Department of Global Health & Social Medicine

"This article is a contribution to the sociological and anthropological literature on the recent globalization of Western biomedical research ethics and bioethics. Focusing on Singapore, the article identifies and traces the genealogy of the concepts, expertise, and techniques that made it possible to introduce and develop a bioethical assemblage in the Southeast Asian city-state at the turn of the twenty-first century. It argues that what made such a development possible was a particular style of reasoning, the ‘‘will to modernize,’’ which has characterized the thinking and acting of the Singaporean leadership ever since the country’s independence. After describing the elements that make up the will to modernize, most notably the concept of modernization-as-economic- development and the notion of infrastructure, the article shows how these elements have allowed for Singapore’s efforts to transform the island into a global hub for the life sciences from the mid-1980s onward. The article also shows how the development of a bioethical assemblage in the Republic was made possible by the fact that, for the governing elite, such an assemblage was conceived as a ‘‘(soft) infrastructure’’ that was necessary to transform Singapore into a global hub for biomedical research."

"This article examines the governmental apparatus organised around Singapore’s Blood Transfusion Service (SBTS) and the knowledge, experts and techniques associated with transfusion medicine. I term this apparatus, which was in place in the Singapore from its first steps towards political independence in 1959 until 1990, ‘Singapore’s haemato-logic assemblage’. Drawing on the work of Foucault, the article explores how this assemblage overflowed into and reconfigured understandings of biological sociality and citizenship in post-colonial Singapore. More specifically, it argues that, in the 30 years following independence, this assemblage brought into being a new figure of the biological citizen by creating a sphere of possibilities for ingaporeans to think and act accordingly. This new figure of the citizen is ‘the blood donor’. Articulated around the SBTS and the knowledge and techniques of transfusion medicine, this donor is a Singaporean who gives blood to save the lives of fellow citizens and participates, thereby, in the development and modernisation of the newly independent nation. To substantiate this argument, the article shows how the haemato-logic assemblage helped to realise this new figure of the citizen by creating – through narratives, statistics, spaces and rewarding schemes – a sphere of possibilities in which Singaporeans could think and act as blood donors."

"This article is a critque of a recent article by Ted Schrecker et al. entitled "Advancing Health Equity in the Global Market Place: How Human Rights Can Help". It argues that, contrary to what Schrecker and other global health activists seem to think, the international human rights framework might not help halt the detrimental consequences of what Schrecker calls market fundamentalism."

"This article examines how a fundamental element of the British bioethical assemblage – the literature on informed consent published between 1980 and 2000, a period when bioethics became a powerful force in the UK – has influenced contemporary understandings of the research subject. Drawing on Foucault, the article argues that this corpus of texts has created a sphere of possibilities in which research subjects can imagine themselves as human beings who reflect and decide whether they want to participate in medical experimentation. In particular, it shows how the narratives found in these texts portray relationships between researchers and their human subjects as ‘paternalistic’, and calls for their replacement by new, more ethical relationships characterized by both ‘dialogue’ and ‘respect’ and articulated around subjects who can ‘think and take decisions’. It also discusses the different strategies – using patient information sheets, a list of possible questions and invitations to take time to reflect – which the bioethical literature has developed in order to realise these new, ethical relationships. As the article suggests, these narratives and strategies provide researchers and research subjects with models and examples of how to interact with each other that are very different from the ones that prevailed before the emergence of bioethics."

"The way in which the scientific and medical use of the human body is problematised and governed in the United Kingdom was radically reconfigured over the last 30 years, changing from a logic of rule articulated around ‘supply’ and ‘solidarity’ to one construed around ‘ethics’. Drawing on the work of Ludwik Fleck and others, this article argues that one of the reasons for this reconfiguration was the existence and influence of a network of philosophers, doctors and lawyers who sought, from the 1960s onwards, to re-moralise medicine: the bioethical thought collective. The article first describes the collective’s membership and organisation, focusing in particular on the form of the interdisciplinary expert committee. It also describes some of the knowledge and practices that make up the community’s thought style, such as its moral concern about modern medicine and the notions of respect for persons and informed consent. The article then shows how these organisational forms, knowledge and practices that characterise the collective have shaped the government of human tissue research over the last 15 years. By highlighting the important role played by expert networks and knowledge, the article makes an original contribution to the sociology of the ethical government of biomedical science."

"This article addresses the proliferation of human rights in international public health over the last 20 years by examining recent attempts at framing the global smoking epidemic as a human rights problem. Rather than advocating in favour or against human rights-based approaches, the article purports to understand
how and why such approaches are being articulated and disseminated. First, it argues that the representation of the global smoking epidemic as a human rights issue has been the product of a small, international network of public health experts and lawyers: the human rights and tobacco control collective or community (HTC). The article describes in particular the HTC’s membership,
its style of thinking and its efforts to articulate and disseminate human rights based approaches to tobacco control. Second, the article argues that the aim of the HTC when framing tobacco control as a human rights issue was not to generate public attention for and the political will to tackle the global smoking
epidemic, as the literature on framing and human rights presupposes. Instead, as the article shows, the HTC framed tobacco control as a human rights problem to tap into the powerful, judicial monitoring and enforceability mechanisms that
make up international human rights."

