To justify policies, allocate resources, and assign different roles in the field of global health, the participating actors and institutions refer to a plural yet limited set of conventions. Their specific characteristics echo elements of the conventions that researchers identified in their studies of western culture, even if they are not identical with them. Elements from the spheres of international security, development, and medical discourses have given rise to distinct conventions in the world of global health. Yet, their basic structure as conventions, or “orders of worth,”: Each of them refers to different conceptions of the common good, as well as distinct institutions and devices for assigning moral worth. We distinguish four major orders of worth that global health actors regularly invoke in the global health field: the orders of survival, order of fairness, order of production, and a domestic, spiritual order.
First, the order of survival considers global health as a live-or-die scenario, where humankind is united by its vulnerability to dangerous infections – and thus the looming threat of being decimated or even eradicated by deadly pathogens. It is the fear and vulnerability of humans to infectious diseases that constitute this order. Where in a globalized society, “germs globalization is permanent while the borders are the transitory phenomena”, being a frequent mantra for this order is that disease knows no border. In this order, the political community is based in humans’ shared vulnerability to contagious diseases irrespective of their socio-economic predispositions and the dystopian scenario to fear is “Mother Nature”. The order’s virtuous behaviour is to control and respond to microbial threats by sacrificing economic interests and other pleasures for the higher value of survival.
Second, the order of fairness is grounded in the language of human rights, which is increasingly invoked in global health conflicts. From the fairness point of view, the problem of health is not one of biological vulnerability to nature, but a problem of distributional (in)justice and thus of health equity and non-discrimination. The underlying notion of community is that we are rights-bearers who owe each other an equal share of the social and medical goods potentially available. The focus here is on those afflictions which could be prevented, alleviated, or cured “in an age of great affluence”, but which are rampant due to social injustice. Health is above all compromised by social inequalities and the forces that produce them. Thus, behaviours that might be criticized as “self-centred” and illegitimate from a survival point of view – for example, when states or social groups delay cooperation in pandemic preparedness to negotiate a fairer access to the benefits of such cooperation – can be defended as legitimate and even necessary from the fairness point of view. Social justice and a “preference for the poor” become major evaluative standards and moral imperatives for global health policies.
Third, the order of production where health is viewed through the lens of natural and economic scarcity in which human beings are driven to maximize utility and economic gain. New measurements of health, counted as the number of healthy years we live, here also became a means to optimize our economic productivity. This order is related to Boltanski and Thévenot’s “industrial” convention, where social organisms should be arranged and managed in a way that makes them as productive as possible. The political community values economic growth, stressing the need for prior investment in health to enable economic development, especially where disease negatively affects economically productive adults, where health services are lacking, or where disease imposes an intolerable economic burden. The order’s moral imperative is to make “smart choices,” for seeking to maximize healthy life years. Also, the individuals should be concerned with optimizing their own health by becoming a self-investing entrepreneur.
Fourth and finally, the global health discourse also harbor more radical positions, which are fundamentally skeptical of medical intrusions into communities and bodies. Classic critiques of medicalization emphasize the intrusive and power-laden nature of bio politics. More recently, these are joined by critiques of digital surveillance and the resistance against violations of privacy through new technological devices. In her reconstruction of canonical global health texts, researcher depicted these critiques as the “spiritual order,” an order which seeks to defend the integrity of the soul and its inspired autonomy against technological intrusion. Yet, as our analysis shows, the defense of privacy in global health also extends to notions of a protection-worthy, autonomous zone of the household and family relations. We combine these notions of spirituality and domesticity into a convention of “spirit,” which credits family solidarity, patriarchal traditions, and personal integrity as institutions that must be shielded from medical dominance and overly instrumental, bio political calculation in their own right. The debates about this private sphere in the case of Community Health Worker(CHW) digitalization reveal the tensions of this order, particularly in postcolonial settings.
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