The struggles and divisions of Indian healthcare workers

Tine Hanrieder reviews Who Cares? Care Extraction and the Struggles of Indian Health Workers, edited by Christa Wichterich and Maya John

Book review: who cares? Care extraction and the struggles of Indian health workers edited by Maya John and Christa Wichterich

In Who Cares? Care Extraction and the Struggles of Indian Health Workers, editors Maya John and Christa Wichterich bring together a collection of essays exploring the extraction and undervaluation of labour in healthcare, specifically within the Indian context. This book is an urgent examination of how precarity and hierarchisation are baked into healthcare labour markets, and the detrimental consequences this has for nurses and other care workers, writes Tine Hanrieder

Local orders in international organisations: the World Health Organization's global programme on AIDS

In 1990, the World Health Organization (WHO) started to downsize its renowned Global Programme on AIDS, despite continued donor and member state support. This turnaround has decisively contributed to WHO's loss of leadership in HIV/AIDS politics. From the viewpoint of both rationalist and constructivist theories of international organisation (IO) agency, an IO engaging in 'mission shrink' is a striking irregularity. In order to account for such apparently self-defeating behaviour, this article adopts an open systems view of IOs and identifies trans-organisational coalitions as important agents of IO change. I argue that subunit dynamics rather than systemic conditions drive IO behaviour, in particular where member states' material power and their formal control of organisational veto positions do not coincide. This approach will be used to retrace the changes in subunit coalitions that drove WHO's erratic HIV/AIDS programme and thus to solve this puzzle of 'mission shrink'. On the basis of insights from the WHO case, the article concludes by offering a heuristic of trans-organisational coalitions and the types of IO change associated with them

Orders of worth and the moral conceptions of health in global politics

The article analyzes the contested concept of global health through the lens of orders of worth. Drawing on pragmatist political and social theory, especially the work of Boltanski and Thévenot, I conceptualize orders of worth as moral narratives that connect visions of universal humankind to ideas about moral worth and deficiency. They thereby differ from the self/other narrative of political identity that is emphasized in International Relations scholarship. Orders of worth do not pitch a particularistic identity against foreign identities, but tie collective identity to a higher common good. They provide tools for moral evaluation and the justification of hierarchy. I use this heuristic to reconstruct four main conceptions of health in global politics: The order of survival, the order of fairness, the order of production, and the order of spirit. Each of them articulates a distinct political identity, as 'we species', 'we liberals', 'we bodies' and 'we souls', and implies different notions of virtuous and selfish conduct in the global community. These orders are derived from scholarly writings and the policies of global health institutions. Finally, I discuss the nature of compromises between the four orders regarding contested issues such as health emergencies or digital medicine

Gradual change in international organisations: agency theory and historical institutionalism

This research note discusses limitations of principal-agent (PA) analysis in explaining gradual change in international organisations (IOs). It suggests that historical institutionalism (HI) can fill important gaps left by the PA approach and identifies scope conditions for both approaches. For this purpose, a distinction is made between two sources of state power that PA usually treats as synergistic - namely the formal control of IO decisions and material power resources. While PA analysis is best applicable where reform coalitions of like-minded member states control both formal and material resources, in many contexts there exist frictions between material and formal power in IOs. In these constellations recent HI-inspired works on gradual modes of change such as 'layering' and 'drift' are of particular relevance. This research avenue is illustrated with empirical examples from a variety of international organisations

Moralische Argumente in den Internationalen Beziehungen

Das handlungstheoretische Fundament der Normenforschung wurde in den deutschen IB durch die Habermas-Rezeption erheblich vorangebracht und in der ZIB-Debatte kontrovers diskutiert. Dieser Aufsatz widmet sich einer Reihe bislang vernachlässigter Probleme, die sich aus der Verschränkung von Handlungstheorie und Moralphilosophie in der Verständigungstheorie internationaler Verhandlungen ergeben. Wo die analytische Trennung zwischen normativer Begründung und empirischer Rekonstruktion aufgehoben wird, drohen nicht nur handlungstheoretische und empirische Verzerrungen, sondern auch eine Preisgabe kritischen Potenzials. Am Beispiel von Nicole Deitelhoffs »Diskurstheorie internationalen Regierens« werden die Moralisierungstendenzen der Theorie da deutlich, wo das rhetorische Handlungsmodell mit moralphilosophischen Argumenten unter den Verständigungsansatz subsumiert wird. Auf empirischer Ebene ist die Analyse auf Moralisierung angewiesen, sobald es das »bessere « Argument zu »beobachten« gilt. Mit dem Formalismus des Universalisierungskriteriums werden dabei normative Parteinahmen nicht umgangen, jedoch als solche unkenntlich gemacht. So verhindert die Diskurstheorie der IB paradoxerweise, dass Räume für normative Kritik entstehen.The introduction of the Habermasian »arguing theory« into German IR has caused a lively discussion about the agency theory underlying research on international norms. This essay addresses some problematic implications of this theory, which have so far been neglected in the debate. By blending moral philosophy and agency theory in the »logic of arguing«, scholars not only distort their theoretical argument and their empirical analysis, but also compromise the theory’s normative-critical contribution. Using the example of Nicole Deitelhoff’s »discourse theory of international governance«, the risk of a moralist fallacy will be demonstrated at two levels: At the theoretical level, it occurs when the »arguing theory« subsumes the competing theory of »rhetorical action« on philosophical grounds. At the empirical level, the arguing approach has to rely on moral judgements when it comes to »observing« the power of the »better argument«. Paradoxically, the seemingly formal criterion of universalization conceals such substantive judgements instead of opening up discursive space for normative contestation

Priorities, partners, politics: the WHO’s mandate beyond the Crisis

The World Health Organization (WHO) is once more asked to reinvent itself and become more effective. This essay discusses recurrent reform proposals directed at the WHO which, in different ways, ask it to find a strategic focus and thereby its niche in the crowded global health arena. Looking back at decades of reform endeavors at the WHO, it exposes the contradictions and unresolved normative conflicts with regard to the WHO’s priorities. Ultimately, the WHO’s effectiveness hinges on Member State support for public authority in global health, and thus the political commitment to protect it against capture by special interests

Wizards, pretenders, or unaccountable curators? How consultants shape policy in underfunded international agencies

Consultancies play an important role in developing policies and strategies for international agencies, such as the World Health Organization (WHO). Drawing on a recent study, Tine Hanrieder and Julian Eckl argue that consultants’ formidable ability to curate and draw together preferred evidence for influential case studies is enhanced by the low funding environment these agencies operate in

The public valuation of religion in global health governance: spiritual health and the faith factor

This article explores how the role of religion is evaluated in global health institutions, focusing on policy debates in the World Health Organization (WHO) and the World Bank. Drawing on Luc Boltanski and Laurent Thévenot’s pragmatist approach to justification, I suggest that religious values are creative and worldly performances. The public value of religion is established through a two-pronged justification process, combining generalizing arguments with particularizing empirical tests. To substantiate the claim that abstraction alone does not suffice to create religious values in global public health, I compare the futile attempts of the 1980s to add ‘spiritual health’ to the WHO’s mandate with the more recent creation of a ‘faith factor’ in public health. While the vague reference to some ‘Factor X’ inhibited the acceptance of spiritual health in the first case, in the second case, ‘compassion’ became a measurable and recognized religious value