Joint IHSP-GHP Seminar: The state and global health: Reflections for a post-democratic world


Charles Meredith House Conference Room, 1130 avenue des Pins Ouest, Montreal, QC, H3A 1A3, CA

McGill Global Health Programs is delighted to partner with the McGill Institute for Health and Social Policy to present this special seminar by Ted Schrecker, Professor of Global Health Politics at Durham University.


Global health researchers routinely investigate the activities of states, for example as providers of health services domestically and development assistance internationally, and are often funded by them through granting agencies. Global health practitioners routinely interact with state agencies, and may well work for them, either as employees or through grant-funded projects. A further layer of complexity involves the influence of state actions and policies on health outcomes by way of channels such as trade and investment agreements and domestic and external security interventions. Yet the social science of global health includes little theorizing, or even critical reflection, on the nature and role of the state - despite the frequency of references, in discussions of global governance and health, to the supposedly ‘post-Westphalian’ character of the global health policy environment.

Whatever one’s view of their rather ambitious claim to have developed ‘a conceptual framework for interpreting recorded human history’, Douglass North and John Wallis remind us that in much of the world the state itself is contested terrain, characterized by ongoing contests among elites over access to the means of violence. Even outside such contexts political choices are increasingly dominated or constrained by wealth, whether through direct corruption (a topic politely avoided in many circles); by the isolation of personal and corporate wealth through capital flight to offshore financial centres (an indispensable facilitator of corruption); or by the ‘exit option’ that capital enjoys with respect to outsourcing or offshoring of production. These are among the contributors to rising inequalities within national borders, even under conditions of formal democracy, and have important ‘on the ground’ implications for such widely agreed objectives as progress towards universal health coverage.

The operations of formal democracy are in turn under attack not only by concentrations of wealth but also from the recent drift to neoliberal authoritarianism in Russia and the United States, and aggressive cyber-interventionism by the former. (The US, of course, has a long history of interfering with elections outside its borders using lower-tech measures.) Finally, there is the paradox of rapid progress on at least some health indicators in showcase jurisdictions such as Bangladesh and Rwanda that are repressive and retrograde in terms of the integrity of political processes and the accountability of governments. Each of these trends on its own is not new, but together they portend a qualitative change in the global political landscape, and quite possibly the end of both the realities and the illusions of progress sustained in the second half of the twentieth century – hence, the title of this paper. I conclude with a few tentative observations, relevant far beyond the global health field, about prospects for survival outside the world we have lost, and the chances for recovering portions of it.

A light lunch will be served.

gabriellamonica.kranz [at] (subject: RSVP%3A%20Ted%20Schrecker%20Seminar) (RSVP)


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