Abstract
Global health problems are often framed as common challenges confronting humanity, and while political commitment and resources have recently increased, a number of faultlines run through efforts to mount collective responses. Although the United States has staked its claim to leadership in the fight against disease, its actions diverge in several key respects from much of the international community, undermining the effectiveness of global efforts. These divergences can be traced to domestic politics, and are related to three debates of significance for international relations more generally: on global governance, models of globalisation, and relationships between development and security. In this article US approaches are contrasted in each of these dimensions with those of the UK, which has been active in promoting its own vision. The prospects for overcoming current limitations are examined on two levels: the technocratic, and the ideological and political. Developments on both levels are evaluated in light of events early in the second term of the Bush administration. In conclusion, it is suggested that there are two contending meta-narratives underlying the faultlines in global health.
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