Some global health issues have higher rates of morbidity and mortality, yet others with lower rates have gained much greater policy attraction. Jeremy Shiffman, a professor in the Department of Public Administration and Policy at American University in Washington, D.C., and his research program have created a conceptual framework (shown in figure 1 below) to understand this variance and the role global health networks played in shaping these differences. In his lecture on Global Health Politics on March 26, organized by the McMaster Health Forum Student Subcommittee, Shiffman explained how his framework can be applied to analyze the effectiveness and emergence of global health networks. The framework comprises four elements – networks, policy environment, issue characteristics and outcomes. The first three factors are interdependent and interact with each other to produce outcomes such as international attention and policy adoption. Each factor has its own sub-elements contributing to their effectiveness in producing outcomes.
Although the presented framework is not meant as a linear tool to be used to effect change, it may be used as a set of strategic considerations for activists to find leverage on pushing their causes. For example, collective action on an issue may be leveraged by considering five sub-elements of the framework: severity of the disease, tractability of a response, politicization of the issue, and heterogeneity of the groups involved in and affected by the issue. These considerations can be seen in the potential factors leading to maternal health achieving better outcomes compared to newborn health; maternal health has been politicized, whereas newborn health hasn’t reached the political sphere.
Discussion after the presentation delved into the broader realm of global health. Shiffman commented on human nature and emotion, and whether it had a place in global health systems. He remarked that human nature means emotion will always be involved in decision-making, and it has a role in pushing for prioritization of certain causes. Yet emotion may prevent activists from seeing beyond their causes and result in crowding out resources for other issues. Furthermore, legitimacy is another consideration of global health networks. Shiffman explained that effectively contributing to positive outcomes does not solely legitimize global health networks; transparency, process of selection, participation and inclusiveness are also factors in creating legitimacy. In fact, global health networks may be distorting global health governance by altering health systems, concentrating power in various areas, and pressuring stakeholders to do what networks want.
Overall, Shiffman’s conceptual framework offered a clear means of breaking down the complexities affecting the prioritization of one global health issue over another. It was both rewarding and intriguing to learn from his insight into how networks and various other considerations affect global health.
By Ceinwen Pope, McMaster student and general member 2013-2014, McMaster Health Forum Student Subcommittee, and Guanru Li, student, Bachelor of Health Sciences Program, Global Health Specialization, McMaster University.