WHOse international health? Cooptation and resistance in the context of health and development, 1970-present

In the 1960s, at the height of the Cold War, a crescendo of liberation and civil rights struggles were forming an organized critique of imperialist development aid. Globally, the Bandung movement of newly liberated nations challenged the neocolonial approach to development and spurred the creation of the G-77, a large group of UN members advocating for fair terms of trade, the end of exploitation, and aid based on the collective well-being of developing countries. Meanwhile across the world, the concept of community participation in decisionmaking was renewed, with activists struggling for bona fide citizen involvement in quotidian and long-term policies affecting their communities and livelihoods. Public health was central to these efforts. By the 1970s, however, critical challenges to mainstream health and development began to be coopted by powerful development institutions, donors, and brokers seeking to change the rules of the game. Participation, for example, was downshifted -- reinterpreted to mean mere presence at the table rather than political power in decisionmaking. This presentation traces the history of cooptation in the context of international health, covering the fates of such progressive ideas as decentralization, gender empowerment, and community participation, and the mixed prospects of “mainstreaming” these approaches. Special attention is paid to the 1978 Alma-Ata primary health care declaration, which called for a new international economic order and integrated socio-political-public health approach to social justice and human well-being. The talk concludes with thoughts on how public health activists and academics can preempt cooptation in the context of political struggle.