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The Global Politics of Neglected Tropical Diseases 被忽视热带病的全球政治
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.41
Obijiofor Aginam
Neglected tropical diseases (NTDs) are a diverse group of diseases that are prevalent among the poorest populations of the world. They pose a formidable obstacle to the socioeconomic development of the already impoverished communities where they are prevalent. Over the past several decades the World Health Organization (WHO)—as the directing and coordinating authority on international health work—has led global efforts to tackle the mortality and morbidity burdens of NTDs. In partnership with other actors, WHO’s global NTD Plan and Roadmap have oscillated between the politics and financial constraints of the organisation as an intergovernmental organisation of sovereign states and the lack of incentives to catalyse private and corporate actors towards effective action. The global politics of NTDs is now firmly anchored on public-private partnerships. These partnerships nonetheless raise questions about the moral obligation towards underwriting the cost of eradicating these diseases in the developing world. The chapter argues that enlightened self-interest and humanitarianism should compel the industrialised world towards a pragmatic action to address the mortality and morbidity burdens of NTDs among the poorest populations of the world.
被忽视的热带病(NTDs)是在世界最贫困人口中流行的一组不同的疾病。它们对已经十分贫困的社区的社会经济发展构成了巨大的障碍。在过去几十年中,世界卫生组织(世卫组织)作为国际卫生工作的指导和协调机构,领导了全球努力,以解决被忽视的热带病的死亡率和发病率负担。世卫组织与其他行为体合作,制定的全球NTD计划和路线图在本组织作为主权国家政府间组织的政治和财政限制以及缺乏激励措施来促进私人和企业行为体采取有效行动之间摇摆不定。被忽视热带病的全球政治现在牢固地建立在公私伙伴关系上。然而,这些伙伴关系提出了在发展中国家承担根除这些疾病费用的道德义务问题。本章认为,开明的利己主义和人道主义应该迫使工业化世界采取务实行动,解决世界上最贫穷人口中被忽视的热带病的死亡率和发病率负担。
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引用次数: 0
Civil Society and Global Health Politics 公民社会与全球卫生政治
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.22
D. McCoy, J. Gafton
Civil society may be defined as both a space in society and a collection of certain types of actor. As a space, it exists alongside the state and markets; as a set of actors, it interacts with a range of governmental bodies and businesses. Over the past three or four decades, neoliberal globalisation has dramatically changed the distribution of power across society, while also institutionalising a set of policies that have diminished the role of the state, undermined democracy, and established the dominance of market logic. These developments have influenced both international health policy and the structures of global governance. Furthermore, they have also shaped the nature of civil society’s participation in global health policy and governance. Crucially, civil society does not merely intervene in global health politics from outside, but is itself sculpted by the ideologies and political conditions that surround it. This chapter explores the political nature of civil society and its relationship to global health politics, including the political nature of new non-state actors such as the Bill and Melinda Gates Foundation and the emergence of global health partnerships, which have ostensibly increased civil society involvement in global health governance. It argues that civil society participation in global health governance tends to represent powerful and hegemonic interests rather than those most in need. It also discusses how current political, economic and technological developments will influence civil society’s participation in global health politics, and shape the challenges faced by society more generally.
