Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases

Abstract

Background: Non-communicable diseases (NCDs) are increasingly recognized as a significant threat to health and development globally, and United Nations (UN) Member States adopted the Political Declaration of the Third High-level Meeting (HLM) on the prevention and control of NCDs in 2018. The negotiation process for the Declaration included consultations with Member States, intergovernmental organizations (IGOs), and non-state actors such as non-governmental organizations (NGOs) and the private sector. With NCD responses facing charges of inadequacy, it is important to scrutinize the governance process behind relevant high-level global decisions and commitments. Methods: Through a review of 159 documents submitted by stakeholders during the negotiation process, we outline a typology of policy positions advocated by various stakeholders in the development of the Declaration. We document changes in text from the draft to the final version of the Declaration to analyse the extent to which various positions and their proponents were influential. Results: NGOs and low- and middle-income countries (LMICs) generally pursued ‘stricter’ governance of NCD risk factors including stronger regulation of unhealthy products and improved management of conflicts of interest that arise when health-harming industries are involved in health policy-making. The private sector and high-income countries generally opposed greater restrictions on commercial factors. The pattern of changes between the draft and final Declaration indicate that advocated positions tended to be included in the Declaration if there was no clear opponent, whereas opposed positions were either not included or included with ambiguous language. Conclusion: Many cost-effective policy options to address NCDs, such as taxation of health-harming products, were opposed by high-income countries and the private sector and not well-represented in the Declaration. To ensure robust political commitments and action on NCDs, multi-stakeholder governance for NCDs must consider imbalances in power and influence amongst constituents as well as biases and conflicts in positioning.

Thinking Politically About UN Political Declarations: A Recipe for Healthier Commitments—Free of Commercial Interests Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases"

“…KB, MM, AJ developed the outline and co-wrote the piece. Authors' affiliations 1 Healthier Societies Program, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. 2 Trinity Business School, Trinity College Dublin, Dublin, Ireland.…”

Public-Private Partnerships With Unhealthy Commodity Industries: Are They Undermining Real Progress in Non-Communicable Disease Prevention? Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases

“…11 What is interesting to note about Suzuki and colleagues' findings is that when there was no direct threat to their own business, industry stakeholder did not necessarily oppose more wide-ranging regulatory interventions. 2 For example, an association of pharmaceutical industries supported the taxation of sugar-sweetened beverages. This further highlights the importance of carefully assessing and managing conflicts of interest when engaging in PPPs and acknowledging that some industry stakeholders are not in the position to contribute to decision-making process in a way that promotes evidence-based public health.…”

“…3 However, while the conflicts of interest of the tobacco industry are generally well understood and managed, Suzuki and colleagues' analysis highlights the need to identify and evaluate other industries that have significant and often irreconcilable conflicts of interest in the prevention of NCDs. 2 In their analysis of stakeholder influence on the United Nations (UN) Political Declaration on NCDs, Suzuki et al document the extent to which the Declaration reflects the policy positions advocated by different public, private and third sector stakeholders during the consultation process. 2 They identified divergent framing between stakeholder groups, and inequalities in whose framing was adopted by the UN in the final Declaration.…”

“…2 In their analysis of stakeholder influence on the United Nations (UN) Political Declaration on NCDs, Suzuki et al document the extent to which the Declaration reflects the policy positions advocated by different public, private and third sector stakeholders during the consultation process. 2 They identified divergent framing between stakeholder groups, and inequalities in whose framing was adopted by the UN in the final Declaration. Notably, the issues raised by non-governmental organizations (NGOs) and low-and middle-income countries (LMICs) were less likely to be adopted than those raised by industry stakeholders and highincome countries.…”

Lacking Clarity or Strategic Ambiguity? Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases"

“…T he increasing prominence of multi-stakeholder fora and partnerships in global health [1][2][3][4] raises questions about how to identify and manage potential tensions between private sector and public heath interests. In their analysis of stakeholder influence on the United Nations (UN) Political Declaration of the 3 rd High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (HLM-NCDs), Suzuki et al highlight how the drafting of the Political Declaration was marked by ambiguity and confusion about the participation of nonstate actors in health governance.…”