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Governing Global Health : Knowledge and power in the global tobacco epidemic

  • Author(s): Kenny, Katherine Elizabeth
  • et al.
Abstract

This dissertation examines the coproduction of epistemic and regulatory authority in the field of global health using the case of international tobacco control. In 2005, the world's first public health treaty -- the Framework Convention on Tobacco Control (FCTC) -- was brought into force by the World Health Organization (WHO). Unanimously adopted by the World Health Assembly in 2003, the FCTC has since become one of the most widely and rapidly adopted treaties in the history of the United Nations. The success of the treaty is frequently attributed to its "unequivocal evidence base" and, as a result, the FCTC is frequently seen primarily as a technical accomplishment. However, the evidence base of global tobacco control has been built on a very particular economic valuing of human life that emerged with the introduction of the Disability Adjusted Life Year (DALY) metric by the World Bank in 1993. The development of the DALY metric, coupled with organizational reconfigurations in the field of world health, instantiated cost-effectiveness as a dominant logic and enabled tobacco control to rise to prominence on the WHO's agenda. At the same time, the international movement for tobacco control began to gain traction as new political and discursive opportunity structures arose amidst WHO reform during the last 1990s. The dissertation argues that the accomplishment of the FCTC is much more than an evidence-based technical accomplishment: it represents the institutionalization of a new way of quantifying disease, economizing life and governing health on a global scale and a key moment in the transition from a post-war configuration of international health to the contemporary neoliberal global health order. Drawing on a range of textual sources, participant observations and interviews with key actors, the dissertation attends to the economization of life by tracing the epistemological, social and political dimensions of the development of the FCTC treaty. Its findings contribute to interdisciplinary scholarship on the history of world health, critical studies of global health and social studies of the relationship between science and policy -- or between knowledge and power -- including science and technology studies, biopolitics and social studies of globalization and postcolonialism

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