Through the lens of public health, in particular HIV/AIDS, this research first scrutinises China’s compliance with and resistance to the norms and rules embedded in the global health regime, and second, illustrates China’s evolving global role and its intentions for global governance. China’s response to its HIV/AIDS epidemic and its active engagement with the multilateral institutions of global health governance are attributable to both necessity and conscious design. While calling for and welcoming the involvement of multiple actors, a sine qua non for China’s continued engagement with global governance and global health governance is that they should be conducted in accordance with the principles of national sovereignty, non-intervention and territorial integrity. Overall, while China does not seek any radical transformation of the prevailing world order, its vision for the global order is not compatible with that espoused by the West which attaches much weight to liberal democratic values thereby justifying the notion and practice of humanitarian intervention. With a preference for a Westphalian model of governance, China is not a ‘responsible stakeholder’ in the liberal democratic order. Beijing advocates multilateral cooperation in a pluralist ‘harmonious world’ and argues that there is no fixed universal blueprint for development. China adopts a twin strategy in its relations with the outside world. On the one hand, it seeks to defend itself from the encroachment of liberal values while maintaining friendly relations with the leading powers of the West; and on the other, to shore up the principles of national sovereignty and non-intervention as well as strengthen ties with Third World countries so as to consolidate a normative and political bulwark against liberal democratic values on the world stage.

The central argument that I advance in this dissertation is that the influence of the Rockefeller Foundation (RF) and the Bill and Melinda Gates Foundation (BMGF) in the governance of global health and agricultural development has been derived from their ability to advance knowledge structures crafted to accommodate the preferences of the dominant states operating within the contexts where they have sought to catalyze change. Consequently, this dissertation provides a new way of conceptualizing knowledge power broadly conceived as well as private governance as it relates to the provision of public goods. In the first half of the twentieth-century, RF funds drove scientific research that produced tangible solutions, such as vaccines and high-yielding seed varieties, to longstanding problems undermining the health and wealth of developing countries emerging from the clutches of colonialism. At the country-level, the Foundation provided advanced training to a generation of agricultural scientists and health practitioners, and RF expertise was also pivotal to the creation of specialized International Organizations (IOs) for health (e.g. the League of Nations Health Organization) and agriculture (e.g. the Consultative Group on International Agricultural Research) as well as many informal international networks of experts working to solve common problems. Finally in the neo-liberal era, RF effectively demonstrated how the public-private partnership paradigm could provide public goods in the face of externally imposed austerity constraining public sector capacity and the failure of the free-market to meet the needs of populations with limited purchasing power. Since its inception, the BMGF has demonstrated a similar commitment to underwriting innovation through science oriented towards reducing global health disparities and increasing agricultural productivity in poor countries, and has greatly expanded the application of the Public-Private Partnership (PPP) approach in both health and agriculture. Unlike its intellectual forebear, BMGF has been far more focused on end-points and silver bullets than investing directly in the training of human resources. Moreover whereas RF has for most of its history decentralized its staff, those of BMGF have been concentrated mainly at its headquarters in Seattle. With no operational programs of its own, BMGF has instead relied heavily on external consultants to inform its programs and remains dependent on intermediary organizations to implement its grants. Despite these and other differences, both RF and BMGF have exhibited a common capacity to catalyse institutional innovation that has benefited historically marginalized populations in the absence of structural changes to the dominant global power structure. A preference for compromise over contestation, coupled with a capacity for enabling innovation in science and governance, has resulted in broad acceptance for RF and BMGF knowledge structures within both state and international policy arenas. This acceptance has translated into both Foundations having direct influence over (i) how major challenges related to disease and agriculture facing the global south are understood (i.e. the determinants and viable solutions); (ii) what types of knowledge matters for solving said problems (i.e. who leads); and (iii) how collective action focused on addressing these problems is structured (i.e. the institutional frameworks).

After looking at the existing research and considering the devastating effects of the present COVID-19 pandemic, the problem at the core of this thesis is found in the fact that the world is rather unprepared (Lakoff, 2017) for this type of crisis. While conducting an extensive review of the available resources, the lack of data and attention given to city networks concerning the topic of health was identified. The purpose of this thesis is to fill in the knowledge gap by exploring the potential of transnational city networks as actors in global health governance at times of global health emergencies, such as the present pandemic crisis. I find that the ongoing pandemic presents an opportunity to test the ability of cities and city networks to quickly re-orient their policy focus and collectively mobilize in reaction to a problem that impacts the whole world (Acuto et al., 2021, p.146). As the pandemic evolves, transnational city networks have taken it upon themselves to deal collectively with the public health challenges and economic recovery (Pipa and Bouchet, 2020a, p.606), and in this process, they have without a doubt proven their potential as global health actors, particularly in the initial phase of the pandemic response.

