Purpose

The purpose of this paper is to investigate how “manias” in global health governance lead to health inequalities even before, during and in the aftermath of acute health crises such as the COVID-19 pandemic. “Manias” as used here refer to obsessive ir/rational behaviors, misguided policy/strategic choices and the exercise of power that benefit the major global health actors at the expense of stakeholders.

Design/methodology/approach

From post-colonial and historical perspectives, this study delineates how the major global health actors influence outcomes in global health governance and international business when they interact at the national–global level using an illustration from an emerging economy.

Findings

Power asymmetry in global health governance is constructed around the centralization of economic influence, medico-techno-scientific innovation and the geopolitical hegemony of a conglomerate of super-rich/powerful actors. They cluster these powers and resources in the core region (industrialized economies) and use them to influence the periphery (developing economies) through international NGOs, hybrid organizations, MNCs and multilateral/bilateral agreements. The power of actors to maintain manias lies in not only how they influence the periphery but also the consequences of the periphery’s “passivity” and “voluntary” renunciation of sovereignty in medical innovations and global health policies/politics.

Social implications

As a quintessential feature of manias, power asymmetry makes it harder for weaker actors to actually change the institutional conditions that produce structural inequalities in global health.

Originality/value

This timely and multidisciplinary study calls for a novel architecture of global health governance. Thus, democratizing global health governance with sufficiently foresighted investments that prioritize equitable access by and the inclusiveness of vulnerable stakeholders will help dismantle institutionalized manias while decreasing health inequalities.

中文翻译：

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从埃博拉病毒到COVID-19：是什么解释了制度化的躁狂症以及全球卫生治理中对非最佳解决方案的最终偏爱？

目的

本文的目的是调查全球卫生治理中的“躁狂症”如何导致健康不平等，甚至在急性健康危机（如COVID-19大流行）之前，之中和之后也是如此。这里使用的“狂热症”指的是强迫性的不理性/理性行为，误导的政策/战略选择以及行使权力，这些行为使全球主要卫生行动者受益，而利益相关者却为此付出了代价。

设计/方法/方法

从后殖民和历史的角度来看，本研究使用新兴经济体的插图描绘了主要的全球卫生参与者在国家与全球层面互动时，如何影响全球卫生治理和国际商业的成果。

发现

全球卫生治理中的权力不对称是围绕经济影响力的集中，医学技术科学创新和超富裕/有权势的企业集团的地缘政治霸权而建立的。它们将这些权力和资源聚集在核心区域（工业化经济体）中，并利用它们通过国际非政府组织，混合组织，跨国公司和多边/双边协议对周边地区（发展中经济体）产生影响。行为者维持躁狂症的力量不仅在于他们如何影响周边国家，还在于周边国家在医疗创新和全球卫生政策/政治中“被动”和“自愿”放弃主权的后果。

社会影响

作为躁狂症的典型特征，权力不对称使得较弱的参与者更难真正改变造成全球健康结构不平等的体制条件。

创意/价值

这项及时而多学科的研究要求建立一种新型的全球卫生治理架构。因此，通过充分预见的投资使全球卫生治理民主化，优先考虑弱势利益相关者的公平获取和包容性，将有助于消除制度化的躁狂症，同时减少卫生不平等现象。