Since 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on the emergence and effectiveness of global health networks. The supplement examines networks concerned with six global health problems: tuberculosis (TB), pneumonia, tobacco use, alcohol harm, maternal mortality and newborn deaths. This article presents a conceptual framework delineating factors that may shape why networks crystallize more easily surrounding some issues than others, and once formed, why some are better able than others to shape policy and public health outcomes. All supplement papers draw on this framework. The framework consists of 10 factors in three categories: (1) features of the networks and actors that comprise them, including leadership, governance arrangements, network composition and framing strategies; (2) conditions in the global policy environment, including potential allies and opponents, funding availability and global expectations concerning which issues should be prioritized; (3) and characteristics of the issue, including severity, tractability and affected groups. The article also explains the design of the project, which is grounded in comparison of networks surrounding three matched issues: TB and pneumonia, tobacco use and alcohol harm, and maternal and newborn survival. Despite similar burden and issue characteristics, there has been considerably greater policy traction for the first in each pair. The supplement articles aim to explain the role of networks in shaping these differences, and collectively represent the first comparative effort to understand the emergence and effectiveness of global health networks.

Global health issues vary in the amount of attention and resources they receive. One reason is that the networks of individuals and organizations that address these issues differ in their effectiveness. This article presents key findings from a research project on the emergence and effectiveness of global health networks addressing tobacco use, alcohol harm, maternal mortality, neonatal mortality, tuberculosis and pneumonia. Although networks are only one of many factors influencing priority, they do matter, particularly for shaping the way the problem and solutions are understood, and convincing governments, international organizations and other global actors to address the issue. Their national-level effects vary by issue and are more difficult to ascertain. Networks are most likely to produce effects when (1) their members construct a compelling framing of the issue, one that includes a shared understanding of the problem, a consensus on solutions and convincing reasons to act and (2) they build a political coalition that includes individuals and organizations beyond their traditional base in the health sector, a task that demands engagement in the politics of the issue, not just its technical aspects. Maintaining a focused frame and sustaining a broad coalition are often in tension: effective networks find ways to balance the two challenges. The emergence and effectiveness of a network are shaped both by its members' decisions and by contextual factors, including historical influences (e.g. prior failed attempts to address the problem), features of the policy environment (e.g. global development goals) and characteristics of the issue the network addresses (e.g. its mortality burden). Their proliferation raises the issue of their legitimacy. Reasons to consider them legitimate include their members' expertise and the attention they bring to neglected issues. Reasons to question their legitimacy include their largely elite composition and the fragmentation they bring to global health governance.

Where once global health decisions were largely the domain of national governments and the World Health Organization, today networks of international organizations, governments, private philanthropies and other entities are actively shaping public policy. However, there is still limited understanding of how global networks form, how they create institutions, how they promote and sustain collective action, and how they adapt to changes in the policy environment. Understanding these processes is crucial to understanding their effectiveness: whether and how global networks influence policy and public health outcomes. This study seeks to address these gaps through the examination of the global network to stop tuberculosis (TB) and the factors influencing its effectiveness over time. Drawing from ∼ 200 document sources and 16 interviews with key informants, we trace the development of the Global Partnership to Stop TB and its work over the past decade. We find that having a centralized core group and a strategic brand helped the network to coalesce around a primary intervention strategy, directly observed treatment short course. This strategy was created before the network was formalized, and helped bring in donors, ministries of health and other organizations committed to fighting TB-growing the network. Adaptations to this strategy, the creation of a consensus-based Global Plan, and the creation of a variety of participatory venues for discussion, helped to expand and sustain the network. Presently, however, tensions have become more apparent within the network as it struggles with changing internal political dynamics and the evolution of the disease. While centralization and stability helped to launch and grow the network, the institutionalization of governance and strategy may have constrained adaptation. Institutionalization and centralization may, therefore, facilitate short-term success for networks, but may end up complicating longer-term effectiveness.

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Summary Increased attention is being paid to networks in public administration and development policy, yet there is limited understanding of how voluntary global networks form and why some of these networks cohere and emerge faster than others. Comparisons between the global networks for tuberculosis (TB) and pneumonia reveal processes of network formation relevant to other contexts. Though selected as most similar paired cases, their trajectories of network emergence diverged and TB's formed far earlier and more easily. By using a theoretic framework allowing for networks to be considered as outcomes of a policy process, this study reveals an iterative process of network emergence corresponding to the three streams model of issue attention. Successful emergence is based on building shared identities among policy entrepreneurs, agreeing on issue frames, creating institutions, developing relationships, sustaining latent networks during issue neglect, and linking to opportunities in the policy environment. Further, this study reveals that once formed, network structures enable access to political opportunities and more effective development policymaking and governance. Additionally, for networks struggling to take shape, we identify deliberate efforts that can overcome earlier iterations of failed attempts at network formation.

Commenting on a recent editorial in this journal which presented four challenges global health networks will have to tackle to be effective, this essay discusses why this type of analysis is important for global health scholars and practitioners, and why it is worth understanding and critically engaging with the complexities behind these challenges. Focusing on the topics of problem definition and positioning, I outline additional insights from social science theory to demonstrate how networks and network researchers can evaluate these processes, and how these processes contribute to better organizing, advocacy, and public health outcomes. This essay also raises multiple questions regarding these processes for future research.

Some norms go through long contested periods, resulting in norm change, rejection, or persisting conflict. Others are adopted quite quickly, with little resistance across diverse societies. An underlying and unanswered theoretical question is why? A foundational characteristic of a norm as a concept, and a key aspect of constructivist scholarship on norms, is the role of values and moral principles in giving norms meaning and in motivating global policy change. For a field placing significant emphasis on the importance of ideas, the limited theorizing around the value-based content of these ideas is a notable shortcoming. Emphasizing the importance of moral values as among the most deeply held beliefs, I outline a theory of how moral values and moral distance can help explain why certain normative processes and outcomes occur. Building from constructivist work on norms and social psychology scholarship on morality, I propose that moral distance, the degree of alignment, overlap, or separation in moral values between actors can help to explain the type of contestation, the intensity and duration of contestation, and what processes or outcomes are more likely to transpire. The shorter the moral distance, the more likely persuasion or adaptations will occur, leading to the eventual adoption of a norm. The greater the moral distance, the more likely prolonged and heated contestation will occur, leading to rejection or enduring contestation. I argue that centering the analysis of moral values and moral distance in research on normative agreement and disagreement can therefore contribute to understanding why or under what circumstances conflict is more or less likely to happen.