Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases 1078 1089 4001 10.34172/ijhpm.2020.257 EN Mao Suzuki Department of Political Science and International Relations, University of Southern California, Los Angeles, CA, USA HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA 0000-0002-5848-2730 Douglas Webb HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA Roy Small HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA Journal Article 2020 06 13 Background<br />Non-communicable diseases (NCDs) are increasingly recognized as a significant threat to health and development globally, and United Nations (UN) Member States adopted the Political Declaration of the Third High-level Meeting (HLM) on the prevention and control of NCDs in 2018. The negotiation process for the Declaration included consultations with Member States, intergovernmental organizations (IGOs), and non-state actors such as non-governmental organizations (NGOs) and the private sector. With NCD responses facing charges of inadequacy, it is important to scrutinize the governance process behind relevant high-level global decisions and commitments.<br /> <br />Methods<br />Through a review of 159 documents submitted by stakeholders during the negotiation process, we outline a typology of policy positions advocated by various stakeholders in the development of the Declaration. We document changes in text from the draft to the final version of the Declaration to analyse the extent to which various positions and their proponents were influential.<br /> <br />Results<br />NGOs and low- and middle-income countries (LMICs) generally pursued ‘stricter’ governance of NCD risk factors including stronger regulation of unhealthy products and improved management of conflicts of interest that arise when health-harming industries are involved in health policy-making. The private sector and high-income countries generally opposed greater restrictions on commercial factors. The pattern of changes between the draft and final Declaration indicate that advocated positions tended to be included in the Declaration if there was no clear opponent, whereas opposed positions were either not included or included with ambiguous language.<br /> <br />Conclusion<br />Many cost-effective policy options to address NCDs, such as taxation of health-harming products, were opposed by high-income countries and the private sector and not well-represented in the Declaration. To ensure robust political commitments and action on NCDs, multi-stakeholder governance for NCDs must consider imbalances in power and influence amongst constituents as well as biases and conflicts in positioning. https://www.ijhpm.com/article_4001_65577e3e9ca83f21248bec38a0cd1a78.pdf