公民社会可以被定义为社会中的一个空间和某些类型行动者的集合。作为一个空间,它与国家和市场并存;作为一组参与者,它与一系列政府机构和企业相互作用。在过去的三四十年里,新自由主义全球化极大地改变了整个社会的权力分配,同时也使一系列政策制度化,这些政策削弱了国家的作用,破坏了民主,确立了市场逻辑的主导地位。这些发展对国际卫生政策和全球治理结构都产生了影响。此外,它们还塑造了民间社会参与全球卫生政策和治理的性质。至关重要的是,公民社会不仅从外部干预全球卫生政治,而且它本身也受到围绕它的意识形态和政治条件的影响。本章探讨民间社会的政治性质及其与全球卫生政治的关系,包括新的非国家行为体的政治性质,如比尔和梅林达·盖茨基金会和全球卫生伙伴关系的出现,这些伙伴关系表面上增加了民间社会对全球卫生治理的参与。它认为,民间社会参与全球卫生治理往往代表强大和霸权的利益,而不是最需要的利益。它还讨论了当前的政治、经济和技术发展将如何影响民间社会对全球卫生政治的参与,并更广泛地塑造社会面临的挑战。
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引用次数: 0
The Politics of Global Health Inequalities 全球卫生不平等的政治
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.15
Y. Shawar, J. P. Ruger
Careful investigations of the political determinants of health that include the role of power in health inequalities—systematic differences in health achievements among different population groups—are increasing but remain inadequate. Historically, much of the research examining health inequalities has been influenced by biomedical perspectives and focused, as such, on ‘downstream’ factors. More recently, there has been greater recognition of more ‘distal’ and ‘upstream’ drivers of health inequalities, including the impacts of power as expressed by actors, as well as embedded in societal structures, institutions, and processes. The goal of this chapter is to examine how power has been conceptualised and analysed to date in relation to health inequalities. After reviewing the state of health inequality scholarship and the emerging interest in studying power in global health, the chapter presents varied conceptualisations of power and how they are used in the literature to understand health inequalities. The chapter highlights the particular disciplinary influences in studying power across the social sciences, including anthropology, political science, and sociology, as well as cross-cutting perspectives such as critical theory and health capability. It concludes by highlighting strengths and limitations of the existing research in this area and discussing power conceptualisations and frameworks that so far have been underused in health inequalities research. This includes potential areas for future inquiry and approaches that may expand the study of as well as action on addressing health inequality.
对健康的政治决定因素(包括权力在健康不平等中的作用——不同人口群体之间健康成就的系统性差异)的仔细调查正在增加,但仍然不足。从历史上看,许多检查健康不平等的研究都受到生物医学观点的影响,因此侧重于“下游”因素。最近,人们更多地认识到卫生不平等的“远端”和“上游”驱动因素,包括行为者所表达的权力的影响,以及嵌入社会结构、机构和进程的影响。本章的目的是研究迄今为止如何将权力概念化和分析与卫生不平等有关。在回顾了健康不平等奖学金的状态和在全球健康研究权力的新兴兴趣之后,本章提出了权力的各种概念,以及它们如何在文献中用于理解健康不平等。本章强调了在社会科学中研究权力的特殊学科影响,包括人类学、政治学和社会学,以及批判理论和健康能力等交叉视角。最后,它强调了这一领域现有研究的优势和局限性,并讨论了迄今为止在卫生不平等研究中未充分利用的权力概念和框架。这包括未来调查的潜在领域和可能扩大对解决保健不平等问题的研究和行动的方法。
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引用次数: 2
The Politics of Gender and Global Health 性别政治与全球健康
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.4
S. Hawkes, K. Buse
Politics, simply understood as who gets what, when, and how, is self-evidently central to health policy and health equity outcomes. The material, ideational, and institutional interests and power of stakeholders will determine whose health is given salience and who influences those decisions. Gender, understood as the roles, behaviours, activities, and attributes that are expected, allowed, and valued in a woman or man in any given context in turn impacts the influence and interests of those stakeholders. This chapter explores the impact of gender on health outcomes as well as the global health complex’s responding to or leveraging gender to ensure more equitable outcomes. The chapter begins by setting out the significant differences in the gendered distribution of health outcomes. It then presents a conceptual framework that explains the ways through which gender impacts those outcomes, namely how gender serves as and interacts with other determinants of health, how gender influences the differences in health-harming and health-affirming behaviours between men and women, and how gender impacts health programmes and delivery. The chapter provides a historical account of the manner in which global health organisations have treated (largely ignored) gender. It concludes with a discussion of the politics of health that explains why global health remains gender blind despite centuries of empirical evidence to suggest that it could be amongst the most influential determinants of health and promotes ideas of what will be required to ensure that global health is more gender responsive.
