Theorising global health promotion: a critical health citizenship framework

Global health promotion aims to enhance transnational health equity. As such, borders, movements of people or pathogens across national borders, and fairness or justice in health sit at the core of global health promotion. In this paper, I present a critical health citizenship framework aimed at conceptualising transnationality in relation to health equity. The framework addresses the interweaving of the construction of nation-states (with the attendant (contested) laws, policies, and institutions) and everyday dividing practices underpinning health inequities. I argue that theorisation around the interlinked concepts of borderisation, belonging, and ‘acts of citizenship’ provides a powerful tool within global health promotion research, firstly, to expose, and, secondly, to shift power relations that underpin health inequities. The framework asks three interlinked questions: (1) What processes of borderisation underpin differentiation by vitality (healthy environments; access to healthcare spaces, health products, and health resources)? (2) What belongings are enabled or fractured through (a) borderisation or (b) acts of citizenship? (3) How do acts of citizenship enable shifts from health ‘subjects’ and ‘abjects’ to health citizens, with the right to have rights and to be embedded in an ethics of health justice and care? I illustrate the framework with examples.