Ghost in the Machine: racialized organization theory, international institutions, and technocratic policymaking in global health

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 7. Medical Markets, Capitalism, and the Organization of Care

Abstract

International organizations are increasingly employing technocratic approaches to global governance that emphasize the role of expert knowledge in policymaking. Although technocracy is well-documented in international law and finance, its influence is also expanding into global health through the growing epistemic authority of biomedical approaches to health and illness. By moving toward technical expertise, international institutions like the World Health Organization (WHO) can both maintain the guise of neutrality and obscure the existence of inequality in global health policymaking. In contrast, work on racialized organization theory frames organizations as racial structures that contribute to racial inequality independent of bad actors or individual discretion.

In this paper, I explore if, how, and with what consequences racialized organization theory can be applied to global governance institutions. Accordingly, I examine the WHO’s policymaking around what it calls “traditional, complementary, and integrative” medicine (TCI). Drawing on archival documents, I analyze how the organization’s stance towards TCI has changed over time, with particular attention to recent developments around standardization and benchmarking. Specifically, I interpret the WHO’s discursive emphasis on “evidence-informed decision-making” as a potential form of racialized administrative burden that is faced by non-Western, non-biomedical practices of health and healing. Using this framework, I trace the learning, psychological, and compliance costs that TCI experts must face in order to be integrated into global health policymaking.

I argue that the WHO’s increasing involvement in regulating TCI is how the institution manages the tension between mainstream biomedical and more “fringe” ideas. Moreover, the application of the organization’s “science-based mandate” through policy requirements, organizational rules, and resource distribution contributes to a persistent pattern of racial inequality in the politics of knowledge and expertise within global health. I close by reflecting on how this case study can inform more sociological studies of racialized inequality in global governance and its institutions.

Author

• Sutina Chou, University of California-San Francisco