Sub-theme 7. Global health commons between pandemics and glocal health
Public health services as a common good in the era of the Sustainable Development Goals
At a time when global health policy calls for universal health coverage, many countries are still grappling with how to address inequities of access to public health services. Different demand and supply-side financing approaches have been introduced over the past years, but major inequities between and within countries have remained. A general debate about the extent to which public health should be regarded as a common good, including questions about the democratization of the governance of the public health system, seems missing. Moreover, a “local common” is what everyone shares on the one hand, but towards which everyone has responsibilities on the other. The government and the public should have a platform where commoning practices in the form of solidarity and collectives are forged, maintained and reinforced at the intersection of commoning healthcare distribution. Unfortunately, when it comes to health, the concept of “local commons” can increasingly be summed up in the now proverbial Hardin “tragedy of the commons.”Additionally, despite the government’s commoning practices and processes in healthcare, public health services still remain under-resourced and unable to offer reliable access to healthcare. With this panel, we call for transdisciplinary disciplines researching on the global debates on health policy and coordination, regulation and legislation, tax and subsidization of healthcare, access, financing of healthcare services, and the commons. Therefore, we ask for paper contributions highlighting how public health services as a common good are under threat in the Sustainable Development Goals (SGDs) and the global health agenda.
Panel 7.4. A
1. Living Glocally with Diabetes: From Global Health Funding to Lived Experience of the Disease in Conakry, Guinea
University of Geneva, Switzerland
While a silent pandemic of diabetes is threatening the African region with an increase of 129% by 2045, it remains marginal in Global Health policies despite the SDG’s indicator 3.4.1 on non-communicable diseases (NCD). Global Health programs shape which diseases are to be mapped as priorities. For countries depending on international aid such as Guinea, this process of triage translate into how local health services are able to deliver medical care. Thus, diabetes in Guinea is an exemplary case of the regime of global priorities. While the country was the target of massive funding during the Ebola outbreak (2014-2015), NCDs remain often undiagnosed and untreated. Additionally, even though insulin patent was sold for 1 $ CAN by its discoverers in 1922, it remains one of the most expensive treatments due to pharmaceutical companies’ oligopoly and generic insulin’s regulatory framework.
The paper addresses neglected spaces of care regarding diabetes at the crossroads of the local and the global building on three interrelated issues. Firstly, access to insulin as well as medical care in terms of availability, accessibility, accommodation, affordability, and acceptability. Secondly, clinical encounters in two different public hospitals of Conakry, whose one specialized in pediatric diabetes. Thirdly, how global health funding policies impact life trajectories. The (non-)treatment of diabetes in Guinea hence illustrates ‘the tragedy of the commons’ within healthcare: how life expectancy – when suffering from diabetes – becomes a glocal journey.
2. Building Legitimacy by Leveraging the Polycentricity of Vaccination Campaigns
Ostrom Workshop, Indiana University, USA
States in conflict or recently independent states often struggle with building their capacity and creating peaceful options for the future. But strengthening state capacity is limited by the amount and type of resources a state has, the reach and resilience of different infrastructures (i.e., roads, supply lines), limitations on consolidation efforts, and a lack on the legitimate control of the use of violence. Not only is building state capacity difficult for new states and states in conflict, but exogenous shocks like natural disasters can be disruptive and weaken states further. The provision of services, particularly education and health care, has been linked to efforts of states to increase their capacity, but these provisions do not follow a linear path nor are they always effective. I argue that only under certain conditions – working with international organizations, local leaders, and sometimes rebel groups – vaccination campaigns act as a type of service provision that allows the state to build short-term symbolic capacity, or legitimacy, in the eyes of citizens. This short-term legitimacy building will then lay the foundation for the state to start increasing their long-term legitimacy and material capacity. As part of a larger project on state capacity building, this paper will attempt to unpack the nested governance structures that are already in place to try and make state-wide vaccinations possible in recently independent and conflict-ridden states. I use two Ebola outbreaks in 2018 and the subsequent vaccination campaigns in the Democratic Republic of the Congo to illustrate this.
