London School of Hygiene and Tropical Medicine, London, UK.
Int J Health Policy Manag. 2015 Feb 5;4(2):119-21. doi: 10.15171/ijhpm.2015.25. eCollection 2015 Feb.
Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today.
希夫曼正确地提出了谁在全球卫生中行使权力的问题，他认为权力是一个复杂的概念，其行使方式往往不透明。权力不是基于财政实力，而是基于知识或经验，这种权力难以估量，但它可能为在全球卫生议程上提出道德主张提供合法性，无论是现在还是将来。二十年前，在一个健康环境不那么复杂的情况下行使权力。世界卫生组织（世卫组织）能够发挥其作为世界卫生领导者的权威。如今的情况大不相同。全球卫生的财政资源正由各种组织争夺，在这种权力分散且有些隐蔽的环境中，每个组织都必须大声、公开地确立和提出自己的道德主张。我们观察到两种让行为体在全球卫生领域获得道德权威的方式。一种是基于科学知识的权力，另一种是政策过程中的程序，这通常与广泛协商和参与的概念联系在一起。我们借鉴布迪厄（Bourdieu）提供的一个特定框架来讨论这些问题，他通过关注不同类型的资本来分析行为体权力的来源。理解权力的不同方法或理论将在一定程度上回应希夫曼向卫生政策分析师提出的挑战。我们需要更全面地探讨全球卫生中的权力所在，以及它是如何行使的，以便了解当今全球卫生行为体的潜在卫生议程和合法性主张。