Submitted by Leoná Rodrigues (leonarodrigues@id.uff.br) on 2017-06-20T17:42:48Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Analise da Cooperacao tecnica - Eduardo Mazzaroppi.pdf: 1349734 bytes, checksum: 0f4da5f948735609b59c156a33e1a187 (MD5) / Approved for entry into archive by Biblioteca da Faculdade de Direito (bfd@ndc.uff.br) on 2017-07-20T19:27:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Analise da Cooperacao tecnica - Eduardo Mazzaroppi.pdf: 1349734 bytes, checksum: 0f4da5f948735609b59c156a33e1a187 (MD5) / Made available in DSpace on 2017-07-20T19:27:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Analise da Cooperacao tecnica - Eduardo Mazzaroppi.pdf: 1349734 bytes, checksum: 0f4da5f948735609b59c156a33e1a187 (MD5) / O projeto de pesquisa “Análise da cooperação técnica Brasil-Moçambique como estratégia de governança global da saúde” discute, a partir da análise da parceria Fiocruz-Moçambique, a cooperação técnica internacional em saúde como estratégia pós-nacional de governança global da saúde. Defende-se a cooperação técnica internacional (CTI), principalmente a cooperação Sul-Sul estruturante em saúde, como instituição consonante com a noção de pós-nacionalidade, participando ela da governança global da saúde. O presente estudo opera uma análise interpretativa de aspectos macro e micro estruturais da governança global. Começa-se discorrendo acerca das noções contemporâneas de pós-nacionalidade e de governança global. Em seguida, passa-se à discussão acerca da cooperação técnica, enquanto instituto afeito às Relações Internacionais (RI), ao Direito e à governança em saúde na atualidade. Finalmente, analisa-se o caso da cooperação Brasil-Moçambique estabelecida entre a Fundação Oswaldo Cruz (FIOCRUZ) e o Ministério da Saúde de Moçambique, notadamente quanto aos entraves e gargalos enfrentados nos últimos anos. Conclui-se sugerindo alternativas e indicando caminhos para a superação dessas dificuldades, sob um enfoque pós-nacionalista, considerando-se a cooperação técnica poderoso instrumento de construção de um modelo de cidadania e de governança global. / The research project "Analysis of technical cooperation Brazil-Mozambique as global governance of health strategy" discusses, from the analysis of Fiocruz-Mozambique partnership, international technical cooperation in health and post-national strategy for global health governance. It supports international technical cooperation, mainly structuring South-South cooperation in health, as consonant institution with the notion of post-nationality, taking part into global health governance. This study operates an interpretive analysis of macro and microstructural aspects of global governance. It starts discoursing contemporary notions of post-nationalism and global governance. Then it situates technical cooperation in international relations, law and governance on health in the present. Finally, it is analyzed the Brazil-Mozambique`s cooperation on health, which was established between the Oswaldo Cruz Foundation (FIOCRUZ) and the Ministry of Health of Mozambique, especially considering current obstacles and bottlenecks. It concludes by suggesting alternatives and indicating ways to overcome these difficulties, in a post-nationalist approach, considering the technical cooperation a powerful tool toward a model of citizenship and global governance

