Global health in public policy: finding the right frame?

Abstract

One of health promotion's major contributions has been its discursive challenge to biomedical and even behavioural models of health and illness. The concept of social determinants of health is now widely accepted by health authorities in many parts of the world. When health promoters focus on these determinants, however, it is often at local or national scales. Contemporary globalisation demands a more critical appraisal of how many health problems have become inherently global in cause and consequence. In making such an appraisal, it is helpful to consider how global health is presently being framed to determine which arguments are most likely to be health-promoting for the greatest number. This article reviews five such frames: health as security, as development, as global public good, as commodity, and as human right. Most offer some useful argumentation to health promotion, although the rights-based frame, when supported by ethical reasoning (a moral voice), is the most consistent with health promotion's more empowering roots.

Keywords:

• Globalization
• health promotion
• public policy

Acknowledgements

This article is based on a presentation initially sponsored by Flinders University of South Australia, 18 March 2005. Thanks to Colleen O’Manique and Ted Schrecker for detailed comments, and to two anonymous reviewers. Further work on this article was supported by the Canada Research Chairs program and the Canadian Institutes of Health Research grant 79153: Health in an Unequal World: Global Ethics and Policy Choices. A different version of this article appears as Chapter 6: Working to Build Empowerment: the Global Challenge, in R. Labonté and G. Laverack, From local to global empowerment: health promotion in action, London: Palgrave Macmillan, 2008.