Covid-19 and the limits of global health and international development

By Rory Horner, University of Manchester, UK

Covid-19 highlights the need for a different kind of geographical imaginary from the one that dominates global health and international development. Both fields, whether in research or in practice, are largely associated with the problems of ‘poor’ people and ‘poor’ countries. For example, framings of global health often centre around particular suffering slots, such as hospitals in Africa, rather than wider health systems. Yet the Covid-19 pandemic is a health issue that has affected people all around the world, with very uneven impacts that are not easily correlated with national income level.

Global health and international development should focus on the biggest challenges facing the world, but these do not solely relate to the global South – as highlighted, but not solely demonstrated, by Covid-19. Clearly, huge health and development challenges are still located within the global South, the classic geographical focus of global health and international development. Yet we live in an inter-connected world which is not easily divided into a North which has overcome development challenges and a South where those problems are mostly faced. Addressing global climate change and inequality, and not just fighting the Covid-19 pandemic, would benefit from change in all countries. Global health should be remade, while Covid-19 augments the case for moving towards a new paradigm of global development.

The related fields of global health and international development both have colonial origins, when missionary and civilising rationales were applied to health and wider development in colonies. While international health’s usage grew earlier in the 20^th century, the international arena was firmly institutionalised, in both health (e.g. World Health Organisation) and development (e.g. Bretton Woods Institutions), in the mid-20^th century and in a context of extensive state building with newly independent states.

Although a transition from international to global health has taken place since the turn of the Millennium, including as manifest in a change in terminology and as a field of study and research, a more recent debate has emerged over a shift from international to global development. In a paper published in Area last month, I set out the lessons that could be learned from that transition. Here, I apply some of these lessons to the Covid-19 pandemic specifically, particularly around the limitations of narrower views of global health and what a more holistic approach for both global health and global development might offer.

The shift from international to global is sometimes perceived as a rebranding rather than a substantive shift

Despite the growing frequency of usage of the term global health, considerable confusion has been found over what it actually means. In 1999, Supinda Bunyavanich and Ruth Walkup held conversations with 29 health leaders in the United States about the framing of global health. About half felt that there was no need for a new terminology and that “global health” was meaningless jargon. The other half thought that there were profound differences between international health and global health and that “global” clearly meant something transnational. Although these respondents believed that a major shift had occurred within the previous few years, they seemed unable to clearly articulate or define it.

Some parallels can already be found in the transition from international to global development, where clear differences have emerged over how ‘global development’ is interpreted. The terms are often used interchangeably with the Wikipedia definition being one such example. Despite intentions by some for a substantive shift to better fit the contemporary context, to others it may appear as a fashionable relabelling.

The geographical imaginaries of the global often focus on particular suffering slots

Global health can refer to many different things. Clare Herrick and David Reubi, in their volume Global Health and Geographical Imaginaries, have even suggested that part of the power of the idea of global health comes from its polysemous nature. One analysis identified five metaphors – global health as foreign policy, security, charity, investment and as public health.

Yet ‘global health’ is still often used primarily in relation to geographical imaginaries which are consistent with international health. Examples include: in security framings, when influenced by Northern interests, when used in foreign policy and in associations with particular suffering slots in the global South. Such geographical imaginaries are not easily correlated with the people and places worst hit to date by the health impact of Covid-19. Moreover, they leave others out, such as ‘regular’ citizens, patients, doctors, and community health workers efforts in producing “healthier” places.

A whole variety of understandings and metaphors may be deployed vis-à-vis global development. Few actually explain what they mean by global development and, as with health, the somewhat ambiguous nature of the term may be part of the attractiveness and power of the framing. The danger of older geographical imaginaries persisting vis-à-vis global development is of overlooking a range of new actors, of challenges such as climate change and inequality, and the nature of contemporary interconnectedness (e.g. trade, finance, climate change, as well as public health through infectious diseases) which underlies many development issues.

We must overcome residual understandings of problems in the global South

Global health problems are still often portrayed in a residual context of lack of ideas, practices, resources, knowledge, tools, technologies, which global health actors seek to address in low and middle-income countries. This is despite continued arguments for a relational global health (in understanding and research) centred around inter-dependency, the contributions of various nations, a biosocial focus across global North and South and the actual burden of disease.

This holds a warning for understandings of, and research on, global development and where relational approaches hold considerable potential. The interconnected, relational nature of political-economic processes which underly contemporary challenges facing the world, including global inequality and climate change, cut across global North and global South and require a more holistic analysis. Covid-19 accentuates the case not just from a health point of view as noted above, but from a broader development angle.

Post-pandemic global health and global development

The pandemic could be a critical juncture, with legacies for decades to come. It could lead to an ugly scenario of global meltdown, a bad scenario of a return to the pre-Covid-19 state of climate breakdown and considerable inequality; or it could lead to a good scenario of a transition towards global sustainable development. While the latter needs to be fought for, the ultimate legacies of Covid-19 are still uncertain. What is clear, however, is that the Covid-19 pandemic demonstrates a rationale for moving beyond understandings, practice and framings of global health and global development which are just associated with particular suffering slots in the global South.

About the author: Rory Horner is a geographer who is a Senior Lecturer at the Global Development Institute, University of Manchester and a Senior Research Associate at the Department of Geography, Environmental Management and Energy Studies at the University of Johannesburg. His research focuses on globalisation, trade and development, with a particular interest in the pharmaceutical industry in India and sub-Saharan Africa.