Katherine Kenny, doctoral student in Science Studies at the University of California, San Diego, under the guidance of Professors Isaac Martin and Steven Epstein, will conduct research on the politics of knowledge and governance in international tobacco control and global health. In early 2005, the World Health Organization signed into force the world's first international treaty directed specifically towards a matter of health in the form of the Framework Convention on Tobacco Control (FCTC). As such, the FCTC provides an excellent case through which to examine emergent forms of transnational governance and the co-production of the science and policy of public health on a global scale.
This dissertation research, supported by the NSF Program on Science, Technology and Society, will address the following research questions: 1) How have the various problems associated with tobacco come to be seen as an issue of global significance? 2) How has international regulation, in the form of a legally binding, health related treaty, emerged as the best solution to the global tobacco problem? 3) How has the development of the FCTC contributed to and shaped the emerging field of "global health"? Drawing on a range of textual sources, data from participant observation and interviews with key actors, and using interpretive methods of analysis, this dissertation will employ the FCTC as a case study in the global governance of scientific knowledge.
This research stands to make an important contribution to interdisciplinary studies of the relationship between science, society and the state by emphasizing the global and postcolonial contexts of the development of the FCTC and global health more generally. The results of this research will be of interest to scholars of science studies, social history, medicine and public policy, and social studies of governance, postcolonialism and globalization. Furthermore, this research will encourage collaboration between the critical social sciences and the rapidly proliferating field of global health.
On February 27th 2005, the world’s first international health treaty came into force under the auspices of the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC). Characterized as a global solution to a problem brought about by various processes of globalization, the FCTC is intended to address the world’s single leading preventable cause of death – tobacco use – as well as the devastating social, economic, and environmental consequences it is reported to entail. The FCTC is the first treaty ever negotiated by the WHO and the first legally binding international agreement specifically directly towards a matter of health. It has also become one of the most widely and rapidly adopted treaties in the history of the United Nations: it was unanimously adopted by the World Health Assembly in 2003, came into force with 168 signatories in 2005, and has since been acceded to by an additional 9 member state parties – meaning that the treaty is legally binding in 177 Nations representing over 90% of the world’s population. The treaty is widely hailed as a "landmark global health intervention" and its success attributed to its "unequivocal evidence base". This dissertation asks: what, precisely, is the evidence base of global tobacco control? How has the scientific evidence been mobilized in support of this unprecidented international health regulation? And how does the development of the FCTC treaty relate to the broader reconfiguration of the field of world health – frequently characterized as a transition from international to global health – at the dawn of the 21st century. Drawing on a range of textual sources, ethnographic field work and in-depth interviews with key informants, this dissertation uses interpretative methods of analysis to explore the creation of the FCTC as a case study in emerging forms of global health governance. The dissertation finds that the evidence base of global tobacco control has been built on a very particular way of quantifying the global burden of disease that was introduced with the development of the Disability Adjusted Life Year (DALY) metric by the World Bank in 1993. The DALY metric ascribes economic value to the individual years of life lost to ill-health and facilitates the use of cost-benefit analysis of potential health interventions. On a DALY-logic, tobacco control came to be seen as a global health priority resulting, eventually, in the passage of the FCTC. The DALY metric and eventual FCTC treaty are frequently presented primarily as technical achievements. However, this dissertation shows them to be far more. It argues their development represents a key moment in the institutionalization of a particular way of quantifying disease, economizing life and governing health. It argues that more so that any particular organizational change, it is this economization of life that is the key feature of the transition from international to global health at the dawn of the 21st century. Intellectual Merit: This dissertation project is, in part, a historical narrative of international tobacco control and the history of world health. More fundamentally, however, it contributes to interdisciplinary studies of the relationship between science, society and the state, especially as each of these is rearticulated within an increasingly global context. Its primary contribution is to the field of Science and Technology Studies, where questions about the global dimensions of knowledge production have recently risen to prominence. This dissertation will contribute to resesarch on the political dimensions of evidence-based policy when it is enacted at the global scale. It will also contribute a much-needed critical social science perspective to work in the field of global health by drawing attention to the unavoidable political dimensions of health interventions – even when they seem to be purely technical. Finally, it contributes to literature on the social studies of post-colonialism, or post-colonial technoscience, by coupling the STS critique of the presumed universalism of Western scientific knowledge with attention to the consequences of the history of colonial tropical medicine and cold war international health for the current configuration of neoliberal global health. Broader Impacts: The most immediate result of this research will be a disseration. Once complete, the dissertation will be revised and submitted for publication with an academic press. The intended audience would be readers with an interests in STS, the history of world health and the relationship between scienctific evidence and health policy in the field of contemporary global health. This work has also been publicly presented in a range of settings including professional conferences, graduate workshops, undergraduate courses, and university colloquia series.