3. Making Food Safer in Palestine: A One Health Approach to Antimicrobial Resistance
Swiss Tropical and Public Health Institute, Switzerland
A One-Health and transdisciplinary perspective, considering human-animal-environmental interfaces, is central to food safety as it embeds food production systems in their environmental, socioeconomic, and public health context, which is rooted in common health.
This research used a mixed-methods design (qualitative, quantitative, and laboratory studies) to find a critical methodology to foster food safety by better understanding zoonotic foodborne illness transmission and their resistance to antimicrobials in complex socio-ecological systems like those in Palestine. Broiler production was chosen as a prime example of food production in Palestine.
In the qualitative part, the multi-stakeholder discussion groups pointed out various challenges along the food production chain in Palestine, such as a striking scarcity of public slaughterhouses, insufficient coordination between authorities, a gap between public and private sectors, and inconsistent application of the law. A semi-structured observational study shows that public slaughterhouses and meat markets have effective hygiene, unlike traditional broiler production, while large-scale farms implement biosecurity measures. In phenotypic and genotypic analysis, we found a high frequency of Campylobacter and Salmonella in the chicken meat production chain with multiple antimicrobial resistance. This supports a substantial public health burden associated with Salmonella and Campylobacter from chicken sources.
This project recommends urgently building an integrated national surveillance system in Palestine to efficiently and sustainably monitor and manage zoonotic disease outbreaks, the spread of AMR, and other health threats.
4. Statecraft Through Disease: ‘Pandemic Preparedness’ in East Africa’s Promised Federal State
Department of Anthropology, Northwestern University, USA
The East African Federation is a proposed political and economic union of seven sovereign states in East Africa. To develop the promise of a “unified East Africa,” development aid from GIZ (Germany) and USAID (USA) for “pandemic preparedness”, has been used to expand programming under the bureaucracy of its proposed capital, Arusha, Tanzania. Since 2017 the East African Community has established an online archive of film interviews with individuals involved in crafting East African Community (EAC) institutions. This paper analyzes this growing archive with attention to how funding for disease outbreak preparedness (such as a 2019 “cross border field simulation” with Kenya and Tanzania) offers a theory of statecraft through disease. Narratives from nurses, doctors, health officials, and other professionals involved in responding to infectious diseases such as Ebola, Rift Valley Fever, and COVID-19 reveal tensions between sovereignty, biopolitical value, global medical apartheid, and extra-state violence in a global health infrastructure project under the age of sustainable development goals.
Panel 7.4. B
1. Health Commons as a Relational Good.
Seoul National University, Republic of Korea
Prior research on health commons has concentrated more on healthcare commons and knowledge commons connected to health than on health itself. Health is typically thought of as a personal good, but when social determinants of health are taken into account, personal health can be seen as a commons. The political, economic, social, and cultural environment has an impact on one’s health in diverse ways. Examples include the state of the workforce, the natural environment, housing, diet, and health behaviors. Thus, housing, a community, or the people of a country share environments that have an impact on human health. Personal health personal health itself is a form of commons in this sense.
It becomes visible that one’s health is maintained and managed through communal care when one views health as a commons. The reciprocal relationships among community members are used to accomplish this. All community members are interrelated with them and have a duty to care for them collectively since the external factors that affect health, such as green space, housing, access to clean water and food, clean air, and education, are shared resources. Even personal health behaviors like physical activity, food, smoking, drinking, and other practices are affected by relationships in the community and with other people. For instance, a family that eats and lives together shares food, and exercising is encouraged more by group exercise than by solo exercise.
Therefore, not only health itself is ontologically commons, but also it is being commons through relational process.
