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Empowering Individuals: Rise and Expansion of Health Education and Women's Issues at the World Health Organization

Keiko Inoue
School of Education
Stanford University
December 2001

The research question I attempt to answer in my dissertation research is "How do shifts in global norms influence changes within intergovernmental organizations (IGOs), and vice versa?" Specifically, I focus on the emergence and expansion of health education and women's issues within the field of international public health and the World Health Organization (WHO), in relation to the now ubiquitous global norm of adopting the human rights approach to development projects.

Human rights, impelled by the 1948 United Nations Universal Declaration of Human Rights, have become one of the most globalized political values of our time. Over the past century, the human rights framework has dominated the field of international public health, resulting in the increased emphasis on liberalism and notions of individual efficacy and empowerment in health matters. Patients are expected to be more proactive and responsible for their own well being, rather than perceived as passive recipients of medical treatment from an expert. More importantly, the shift to the notion of an active and efficacious individual as patient gave rise to an increased emphasis on health education and promotion programs, as well as a field dedicated to this particular pedagogy.

Additionally, a focus on girls and women has resulted from the human rights framework. From faceless beings with no rights, women have increasingly acquired equal rights as men, as well as specific rights qua women, over the past century. In the field of international public health, policymakers and technical officers are increasingly adopting the "from the womb to the tomb" rather than viewing women primarily as mothers and reproducers without health needs of their own. Women's health is also expanding as new topics are incorporated under its umbrella, including female genital mutilation, violence against women, abortion, and contraception.

The WHO is an especially salient example of an IGO that has embraced the human rights approach to health by emphasizing the importance of enabling individuals to "make healthy choices" through education. The Department of Noncommunicable Disease Prevention and Health Promotion has organized several international conferences on health education and promotion over the past fifty years, increasingly incorporating the human rights framework each time. The WHO also focuses specifically on women's health through the Department of Gender and Women's Health, which strives to mainstream gender and address previously neglected women's health issues.

This dissertation employs theories of organizations and world society, contributing to the extant literature by merging organizational and global levels of analysis. Traditionally, research on IGOs has consisted of case studies attempting to evaluate efficiency or explore the political relationship between national and organizational actors. Meanwhile, world society theorists have investigated global trends using quantitative, cross-national methodologies. Neither field has produced research that applies in-depth process tracing to understand mechanisms through which phenomena at both levels are related. I attempt to address this gap by analyzing the reciprocal relationship between global changes in the external environment of an IGO and an IGO's internal modifications.

I will conduct content analyses of documents and interviews, as well as gather data through fieldwork and an internship at WHO headquarters in Geneva, Switzerland from January to June 2002. I will explore the relationship between WHO programs and broader shifts in global norms of international public health regarding individual efficacy and women. This research will contribute to the fields of neoinstitutional and world society theories, human rights, international public health, and feminist scholarship. I believe this research will also foster better understanding of IGO decision-making, leading to improved health education and women's programs at WHO and other development organizations.