Can the Sick Speak? Global Health Governance and Health Subalternity

Abstract

Global Health Governance (GHG) uses a set of financial, normative, and epistemic arguments to retain and amplify its influence. During the COVID-19 pandemic, the GHG regime used its own successes and failures to prescribe more of itself while demanding further resources. However, the consistent failures of this form governance and its appeasement to a dominant neoliberal ideology lead to the following question: Is the global health governance regime failing at its goal of improving health or succeeding at other political and ideological goals that necessitate such failures? Using concepts and ideas from social theory and post-colonial studies; I examine the definitions, epistemic basis, and drivers of GHG and propose certain conditions for the legitimacy of a global health governance system. Examining historical and current cases, I find that the GHG regime currently fails to fulfil such conditions of legitimacy and instead creates spaces that limit rather than help many populations it purports to serve. Those spaces of sickness confine people and reduce them into a state of health subalternity. In being health subalterns, people’s voices are neither sought nor heard in formulating the policies that determine their health. Finally, I argue that research and policymaking on global health should not be confined to the current accepted frameworks that assumes legitimacy and benevolence of GHG, and propose steps to establish an alternative, emancipatory model of understanding and governing global health.