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When People Come First

By João Biehl & Adriana Petryna

The Global health community is an evolving and expanding field. Below, João Biehl and Adriana Petryna consider the importance of addressing the medical, social, political, and economic dimensions of the global health enterprise, and demonstrate the crucial role of ethnography as an empirical lantern in global health.

While global health initiatives and teaching programs are booming worldwide and have begun to displace earlier framings such as tropical medicine and international health, critical analyses of the social, political, and economic processes associated with this quickly evolving field are still few and far between. Our new book When People Come First is an empirical and theoretical investigation of the contemporary global health enterprise. It brings together an international and interdisciplinary group of scholars to address the actual impacts of global health interventions on care, health systems, governance and citizenship. Vivid case studies demonstrate the crucial role of ethnographic research as an empirical lantern in global health and, overall, the book argues for a more comprehensive, people-centered approach.

In the course of the twentieth century, innovations in public health and medicine helped to increase life expectancy at birth by almost thirty years in the United States and other rich countries. Meanwhile, mortality rates remained high and life expectancies short in poor countries. Advances in medical technology continue to give cause for hope, as does the substantial increase in funding available to address some of the world’s most pressing health challenges. New state policies, public-private partnerships, and multidisciplinary research collaborations are reshaping the field that has come to be known as global health and, in the process, transforming realities on the ground. In emerging democratic economies—such as Brazil, India, and South Africa—we see patients and activists engaging in struggles over access to high-quality care and, at a more fundamental level, debating the meaning and implications of health conceived as a right rather than a privilege or commodity alone.

“New state policies, public-private partnerships, and multidisciplinary research collaborations are reshaping the field that has come to be known as global health.”

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