CITATION: A framework on the emergence and effectiveness of global health networks
Jeremy Shiffman, Kathryn Quissell, Hans Peter Schmitz, David L. Pelletier, Stephanie L. Smith, David Berlan, Uwe Gneiting, David Van Slyke, Ines Mergel, Mariela Rodriguez, Gill Walt.
Health Policy and Planning 2015;1–14
Since 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on the emergence and effectiveness of global health networks. The supplement examines networks concerned with six global health problems: tuberculosis (TB), pneumonia, tobacco use, alcohol harm, maternal mortality and newborn deaths. This article presents a conceptual framework delineating factors that may shape why networks crystallize more easily surrounding some issues than others, and once formed, why some are better able than others to shape policy and public health outcomes. All supplement papers draw on this framework. The framework consists of 10 factors in three categories: (1) features of the networks and actors that comprise them, including leadership, governance arrangements, network composition and framing strategies; (2) conditions in the global policy environment, including potential allies and opponents, funding availability and global expectations concerning which issues should be prioritized; (3) and characteristics of the issue, including severity, tractability and affected groups. The article also explains the design of the project, which is grounded in comparison of networks surrounding three matched issues: TB and pneumonia, tobacco use and alcohol harm, and maternal and newborn survival. Despite similar burden and issue characteristics, there has been considerably greater policy traction for the first in each pair. The supplement articles aim to explain the role of networks in shaping these differences, and collectively represent the first comparative effort to understand the emergence and effectiveness of global health networks.
1. Global health networks — webs of individuals and organizations linked by a shared concern for a health condition—now exist for most high-burden health problems that low- and middle-income countries face. However, scholars have paid them scant attention, so we know little about their origins and the influence they have in global health.
2. These networks vary in their capacities to attract attention, generate funding, develop interventions and convince national governments to adopt policies and carry out programmes. This variance may help explain why mortality and morbidity have declined more rapidly for some conditions than others.
3. The emergence and effectiveness of global health networks can be understood by considering three categories of factors: features of the networks and actors that comprise them, their policy environments and particular characteristics of the issues they address.
The final feature is ‘framing strategy’ (Factor 4) (Snow et al. 1986; Benford and Snow 2000; McInnes and Lee 2012; McInnes et al. 2012): how network actors publicly position an issue in order to attract attention and resources. Networks may differ in their capacities to discover frames that work. HIV/AIDS communities have been particularly adept at this: when HIV/AIDS was understood as a public health problem afflicting only certain population groups it had difficulty attracting resources; when advocates reframed it as an exceptional disease that posed an existential threat to humanity, politicians began to pay attention (Prins 2004; Harris and Siplon 2007).
Best wishes, Neil
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