‘Global health’: meaning what?

Abstract

‘Global health’ is emerging as an increasingly widely invoked and powerful discursive construct. But what does it mean? It is described as a metaphor, a conceptual framing, a set of legal norms, and as a distinct field of practice;1 2 as an emerging science, an area of policy and research and as a formative disciplinary field of study.3 But the precise dimensions of the idea remain unclear.4 5 While we have yet to clarify what we mean by global health, we should circumspect as to what it is allowed to mean. Too often, discourse appears to point in one direction, while reality runs rapidly in quite another. The appearance of an agreed language may obscure and suppress important differences in philosophy, strategy and priority.6 Global health may well be invoked to support and enable policies and actions with genuinely universal and equitable benefit. But it may also be used to justify measures that are neither progressive nor just. We should not assume that a harmonious interpretation will, over time, emerge. Rather, we should expect an emergent global health paradigm to be characterised by potentially fierce contest. We should encourage that contest, played out through transparent, honest and evidence-based debate. The quality of that debate, from the health perspective, will depend on an ability to understand, engage with and draw on insights from a wide field of intellectual traditions and disciplines. If global health is to be an organising framework for thinking and action, we should ask: what does it imply, what does it endorse? For proponents of a global health vision characterised by health as an intrinsic social goal, and by health equitably generated within and across populations, understanding how the concept is framed from other political perspectives, based on other disciplinary values, will require a polymathic …

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