Neoliberal regime change and the remaking of global health: from rollback disinvestment to rollout reinvestment and reterritorialization

Abstract

This article examines the impacts of two interconnected but distinct regimes of neoliberalism on global health. The first is the ‘rollback’ regime associated most commonly with the 1980s and 1990s when efforts to build universal primary health care systems around the world were undermined by Structural Adjustment Programs (SAPs) and associated forms of austerity and market rule. This rollback regime of neoliberal conditionalization led to widespread health service cutbacks, user fees, and other market-driven reforms that effectively replaced plans for ‘health for all’ with more selective and exclusionary approaches. The second neoliberal regime has been rolled-out in part as a response to the resulting gaps in care and associated forms of suffering and ill-health. Where the rollback regime enforced disinvestment, the ‘rollout’ regime insists instead on prioritizing investment. But even as it thereby addresses the health risks produced by financialized neoliberal conditionalization, this reformed rollout regime has doubled-down on selectivity by adapting calculations from global finance to manage global health interventions. This emphasis on rationed and targeted life-saving investment is theorized here as illustrating a shift from the rollback regime’s Laissez-faire ‘macro market fundamentalism’ to an Aidez-faire rollout of ‘micro market foster-care’.

Acknowledgements

Many deep thanks to Owain Williams for support through every step of writing and editing; to Susan Sell for generous encouragement; and to Sari Niedzwiecki, my POLI 186 students in Santa Cruz, and the anonymous reviewers for excellent questions and advice.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributor

Matthew Sparke is a Professor of Politics at the University of California Santa Cruz where he teaches about political economy, globalization and global health. His research is focused on the politics of space, geopolitics and geoeconomics, including the diverse ways in which the geographies of citizenship and belonging are shifting in the 21st century with embodied life and death consequences.