Paper short abstract:

This qualitative study explores epistemological power in the debate about the meanings of global health and international health. Four positions are mapped against a decolonial framework that reveals their epistemological foundations and entailed power relations in global health governance.

Paper long abstract:

The COVID-19 pandemic has spiraled contestations of epistemological power in the sphere of health research and governance. Positions of power become visible through dominating concepts that have guided the governance of the pandemic. To explore such power dynamics, we employ a qualitative study of the debate about Global Health and International Health and the meanings and uses of both concepts. We conducted a literature review and in-depth interviews with selected experts who have published on this debate to critically analyze different conceptual positions. Results were integrated into a decolonial theoretical framework based on decolonial literature. As a result, we map four different conceptions of Global and International Health: International Health, liberal Global Health, critical Global Health, and decolonial Global Health. While International Health is referred to as part of between-states diplomacy, critical and decolonial Global Health occur mostly in academic and activist debates, and liberal Global Health dominates global governance. Our critical framework reveals that historical Western hegemony continues to reproduce power asymmetries in global governance through exerting epistemological power in health research and governance. This contributed to the global inequalities highlighted by the COVID-19 pandemic, in which unequal vaccine distribution represents an example of liberal Global Health policy. Mapping different conceptions of Global and International Health and their functions in health governance enhances an understanding of the power relations they entail. By exposing contemporary health governance as rooted in colonial power relations, we promote further development of emancipatory conceptions of health that address global inequalities and envision epistemic diversity.