Bill & Melinda Gates Foundation, Global Health , Seattle , WA , USA.
Department of Interdisciplinary Research, Office OU , Toronto , Canada.
Glob Health Action. 2019;12(1):1651017. doi: 10.1080/16549716.2019.1651017.
: The current approach to global health has significantly contributed to improving it, as evidenced by the progress made toward the Millennium Development Goals (MDGs). However, the health gains achieved are often highly unequitable, and the current approach is expected to be insufficient to meet the future health equity challenges. There is an urgent need to re-think and expand the scope of research and programmatic strategies. : This paper aims to assess the ideological underpinnings of the currently dominant norms in global health, with the goal of highlighting the research and programmatic areas that are marginalized and warrant greater efforts in order to resolve persistent health inequity and achieve the UN Sustainable Development Goals (SDGs). : We have conducted a critical review of the literature that traces the historical origins of global health to the period between the mid-19th century and the end of the 20th century. : Critical review of the historical origins of global health reveals a set of dominant norms in global health that are ideological in character, and profoundly shape the current practice. We identified key manifestations of the ideological underpinnings as 1) Democratic deficit, 2) Depoliticization of the discourse, 3) Marginalization of the scholarship that interrogates the relations of power. : Examination of the dominant norms that shape the foundation of our knowledge and action in global health is required to solve persistent health inequity challenges and meet the SDGs. Inversion of the key manifestations of the dominant norms can serve as guiding principles to elaborate alternative frameworks that have the theoretical and programmatic potential for a fundamental rather than an incremental change in the practice of global health.
目前的全球卫生方法在改善全球卫生方面做出了重大贡献,千年发展目标(MDGs)的进展就是证明。然而,所取得的健康收益往往极不平等,而且预计目前的方法不足以应对未来的公平性挑战。迫切需要重新思考和扩大研究和方案战略的范围。本文旨在评估当前全球卫生主导规范的思想基础,目的是突出边缘化的研究和方案领域,需要加大努力,以解决持续存在的健康不公平问题,实现联合国可持续发展目标(SDGs)。我们对文献进行了批判性回顾,追溯了全球卫生的历史起源,可以追溯到 19 世纪中叶到 20 世纪末。对全球卫生历史起源的批判性回顾揭示了一套在思想上具有主导地位的全球卫生规范,这些规范深刻地塑造了当前的实践。我们确定了思想基础的主要表现形式为 1)民主赤字,2)话语非政治化,3)质疑权力关系的学术研究边缘化。需要检查塑造我们在全球卫生方面的知识和行动基础的主导规范,以解决持续存在的健康公平挑战并实现可持续发展目标。扭转主导规范的主要表现形式可以作为指导原则,制定替代框架,这些框架具有理论和方案潜力,能够从根本上而不是渐进地改变全球卫生实践。