Sidsel Roalkvam

The political origins of health inequity: prospects for change

Ole Petter Ottersen, Jashodhara Dasgupta, Chantal Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, Bience P Gawanas, Rita Giacaman, John Gyapong, Jennifer Leaning, Michael Marmot, Desmond McNeill, Gertrude I Mongella, Nkosana Moyo, Sigrun Møgedal, Ayanda Ntsaluba, Gorik Ooms, Espen Bjertness, Ann Louise Lie, Suerie Moon, Sidsel Roalkvam, Kristin I Sandberg, Inger B Scheel

What Counts as Progress? The Contradictions of Global Health Initiatives

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 peoples health?

Health governance in India: Citizenship as situated practice

Despite the impressive growth of the Indian economy over the past decades, the country struggles to deal with multiple and overlapping forms of inequality. One of the Indian governments main policy responses to this situation has been an increasing engagement with the ‘rights regime’, witnessed by the formulation of a plethora of rights-based laws as policy instruments. Important among these are the National Rural Health Mission (NRHM). Grounded in ethnographic research in Rajasthan focused on the management of maternal and child health under NRHM, this paper demonstrates how women, as mothers and health workers, organise themselves in relation to rights and identities. I argue that the rights of citizenship are not solely contingent upon the existence of legally guaranteed rights but also significantly on the social conditions that make their effective exercise possible. This implies that while citizenship is in one sense a membership status that entails a package of rights, duties, and obligations as well as equality, justice, and autonomy, its development and nature can only be understood through a careful consideration and analysis of contextually specific social conditions.

Choosing Vaccination: Negotiating Child Protection and Good Citizenship in Modern India

A global effort exists today to reach every child worldwide with vaccines. To get there, success in India is deemed cruical by international actors. Despite extensive international resources put into the universal immunization programme in India over the past 25 years, immunization rates remain low. This article explores how socio‐cultural realities in rural North India influence implementation of this effort, and questions the idea that vaccines can provide a quick‐fix road to health improvement. The authors identify three interfaces in rural vaccination programmes: between different knowledge systems; between social classes; and between government and citizens. At these interfaces they explore the role of a new cadre of community health workers (ASHA), deployed as a governmental tool under the National Rural Health Mission (NRHM), a fresh state health initiative. Despite a new language of community participation under the NRHM, reaching top‐down targets remains the main objective set for health workers. Furthermore, information strategies present vaccination as the moral choice according to national needs, catering to discourses in Indian society ultimately legitimizing social inequalities. Choosing to vaccinate becomes a statement of belonging to the modern, implying a high moral status. Marginalized groups, conversely, are blamed for not being part of that moral community. Non‐participation in the programme may represent a wish for dignity and a moral community of ones own. The authors call for a changed focus in preventive health care, in order to reach all parts of the population: quality of delivery, local knowledge and structural constraints must be addressed.

Vaccines and the Global System/or Why Study Vaccines?

On December 21 2002 President George Bush rolled up his sleeve, presented a deltoid muscle on his left arm and was pricked 15 times with a tiny, bifurcated needle, whose prongs held between them a droplet of vaccine virus derived from an infected calf. The Commander in Chief’s vaccination was the keystone of a public health campaign to immunize 10 million police and health workers against smallpox by the fall of 2003, preparing the nation for a terrorist warfare attack. (Allen, 2007, p. 11)

Commission on Global Governance for Health: just another report? – Authors' reply

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