A ‘New Scramble for Africa’: The Struggle in Sub-Saharan Africa to Set the Terms of Global Health

Abstract

At population levels, health outcomes are determined more by social conditions than by either biology or technological interventions. Therefore, entrenched and increasing inequalities associated with global transformations in political economy are among the most significant causal factors for so-called ‘global health’ problems that disproportionately afflict sub-Saharan Africans. Growing attention is being paid to the social causes of ill health, as evidenced in the WHO's recently introduced Commission on the Social Determinants of Health. However, the predominant paradigm continues to support a biotechnical/clinical health model that privileges pharmaceutical treatment of individual diseases over support for broader social change that would include improved broadly based national health systems as well as revised international economic structures. This paper examines the struggle involved in setting the normative framework for health in sub-Saharan Africa and the roles of major external actors in setting the policy agenda.