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Problématique : Alors que l’on connaît depuis plusieurs décennies les conséquences dramatiques des injustices sociales sur la santé, il existe un profond problème d’application des connaissances pour informer les pratiques et/ou les politiques. Au-delà d’un manque de prise en compte des connaissances pour l’action, il semblerait que la difficulté à lutter contre les inégalités soit plutôt liée à l’enracinement des systèmes de production et d’utilisation des connaissances dans des structures injustes. Approche théorique et cadre conceptuel : Cette thèse s’inscrit dans la quatrième vague de recherche sur le transfert de connaissances qui consiste à mieux comprendre les caractéristiques sociales des connaissances. En d’autres mots, il s’agit d’intégrer une approche d’épistémologie sociale dans la recherche sur le transfert de connaissances. Nous nous intéressons spécifiquement au concept d’oppression épistémique qui consiste en la répétition dans la durée de trois degrés d’exclusions épistémiques. L’exclusion de troisième degré représente un mode de vie épistémique qui est dirigé par des groupes sociaux dominants, qui ne permet pas de prendre en compte d’autres systèmes de pensée et de connaissances que les leurs. L’exclusion de second degré est le fait, pour des individus déjà opprimés socialement, de devoir utiliser des ressources qui ne sont pas les leurs, pour pouvoir participer à la construction de nouvelles ressources communes dans ce système. L’exclusion de premier degré concerne l’impossibilité, pour des individus, d’être considéré comme des « connaisseur·ses » du fait de préjugés à leur encontre. Cette thèse vise à analyser comment les pratiques quotidiennes et le contexte de la santé mondiale favorisent une oppression épistémique. Méthodologie : Nous étudions trois phénomènes correspondant aux trois degrés d’exclusion épistémique, en suivant une échelle d’analyse à trois niveaux (macroscopique, mésoscopique, microscopique) qui rappellent les trois branches de l’épistémologie sociale (système, groupe, individus). Pour cela, nous étudions en premier lieu la construction d’une ressource épistémique commune en santé mondiale à un niveau macroscopique : la couverture santé universelle (CSU) grâce à une revue critique des écrits. En deuxième lieu, nous étudions l’appropriation de cette ressource épistémique à un niveau mésoscopique, et la manière dont un groupe de scientifiques prend ou non en compte des voix dissidentes, en promouvant une définition différente de la CSU. Pour cela, nous réalisons une étude de cas d’un programme de recherches interventionnelles sur la CSU. En troisième lieu, nous étudions le rôle de la source des connaissances sur leur perception grâce à une expérimentation en santé mondiale. Résultats : À travers l’avènement de la CSU, nous observons la présence d’un pouvoir productif qui, tout en donnant l’impression d’une approche ancrée dans les droits humains et inclusive, favorise une conception marchande de la santé, menée par un « centre » de la santé mondiale. Nous avons également observé que l’appropriation de la CSU dans un programme de recherches interventionnelles n’a pas permis de créer une définition dissidente de la CSU. Plusieurs alliances épistémiques, c’est-à-dire des affiliations entre membres partageant la même orientation des études pour analyser la CSU sont apparues : une alliance santé publique, une alliance économique, une alliance anthropologique et une alliance critique. Cette dernière, qui proposait une réflexion globale sur la déconstruction et la gouvernance de la CSU, a été manquée, du fait d’inégalités concomitantes. Enfin, nous avons pu voir à un niveau microscopique que le « messager » peut être plus important que le « message » et participer à invisibiliser ou diminuer certaines voix dans la gouvernance globale en santé. Discussion et valeur ajoutée de la thèse : Les trois degrés d’exclusion épistémiques peuvent s’entrevoir de façon complémentaire. Du fait de la proximité des mondes scientifique et politique, et de la volonté de produire des connaissances pour l’action en santé mondiale, l’avènement de la CSU peut influencer la manière dont les scientifiques s’approprient ce concept. Cela peut limiter les possibilités de diversité épistémique et favoriser l’exclusion de certaines voix. À l’inverse, le sentiment d’exclusion peut conduire à se limiter dans sa contribution intellectuelle. Partant du postulat dont chacun·e de nous peut participer à changer les structures qui créent les injustices, en résistant à l’oppression épistémique, nous proposons un continuum d’actions pour lutter contre les inégalités dans la gouvernance globale en santé. / Background: The dramatic consequences of social injustice on health have been known for several decades, but social injustice also has an impact on knowledge translation. Rather than relating to a lack of knowledge uptake for action, the difficulty in addressing inequalities connects to knowledge production and use systems rooted in unjust structures. Theoretical approach and conceptual framework: This thesis aims to better understand the social characteristics of knowledge, and explores the integration of a social epistemology approach into knowledge translation research. We specifically focus on epistemic oppression, which consists of the repetition over time of three types of mutually reinforced epistemic exclusion. One type applies to an epistemic way of life led by dominant social groups, who prevent new systems of thought and knowledge, different from their own, to surface. A second type relates to socially oppressed individuals who must use resources they do not own to contribute to the construction of new common resources within the dominant system. The last type of epistemic exclusion consists of the impossibility of individuals being recognized as "knowers" because of prejudices that make them appear illegitimate. This thesis aims to analyze how everyday practices and the global health context foster epistemic oppression. Methodology: We study three processes, each related to a type of epistemic exclusion and following a three-level scale of analysis (macroscopic, mesoscopic and microscopic), which also covers the three branches of social epistemology (system, group and individual). First, we focus on the construction of an epistemic resource in global health at a macroscopic level, namely, universal health coverage (UHC), through a critical review of the literature. Secondly, we study the appropriation of this epistemic resource at a mesoscopic level, and how a group allows or does not allow dissenting voices, thus promoting a different definition of UHC. To this end, we conduct a case study of an interventional research program on UHC. Finally, we elaborate on the role of knowledge sources on the perception of knowledge through an experiment in global health. Results: The case of UHC demonstrates the existence of a productive power that, while giving the impression of an inclusive human approach, favours a market-based conception of health led by a global health "centre". We also observed that the appropriation of UHC in an interventional research program did not create a dissident; unorthodox definition of UHC. Several epistemic alliances (i.e. affiliations between members sharing the same orientation of studies to analyse UHC), emerged: a public health alliance, an economic alliance, an anthropological alliance, and a critical alliance. The latter, which suggested a global reflection on the deconstruction and governance of the UHC, did not occur because of concomitant inequalities. Finally, at a microscopic level, we showed that the "messenger" can be more important than the "message" when disseminating knowledge. Discussion and research value: The three types of epistemic exclusion can be read complementarily. Due to the proximity of the scientific and political worlds, and the desire to produce knowledge for action in global health, the social construction of UHC may influence how scientists appropriate this concept. It may limit the possibilities of epistemic diversity, and thus promoting the exclusion of some voices and points of view. A feeling of exclusion can, in turn, lead to self-limitation. Based on the premise that everyone can contribute to changing the structures that create injustice by resisting epistemic oppression, we propose a continuum of actions to address inequalities in global health governance.

No description available.