Knowledge, politics and power in global health Comment on “Knowledge, moral claims and the exercise of power in global health”

This article agrees with recent arguments suggesting that normative and epistemic power is rife within global health policy and provides further examples of such. However, in doing so, it is argued that it is equally important to recognize that global health is, and always will be, deeply political and that some form of power is not only necessary for the system to advance, but also to try and control the ways in which power within that system operates. In this regard, a better focus on health politics can both expose illegitimate sources of power, but also provide better recommendations to facilitate deliberations that can, although imperfectly, help legitimate sources of influence and power

Kantian constitutional jurisprudence and a minimal ethical foundation for a cosmopolitan order.

The purpose of this project is to outline a Kantian form of cosmopolitan theory in relation to the normative requirements necessary for a constitutional global order and to provide a comprehensive defense of cosmopolitan ethics against realist, pluralist and communitarian critiques. The project consists in a theoretical exploration of Kantian cosmopolitanism and the normative requirements consistent with, and necessary to, a Kantian based cosmopolitan constitution. The project addresses such topics as Kantian cosmopolitanism, the principle of cosmopolitan law, cosmopolitan right, the laws of hospitality, the normative principles behind the idea of a federation of states, a cosmopolitan epistemology of culture and a possible normative basis for a Kantian form of global distributive justice. Contrary to many historical conceptions of cosmopolitanism, the project interprets Kantian cosmopolitan thought as a form of international constitutional jurisprudence that requires minimal ethical / legal demands versus the more rigorous demand of establishing a world state or a utopian moral order. By viewing Kantian cosmopolitan theory as a form of international jurisprudence, it has better promise to satisfy communitarian, realist and pluralist concerns without surrendering cosmopolitan principles of human worth and global ethical order. In contrast to an extreme form of cosmopolitanism, this project provides an alternative Kantian version of cosmopolitanism that allows for various ethical perspectives on a culturally local and state level, while providing a minimal global ethical umbrella for international cooperation and cosmopolitan principles. However, this thesis does not represent a strict interpretation of Kant or of his political theory. What this project provides is a Kantian based form of cosmopolitanism, which not only pulls from Kant, but also from contemporary cosmopolitan arguments found throughout political philosophy. In this regard, it provides a more comprehensive understanding of Kantian cosmopolitanism and what normative implications this vision has for contemporary international political theory

Pay for performance at a crossroads:Lessons from taking a global perspective

Purpose: The use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts. Design/methodology/approach: The authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries. Findings: The quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting. Originality/value: The research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature

Hygiene and biosecurity: the language and politics of risk in an era of emerging infectious diseases

Infectious diseases, such as methicillin-resistant Staphylococcus aureus and avian influenza, have recently been high on the agenda of policy makers and the public. Although hygiene and biosecurity are preferred options for disease management, policy makers have become increasingly aware of the critical role that communication assumes in protecting people during outbreaks and epidemics. This article makes the case for a language-based approach to understanding the public perception of disease. Health language research carried out by the authors, based on metaphor analysis and corpus linguistics, has shown that concepts of journeys, pathways, thresholds, boundaries and barriers have emerged as principal framing devices used by stakeholders to advocate a hygiene based risk and disease management. These framings provide a common ground for debate, but lead to quite different perceptions and practices. This in turn might be a barrier to global disease management in a modern world

Pay for performance at a crossroads: lessons from taking a global perspective

Purpose: The use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts. Design/methodology/approach: The authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries. Findings: The quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting. Originality/value: The research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature

Quantifying evidence toward pathogenicity for rare phenotypes: The case of succinate dehydrogenase genes, SDHB and SDHD.

PURPOSE: The weight of the evidence to attach to observation of a novel rare missense variant in SDHB or SDHD in individuals with the rare neuroendocrine tumors, pheochromocytomas and paragangliomas (PCC/PGL), is uncertain. METHODS: We compared the frequency of SDHB and SDHD very rare missense variants (VRMVs) in 6328 and 5847 cases of PCC/PGL, respectively, with that of population controls to generate a pan-gene VRMV likelihood ratio (LR). Via windowing analysis, we measured regional enrichments of VRMVs to calculate the domain-specific VRMV-LR (DS-VRMV-LR). We also calculated subphenotypic LRs for variant pathogenicity for various clinical, histologic, and molecular features. RESULTS: We estimated the pan-gene VRMV-LR to be 76.2 (54.8-105.9) for SDHB and 14.8 (8.7-25.0) for SDHD. Clustering analysis revealed an SDHB enriched region (ɑɑ 177-260, P = .001) for which the DS-VRMV-LR was 127.2 (64.9-249.4) and an SDHD enriched region (ɑɑ 70-114, P = .000003) for which the DS-VRMV-LR was 33.9 (14.8-77.8). Subphenotypic LRs exceeded 6 for invasive disease (SDHB), head-and-neck disease (SDHD), multiple tumors (SDHD), family history of PCC/PGL, loss of SDHB staining on immunohistochemistry, and succinate-to-fumarate ratio >97 (SDHB, SDHD). CONCLUSION: Using methodology generalizable to other gene-phenotype dyads, the LRs relating to rarity and phenotypic specificity for a single observation in PCC/PGL of a SDHB/SDHD VRMV can afford substantial evidence toward pathogenicity

‘Orientalism is a partisan book’: applying Edward Said's insights to early modern travel writing

Since its publication in 1978, Edward Said's Orientalism has had a significant impact on postcolonial studies in a range of fields. This paper assesses his impact on the historiography of Anglophone travel writing concerning Ottoman Empire during the early modern period. Said's analysis of the relationship between representational power and colonial authority remains relevant to our understanding of early modern travel texts. Said's epistemology raises significant issues for historians of early modern intercultural encounters. This article summarises recent debates surrounding early modern travel narratives. It contrasts doctrinaire applications of Said's theory with more recent, particularistic studies. It provides a much-needed survey of travel writing historiography that considers the continuing impact of Said's postcolonial thought on the study of early modern travel narratives relating to the Ottoman Middle East. In so doing, it explores the lack of fit between early modern travel narratives and Said's methodology. I explore the methodological problems thrown up by conventional applications of Said's epistemology to precolonial travellers' texts. Based on a wide-ranging survey of Said's oeuvre, the article demonstrates that, more than 30 years on, Said's work remains relevant to the historiographical challenges presented by early modern English travel writing about Islam

Introducing Jus ante Bellum as a cosmopolitan approach to humanitarian intervention

Cosmopolitans often argue that the international community has a humanitarian responsibility to intervene militarily in order to protect vulnerable individuals from violent threats and to pursue the establishment of a condition of cosmopolitan justice based on the notion of a ‘global rule of law’. The purpose of this article is to argue that many of these cosmopolitan claims are incomplete and untenable on cosmopolitan grounds because they ignore the systemic and chronic structural factors that underwrite the root causes of these humanitarian threats. By way of examining cosmopolitan arguments for humanitarian military intervention and how systemic problems are further ignored in iterations of the Responsibility to Protect, this article suggests that many contemporary cosmopolitan arguments are guilty of focusing too narrowly on justifying a responsibility to respond to the symptoms of crisis versus demanding a similarly robust justification for a responsibility to alleviate persistent structural causes. Although this article recognizes that immediate principles of humanitarian intervention will, at times, be necessary, the article seeks to draw attention to what we are calling principles of Jus ante Bellum (right before war) and to stress that current cosmopolitan arguments about humanitarian intervention will remain insufficient without the incorporation of robust principles of distributive global justice that can provide secure foundations for a more thoroughgoing cosmopolitan condition of public right