The role of the state has been underplayed in scholarship on global health. Taking a historical view, this paper argues that state institutions, practices and ideologies have in fact been crucial to the realisation of contemporary global health governance and to its predecessor regimes. Drawing on state theory, work on governmentality, and Third World approaches to international law, it traces the origins of the ‘health state’ in late colonial developmentalism, which held out the prospect of conditional independence for the subjects of European empires. Progress in health was also a key goal for nationalist governments in the Global South, one which they sought to realise autonomously as part of a New International Economic Order. The defeat of that challenge to the dominance of the Global North in the 1980s led to the rise of ‘global governance’ in health. Far from rendering the state redundant, the latter was realised through the co-option and disciplining of institutions at national level. To that extent, the current order has an unmistakably imperial character, one which undercuts its declared cosmopolitan aspirations, as evidenced in the approach to vaccine distribution and travel bans during the Covid-19 pandemic.

The spread of COVID-19 has seen a contest over health governance and sovereignty in Global South states, with a focus on two radically distinct modes: (1) indicators and metrics and (2) securitisation. Indicators have been a vehicle for the government of states through the external imposition and internal self-application of standards and benchmarks. Securitisation refers to the calling-into-being of emergencies in the face of existential threats to the nation. This paper contextualises both historically with reference to the trajectory of Global South states in the decades after decolonisation, which saw the rise and decline of Third-World solidarity and its replacement by neoliberalism and global governance mechanisms in health, as in other sectors. The interaction between these modes and their relative prominence during COVID-19 is studied through a brief case-study of developments in Kenya during the early months of the pandemic. The paper closes with suggestions for further research and a reflection on parallel trends within Global North states.

By foregrounding a widened view of the rule of law in transnational legal processes, the works under discussion in this symposium can support innovative critical perspectives on global health law –a field that has gained wide attention due to the spread of COVID-19 around the world (Lander, 2020; Bhatt, 2020). Legal and socio-legal scholars in the decade and a half before the pandemic worked on locating global health law and articulating its underlying principles. Lawrence Gostin's 2014 monograph offers a synoptic view centred on international institutions (e.g. the World Health Organization, World Trade Organization, UN Human Rights Council) and problems (e.g. infectious-disease response, tobacco control), along with an elaboration of its normative basis in universal moral principle and international human rights law (Gostin, 2014). Struggles over access to essential medicines and intellectual property in the early 2000s are, for example, represented in terms of the right to health constraining international trade law. Andreas Fischer-Lescano and Guenther Teubner's 2004 reading is oriented more by social theory than by doctrinal or ethical frames (Fischer-Lescano and Teubner, 2004, pp. 1006, 1008). A functional health regime has ‘differentiated out’, they observe, and operates as a discrete communication system across borders, albeit one that is threatened by the preponderant economic system. On this model, the battle for access to medicines amounts to ensuring, via human rights guarantees, that the rationality of the health system is not replaced by that of its economic rival in legal and policy communications (Fischer-Lescano and Teubner, 2004, pp. 1030, 1046).

This article examines responses to the terrorist attack on the Westgate Shopping Centre in Nairobi in September 2013 in order to investigate the role played by blood donation, as an expression of national dreams, in the political imaginary of contemporary Kenya. It considers the symbolic effectiveness of calls for blood donation made by political figures in the aftermath of the attacks. Such calls drew on a tradition of donation drives begun in the early years of independence, which emphasized the modernizing imperative of the new state and the importance of unity, hard work and self-sacrifice in building the nation. However, the reaction to Westgate, including calls for blood donation, also needs to be understood with reference to the response of American and other leaders to equivalent terrorist attacks in more recent years. These elite dreams found resonance among ordinary citizens and blood donation recruiters. But they were also subjected to trenchant critiques that sought to expose the reality of the transfusion system, as well as the inequality and injustice that mark the general healthcare system and Kenyan society as a whole. These shortcomings were also highlighted by mobilization drives organized by Kenya's Somali and Asian communities both before and during the Westgate crisis. The latter are presented by their organizers as a means of overcoming historic exclusion and discrimination.

In this paper we explore a case for judicial review brought against the Secretary of State for International Development by an Ethiopian national, Mr O. The claimant alleged that the Department for International Development (DfID) had failed adequately to assess evidence of human rights violations in Ethiopia to which funds provided by DfID had contributed. Warby J ruled that the claim merited a full hearing. DfID is unaccustomed to judicial review: the O case is the first time since the 1995 Pergau Dam case that UK development aid has been reviewed by the courts. We study Warby J's judgment and its implications for accountabiity for aid decisions. We argue that both the wider context for aid and the legal framework governing development assistance have changed significantly in the 20 or so years since Pergau. In particular, we show that despite the UK's new legal commitment, made in 2015, to spend 0.7% of gross national income (GNI) on official development assistance, the existing mechanisms for scrutinising aid decisions are inadequate. We argue that there is an accountability gap in relation to the UK's now considerable development spending and explore the role of judicial review in this context.