政治,简单地理解为谁得到什么、何时得到以及如何得到,显然是卫生政策和卫生公平结果的核心。利益相关者的物质、思想和制度利益和权力将决定谁的健康受到重视,谁会影响这些决定。性别,被理解为在任何特定环境中期望、允许和重视的女性或男性的角色、行为、活动和属性,反过来影响这些利益相关者的影响力和利益。本章探讨了性别对健康结果的影响,以及全球卫生综合体如何应对或利用性别问题以确保更公平的结果。本章首先阐述了保健结果的性别分布方面的重大差异。然后,它提出了一个概念框架,解释了性别影响这些结果的方式,即性别如何作为健康的其他决定因素并与之相互作用,性别如何影响男女之间危害健康和肯定健康行为的差异,以及性别如何影响健康方案和提供服务。本章对全球卫生组织对待(在很大程度上被忽视)性别的方式进行了历史描述。报告最后讨论了卫生政治,解释了为什么尽管几个世纪以来的经验证据表明,全球卫生可能是最具影响力的健康决定因素之一,但全球卫生仍然对性别视而不见,并促进了确保全球卫生更加注重性别平等所需的想法。
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引用次数: 5
The Politics of Global Tobacco Control 全球烟草控制的政治
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.38
Kelley Lee
This chapter examines the politics that has shifted tobacco control policy over the past three decades, from a long-neglected public health issue to a flagship global health issue supported by collective action by state and non-state actors. These efforts were spurred by the expansion of leading transnational tobacco companies (TTCs) into emerging markets, beginning in the 1960s, amid growing regulation and declining sales in traditional markets. By the 1990s tobacco use was steadily rising in the wake of the global expansion of the tobacco industry. The negotiation of the World Health Organization Framework Convention on Tobacco Control (FCTC) became the focus of intense political contestation between a powerful industry seeking to protect its commercial interests and an alarmed public health community. Since adoption of the FCTC in 2004, this political battle has shifted to its effective implementation in signatory states. This has included the eventual negotiation of the FCTC Protocol to Eliminate the Illicit Trade in Tobacco Products and continued efforts by the tobacco industry to sustain sales through a variety of political strategies.
本章考察了在过去三十年中将烟草控制政策从一个长期被忽视的公共卫生问题转变为国家和非国家行为者集体行动支持的旗舰全球卫生问题的政治因素。这些努力受到主要跨国烟草公司自1960年代开始向新兴市场扩张的推动,当时传统市场的管制日益加强,销售额不断下降。到20世纪90年代,随着烟草业的全球扩张,烟草使用量稳步上升。《世界卫生组织烟草控制框架公约》(FCTC)的谈判成为寻求保护其商业利益的强大行业与警惕的公共卫生界之间激烈政治争论的焦点。自2004年通过《烟草控制框架公约》以来,这场政治斗争已转向在签署国有效实施该公约。这包括最终就《消除烟草制品非法贸易框架公约议定书》进行谈判,以及烟草业通过各种政治战略继续努力维持销售。
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引用次数: 1
The Politics of Global Vaccination Policies 全球疫苗接种政策的政治
Pub Date : 2020-03-19 DOI: 10.1093/OXFORDHB/9780190456818.013.34
S. Blume
Organised efforts to prevent the spread of infectious diseases through mass vaccination began slowly. By World War I, although successes in saving soldiers’ lives offered encouragement, vaccination practices differed from country to country. In 1945, amid the rapid post-war spread of tuberculosis, preventive vaccination was deemed a necessary ‘technological fix’. During the Cold War period, technical cooperation coexisted with ideological rivalry. Although the Soviet Union and the United States supported vaccination for different reasons, they successfully cooperated on the WHO smallpox eradication programme beginning in 1965. Out of this grew the EPI, and disputes between supporters of ‘vertical’ and ‘horizontal’ approaches emerged. In recent decades new vaccine production has become a major driver of market growth for the pharmaceutical industry. New forms of collaboration between public and private sectors (such as public-private partnerships) have been crafted, whilst the global introduction of new vaccines is supported by the GAVI Alliance. However, at a time of shrinking health care budgets the wisdom of disease eradication targets is contested, and parents everywhere are becoming more critical.
