Global health

25.03.2024: Gesundheit ohne Grenzen

Krankheiten und ihre Ursachen überschreiten Ländergrenzen – das hat nicht zuletzt die Corona-Pandemie gezeigt. Beim Schutz der Gesundheit ist daher weltweite Zusammenarbeit gefragt. Deutschland spielt in diesem komplexen Geflecht eine wichtige Rolle. Wie stark die globale Gesundheitspolitik aber von Machtverhältnissen und nationalen Egoismen geprägt und der Instrumentalisierung für wirtschaftliche und politische Interessen ausgesetzt ist, zeigte das Gefeilsche um Impfstoffe in der Covid-19-Krise. Auch das deutsche Global-Health-Engagement stößt an Grenzen, wenn die bundesregierung gemeinsam mit anderen Industrieländern die Patentfreigabe für Corona-Impfstoffe und -Medikamente blockiert und damit den Gewinnen der Hersteller Vorrang vor globalem Gesundheitsschutz einräumt.

Jens Holst

09.03.2024: Sacrificing globalism on the altar of decolonization

Rapid response

In January 2024, BMJ Global Health published another attempt to redefine 'global health' with the aim of filling the term with 'greater clarity and precision' in a pragmatic and more inclusive sense. The authors intend '‘to offload colonial vestiges present within the field and terminology of ‘global health’. Their argument, however, turns out to be alarmingly unconvincing and narrow. It is based on data from a single country and, worse still, the field of humanitarian aid. Moreover, the authors reduce global health to health care and healthcare systems, neglecting the social, environmental, political and commercial determination of health, as well as inequalities and power imbalances between and within countries.

Jens Holst

21.02.2024: Salud Global: ¿Cuál es el desafío?

La salud global ocupa actualmente un lugar destacado en la agenda política internacional y desempeña un papel importante en las cumbres de foros internacionales como el Grupo de los 7 (G7) y el Grupo de los 20 (G20). Desde el punto de vista de las ciencias de la salud y la política sanitaria, la creciente importancia política de la salud mundial y su consideración en la escena internacional hace tiempo que deberían haberse producido. Sin embargo, el concepto actual de la salud mundial adolece de una serie de limitaciones conceptuales, ya que el alcance y el contenido del debate no suelen estar a la altura de la complejidad de los retos. Esto contradice en cierto modo la evolución que ha hecho de la salud global convirtiéndose en un importante tema transversal. Es alentador que en los últimos años el contexto global de la salud haya pasado cada vez más a un primer plano. Sin embargo, esto requiere un enfoque de derechos humanos que considere la salud no como un "modelo de negocio" rentable, sino como una aspiración de todo ser humano. La salud mundial también debe abordar las raíces y principales causas del empobrecimiento del Sur global, a saber, el colonialismo, un orden económico orientado a la maximización del beneficio a corto plazo y, en particular, la explotación ecológica de los recursos naturales. Una política sanitaria mundial responsable debe abordar realmente los problemas existentes y no limitarse a restablecer las condiciones que condujeron a la crisis sanitaria mundial y planetaria.

Jens Holst

20.02.2024: Global Health - What is the challenge?

Global health is currently high on the international political agenda and plays an important role at summits of international fora such as the Group of 7 (G7) and the Group of 20 (G20). From the perspective of health science and health policy, the growing political importance of global health and its consideration on the international stage is long overdue. However, the current understanding of global health suffers from a number of conceptual limitations, as the scope and content of the debate is often not commensurate with the complexity of the challenges. The dominant global health discourse often fails to live up to the claim to universalism implicit in the term 'global'. In contrast, global health policy has become an important and complex cross-cutting issue and task. It is encouraging that in recent years the global context of health has increasingly come to the fore. However, this requires a human rights approach that sees health not as a profitable "business model", but as an aspiration of every human being. Global health must also address the roots and underlying causes of the impoverishment of the global South, namely colonialism, an economic order geared to short-term profit maximisation and in particular the ecological exploitation of natural resources. Responsible global health policy must actually address existing problems and not be limited to restoring the conditions that led to the global and planetary health crisis.

Jens Holst

03.08.2023: Distracted and captured by decolonialism

Reply to the critique of Holst, van de Pas & Tinnemann: The Virchow Prize: cementing commodification, coloniality and biomedical reductionism in global health?

Criticising manstream developments is always uncomfortable. The Virchow Prize for Global Health should be such a nice event to celebrate at the Global Health Summit in Berlin. The contradictions between the awarding foundation and prevailing trends in global health, on the one hand, and the legacy of its namesake on the other, are all too easily overlooked. And when someone points this out, as Holst, van de Pas and Tinnemann did in BMJ Global Health in April 2023, they have to be caught in the crossfire. And what better way to do that than to accuse them of anti-decolonisation? In his rebuttal, "Distracted and captured by decolonialism", Jens Holst debunks the criticism of his critique and points out blind spots in the decolonisation debate.

Jens Holst

03.05.2023: The Virchow Prize

Cementing commodification, coloniality and biomedical reductionism in global health?

