International Relations

Global health problems are often framed as common challenges confronting humanity, and while political commitment and resources have recently increased, a number of faultlines run through efforts to mount collective responses. Although the United States has staked its claim to leadership in the fight against disease, its actions diverge in several key respects from much of the international community, undermining the effectiveness of global efforts. These divergences can be traced to domestic politics, and are related to three debates of significance for international relations more generally: on global governance, models of globalisation, and relationships between development and security. In this article US approaches are contrasted in each of these dimensions with those of the UK, which has been active in promoting its own vision. The prospects for overcoming current limitations are examined on two levels: the technocratic, and the ideological and political. Developments on both levels are evaluated in light of events early in the second term of the Bush administration. In conclusion, it is suggested that there are two contending meta-narratives underlying the faultlines in global health.

This article critically engages with recent efforts to frame the global AIDS pandemic as an international security issue. The securitization of HIV/AIDS is significant, the article argues, not just because it is a novel way of conceptualizing the global AIDS pandemic, but also because it marks an important contemporary site for the global dissemination of a biopolitical economy of power revolving around the government of ‘life’. This biopolitical dimension to the securitization of AIDS brings into play a set of potentially racist and normalizing social practices, which, the article argues, international political actors should seek to avoid in their attempts to find appropriate and effective responses to the global AIDS pandemic. Ways of minimizing these dangers are explored in the conclusion of the article.

The South African government’s open challenging of the international AIDS control regime presents a paradox for the study of international regimes and epistemic communities: why would a state that would presumably benefit the most from a regime not only refuse to adhere to its precepts, but openly challenge its basic tenets? I argue that a fundamental disjuncture exists between the international AIDS control regime and the South African government, and that this disjuncture is rooted in the country’s negative past experiences with public health interventions and the attempts to forge a new, African Renaissance-inspired self-identity. This disjuncture finds its expression through the development of a counter-epistemic community which offers scientific expertise and policy recommendations to the South African government. The counter-epistemic community translates history and identity into policy outcomes that challenge the established discourse.

In recent years it has increasingly been claimed that health-sector initiatives have the potential to make a meaningful contribution to post-conflict peacebuilding. This article examines two types of such claims - that health can act as a ‘bridge for peace’, and that health-sector reconstruction can assist in rebuilding the social contract and reestablishing the legitimacy of the government - and how they played out in the case of Sierra Leone. In this case there was an opportunity for health-sector assistance to go beyond mere humanitarian relief and for it to play an active role in promoting peace and stability. It is argued that the best chance of success may lie in a successful blending of Health as a Bridge for Peace-type approaches and ‘top-down’ government-centred interventions as the country moves from the immediate post-war relief phase to the longer-term process of securing future peace and stability.

African healing systems have always been pluralistic in form and structure, capable of absorbing new traditions and practices. The spread of Chinese medicine in Tanzania over the past decade is a testament to the flexibility of pluralistic healing systems, as well as evidence of south-south processes of globalisation that are often ignored by the literature on globalisation. This article suggests, through a study of a Chinese medical clinic in Dar es Salaam, that its popularity highlights the strengths of local cultures despite increasing globalising forces, and that any consideration of globalisation must include south-south (or East-south) dynamics as well as the customary focus on the north-south track. The article also suggests that whilst the absorption of new traditions of healing speaks to the strength of the local, it also functions as an indication of the failure of alternative healing systems to address key current medical needs, and as such represents a crisis in health, as much as strength, in the healing sector.

Social policy initiatives that actively promote greater interaction between the state and civil society are an increasingly important component in the politics of poverty reduction and the promotion of better health for poor people. To address local inequalities, and to strengthen rural economies, local societies and local public services, the government in Peru has introduced a new public space that is designed to incorporate ordinary people into the planning, implementation, administration, management and supervision of public activities. Instead of facilitating cooperation at the district level, this article shows that the idea of people working together and helping each other is undermined by the dislocation of the new public space from the political, cultural and geographical conditions under which social interaction takes place.