通过大规模接种疫苗来预防传染病传播的有组织努力起步缓慢。到第一次世界大战时,尽管拯救士兵生命的成功令人鼓舞,但接种疫苗的做法因国而异。1945年,在战后结核病迅速蔓延之际,预防性疫苗接种被认为是一种必要的“技术解决方案”。在冷战时期,技术合作与意识形态竞争并存。尽管苏联和美国出于不同的原因支持疫苗接种,但它们在1965年开始的世卫组织根除天花规划上进行了成功的合作。由此产生了EPI,“垂直”和“水平”方法的支持者之间出现了争议。近几十年来,新疫苗生产已成为制药工业市场增长的主要推动力。公共和私营部门之间的新合作形式(如公私伙伴关系)已经形成,同时全球引进新疫苗得到了全球疫苗和免疫联盟的支持。然而,在卫生保健预算缩减之际,疾病根除目标是否明智受到了质疑,各地的家长变得更加挑剔。
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引用次数: 0
The Global Politics of Access to Medicines 获取药物的全球政治
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.16
S. Moon, E. Hoen
Access to medicines has been a fierce battleground in global health, with the most polarising debates focused on medicine prices and the role of patent monopolies. The way ‘access to medicines’ has been framed has evolved considerably since the 1970s, when the focus was primarily on rational use of generic drugs widely available in developing countries. In the 1990s the advent of the WTO TRIPS Agreement clashed directly with a growing global HIV crisis; the politics of ‘access to medicines 1.0’ that emerged centred squarely on antiretrovirals for HIV/AIDS and intellectual property rules. Subsequently, significant ideational and political shifts have resulted in an ‘access politics 2.0,’ characterised by an expansion of concerns to all diseases, tighter linkages between innovation and access concerns, and shifting political dynamics as high-income countries began to experience directly the challenge of high drug prices. These shifts imply a more complex and potentially more consequential politics of access to medicines in the future.
获得药品一直是全球卫生领域的一个激烈战场,最两极分化的辩论集中在药品价格和专利垄断的作用上。自20世纪70年代以来,制定“获得药物”的方式发生了很大的变化,当时的重点主要是合理使用在发展中国家广泛可用的仿制药。20世纪90年代,世贸组织《与贸易有关的知识产权协定》的出台与日益严重的全球艾滋病毒危机直接发生冲突;出现的“获得药物1.0”政治直接集中在艾滋病毒/艾滋病的抗逆转录病毒药物和知识产权规则上。随后,重大的观念和政治转变导致了“获取政治2.0”,其特点是对所有疾病的关注扩大,创新与获取问题之间的联系更加紧密,随着高收入国家开始直接经历高药价的挑战,政治动态也在发生变化。这些转变意味着未来获得药物的政治将更加复杂,可能也更加重要。
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引用次数: 1
Global Health Politics 全球卫生政治
Pub Date : 2020-03-19 DOI: 10.1093/oxfordhb/9780190456818.013.1
C. Mcinnes, Kelley Lee, J. Youde
Global health politics has emerged over the last two decades as a distinct interdisciplinary field of study which, although its boundaries are not set, is beginning to demonstrate signs of maturity. It is concerned with the actions, practices, and policies that govern the sphere of global health. Its emergence then is intimately linked with the reconceptualisation of health as global. The field addresses not only the processes of decision-making, but also the structures of power that shape what is possible and the requirement for collective action to address global problems. Politics is unavoidable, necessary and integral to effectively addressing global health challenges. The study of global health politics therefore is not about how to minimise interference in rational decision-making, but rather about explaining and improving the quality of political institutions and processes that will in turn improve global health actions and ultimately outcomes. Fundamental to this is an understanding of the nature of politics and the workings of power. But the field also requires knowledge and techniques from a variety of disciplines, which intersect to produce a more complete understanding than any one discipline can provide. The result is inherently both multi- and interdisciplinary, characterised by methodological pluralism and varied theoretical perspectives.
