Generating Sustained Political Priority for Non‐communicable Diseases: Towards a Suitable Governance Model
| Author | Carmen Huckel Schneider,James A. Gillespie,Anne Marie Thow |
| Date | 01 September 2017 |
| Published date | 01 September 2017 |
| DOI | http://doi.org/10.1111/1758-5899.12416 |
Generating Sustained Political Priority for
Non-communicable Diseases: Towards a
Suitable Governance Model
Carmen Huckel Schneider, James A. Gillespie and Anne Marie Thow
Menzies Centre for Health Policy, University of Sydney
Abstract
The 2011 high-level meeting of the United Nations General Assembly on non-communicable diseases (NCDs), and subsequent
developments in global public policy on NCDs can be seen as a contemporary case study in global health governance. As the
debate on what constitutes appropriate and desirable governance continues, highly contrasting models are being compared
as starting points. We define these as the global health initiative model and the convention/strategy model. Each has a differ-
ent strategy at its core and represents a different response to key normative challenges that are said to plague global health
governance –participation, scope of action, balancing power, legitimacy and effectiveness. As the current structure of the Glo-
bal Coordinating Mechanism for NCDs within the WHO emerges as a possible new model, we argue that these normative
challenges need to be addressed to safeguard against potential policy ineffectiveness.
In September 2011, a high-level meeting of the United
Nations General Assembly (GA) discussed the worldwide
threat posed by the epidemic of non-communicable dis-
eases (NCDs). It was only the second time that health was
the topic of a GA meeting; the first being a Special Session
on HIV/AIDS held in 2001. It can therefore be seen as a sig-
nificant global health policy event.
Priority for action was given to four groups of diseases
(cardiovascular, cancer, chronic lung diseases and diabetes),
a set of risk factors, and a member-state focused pro-
gramme of action. The concluding resolution also made sev-
eral references to a range of governance related issues
including ‘leadership’,‘partnership’,‘coordination’,‘alliances’,
‘networks’,‘cooperation’and ‘innovative approaches to long-
term financing’(United Nations General Assembly, 2011).
Beyond this however, the question of how global action on
NCDs should be governed remained open.
The subsequent development of global NCDs policy can
be seen as a contemporary case study in global health gov-
ernance, following various attempts over the past 20 years
to establish and maintain novel governance mechanisms to
sustain political priority for particular health issues. These
include the Global Alliance for Vaccines and Immunisation
(GAVI) established in 2000, the Global Fund to Fight AIDS,
Tuberculosis and Malaria (GFATM) established in 2002, both
of which operate in tightly defined policy spaces and
involve decision-making structures that are linked to, but
function at a distance from, the World Health Organisation.
In contrast, in the few years since the GA meeting, global
NCD governance appears to have moved in a direction that
gives considerably greater heed to the institutions of the
United Nations (Beaglehole et al., 2011a). A second GA
meeting took place in July 2014, and a third is scheduled
for 2018. These have provided the basis for the establish-
ment of the World Health Organisation’s Global Coordinat-
ing Mechanism (GCM) for NCDs, which, in the absence of
any alternative, is functioning as the pre-eminent global
NCD governance body. The debate on the most appropriate
and desirable NCD governance model continues within a
broader global policy context that includes critique and
response to established governance structures. Examples
include issue focused funding oriented organisations such
as GFATM, and ‘hard law’instruments such the much hailed
Framework Convention for Tobacco Control (Gostin, 2014;
Sridhar et al., 2013). These two examples represent highly
contrasting models that respond differently to key norma-
tive global governance challenges.
In this survey article we make use of this case study to
survey global health governance trends by contrasting
potential benefits and pitfalls of different models. We begin
by reviewing the historical policy context of NCDs as an
issue area in need of global policy action, and compare this
with the policy space that emerged around HIV/AIDS at the
turn of the century. We then compare and contrast the two
broad models of governance that are presented as options
in this policy space; a global health initiative model, and a
convention/strategy model, as well as WHO’s current Global
Coordinating Mechanism as an emerging third model. We
do this by addressing five key normative challenges of glo-
bal governance; participation, scope of action, balancing
power, legitimacy and effectiveness with respect to each.
Historical policy context
Long dismissed as diseases of affluence, NCDs have strug-
gled for global political attention. Even as research showed
©2017 University of Durham and John Wiley & Sons, Ltd. Global Policy (2017) 8:3 doi: 10.1111/1758-5899.12416
Global Policy Volume 8 . Issue 3 . September 2017
364
Survey Article
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