Alternatives in & to global health: actors, issues, interventions

Workshop, Villejuif, April 12th, 2019



Global health emerged from the claimed need for a re-invention of postwar international public health’s focus on nation-states and intergovernmental UN institutions. Itself an alternative, global health grew as a field and became the dominant register of intervention in the ‘health of others.’ Nonetheless, global health was and is the target of mounting critiques. Diverse in origins these critiques—coming from public health experts, officials in recipient countries, NGOs, or scholars interested in social medicine—share a certain understanding of what global health is, namely 1) a series of vertical, disease-oriented and top-down selective programs, 2) standardized and technology-oriented intervention that focus on performance’s assessment rather than needs evaluation and 3) decision making power located with donors as “investors”. Whether relevant or not, this diagnosis of global health has operated as the basis for considering alternatives since the late 1990s. The question has acquired a new visibility since 2010, as growing debates about ‘Universal Health Coverage’ have provided a new stage for discussing issues of access to care, inequalities, health system financing, and health system organization.

Examining alternatives in the context of a field that styles itself planet encompassing, we hope to interrogate processes, logics, ethics, and objects that--in opposition to global health or from within it—are preformed or act as alternatives, frictions, supplements, or critique. Our goal is to understand how an alternative to planetary equivalences like 'global' and 'health' might be imagined, foreclosed, or lived. We hope to query the techniques that enable and question global health’s equivalences while asking who the audience of these critiques might be.

The aim of this one-day exchange is to engage the diversity of global health critique, the various actors involved, and the ways in which they intervene. Three analytical issues will be of special interest:

  • The interplay between alternatives IN and alternatives TO. We will discuss several different theorizations of alternative and critique. “Partners in Health” may be a typical example of alternatives in as it situates its interventions in favor of community-based medicine attentive to structural inequalities as a reimagining global health. The globalization of Indian Ayurveda, might be an alternative to as it re-invents industrial formulations, whose use are promoted as responses to the limitations of biomedicine without any connection with global health as field.
  • The continuities of social medicine. 2010s’ discussions about universal health coverage resurrected interests and references to the 1960s-1980s primary health care (PHC) strategy as a peculiar moment in the complex trajectory of social medicine. Far from cultivating the kind of nostalgia typical of previous debates around PHC, these references approach PHC as model for the present, rooted in reconsidered, actualized and enlarged local and national experiences of community needs and health care governance.
  • Thinking beyond the ‘North-South’ divide. Processes of health globalization can’t be reduced or equated to gatherings of actors mobilizing money in the North to intervene in the South. The landscape is more diverse. It includes South-South interventions and exchanges that cross the porous boundaries between global health actors and programs. In parallel, issues regarding the government of health in the North and in South converged in the context of economic crisis, which led, for instance, to the spread of community health experiments in countries like Greece or Spain deeply affected by austerity policies.    



Jean-Paul Gaudillière (Cermes3)



Marlee Tichenor (University of Edinburgh)

What is universal about universal health coverage?: Valuing and de-valuing systems of solidarity




Blandine Destremau (IRIS)

"Caring for the elderly: a blind spot of Global Health? Consideration from the Cuban case"






Sarah Pinto (Tufts University)

Ethics and counter-ethics in an Indian dream analysis: "Alternative" as modus operandi in 20th century psychiatry




Claudia Lang (Cermes3)      

"Primary health care as alternative in or to global health? The case of Kerala"