In the tradition of Rudolf Virchow, any foundation using his name should safeguard his legacy. Taking Virchow seriously will require that future Prize winners (including especially groups, movements and organisations) are predominantly entities with outstanding contributions related to the social aspects of global health, fostering a comprehensive, universal, contextualised and just approach within the remits of the right to health. The first iteration of the Virchow Prize in October 2022, and especially the equinomous foundation behind it require some scrutiny. Virchow believed in social reform to achieve a constitutional democracy by reducing the power of the monarchy and the nobility. A consistent translation of Virchow’s writings into today’s reality would ultimately suggest reducing the power of the financial aristocracy and its philanthropic organisations, which are increasingly dominating global health. Jens Holst, Remco van de Pas and Peter Tinnemann published their critical appraisal of the Virchow Prize in the BMJ Global Health 2023;8:e011240. doi:10.1136/bmjgh-2022-011240.

Jens Holst

18.03.2023: The biomedical securitization of global health

The COVID-19 outbreak has highlighted the continuing menace to humanity of global health issues that had been suppressed and considered under control, at least in the Global North. The massive warfare activities in Ukraine in the third year of the pandemic have reawakened the sense of threat particularly in Europe. Both the pandemic and the war, as well as the escalating climate crisis, have made global insecurity more tangible. The existing and likely crises caused by these unfortunate occurrences – mass displacement, increasing prices for products of basic needs such as food and energy, and the overall severe impact on global economy—will burden people in low-income countries most but not at all exclusively. Especially the fatal effects on future generations understandably reinforce the desire for a safer world. Enhanced security is needed in times of growing uncertainty, threatened ancestral rights and dwindling opportunities for a large part of mankind. The current global order has therefore been aptly described as a world risk society. Even if this need for security is comprehensible, the nature of the security discourse in global health and beyond raises fundamental questions and concerns.

Jens Holst & Remco van de Pas

10.10.2022: Viral Neoliberalism: The Road to Herd Immunity Still A Rocky One

The almost ubiquitous spread of neoliberalism has contributed to shifting the prevailing economic system from one of coordinated market capitalism. Neoliberalism is commonly considered an economic theory but is a rather toxic ideology. The pandemic caused by the neoliberalism virus has been and is actually a public health challenge in itself. The neoliberalism virus has proven to be extremely efficient in both manipulating individuals and societies and blurring analytics. The virus has a double stranglehold on a large part of the media, in terms of both content and the economic framework conditions. Viral neoliberalism has been very successful in concealing the contradiction between economic liberalization and the extension of free markets on the one hand, and the growth in market power and dominance of corporate entities and monopolies on the other.15 In fact, under the rules of the game set by neoliberal strategists, pre-existing inequalities have increased and new ones emerged. This is not at all surprising as the "free play of market forces" did not take place in a space free of domination. Evidence shows that neoliberal reform approaches in the health sector tend to have negative impacts on key global health issues such as equity and fairness.The inequitable global distribution of COVID-19 vaccines has highlighted with unusual clarity the extent to which the symptoms of the neoliberal virus are shaping today's world. While overall global wealth has significantly grownthe socioeconomic gap between and within countries has widened.The inequitable and undemocratic nature of the current economic system is unsustainable because it endangers the planet's possibilities for supporting and reproducing life. To enable sustainable living, it is ultimately inevitable to impose political limits on corporate power, because even broader and stronger mass protest movements will be unavailing as long as governments refrain from tackling and shackling the corporate miscreants.

Jens Holst

18.08.2022: Global health and health security

Conflicting concepts for achieving stability through health?

Global health is high on the international political agenda and has played an important role at recent summit meetings of international forums such as the ‘Group of 7’ (G7) and the ‘Group of 20’ (G20). The increasing political importance of global health and the attention it receives on the international stage is long overdue from the point of view of public health and health policy. The prevailing global health discourse, however, often fails to fulfil the claim of universalism implicitly associated with the term ‘global’. Moreover, it tends to neglect the requirements of a comprehensive transdisciplinary and interdisciplinary understanding of health policy. In fact, there is a large discrepancy between the current state of knowledge and global health policy practice. Global health policies are increasingly determined by foreign-policy priorities and security concerns, and security frequently features as the contextual framework in political health and foreign-policy documents. The dominant security discourse is problematic because security-oriented policies focus on safeguarding the status quo, however inequitable and unfair it may be, instead of pushing for social balance and integration across national borders. This threatens to undermine what politics should be geared towards: the rights and legal entitlements of people, as laid down in human rights and in the WHO constitution. Please find the Paper by Jens Holst and Oliver Razum publiched online in Global Health Action on March 8, 2022 here.

Jens Holst and Oliver Razum

19.04.2022: Biomedical Perspective: Critical Assessment of an Outdated Concep

The concept of biomedicine stems from Robert Koch's theory that diseases are caused by pathogens or other factors, and is based on the premise of a simple cause-and-effect relationship between measurable pathophysiological triggers and disease phenomena. The biomedical perspective guides health care and clinical practice worldwide, but has obvious limitations in the case of non-communicable and mental diseases. It also ignores the social determinants of health and illness, and thus important findings from health sciences research. At the same time, the dominance of the biomedical perspective is growing worldwide, not least due to the management of epidemics and pandemics and the expansion of genetic and new molecular biological methods. Reducing health and disease to biological factors tends to promote the medicalisation of social problems and individual lifestyles. Models that primarily consider organic-pathophysiological causes of chronic-degenerative diseases offer only limited approaches for prevention and health counselling. Even in medical secondary and tertiary prevention, potentially promising behavioural changes through patient counselling and education fall short if they do not sufficiently address environmental prevention.

Jens Holst