, Volume 6, Issue 1, pp 10–33 | Cite as

Making medicines essential: The emergent centrality of pharmaceuticals in global health

  • Jeremy A Greene
Original Article


Expanding access to pharmaceuticals has become one of the most visible aspects of twenty-first century global health practices, as evidenced by the moral urgency of antiretroviral rollout and the pressing call for new drugs for neglected diseases. However, the role of prescription drugs in public health was far less obvious to the framers of international health organizations only a half-century ago. This article examines the evolving role of pharmaceuticals in global health practices by charting the emergence of the category of ‘essential medicines’: initially a list of 186 drugs first defined by the World Health Organization (WHO) in 1977 to be ‘basic, indispensable, and necessary for the health of the population’, and subsequently expanded by actors beyond the WHO including NGOs, pharmaceutical companies and the broader financial community. This apparently simple act of list-making worked to transport a set of commodities from the private, commercial sphere into a public health commons, and sparked a series of methodological, logistical and political controversies over the winnowing of ‘essential’ from ‘inessential’ that collapsed evidentiary, regulatory, participatory and market terms into a single process. To ask ‘what practices render a medicine essential?’ is therefore to address the shifting ecology of knowledge governing global health today.


global pharmaceuticals global health international health essential medicines pharmaceutical industry essential drugs 



The author gratefully acknowledges the time and historical insight provided by several former and current actors within the Essential Medicines Programme of the WHO, especially Margaretha Helling-Borda, Hans Hogerzeil, Richard Laing and Jonathan Quick. The archival work supporting this project would not have been possible without the generous assistance of Marie Villemin at the archives of the WHO, and the manuscript benefitted from discussions with Paul Cruickshank, Dennis Ross-Degnan, David Jones, Stephen Pemberton and Anita Wagner. Earlier versions of this article were presented at a Global Health Histories Seminar at the WHO in December 2009, the November 2010 meetings of the American Anthropological Association and a December 2010 conference on Drugs, Standards and the Practices of Globalization supported by the European Science Foundation, the Centre de Recherches Médecine, Sciences, Santé et Société and the Ecole des Hautes Etudes en Sciences Sociales.


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© The London School of Economics and Political Science 2011

Authors and Affiliations

  • Jeremy A Greene
    • 1
    • 2
  1. 1.Department of the History of ScienceHarvard UniversityCambridgeUSA
  2. 2.Division of PharmacoepidemiologyBrigham & Women's HospitalBostonUSA

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