Why do some global health initiatives receive political priority while others don't?
A conversation with Professor Jeremy Shiffman about political advocacy for maternal, newborn and child health
In the world of global health, some issues gain high levels of political attention and investment, while others don't. Professor Jeremy Shiffman, a political scientist at Syracuse University, has been developing a new field of enquiry to analyse the critical factors underlying successful political advocacy for global health causes. Shiffman has a particular interest in maternal, newborn and child health. His case study on political priority for reducing maternal mortality was presented at the 2007 Women Deliver Conference and he is currently researching global advocacy for newborn health.
Professor Shiffman gave a seminar to share his findings before a packed audience of global health practitioners at WHO Headquarters on 5 September 2008. The Partnership website team sat down with him afterwards to discuss his findings.
Q: You have studied the way in which global health initiatives receive very different levels of political priority. What are the key factors which influence whether a global health initiative achieves political visibility?
A: There are several factors which consistently matter. One is the existence of credible evidence to prove the severity of the problem. Another factor is leadership--having effective global champions for the issue. The third factor is the existence of a set of institutions who are advocating successfully to promote the issue. Beyond that we do not know yet. This hasn't been researched much, and my objective is contribute useful knowledge on the subject.
Q: In your case study on maternal health, you have listed additional factors which influence levels of political priority?
A: Yes, we have learnt from the maternal health movement that ideas are a very important factor. Ideas are the way policy communities frame and promote their issues. Any given issue can be framed in multiple ways. AIDS for example was framed as a public health problem, a humanitarian crisis, a development issue and a security concern. There are multiple ways to position an issue and some of these public positionings resonate with political leaders while others don't. It's absolutely critical for policy and advocacy communities to think about how they are framing their issues in the way that will make political leaders say "Oh yes, this issue is important".
Q: In the case of the safe motherhood initiative, what worked and what didn't in terms of the issue gaining political priority?
A: I should say that, since 2007, maternal mortality has been gaining much more political attention. For a long time before that, the safe motherhood community did face difficulties. They disagreed among themselves on the appropriate set of effective interventions, and thus were not able to position their issue effectively so it resonated with political elites. They were also unable to agree on how to measure progress. They had many talented champions - and I admire all of them - but the community as a whole didn't have effective leadership. So there were many disagreements within this policy community that inhibited them from advancing further.
Q: Did the maternal health community succeed in creating what you call "internal" or "external" frames for its issue?
A: The internal frame refers to the way that actors understand their issue and express their concern about it. Internally, the maternal health community struggled. They all agreed that maternal mortality was a crisis, and this glued them together. However, they did not agree on what was to be done. Today they have moved forward into a new phase. Externally, I don't know yet if they have discovered their external frame. I see the new thrust, coming from Women Deliver conference, to focus on this as a development issue. It's an interesting idea, let's see if it resonates.
Q: In the current context of the Partnership for Maternal, Newborn & Child health, the maternal health community is one of the three concerned communities. Do you see these communities being more complimentary and successful in gaining political priority, or rather in tension with each other?
A: I think we see both: complimentarity and tension. There is complimentarity in the sense that the maternal health community is now provided with the opportunity to join hands with others: those working on newborn and child health. This creates a far broader and stronger global alliance than if they acted alone. The tension is that this also diffuses their issue identity. When you integrate the maternal, the newborn and the child, there is less attention to the maternal side only. So there is a clear tension. One needs to sort this through.
Q: Today, your lunchtime seminar attracted a substantial crowd here at WHO. The audience was captivated by your framework for political priority, indicating this sort of research on global advocacy is quite new and much needed. Do you know of other such research going on?
A: As far as I know, the study of global health advocacy is in its infancy. There are a lot of people who do very effective advocacy and are very knowledgeable on this subject. But academic research on global health advocacy is minimal. In public policy studies, we have a whole field called "agenda-setting" which has advanced in many other directions, but hasn't really included global health as yet.
Q: What has driven your personal interest in pursuing global advocacy research, it's a complex subject to develop?
A: Ultimately, because I care about global health equity, and think it's revolting that poor people have to die from preventable causes. I am academic first, but I hope that my academic work will contribute to greater social equity. I feel passionate about it even though I am supposed to be impartial.
Q: Why focus on maternal, newborn and child health when there are many other global health issues?
A: My interest in maternal, newborn and child health is very strong emotionally, but intellectually this issue is like any other. My personal concern is very stronggreat since it makes me very sad to see how few resources have been devoted to maternal, newborn and child health when so many of these deaths could be prevented. Meanwhile, other causes dominate the scene, even when their relative disease burdens do not completely justify that. Intellectually, I am studying this issue like other global health priorities, aiming to generate more knowledge in the specific area of contribute broader knowledge to the field of global health advocacy.
Thank you very much for your time.
- Listen to the audio file of the Lunchtime Seminar on "Political Priority for Global Health Initiatives"
Presentation by Prof. Jeremy Shiffman "Generation of political priority for global health initiatives", September 5, 2008
Jeremy Shiffman, Stephanie Smith, "Generation of political priority for global health initiatives:a framework and case study of maternal mortality", Lancet, October 2007
- Read Professor Shiffman's article on generating political priority for maternal mortality in 5 Developing Countries