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By John Gaventa, Rajesh Tandon

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International health has always relied to some extent on non-statist forms of authority. g. White 2005). Yet what is emerging today appears different in several important respects. First, the sheer size, scope and resources of the health programmes concerned. Second, the predom­ inance of private, philanthropic and hybrid public–private arrangements, rather than international ones accountable to member states. And third, the moral authority that global health programmes can now exert in a globalized world of mobile people and microbes, where fears of epidemic spread and ideas of global health security abound (Dry 2008).

These have engaged with a particular disease context – in which, with HIV infection rates currently below 5 per cent,3 living with HIV is still a socially un­ usual experience – and a particular political-economic context. Notable features of the latter include President Jammeh’s democratically elected yet authoritarian regime,4 a long history of international donor and NGO involvement in developmental affairs, and two decades of intensifying neoliberal policies which have prioritized private business entrepreneurs and the coastal tourist industry, leaving the majority of Gambians in deep poverty and a grinding everyday struggle for livelihoods.

And S. Bernstein (2005) ‘Knowledge in power: the epistemic construction of global governance’, in M. Barnett and R. Duvall, Power in Global Governance, Cambridge: Cambridge University Press, pp. 294–340. Appadurai, A. (2000) ‘Grassroots globalization and the research imagination’, Public Culture, 12(1): 1–19. Archibugi, D. (2008) The Global Commonwealth of Citizens: Toward Cosmo­politan Democracy, Prince­ ton, NJ: Princeton University Press. Batliwala, S. (2002) ‘Grassroots ­movements as transnational ­actors: implications for global ­civil society’, Voluntas: Inter­ national Journal of Voluntary and Nonprofit Organizations, 13(4): 393–409.

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