International Power Relationships and Global Health

Philippe Bocquier , Université catholique de Louvain

This paper challenges methodological nationalism—the assumption that countries are self-contained, homogeneous units—and argues that such an approach conceals the global power relations shaping health outcomes. It reconceptualises international trade as a relational system that structures hierarchies and inequalities, drawing on network theory and the Fundamental Cause Theory of health disparities. The study asks whether countries’ structural positions in the global trade network influence their capacity to improve population health, measured through progress in life expectancy. Using trade data and mortality indicators (2015–2019) for 178 countries, the analysis adapts Courgeau’s relative intensity index from migration studies to quantify trade ties adjusted for economic size, yielding measures of intensity (exchange strength) and dissymmetry (directional imbalance). These indicators are incorporated into structural equation models linking trade position, GDP per capita, and changes in life expectancy to estimate direct and indirect effects of global trade asymmetries on health. Results suggest that greater trade intensity and dissymmetry are associated with higher GDP and connection to healthier partners. GDP itself shows a strong negative effect on life expectancy gains, while partners’ health levels exert only modest influence. The higher the intensity and, especially, dissymmetry, the lower the country’s progress in life expectancy, but their effect is indirect, essentially through GDP. The study provides proof of concept for using relational indicators to explain cross-national health differences. It calls for extending this framework beyond the nation-state to explore how global interdependencies and power asymmetries shape countries’ capacities to achieve health equity.

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 Presented in Session 35. International and Cross-Country Health Comparisons