全球卫生政治在过去二十年中作为一个独特的跨学科研究领域出现,尽管其边界尚未确定,但已开始显示出成熟的迹象。它涉及管理全球卫生领域的行动、做法和政策。因此,它的出现与全球卫生的重新概念化密切相关。这一领域不仅涉及决策过程,而且还涉及决定可能性的权力结构以及为解决全球问题采取集体行动的要求。政治对于有效应对全球卫生挑战是不可避免的、必要的和不可或缺的。因此,对全球卫生政治的研究不是关于如何最大限度地减少对理性决策的干预,而是关于解释和提高政治制度和进程的质量,从而改善全球卫生行动和最终结果。这一点的基础是对政治本质和权力运作的理解。但该领域也需要来自不同学科的知识和技术,这些学科相互交叉,产生比任何一门学科都能提供的更全面的理解。其结果是固有的多学科和跨学科,其特点是方法论的多元化和不同的理论观点。
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引用次数: 0
Non-Communicable Diseases and Global Health Politics 非传染性疾病和全球卫生政治
Pub Date : 2019-02-28 DOI: 10.1093/oxfordhb/9780190456818.013.35
R. Magnusson
Non-communicable diseases (NCDs), including cardiovascular disease, cancer, chronic respiratory diseases, and diabetes, are responsible for around 70 percent of global deaths each year. This chapter describes how NCDs have become prevalent and critically evaluates global efforts to address NCDs and their risk factors, with a particular focus on the World Health Organization (WHO) and United Nations (UN) system. It explores the factors that have prevented those addressing NCDs from achieving access to resources and a priority commensurate with their impact on people’s lives. The chapter evaluates the global response to NCDs both prior to and since the UN High-Level Meeting on Prevention and Control of Non-communicable Diseases, held in 2011, and considers opportunities for strengthening that response in future.
包括心血管疾病、癌症、慢性呼吸系统疾病和糖尿病在内的非传染性疾病每年造成的死亡人数占全球死亡人数的70%左右。本章描述非传染性疾病如何变得普遍,并批判性地评估全球应对非传染性疾病及其风险因素的努力,特别关注世界卫生组织(世卫组织)和联合国(联合国)系统。它探讨了阻碍那些解决非传染性疾病的人获得资源的因素,以及与其对人们生活的影响相称的优先事项。本章评估了2011年联合国预防和控制非传染性疾病高级别会议之前和之后对非传染性疾病的全球应对措施,并审议了今后加强这一应对措施的机会。
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引用次数: 4
Critical Approaches to Global Health 全球卫生的关键方法
Pub Date : 2018-11-01 DOI: 10.1093/oxfordhb/9780190456818.013.5
A. Ingram
This chapter places the critical analysis of global health in wider intellectual and political perspective, situating critical thinking in relation to the philosophical idea of Enlightenment and ensuing debates about the nature of power, knowledge, and freedom. After a brief genealogy of critical thought, the chapter considers some of the main sources of critical thinking in global health and provides a brief survey of critical takes on health in the era of globalisation. It then considers three influential varieties of critique—of political economy, of representation, and of biopower—while touching on other critical perspectives, including feminism and anticolonial thought. As a way of prompting further reflection, the concluding section of the chapter considers recent debates about the problems of the critical enterprise itself.
本章将全球健康的批判性分析置于更广泛的知识和政治视角中,将批判性思维与启蒙运动的哲学思想以及随后关于权力、知识和自由本质的辩论联系起来。在批判性思维的简短谱系之后,本章考虑了全球健康批判性思维的一些主要来源,并提供了全球化时代对健康的批判性看法的简要调查。然后,它考虑了三种有影响力的批评——政治经济学、代表性和生物权力——同时触及了其他批评观点,包括女权主义和反殖民主义思想。作为一种促进进一步反思的方式,本章的结论部分考虑了最近关于关键企业本身问题的辩论。
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引用次数: 0
期刊
The Oxford Handbook of Global Health Politics
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