Knowledge and Networks – Key Sources of Power in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

Document Type : Commentary


London School of Hygiene and Tropical Medicine, London, UK


Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today.


Main Subjects

Shiffman, J. Knowledge, moral claims and the exercise of power in global health. Int J Health Policy Manag 2014; 3: 297-9. doi: 10.15171/ijhpm.2014.120
Vaughan JP, Modedal S, Kruse SE, Lee K, Walt G, de Wilde K. Financing the World Health Organization: global importance of extrabudgetary funds. Health Policy 1996; 35; 229-45. doi: 10.1016/0168-8510(95)00786-5
Sridhar D, Gostin L. Reforming the World Health Organization.  JAMA 2011; 303: 15; 1585-6. doi: 10.1001/jama.2011.418
Frenk J, Moon S. Governance challenges in global health. N Engl J Med 2013; 368: 936-42. doi: 10.1056/NEJMra1109339
Bruen C, Brugha R. A ghost in the machine? politics in global health policy. Int J Health Policy Manag 2014; 3: 1–4. doi: 10.15171/ijhpm.2014.59
Bourdieu P. Outline of a theory of practice. Cambridge: University of Cambridge Press; 1977.
Bourdieu P. The forms of capital. In: Richardson J, editor. Handbook of Theory and Research for the Sociology of Education. New York: Greenwood; 1984. P. 241-58.
Greenhalgh T, Wieringa S. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. J R Soc Med 2011; 104: 501-9. doi: 10.1258/jrsm.2011.110285
Barnes A, Parkhurst J. Can Global Health Policy be Depoliticized? A Critique of Global Calls for Evidence‐Based Policy. In: Brown G, Yamey G and Wamala S, editors. Handbook of Global Health Policy. UK: John Wiley & Sons, Ltd; 2014.
Buse K, Mays N, Walt G. Making Health Policy. Berkshire: Open University Press-McGraw Hill; 2012.
McCoy D, Kembhavi G, Patel J, Luintel A. The Bill and Melinda Gates Foundation’s grant-making programme for global health. Lancet 2009; 373: 1645-53. doi: 10.1016/s0140-6736(09)60571-7
Walt G. WHO under stress: implications for health policy. Health Policy 1993; 24; 125-44. doi: 10.1016/0168-8510(93)90030-s