The development of 157 tanoak [Lithocarpus densiflorus (Hook. and Am.) Rehd.] and 130 Pacific madrone (Arbutus menziesii Pursh) sprout-clumps 1 to 6 yr after cutting or burning was studied on a range of sites in southwest Oregon. The width and area of sprout-clumps originating from trees ≥ 2-cm stem diameter at 1.4-m height of both species was related to the size of the parent stem and time since cutting (tanoak, r2 = 0.77 and 0.75; Pacific madrone, r2 = 0.84 and 0.83). The sprouting capacity of tanoak develops slowly, and 5 to 6 yr after cutting, sprout-clumps produced by small tanoak 40 to 50 yr old averaged only 37 cm in diameter. Prediction equations, along with stem-diameter distributions of these species in forest stands, can be used to estimate hardwood foliar cover up to 6 yr after cutting.

Kudzu is an aggressive, nonnative vine that currently dominates an estimated 810,000 ha of mesic forest communities in the eastern United States. To test an integrated method of weed control, abundances of kudzu and other plant species were compared during 4 yr after six herbicide treatments (clopyralid, triclopyr, metsulfuron, picloram + 2,4-D, tebuthiuron, and a nonsprayed check), in which loblolly pines were planted at three densities (0, 1, and 4 seedlings m−2) to induce competition and potentially delay kudzu recovery. This split-plot design was replicated on each of the four kudzu-dominated sites near Aiken, SC. Relative light intensity (RLI) and soil water content (SWC) were measured periodically to identify mechanisms of interference among plant species. Two years after treatment (1999), crown coverage of kudzu averaged < 2% in herbicide plots compared with 93% in the nonsprayed check, and these differences were maintained through 2001, except in clopyralid plots where kudzu cover increased to 15%. In 2001, pine interference was associated with 33, 56, and 67% reductions in biomass of kudzu, blackberry, and herbaceous vegetation, respectively. RLI in kudzu-dominated plots (4 to 15% of full sun) generally was less than half that of herbicide-treated plots. SWC was greatest in tebuthiuron plots, where total vegetation cover averaged 26% compared with 77 to 111% in other plots. None of the treatments eradicated kudzu, but combinations of herbicides and induced pine competition delayed its recovery.

We develop a polarimetry-based remote-sensing method for detecting and identifying life forms in distant worlds and distinguishing them from non-biological species. To achieve this we have designed and built a bio-polarimetric laboratory experiment BioPol for measuring optical polarized spectra of various biological and non-biological samples. Here we focus on biological pigments, which are common in plants and bacteria that employ them either for photosynthesis or for protection against reactive oxygen species. Photosynthesis, which provides organisms with the ability to use light as a source of energy, emerged early in the evolution of life on Earth. The ability to harvest such a significant energy resource could likely also develop on habited exoplanets. Thus, we investigate the detectability of biomolecules that can capture photons of particular wavelengths and contribute to storing their energy in chemical bonds. We have carried out laboratory spectropolarimetric measurements of a representative sample of plants containing various amounts of pigments such as chlorophyll, carotenoids and others. We have also measured a variety of non-biological samples (sands, rocks). Using our lab measurements, we have modelled intensity and polarized spectra of Earth-like planets having different surface coverage by photosynthetic organisms, deserted land and ocean, as well as clouds. Our results demonstrate that linearly polarized spectra provide very sensitive and rather unambiguous detection of photosynthetic pigments of various kinds. Our work paves the path towards analogous measurements of microorganisms and remote sensing of microbial ecology on the Earth and of extraterrestrial life on other planets and moons.

Background: Elevated plasma homocysteine concentrations have been associated with both cognitive impairment and dementia. However, it is unclear whether some cognitive domains are more affected than others, or if this relationship is independent of B12 and folate levels, which can also affect cognition. We examined the relationship between plasma homocysteine and cognitive decline in an older hypertensive population.

Methods: 182 older people (mean age 80 years) with hypertension and without dementia, were studied at one center participating in the Study on COgnition and Prognosis in the Elderly (SCOPE). Annual cognitive assessments were performed using a computerized assessment battery and executive function tests, over a 3–5 year period (mean 44 months). Individual rates of decline on five cognitive domains were calculated for each patient. End of study plasma homocysteine, folate and B12 concentrations were measured. The relationship between homocysteine levels and cognitive decline was studied using multivariate regression models, and by comparing high versus low homocysteine quartile groups.

Results: Higher homocysteine showed an independent association with greater cognitive decline in three domains: speed of cognition (β = −27.33, p = 0.001), episodic memory (β = −1.25, p = 0.02) and executive function (β = −0.05, p = 0.04). The association with executive function was no longer significant after inclusion of folate in the regression model (β = −0.032, p = 0.22). Change in working memory and attention were not associated with plasma homocysteine, folate or B12. High homocysteine was associated with greater decline with a Cohen's d effect size of approximately 0.7 compared to low homocysteine.

Conclusions: In a population of older hypertensive patients, higher plasma homocysteine was associated with cognitive decline.