What Counts as Progress? The Contradictions of Global Health Initiatives
What Counts as Progress? The Contradictions of Global Health Initiatives
复制标题
什么才算是进步？
DOI：
10.1080/08039410.2015.1134645
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发表时间：
2016
影响因子：
0.7
通讯作者：
D. McNeill
中科院分区：
文献类型：
--
作者：
S. Roalkvam;D. McNeill
为孕产妇和儿童保健提供资金的全球倡议挽救了数百万人的生命，并保护数百万人免受致残和使人衰弱的疾病的摧残；为这事，他们是应当大受称赞的。这种技术和垂直方案对全球一级的决策者具有吸引力；但是，这些保健干预是在复杂的社会和经济结构中进行的，并且已经就这些方案的一些消极后果以及对地方、国家和全球各级治理的影响提出了相关问题。基于最近和正在进行的研究，特别是来自印度的案例研究，本文批判性地评估了这些相关问题。这些规划是否实际上可能削弱地方卫生系统，而地方卫生系统本身和确保卫生改善都至关重要？它们是否会改变问责制的方向，使国家政府向上对捐助者负责（实现特定的数字目标），而不是向下对其公民负责？这些方案是否也有助于使全球公共卫生领域非政治化，转移人们对强国纠正对人民健康产生负面影响的全球政治经济和全球治理缺点的责任的注意力？
Global initiatives to finance maternal and child health have saved millions of lives and protected millions more against the ravages of crippling and debilitating disease; for this they are to be highly commended. Such technological and vertical programmes are appealing to policy-makers at the global level; but these health interventions take place within complex social and economic structures, and pertinent questions have been raised both about some negative consequences of these programmes and the implications for governance at local, national and global levels. Based on recent and ongoing research, and especially on a case study from India, this article critically assesses these related concerns. Is it the case that these programmes may actually weaken local health systems, which are crucial both in themselves and for ensuring health improvements? Do they change the direction of accountability, with national governments becoming accountable upwards to donors (for achieving specified numerical targets) rather than downwards to their citizens? And do such programmes also serve to de-politicize the field of global public health, diverting attention from the responsibilities of powerful nations to rectify the shortcomings of the global political economy and global governance which impact negatively on people's health?