IFGH 2012: Reflexive Governance “Putting the Public” Back into Public Health and Health Rights or Health Professionals and Patients

January 31, 2012

Authors: Su-ming Khoo

Author Affiliations: School of Political Science and Sociology, National University of Ireland, Galway

Option 2– lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Poster


What theories of governance inform our understanding of the public roles of health professionals and patients in the ‘liquid’ global context of complex, mixed health systems undergoing reforms?


Theories of nodal and reflexive governance can help to explain the formation of global public health goods and claims for health rights. Nodal governance explains consumer claims for public health through networked activism (Khoo 2011). However, health consumerism is ambivalent about individual consumer privileges versus basic and collective health needs, especially when the context transforms from lower income to higher income conditions. Reflexive governance (Kaul 2009) is a theory that aligns with rights-based approaches to ground the governance of public health in ‘liquid times’ (Bauman 2007). This combination may provide more coherent and conceptually robust grounds for integrating governance strategies based upon substantive rights and democratic procedures.

Lessons learned/ Main arguments advanced:

The paper argues that the current debates on global health governance rely on thin conceptions of the patient, the health professional, and public policymaking.. The rights approach provides alternative normative and procedural criteria for assessing governance. It suggests that the prevailing technocratic version of health governance should be supplemented by principle of participation in relation to accountability, transparency, fairness and justice. This requires the practice of critical reflexivity as well as normative identification on the parts of both health workers and users of health services. Active and reflexive agency implies a shift in perspective to view health as a sphere where democracy and public health intertwine as public goods.

Next steps:

The paper makes the case for a thicker and more concrete approach to public health and health rights, that has at its centre information and education geared towards the substantive development of health professionals’ and patients’ subjectivity and agency as rights-holders and duty-bearers.


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