Neoliberal regime change and the remaking of global health: from rollback disinvestment to rollout reinvestment and reterritorialization

Abstract

This article examines the impacts of two interconnected but distinct regimes of neoliberalism on global health. The first is the ‘rollback’ regime associated most commonly with the 1980s and 1990s when efforts to build universal primary health care systems around the world were undermined by Structural Adjustment Programs (SAPs) and associated forms of austerity and market rule. This rollback regime of neoliberal conditionalization led to widespread health service cutbacks, user fees, and other market-driven reforms that effectively replaced plans for ‘health for all’ with more selective and exclusionary approaches. The second neoliberal regime has been rolled-out in part as a response to the resulting gaps in care and associated forms of suffering and ill-health. Where the rollback regime enforced disinvestment, the ‘rollout’ regime insists instead on prioritizing investment. But even as it thereby addresses the health risks produced by financialized neoliberal conditionalization, this reformed rollout regime has doubled-down on selectivity by adapting calculations from global finance to manage global health interventions. This emphasis on rationed and targeted life-saving investment is theorized here as illustrating a shift from the rollback regime’s Laissez-faire ‘macro market fundamentalism’ to an Aidez-faire rollout of ‘micro market foster-care’.