Final Report Summary - GHG (The Transformation of Global Health Governance: Competing Worldviews and Crises.)
Globalisation is widely seen as changing patterns of health and disease worldwide. But it is also understood as requiring changes to how decisions on health policy are made and organised because, if ‘health is global’, then collective solutions are required for shared health problems. Thus the emergence of ‘global heath governance’ (GHG) both as a policy space and an attendant academic field of inquiry. But explanations for, understandings of and policy responses have been almost wholly based on positivist epistemologies: that GHG is a rational response to exogenous developments, that lack of progress can be accounted for in material factors and institutional architecture, and that an ideal ‘best’ solution is possible.
This project sought to add ideational factors to our understanding, using ‘thin’ social constructivism and framing, hypothesising that competing visions of health were instrumental in understanding both the GHG landscape and the lack of progress. The project provided a comparative analysis across several types of health issues, and analysed how macro level narratives of transformation were reflections of and/or contributed to the governance of individual health issues.
We have found:
• There is no single underlying logic behind calls for GHG. Rather the space is characterised by a number of competing visions and frames, each with its own logic and preferred policy pathways and associative of particular worldviews.
• Five frames can be identified as operational in GHG: evidence based medicine; security; development; rights; and economics.
• No frame is dominant across the entirety of GHG, but different frames have greater levels of policy purchase across different health issues and for some issues a dominant frame can be identified.
• These competing frames and visions are an important part of the explanation for a lack of progress in GHG.
• Framing allows health issues to be tied into other policy arenas (development, security, rights, economics). This multi-sectoral approach can be vital in advancing policy and developing governance frameworks. Claims based on health grounds alone are less likely to succeed. Health is not enough.
• A macro level, ‘grand’ narrative of the transformation of GHG exists, but individual health issues imperfectly reflect this grand narrative. Some such as HIV/AIDS have been constitutive of the narrative while others, such as pandemic influenza, have been relatively unchanged by it. Path dependencies appear to be a crucial explanation for this difference.
• The governance of individual health issues do not form a nested relationship with GHG; nor is there a nested relationship between GHG and wider global governance. Rather we developed a ‘bumper car’ model. In this, individual health issues collide with and sometimes head in the same direction as others within the policy space of GHG; and similarly health governance bumps into other governances. Another metaphor might be that of a kaleidoscope, where the issues stay the same but the pattern of relations are constantly changing and new outcomes are possible.
This project sought to add ideational factors to our understanding, using ‘thin’ social constructivism and framing, hypothesising that competing visions of health were instrumental in understanding both the GHG landscape and the lack of progress. The project provided a comparative analysis across several types of health issues, and analysed how macro level narratives of transformation were reflections of and/or contributed to the governance of individual health issues.
We have found:
• There is no single underlying logic behind calls for GHG. Rather the space is characterised by a number of competing visions and frames, each with its own logic and preferred policy pathways and associative of particular worldviews.
• Five frames can be identified as operational in GHG: evidence based medicine; security; development; rights; and economics.
• No frame is dominant across the entirety of GHG, but different frames have greater levels of policy purchase across different health issues and for some issues a dominant frame can be identified.
• These competing frames and visions are an important part of the explanation for a lack of progress in GHG.
• Framing allows health issues to be tied into other policy arenas (development, security, rights, economics). This multi-sectoral approach can be vital in advancing policy and developing governance frameworks. Claims based on health grounds alone are less likely to succeed. Health is not enough.
• A macro level, ‘grand’ narrative of the transformation of GHG exists, but individual health issues imperfectly reflect this grand narrative. Some such as HIV/AIDS have been constitutive of the narrative while others, such as pandemic influenza, have been relatively unchanged by it. Path dependencies appear to be a crucial explanation for this difference.
• The governance of individual health issues do not form a nested relationship with GHG; nor is there a nested relationship between GHG and wider global governance. Rather we developed a ‘bumper car’ model. In this, individual health issues collide with and sometimes head in the same direction as others within the policy space of GHG; and similarly health governance bumps into other governances. Another metaphor might be that of a kaleidoscope, where the issues stay the same but the pattern of relations are constantly changing and new outcomes are possible.