A social theory on issue ascendance in global health

Why do some global health issues receive attention and resources from international and national political leaders whereas others are neglected? This question has inspired much speculation but little scholarship. To investigate this question I conduct five historical case studies. Three concern global efforts to address high-burden communicable diseases - HIV/AIDS, pneumonia and malaria – and two concern global efforts to ensure survival of particular population groups – mothers and newborns. I draw on in-depth semi-structured interviews with key actors in these global initiatives, as well as historical archival research. The cases are of interest because despite the fact that each initiative is concerned with conditions that harm tens of millions persons annually, they have received different levels of global political support, ranging from high for HIV/AIDS to minimal for pneumonia. Grounded in concepts from sociology and political science, I develop a theory to explain this variance that emphasizes two elements: the ideas actors use to portray the severity and tractability of the problem that concerns them, and the global institutions these actors create in order to promote and sustain these ideas. This theory explicitly challenges materialist interpretations behind issue ascendance in global health that presume that the highest burden conditions will attract priority and resources. Instead it favors an ideational/social explanation for issue ascendance and emphasizes the disjuncture between burden and priority. I conclude the paper by suggesting a future research agenda for investigating global health agenda setting dynamics.