""This article, which discusses the importance of frames and framing when examining the development of global public health, was co-authored with Colin McInnes, Simon Rushton, Anne Roemer-Mahler, Kelley Lee,  Owain Williams, Marie Woodling and Adam Kamradt-Scott."

"This article addresses the increasing influence of economic rationalities in global health over the past 30 years by examining the genealogy of one economic strategy – taxation – that has become central to international anti-smoking initiatives in the global South. It argues that this genealogy sits uncomfortably with the usual story about economics and global health, which reduces the economisation of international health to neoliberal structural adjustment policies aimed at stabilisation, liberalisation and privatisation and laments their detrimental effect on health. While not disputing these policies’ importance and damaging impact, the genealogy of tobacco taxes outlined in this article shows that the economisation of global health is not only about neoliberal structural adjustment policies but also about sin taxes, market failures and health economics. By stressing how changes in health like the global South’s epidemiological transition can impact on economics and how beneficial taxation can be for health, it also shows that the relation between economics and health is not always unidirectional and detrimental to the latter. In doing so, the article contributes to the critique of the often mechanical use of neo-liberalism to explicate change and calls for other stories about the economisation of global health to be told."

This article explores the spatio-temporal logics at work in global health. Influenced by ideas of time–space compression, the global health literature argues that the world is characterised by a convergence of disease patterns and biomedical knowledge. While not denying the influence of these temporalities and spatialities of globalisation within the global health and chronic disease field, the article argues that they sit alongside other,often-conflicting notions of time and space. To do so,it explores the spatio-temporal logics that underpin a highly influential epidemiological model of the smoking epidemic. Unlike the temporalities and spatialities of sameness described in much of the global health literature, the article shows that this model is articulated around temporalities and spatialities of difference. This is not the difference celebrated by postmoderns, but the difference of modernisation theorists built around nations, sequential stages and progress. Indeed, the model, in stark contrast to the ‘one world, one time,one health’ globalisation mantra, divides the world into nation–states and orders them along epidemiological, geographical and development lines.

This article tells a different but equally important story about neoliberalism and global health than the narrative on structural adjustment policies usually found in the literature. Rather than focus on macroeconomic structural adjustment policies, this story draws our attention to microeconomic taxation policies on tobacco, alcohol and sugar now widely recognised as the best strategy to control the global NCD epidemic. Structural adjustment policies are the product of the shift from statist to market-based development models, which was brought about by neoliberal thinkers like Peter Blau and Deepak Lal. In contrast, taxation policies are the result of a different epistemological rupture in international development: the move from economies and physical capital to people and human capital, advocated by Gary Becker and others. This move was part of a wider change, which saw Chicago School economists, under the influence of rational choice theory, redefine the object of their discipline, from the study of markets to individual choices. It was this concern with people and their choices that made it possible for Becker and others to identify the importance of price for the demand for tobacco, alcohol and sugar. The same concern also made it easier for them to recognise that there were inefficiencies in the tobacco, alcohol and sugar markets that required government intervention. This story, I suggest, shows that structural adjustment policies and pro-market ideology do not exhaust the relationship between neoliberalism and global health and should stop dictating how we, as political and social scientists, conceive it.

This article explores the internationalisation of tobacco control as a case study in the history of international health regulation. Contrary to the existing literature on the topic, it argues that the history of international anti-smoking efforts is longer and richer than the making of the World Health Organisation's Framework Convention on Tobacco Control in the early twenty-first century. It thereby echoes the point made by other scholars about the importance of history when making sense of contemporary global health. Specifically, the article shows how the internationalisation of tobacco control started in the 1950s through informal contacts between scientists working on cancer research and how these initial interactions were followed by a growing number of more formal initiatives, from the World Conferences on Tobacco or Health to the Bloomberg Initiative to Reduce Tobacco Use. Rather than arranging these efforts in a linear narrative of progress culminating with the Framework Convention on Tobacco Control, we take anthropological claims about global health's uneven terrain seriously and portray a history of international tobacco control marked by ruptures and discontinuities. Specifically, we identify three successive periods, with each of them characterised by specific understandings of international action, tobacco control expertise, advocacy networks and funding strategies.

This article explores the spatio-temporal logics at work in global health. Influenced by ideas of time–space compression, the global health literature argues that the world is characterised by a convergence of disease patterns and biomedical knowledge. While not denying the influence of these temporalities and spatialities of globalisation within the global health and chronic disease field, the article argues that they sit alongside other, often-conflicting notions of time and space. To do so, it explores the spatio-temporal logics that underpin a highly influential epidemiological model of the smoking epidemic. Unlike the temporalities and spatialities of sameness described in much of the global health literature, the article shows that this model is articulated around temporalities and spatialities of difference. This is not the difference celebrated by postmoderns, but the difference of modernisation theorists built around nations, sequential stages and progress. Indeed, the model, in stark contrast to the ‘one world, one time, one health’ globalisation mantra, divides the world into nation–states and orders them along epidemiological, geographical and development lines.