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Published online by Cambridge University Press: 19 December 2024
I argue that the plagues of the twenty-first century are not an isolated set of diseases ⦠but an ever more complex array of interacting diseases, the spread of which is being driven by the dual (and themselves interacting) forces of globalism and global warming, both of which are shaped by human action, decision making, and the unequal and often oppressive structure of social relations.
Singer (2010: 25)In their introduction to health geographies, Brown et al. (2018) refer to “five cross-cutting critical themes” that thread throughout their chapters. In a book on global health it is inevitable that my own choice of cross-cutting themes overlaps with theirs, but the material I have covered leads me to suggest some alternatives (Table 10.1).
In this concluding chapter I want to use these themes to summarize what has been presented in earlier chapters.
Governance/security
Power, whether political or economic, is held by a wide range of actors – individual, organizational, state or international – with complex relations between different levels. Actors can include NGOs, government departments, private companies, landowners, and so on. All these, often networked together, dictate access to resources, including healthcare, that in turn shape health or its absence. The power contained within these networks may contribute to structural violence, as noted later. Yet states and international organizations alike can, as Farmer (2005: 142) has pointed out, be relatively powerless.
The impotence of international bodies in the face of generally recognised problems, their inability to effect solutions, stems from the self-interest of those who stand to benefit from their oppression of other human beings. In each major problem there is broad recognition of both the moral intolerableness and the political non-viability of the existing situation, coupled with a lack of capacity to respond.
(Farmer 2005: 142)We saw in Chapter 3 that there is a debate among political geographers and international relations researchers as to the relative power exercised by the state and international bodies such as the WHO, notably in addressing infectious disease spread. The Global Health Security Index remains resolutely fixated on security from infectious disease. But countries in the Global North have their own, internal, issues of security.
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