The power-trust cycle in global health: Trust as belonging in relations of dependency

Trust between actors is vital to delivering positive health outcomes, while relationships of power determine health agendas, whose voices are heard and who benefits from global health initiatives. However, the relationship between trust and power has been neglected in the literatures on both international politics and global health. We examine this relationship through a study of relations between faith based organisations (FBO) and donors in Malawi and Zambia, drawing on 66 key informant interviews with actors central to delivering health care. From these two cases we develop an understanding of ‘trust as belonging’, which we define as the exercise of discretion accompanied by the expression of shared identities. Trust as belonging interacts with power in what we term the ‘power-trust cycle’, in which various forms of power undergird trust, and trust augments these forms of power. The power-trust cycle has a critical bearing on global health outcomes, affecting the space within which both local and international actors jockey to influence the ideologies that underpin global health, and the distribution of crucial resources. We illustrate how the power-trust cycle can work in both positive and negative ways to affect possible cooperation, with significant implications for collective responses to global health challenges.

How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power

Caesarean delivery is a common and life-saving intervention. However, it involves an overall increased risk for short-term and long-term complications for both mother and child compared with vaginal delivery. From a medical point of view, healthcare professionals should, therefore, not recommend caesarean sections without any anticipated medical benefit. Consequently, caesarean sections requested by women for maternal reasons can cause conflict between professional recommendations and maternal autonomy. How can we assure ethically justified decisions in the case of caesarean sections on maternal request in healthcare systems that also respect patients’ autonomy and aspire for shared decisions? In the maternal–professional relationship, which can be characterised in terms of reciprocal obligations and rights, women may not be entitled to demand a C-section. Nevertheless, women have a right to respect for their deliberative capacity in the decision-making process. How should we deal with a situation of non-agreement between a woman and healthcare professional when the woman requests a caesarean section in the absence of obvious medical indications? In this paper, we illustrate how the maternal–professional relationship is embedded in a nexus of power, trust and risk that reinforces a structural inferiority for women. To accommodate for beneficial use of power, these decision processes need to be trustworthy. We propose a framework, inspired by Lukes’ three-dimensional notion of power, which serves to facilitate trust and allows for beneficial power in shared processes of decision-making about the delivery mode for women requesting planned C-sections.

Smartphone as a mediating technology of organization

This chapter considers the smartphone as organizational force. Its effects are to blur the boundaries between work and home; to involve different constituent actors and forms of power (bypassing traditional organizational gatekeepers); and to raise new forms of service and exclusion. The smartphone is a small device that impacts large-scale organizing. A site of interaction between the individual and organizing, it raises questions of power, trust, transparency, work–life balance, self-monitoring, surveillance, and self-expression. It is associated with the rise of new, less-regulated forms of work and social movements. Organizational scholars need to further unpack its implications for organizations and organizing.

Are national tourism organisations past their sell-by date? A perspective article

Purpose The purpose of this paper is to explore the sustainability of National Tourism Organisations (NTOs) in light of the increasing power of cities. Design/methodology/approach Based on a review of major societal trends and the author's interpretation of such trends, a tourism futurists’ perspective was applied to better understand the implications of such trends. Findings The future growth of tourism will be constrained by some of the greatest challenges facing society, including unrelenting population growth, ageing demographics, shortages of natural resources, devolution of power and increasing urbanisation. As a result of such trends, this review suggests there will be resurgence in the power of cities, leading to an increase in tourism between not only global cities but also, more importantly, secondary cities. Research limitations/implications The results are limited by selection of the trends and the author's interpretations of such trends. Practical implications The review suggests that city-city marketing will be a key driver in future tourism marketing, over country-country marketing. Originality/value The paper concludes that NTOs are no longer fit for purpose, as power, trust and relevance have shifted in favour of individual city marketing bureaus, over state controlled NTOs.