Framing and the formation of global health priorities

• Published in: The Lancet (British edition) 2022-05, Vol.399 (10339), p.1977-1990
• Main Authors: Shiffman, Jeremy, Shawar, Yusra Ribhi
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Collective action; Cooperation; Ethics; GDP; Global health; Gross Domestic Product; Health policy; HIV; Human immunodeficiency virus; Human rights; Lethality; Localization; Mortality; Norms; Political activism; Political power; Political science; Priorities; Public health; Reproductive health; Research facilities; Research institutions; Scientists; Social activism; Social justice; Tropical diseases
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(22)00584-0

Health issues vary in the amount of attention and resources they receive from global health organisations and national governments. How issues are framed could shape differences in levels of priority. We reviewed scholarship on global health policy making to examine the role of framing in shaping global health priorities. The review provides evidence of the influence of three framing processes—securitisation, moralisation, and technification. Securitisation refers to an issue's framing as an existential threat, moralisation as an ethical imperative, and technification as a wise investment that science can solve. These framing processes concern more than how issues are portrayed publicly. They are socio-political processes, characterised by contestation among actors in civil society, government, international organisations, foundations, and research institutions. These actors deploy various forms of power to advance particular frames as a means of securing attention and resources for the issues that concern them. The ascription of an issue as a security concern, an ethical imperative, or a wise investment is historically contingent: it is not inevitable that any given issue will be framed in one or more of these ways. A health issue's inherent characteristics—such as the lethality of a pathogen that causes it—also shape these ascriptions, but do not fully determine them. Although commonly facing resistance, global health elites often determine which frames prevail, raising questions about the legitimacy of priority-setting processes. We draw on the review to offer ideas on how to make these processes fairer than they are at present, including a call for democratic representation even as necessary space is preserved for elite expertise.