Globalization and health: political grand challenges

The central task of any critical social science is speaking truth about power. After a brief review of 'glass half full' and 'glass half empty' perspectives on recent developments in global health, I argue that such a critical perspective need not answer the question about the glass, but rather ask what more could have been achieved under different social arrangements. I continue with a discussion of how globalization has re-scaled distributional conflicts so they need no longer be resolved within national borders, and enhanced the power of transnational corporations and the ultra-wealthy to the probable detriment of national policy space. I then examine the structural adjustment programs of the 1980s and the 1990s as an early step in the normalization of austerity, and the associated human collateral damage. I conclude by arguing that the constraints in improving health and reducing health inequalities associated with globalization are substantial, while suggesting that they should not be overstated - a point underscored by the selective nature of the policy choices comprising austerity.