Public Health in the Twenty-First Century: Beyond the Multilateral Institutions
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This chapter discusses the processes through which a health issue comes to be understood as global. It traces the evolution of international institutional responses to three health issues that have attained global status—tuberculosis, malaria, and HIV/AIDS—since their emergence. Several factors play a role in determining the global status of these health issues. These factors include the severity and distribution of the disease, the rapidity of its spread, the societal groups it affects, and the availability of a cure. Once a combination of these factors is present, global status can be conferred on the basis of three categories that are seen as transcending national boundaries— “biomedicine,” “human rights,” and “transnational nature.” Over time, these three framings shaped, often in competition among each other, varying approaches to the control of tuberculosis, malaria, and HIV/AIDS. In the 1980s and 1990s, all three were seen as intimately intertwined with globalization. The idea that partnerships between governments, intergovernmental organizations, companies, and civil society were the best ways to address these health issues became dominant in the public health community.