Beyond contagion: explaining international cooperation on health

Thesis

International cooperation on health has varied widely across diseases. While some diseases have received international funding and have been subject to regulation, others have been neglected. This thesis conceptualises, measures and explains variations in international cooperation on health. Explanations begin with a rationalist ‘contagion thesis,’ which predicts that cooperation emerges when a disease poses an international threat. Historically, it appears that much cooperation has not addressed international threats, and many serious threats have not been addressed. To explain this, I turn the ‘health cooperation thesis,’ which predicts that states cooperate on health when the leadership of powerful actors, international institutions or knowledge communities drive cooperative efforts. To test these frameworks, I define indices for measuring cooperation on health, and for measuring the international threat presented by each disease. Using archives, budgets, interviews and secondary sources, I examine major episodes of cooperation from 1918 to 2006. These cases include cooperation on typhus and international standards in the interwar period; cooperation on malaria and smallpox from the 1948 to 1976; and cooperation on nutrition, HIV/AIDS and tobacco control from 1976 to 2006. I also examine the delays to cooperation on pandemic influenza, smallpox, and HIV/AIDS prevention. The case studies and quantitative assessments suggest that contagion explains little of the cooperation observed on health. Powerful actors have initiated and expanded cooperation, as they did for malaria in the 1950s and HIV/AIDS in the present. Knowledge communities have developed new technologies and communicated previously unrealised international externalities in nearly all cases examined. However, international institutions can best explain cooperation beyond contagion. International institution’s rules and autonomy have allowed cooperation to diverge from contagion and the interests of powerful actors, making possible cooperation on nutrition, HIV/AIDS treatment, and tobacco control. Even among infectious diseases with high levels of contagion, like smallpox, cooperation may not have been possible without international institutions.

Authors: Batniji, R

• DOI: 10.5287/ora-eoezjmgx6
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: world health organization; international cooperation on health; global health
• Subjects: international cooperation on health; international institutions; global health