorgen (Chapter 6), describes how non-state actors have the power to influence governments and policy through advocacy and lobbying. It is a refreshing contribution, showing how the power to determine health policy can be influenced by the public in a bottom-up process, although, worryingly, the authority that non-state actors appear to have is seen as due to a lack of governance elsewhere, as opposed to constituting a planned intervention in its own right (p.100).
Other chapters look at the effects that governments, banks, and the private sector have on health determinants, where the health of populations is not always at the forefront of decision makers' minds and can be unfairly determined. A good example is given in Chapter 10, which states that in 2003 the Bush Administration in the USA passed a law which would deny funding to HIV programmes in poorer countries if they included treatment for drug users and sex workers (p.155), even though such a policy was known to be against medical evidence. This strikes me as an issue of particular concern, because medical practice and health care are supposed to be evidence-based. I would also question the relevance of the CIA's role in global health (p. 70), which is mentioned in Chapter 5 by Pieter Fourie in his examination of the perceived relationship between state fragility and HIV. This criticism also applies to the private sector, similarly stated to have its own agenda (Chapter 8) which tends to undermine genuine health organisations, such as the WHO (p. 143). To whom are those who influence international health accountable? This question is raised in several chapters in Health for Some. Governments, banks, and the private sector should be facilitating health care by ensuring that there are no inequalities, rather than actually causing the inequalities. I would have liked Health for Some to contain more information on bad policies and practices, showing to what extent health-care programmes are shaped by the personal beliefs of those with money and power.
The underlying theme throughout Health for Some is that the actors involved in global health are unco-ordinated and ungoverned. The impact is not all negative, however. Chapter 10, 'Making money work: challenges towards coordination of HIV/AIDS programmes in Africa', by Siri Bjerkreim Hellevik, examines the efficiency of the three main actors that fund HIV work. Although these organisations provide further examples of top-down approaches, this chapter highlights how they can work together more cohesively, ultimately having a positive influence on health.
MacLean and Brown note that contributors use a range of methodologies and frameworks, but they argue that despite this the authors are linked by the common goal of wanting to highlight health inequalities and health inequities (p. 16). However, because the book has so many contributors it does not feel as though the issues are addressed comprehensively. MacLean, Brown, and Fourie come from a political-science background, as do most of the contributors, and they all appear to work within the academic and research sector. This would explain the impression that Health for Some is aimed at academics and researchers from a similar background. Although this book may interest people from other disciplines, such as those from the health-care and medical profession, or human rights and advocacy groups, it is not an easy book to read, because the essays are so specialised and because of the amount of jargon and technical terminology used (there is a list of 140 abbreviations at the front of the book, p. xi). For a subject as complex as global health, it would have been more appealing if the editors had written a book using less formal and more engaging language, rather than presenting a compilation of undigested academic papers.
In the Foreword Alan Whiteside states that this book has the potential to influence public health policy (p. x), but I would question whether it is radical enough. I believe that in order to change bad practice you need to upset the status quo, but because Health for Some is written in a controlled academic way it does not do that. While the book presents a selection of relevant and thought-provoking essays, I would have preferred a less academic, more passionate response to the globalisation of health.