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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 publichealth provision. ‘Transitional norm-building in global health: the important role of nonstate 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