Global Health Expertise in the Shadow of Hegemony

Abstract What enables actors to shape norms in global health governance? Scholarship on global health has highlighted the role of experts and expertise in operationalizing norms across a variety of issues. The degree of expert consensus or dissensus and the negotiation processes between expert communities—for example, in international organizations, NGOs or academia—are commonly identified as centrally important for explaining these processes. In this article, we posit that norm-making in global health governance occurs in the shadow of hegemony; a system of status and stratification that is centered on economic and security concerns and maintained by countries at the core of the world system. These countries—notably the USA and other major economies in the Global North—project their hegemonic position in the world system across areas of global organizing, including in global health. We explore the relationship between epistemic consensus and hegemonic interests as parameters that shape the outcome of norm-making processes. To pursue this argument, we examine this relationship in the context of the development of policy norms to counter non-communicable diseases in developing countries and to pursue the securitization of global health.