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Jean-Paul Gaudillière, Claire Beaudevin, Christoph Gradmann, Anne M. Lovell and Laurent Pordié, eds., Global Health and the New World Order: Historical and Anthropological Approaches to a Changing Regime of Governance

In: European Journal for the History of Medicine and Health
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Kirsten Moore-Sheeley Assistant Professor; Program in the History of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA, Kirsten.Moore-Sheeley@cshs.org

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Jean-Paul Gaudillière, Claire Beaudevin, Christoph Gradmann, Anne M. Lovell and Laurent Pordié, eds., Global Health and the New World Order: Historical and Anthropological Approaches to a Changing Regime of Governance (Manchester: University of Manchester Press, 2021), 248 pp., £71.00 (hardback), isbn 978 1 52614 967 1.

Although stewards of global health often associate the field with connectedness and universal ethical and scientific values, global health is quite fractured. In fact, decentralization is a hallmark and stated virtue of the field. The literature critically analyzing global health (or critical global health studies) is similarly fractured, comprised largely of single-site ethnographies and macro-scale political and institutional histories with few studies linking different spatial and temporal scales. Global Health and the New World Order seeks to address this and related gaps, using interdisciplinary approaches to study our latest – but what will by no means be our last – regime of world health governance. Combining historical, anthropological, and sociological perspectives, the volume’s contributors illustrate how purportedly universal health knowledge and standards have been created, circulated, and enacted in specific places. As the editors argue in the introduction, “Studying a dynamic phenomenon like global health requires close attention both to its actual state of being and to the paths of its development over time” (p. 22). For them, this means paying greater attention to the processes animating global health practice. It also means paying greater historical attention to the transition in the 1980s and 1990s from postwar, state-based international health to our current neoliberal regime of global health.

Subsequent chapters reinforce the arguments and interventions laid out in the introduction by examining the globalization of health, particularly the creation and local adaptation of generalized “global” standards, in the late twentieth century and early twenty-first. The book is structured around four main sections, the first two of which are probably most familiar to critical global health scholars: tuberculosis control and mental health. First, Nora Engel draws on ethnographic fieldwork in India to show how staff of the Revised National Tuberculosis Control Programme adapted international guidelines on dots (Directly Observed Treatment Short-Course) to local conditions, continually situating standardized protocols to fit program requirements and patients’ needs. Jean-Paul Gaudillière, Christoph Gradmann, and Andrew McDowell complement this with a chapter on the history, looking at the emergence of dots as an international standard based on experiences in Tanzania in the 1980s as well as the ways Indian health and development experts responded to the country’s adoption of dots in the early 1990s. Together these chapters challenge the idea that there has been a uniform response to dots, even within the same national context. Next, Matthew Heaton complicates the oft-used binary of ‘Africa’ and ‘the global’ by showing how Nigerian psychiatrist Thomas Adeoye Lambo engaged with local, national, and international developments to shape the field of cross-cultural psychiatry as well as Nigeria’s mental health system in the 1960s and 1970s. Taking a slightly different angle on mental health in Africa, Ursula Read discusses how Ghanaian mental health authorities have tried to navigate the human rights discourse and funding channels of global mental health, local concerns and resource constraints, and their own visions of modern mental health care. Both chapters challenge depictions of Africa as places where health standards derived from outside the continent are merely imposed. Moreover, they show how the history of mental health care in Africa has continued to shape African authorities’ responses to this public health issue.

The next two sections cover topics less represented in critical global health studies: traditional medicine and medical genetics. Wen-Hua Kuo analyzes the World Health Organization’s (who) efforts to standardize the names and placement of acupuncture points since the 1980s. He shows how both nationalist and techno-politics infused the creation of such standards out of different traditions, translations, and interpretations of the practice of acupuncture. Next, Steve Sturdy traces a shift in medical genetics from studying the transmission of rare single-gene disorders within families to the genetics of complex diseases within population groups. This methodological shift drove an interest in collecting genomic data from people in the global South, though primarily for the benefit of patients in the global North. Sahra Gibbon then takes a deep dive to show how patient-, clinician-, and researcher-activists in Brazil have tried to redefine a cluster of rare cancers linked to a globally uncommon genetic variant as a significant public health problem in Brazil. Both sections raise interesting questions about the possibilities for the circulation and the politics of access to medical knowledge and techniques in world-scale public health.

The book concludes with two pieces dealing more directly with global health as a regime of health governance. Nitsan Chorev describes how the who responded strategically to neoliberal pressures of the 1980s and 1990s to maintain its position on the world stage, albeit in ways that have made it the subject of critique, most notably during the 2014–16 Ebola epidemic. Finally, in the volume’s epilogue, Didier Fassin outlines some central tensions and contradictions within the field of global health, which help explain the persistence of health inequities and suspicion of global health programs amongst these programs’ so-called recipients. Both chapters at once highlight what is new about global health in terms of its values, relations, and structures, while providing insight into the continuities between this and previous regimes of health governance.

Overall, this volume succeeds in illustrating the utility of a multidisciplinary approach to the study of global health, though different chapters and sections are more successful in this regard than others. For example, the chapter by Gaudillière, Gradmann, and McDowell explicitly discusses methodology, sources, and the utility of combining anthropological and historical approaches to better understand processes of globalization. Read’s chapter uses the history of mental health care in Ghana to great effect in helping to make sense of contemporary mental health programming. Her chapter pairs nicely with Heaton’s historical treatment of Lambo and Nigerian mental health care, which emphasizes the ways in which African experts and circumstances have influenced international knowledge and networks. By contrast, discussions of methodology are not so clearly articulated or integrated in the chapters on medical genetics. Their juxtaposition of the historical and anthropological pieces are intended to demonstrate the utility of interdisciplinary perspectives; while both chapters are fascinating standalone studies, raising some new questions for critical global health scholars, they fit less well with the rest of the volume than do the other chapters.

This volume should be commended for expanding our image of global health beyond communicable disease control and exposing readers to a variety of disciplinary perspectives. The chapters are generally accessible for academic audiences, though some contain more theoretical concepts, interventions, and jargon than others. The aim of the volume to expand critical global health studies in these ways means that many will find reading individual chapters or sections more useful than reading the book in its entirety. Other works may be more helpful to those looking for a comprehensive overview of global health and its historical development. Nonetheless, this edited collection makes productive suggestions for ways to expand critical global health studies and contributes to our knowledge about how the globalization of health care occurs in practice.

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