Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases

Document Type : Original Article

Authors

1 Department of Political Science and International Relations, University of Southern California, Los Angeles, CA, USA

2 HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA

Abstract

Background
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.
 
Methods
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.
 
Results
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.
 
Conclusion
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.

Highlights

Commentaries Published on this Paper 

  • Thinking Politically About UN Political Declarations: A Recipe for Healthier Commitments—Free of Commercial Interests; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases”

          Abstract | PDF

 

  • Lacking Clarity or Strategic Ambiguity?; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases”

        Abstract | PDF

 

  • Public-Private Partnerships With Unhealthy Commodity Industries: Are They Undermining Real Progress in NonCommunicable Disease Prevention?; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases”

         Abstract | PDF

 

  • Commercial Influence on Political Declarations: The Crucial Distinction Between Consultation and Negotiation and the Need for Transparency in Lobbying; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases”

         Abstract | PDF

 

  • Powerful Allies and Weak Consensus: Towards a Deeper Understanding of how Health-Harming Industries Seek to Influence Global Health Governance; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases”

         Abstract | PDF

 

  • “A Promise Unfulfilled”: Stakeholder Influence and the 2018 UN High-Level Meeting on NCDs; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases”

         Abstract | PDF

Keywords

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International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 16 January 2021

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History

  • Receive Date: 13 June 2020
  • Revise Date: 13 December 2020
  • Accept Date: 14 December 2020

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