In this age of rapid growth and globalization, modern society is more vulnerable than ever to a plethora of health disasters. As such, the BK21 Center for Integrative Response to Health Disasters is a research institution at Seoul National University (SNU) that tackles this escalating issue. The research institution focuses on determining how to adeptly respond to health disasters and the complexities of their impact, particularly on a transnational scale. Its vision is of the following: establishing an educational research paradigm and data infrastructure based upon interdisciplinary super-convergence.
Professor Jeremy Shiffman on the formation of global health priorities
On October 17, the BK21 Center for Integrative Response to Health Disasters hosted an online seminar titled Framing and the Formation of Global Health Priorities. The guest speaker who provided their expertise on the topic was Professor Jeremy Shiffman, Bloomberg Distinguished Professor of Global Health Policy at Johns Hopkins University, with joint appointments at the Bloomberg School of Public Health and the Paul H. Nitze School of Advanced International Studies. Professor Shiffman’s research interests include global health policy, health policy analysis using theoretical resources, and qualitative methods in health policy research.
During the seminar, Professor Shiffman outlined his joint study conducted with Professor Yusra Shawar, an associate scientist in the Bloomberg School of Public Health. At its core, the presentation addressed two crucial questions—why and how do some global health issues receive ample attention while others remain neglected to this day?
Motivations for the Study
According to Professor Shiffman, the discrepancy between the severity of certain health issues and the extent of the investment into mitigation has always been apparent. While the World Health Organization (WHO) designated Ebola as a Public Health Emergency of International Concern (PHEIC), the same treatment has never been extended to Cholera, which has had a critical upsurge in outbreaks and an expansion in geographical distribution in recent years. Both HIV/AIDS and Diabetes heavily victimize individuals in all income settings—low, middle, and high—yet global priority has been solely placed upon the creation and distribution of antiretroviral drugs, not insulin.
Such gaps in how health concerns are treated cannot be explained away by objective factors, such as the number of deaths a health issue produces, how quickly it spreads, and whether or not effective and inexpensive interventions are readily available. As of yet, however, there have not been many cases of systematic comparative research done to identify the legitimate causes for this gap. Hence, Professor Shiffman’s primary motivation in undertaking this study was to identify the manner in which global health priorities form, painting the bigger picture and putting the existing whirlwinds of speculation to rest.
Deficiencies in the Construction of Global Health Priorities
Professor Shiffman acknowledged that, from an ethical standpoint, global health priority setting has much room for improvement. He outlined two of the most significant contributors to the flawed construction. First and foremost, there is a democratic deficit in such a priority setting. While the voices of the many that are most affected by detrimental health conditions are underrepresented in conversations, those of political leaders and elites dominate. In addition, competition for scarce resources means that only a small number of today’s global health concerns can be given priority at all. The rest that are deemed less dire inevitably fall through the cracks.
Core Findings: Framing Processes at Work
For the purpose of the seminar, Professor Shiffman defined framing as “the way that political elites and the public understand and portray public issues.” Any issue could be framed in a multitude of ways.
It would be foolish to believe that objective factors play no role in shaping global health priorities. Yet, it is global health elites, including officials in international organizations and prominent scientists, that have the greatest effect on priority setting. These groups use their wide-reaching influence to create convincing frames that secure attention and resources for health issues that are of interest to them.
The three types of framing processes as outlined by the study are securitization, moralization, and technification.
First, securitization refers to “the portrayal of an issue as a serious, potentially existential, threat to humanity.” As a result, such issues are not left to the health sector alone but require action to be taken by both national governments and international organizations. As government leaders are primarily motivated by fear, they wield compulsory power to incentivize citizens to act in accordance with their agendas. Professor Shiffman noted that it is the shared belief of many political scientists that securitization is most often about protecting rich countries from diseases that they fear. In correspondence, longstanding endemic diseases that pose a severe threat to public health in poor countries are more than likely not securitized. The way in which Ebola inspired panic over cross-national transmission and was declared a Public Health Emergency of International Concern (PHEIC) twice, while other more contagious diseases have not been, is demonstrative of this point.
Second, moralization refers to “the portrayal of an issue as an ethical imperative.” The primary actors of such issues are civil society networks, often aligned with governments and international organizations. Motivated by the indignation towards the injustices in society, these networks utilize normative power to mobilize action. An example of a moralized global health concern is HIV/AIDS. Antiretroviral drugs for HIV treatment are now widely deemed as merit goods, based upon the frame that all patients should have ready access to treatment, regardless of their financial means. In the present, only a small number of health concerns have been moralized, while others of equal impact have remained neglected.
Finally, technification refers to “the portrayal of an issue as a wise, cost-effective investment that current science can solve.” Experts, scientists, economists, and research institutions amongst others exercise their epistemic power in order to push governments to act. Such is the case for Neglected Tropical Diseases (NTDs), a disease category invented in the 2000s that has amassed billions in donor funding. According to Professor Shiffman, a small number of well-respected scientists realized that it would be impossible to secure political action for lesser-known diseases unless they were brought together. Hence, they invented the NTDs category using their authority, held by virtue of expertise, to successfully garner funding and government action.
Professor Shiffman concluded his presentation by reiterating that “the ascriptions that global health issues come to acquire, concerning their importance and severity, are historically contingent, not inherent.” He also left the audience with several questions to ponder upon. How can the situation of disease-specific advocacy groups, in constant competition for limited resources, be surmounted so that a more unified agenda can be promoted? What are the methods for remedying the imbalances in global health? How can we reserve space for elite expertise without diminishing the voices of those who are most affected by global health issues? Perhaps keeping the principles for priority setting, as outlined by scholars of global governance, in mind, is a good starting point: transparency, responsiveness, liability, efficiency, and fair distribution.
Written by Hee Seo Lee, SNU English Editor, heeseolee@snu.ac.kr