Global health in the making: China, HIV/AIDS, and the Global Fund to fight AIDS, tuberculosis and malaria.

摘要

This is a study of governance in the emerging global domain. Since the 1990s, the locus of responsibility at the supranational level has been moving away from an exclusive reliance on nation states and the United Nations system, to alternative regimes that aim to distribute responsibility among "partnerships" between a variety of state and non-state actors. This study analyzes the emergence of this additional layer of policy making by focusing on four entities: a globalizing sector (health); a global disease (HIV/AIDS); a global organization (the Global Fund), and a participating country (China).;The study begins by explaining the emergence of the Fund as the result of a fundamental re-framing of HIV/AIDS as a problem that defies national categories and therefore requires transnational governance. It then analyzes the Fund's institutional design as the set of rules this organization introduces into the health domain. In the Fund's implicit constitutional structure, primary responsibility for the provision of health care still rests with the nation state. However, the Fund introduces two major political conditions through its support of national actors: first, that a variety of local stakeholders should have been given voice in the design and implementation of national health policies; and second that these policies conform to norms of international science and public health. The study then provides an empirical investigation of how the Fund's governance model operated in the interaction with a national actor, China. An ethnographic account of China's consecutive applications to the Fund shows how global norms emerged from a hybrid political process in which local, national and global level actors all participated.;The study shows that the emergence of global responsibility regimes such as the Fund, alongside existing governance structures, does not occur without friction. For instance, the scientific institutions that form the basis of the Fund's institutional design only allow for knowledge created according to the rules of international science. By excluding other forms of knowledge, this rule can constrain the Fund's ability to empower local actors. How such frictions will be resolved remains to be seen. The Fund holds important lessons for institution building in the global domain.