This week, the articles examined the inherent tensions between the public or civil society and expertise. In Resisting Empires: Globalism, Relocalization and the Politics of Knowledge author Clark Miller examines a new sort of globalization that emerges, parallel to the traditional notion of globalization, from expert knowledge being used in global areas of study, such as public health. The more experts validate the claims or support actions of international governing bodies the more authority is granted to them and the further they stretch out their elastic arms to aid developing nations in adopting policies focused upon global terms and needs. Ultimately this creates a system where the knowledge production occurs at a much different level and place than the application or dissemination of that knowledge. Miller calls for a “need to bridge gap between those who make knowledge and those who lives are shaped by it” through a relocalization process and a call for a democratization of decision-making and sources of accountability. This new framework for examining globalization, along with a few other authors input, may be helpful when trying to surface issues in implementation of global health initiatives in developing countries.
The impact of globalization on global public health can be largely attributed to the global integration phenomenon; which generates a space where changes in economy, society, policy, culture and environment can emerge simultaneously and can lead to changes in sociopolitical, financial and institutional structures. Within global public health, there exist primarily three visions: Transnational, social and medical. Transnational visions recognize the ability of a communicable disease to spread globally very quickly due to increased international travel. Social visions focus upon the social aspect of public health being an issue of sanitation, overcrowding, infrastructure and so on. The medical vision emphasizes the importance of vaccines, treatments and medicines to combat global health. Each of these visions lead to different priorities and encompass vastly different agenda’s for achieving success within the global public health arena. When examining the visions and the assessment of global health initiatives, it seems that there is a missing piece to this complicated puzzle. Perhaps Millers article hits the nail on the head when it mentions the lack of reflexivity in global governance mechanisms. There appears to be little civil society involved in the decision-making and agenda setting of international global initiatives, and yet these are the people who will be directly effected by the new policy agenda’s. Referring to the article by Stephen Lansing, he points to the inefficiency of knowledge makers to take into account the implementation of the new technology, or knowledge in this case, among local inhabitants, it doesn’t actually address the peoples needs.
Obviously, on a global health sphere, the need to address disease is a top priority, however, what if the need to have food or clean water is also an equally top priority. Author Greg Zachery spoke to one of my classes last semester and mentioned the impact of pharmaceuticals in a village of Africa where he lived. The real problem, he said, was that children were getting their antiretroviral therapy drugs and then being sent off to school with no food for the day. It is common knowledge that a healthy diet is necessary to maintain ones immune system, even with HIV. If the larger issue of global public health in Africa, according to the locals, is food accessibility and less pharmaceutical accessibility, then why are billions of dollars each year being poured into the Bill and Melinda Gates Foundation, GAVI, The Global Fund, and this is just to name a few. This examples supports the disconnect that Miller talks about and even sheds light to the possibility of rectifying this disconnect with a re-evaluation of goals that should be based upon the indigenous knowledge of local needs. After all, the long-term benefit of ART’s to help a patient live a long healthy life might be trumped by the fact they are starving to death from poor nutrition.
No comments:
Post a Comment