2. Making Public Health a glocal agenda: Universal Health Coverage as a Common Good in Kenya
Maseno University, Kenya
Public health services as a common good are under threat in the Sustainable Development Goals (SGDs) and the global health agenda. Universal Health Coverage (UHC) is at the epicentre of the global health agenda. In Kenya, free maternity services (FMS) are key attributes of UHC. Kenya introduced free maternity services in 2013 for free births in all public health facilities. Following a piloting phase, UHC was fully rolled out in February 2022. UHC is innovative in its ambitions of social solidarity and in its vision on the role of the state in tackling inequity. Since the crafting of FMS adopted a top-down approach, this paper describes the local perceptions of achieving UHC through FMS. Firstly, it describes UHC as a lens to the social contract between citizens and the state and the future of public health care. Secondly, the frictions accompanying UHC, such as obligation, solidarity and the public good, may have among policy-makers, state bureaucrats, health workers, and citizens. Thirdly, how bargaining power and local power relations could shape the glocalization of UHC policy packages. Therefore, to make UHC a glocal agenda, the government and the public should have a platform where commoning practices in solidarity and collectives are forged, maintained, and reinforced at the intersection of commoning healthcare distribution. This implies that integrating local views during policy-making would create trust, a sense of ownership, and accountability, thus making public health a glocal agenda.
3. Housing Affordability and Maternal Health
Rutgers, The State University of New Jersey, USA
In most countries, housing cost inflation has outpaced income growth and 1.6 billion people are expected to be impacted by the global housing shortage by 2025, largely in cities. In the U.S., 37.1 million households live in unaffordable housing (relative to income). Although reproductive-age women have disproportionately higher housing costs particularly following childbirth, it is not known whether housing affordability is associated with maternal health. There is also considerable debate regarding the impacts of public affordable housing programs, yet their role in mitigating adverse health effects of high housing costs has not previously been investigated. We addressed these gaps using data from New Jersey, which is the most densely-populated state in the U.S. and largely contained in the New York and Philadelphia metropolitan areas. Our objective was to estimate associations between area-level housing costs and maternal health outcomes, as well as the extent to which availability of publicly supported affordable housing attenuates those associations.
We linked individual birth records in New Jersey to maternal hospital discharge records, municipal-level rental costs, and availability of publicly supported affordable housing data. We estimated multilevel logistic models of associations between municipal-level rental costs relative to income and maternal morbidity, as well as the extent to which availability of publicly supported affordable housing attenuated those associations, while controlling for individual-level factors and municipal-level poverty, median rent, and population size.
We found that higher municipal housing costs were associated with greater odds of maternal morbidity and availability of affordable housing attenuated the associations.
4. From impoverishment to empowerment: re-creating healing narratives
By exploring commoning for the last years, I came to identify different collective narratives that make us perpetuate suffering.
1. The myth of scarcity
This is brought by a dysfunctionnal economy of strokes , that means that we learn to search for recognition of the authority, rather than to give and get recognition to and from our peers, which then creates abundance.
2. The myth of competition
The fear of lacking resources brings competition. As we are not in peace within ourselves, we built a socio-legal framework that foster competition and pseudo-rationalism , that is war against those deemed different.
3. The myth of the state and the market
Ignorant of our individual and collective capacities, we rely on external authorities to make decisions for us. Hence we come to believe that companies create jobs, and the state provides us with a safety net. In reality, companies and the state only exist because they extract value from the multitude, in the form of the collective intelligence brought, or taxes for example [3, 4].
4. The myth of materiality
Once aware of these myths, we can explore new avenues through the alliance of play, arts, and meditation for example [5, 6, 7].
1. Steiner, 1971. https://doi.org/10.1177/036215377100100305
2. Capra and Mattei, 2015. https://www.fritjofcapra.net/the-ecology-of-law/
3. Dardot and Laval, 2014. https://www.editionsladecouverte.fr/commun-9782707169389
4. Rushkoff, 2019. https://www.teamhuman.fm/book
5. Winnicott, 2005. https://www.routledge.com/Playing-and-Reality/Winnicott/p/book/9780415345460
6. Jung, 1963. https://en.wikipedia.org/wiki/Memories,_Dreams,_Reflections
7. Goenka, 2020. https://youtu.be/MwV9wnBrZps