Global health governance and the limits of state-centrism
While some theories frame global health governance (GHG) as a universalist endeavour to achieve ‘health for all’ in an interconnected world, others view it as a collective of states, experts and institutions that address transnational health threats in an anarchical world system. Despite the virtuous dressing of global solidarity and the plurality of actors, GHG is multi-faceted and woven with power struggles. One normative concept that remains consistent is the nation-state as the primary decision-making actor. However, are all states regarded as equal in global health governance? This project focuses on the challenges of state-centrism in global health governance and how it marginalises postcolonial states, particularly where global health objectives intersect with foreign policy. I argue that state-centrism in GHG is not only skewed towards west-centric imaginations of authority but historically served to consolidate Western power. By assuming a Weberian outlook on statehood as having the ‘monopoly on the legitimate use of violence’, it further strengthens the North-South divide and ignores the distinct social and political structures of Global South states, whereby colonialism weakened many of their institutions and resources. During intra-state conflicts (‘new wars’) in the Middle East, the state is no longer viewed as a functional, territorial unit of authority with a monopoly on legitimate violence. What challenges, then, do state-centric policies pose for societies confronted with war and public health crises? Through a document and archival approach, this research adopts a postcolonial lens on the academic, policy and official discourses on state-centric policies in GHG. By understanding how state-centrism is consolidated through institutional mandates and the socio-political challenges faced by global health actors during the Arab uprisings, this research will also provide crucial insights into whether a polycentric, decolonial approach to GHG is possible.