Political priority in the global fight against non–communicable diseases

Abstract

The prevalence of non-communicable diseases (NCDs) - such as cancer, diabetes, cardiovascular disease, and chronic respiratory diseases - is surging globally. Yet despite the availability of cost-effective interventions, NCDs receive less than 3% of annual development assistance for health to low and middle income countries. The top donors in global health - including the Bill and Melinda Gates Foundation, the US Government, and the World Bank - together commit less than 2% of their budgets to the prevention and control of NCDs. Why is there such meagre funding on the table for the prevention and control of NCDs? Why has a global plan of action aimed at halting the spread of NCDs been so difficult to achieve? This paper aims to tackle these two interrelated questions by analysing NCDs through the lens of Jeremy Shiffman's 2009 political priority framework. We define global political priority as 'the degree to which international and national political leaders actively give attention to an issue, and back up that attention with the provision of financial, technical, and human resources that are commensurate with the severity of the issue'. Grounded in social constructionism, this framework critically examines the relationship between agenda setting and 'objective' factors in global health, such as the existence of cost-effective interventions and a high mortality burden. From a methodological perspective, this paper fits within the category of discipline configurative case study. We support Shiffman's claim that strategic communication - or ideas in the form of issue portrayals - ought to be a core activity of global health policy communities. But issue portrayals must be the products of a robust and inclusive debate. To this end, we also consider it essential to recognise that issue portrayals reach political leaders through a vast array of channels. Raising the political priority of NCDs means engaging with the diverse ways in which actors express concern for the global proliferation of these diseases. Ultimately, our political interactions amount to struggles for influence, and determining which issues to champion in the midst of these struggles - and which to disregard - is informed by subjectively held notions of the right, the good, and the just. Indeed, the very act of choosing which issues to prioritise in our daily lives forces us to evaluate our values and aspirations as individual agents against the shared values that structure the societies in which we live.