Agency, Structure and the Power of Global Health Networks

Abstract

Global health networks—webs of individuals and organizations linked by a shared concern for a particular condition—have proliferated over the past quarter century. In a recent editorial in this journal, I presented evidence that their effectiveness in addressing four challenges—problem definition, positioning, coalitionbuilding and governance—shapes their ability to influence policy. The editorial prompted five thoughtful commentaries that reflected on these and other challenges. In this follow-up editorial, I build on the commentaries to suggest ways of advancing research on global health networks. I argue that investigators would do well to consider three social theory-influenced global governance debates pertaining to agency—the capacity of individuals and organizations to act autonomously amidst structural constraints. The three debates concern the relationship between agency and structure, the power of ideas vis-à-vis interests and material capabilities, and the level of influence of non-state actors in a global governance system that most scholars identify as state-dominated. Drawing on these debates, I argue that rather than presume global health network influence, we need to find more robust ways to investigate their effects. I argue also that rather than juxtapose agency and structure, ideas and interests and non-state and state power, it would be more productive to consider the ways in which these elements are intertwined.

Role of Dentistry in Global Health: Challenges and Research Priorities

“…Global health networks do matter, especially to shape the way that challenges and solutions are understood and to advocate for governments and international agencies to address them. As argued by Shiffman (2017 , 2018) , all global health networks face 4 key strategic challenges in generating attention and resources for the conditions that concern them ( Figure ).…”

“…and international agencies to address them. As argued by Shiffman (2017Shiffman ( , 2018, all global health networks face 4 key strategic challenges in generating attention and resources for the conditions that concern them ( Figure).…”

"The Actor Is Policy": Application of Elite Theory to Explore Actors’ Interests and Power Underlying Maternal Health Policies in Uganda, 2000-2015

“…25,28 While power takes different forms, in this paper we have considered access and control over financial resources, control of vital information, skills (especially professional expertise) and positional power (including controlling the structures and managing the policy processes). [29][30][31][32] We concurrently analysed how members of the different elite groups applied power in its different forms to advance their diverse, and sometimes interlinked, interests to influence maternal health policies (see Figure 1).…”

COVID-19 and Power in Global Health

“… 8 They can galvanize action, particularly when they manifest frame coherence, or consensus among experts about the problem and its solutions, and when that consensus resonates with the public and policy-makers. 12 Initially, leaders framed COVID-19 as an existential threat to national security, with the response being a ‘war,’ the virus being an ‘enemy,’ and healthcare workers termed ‘warriors.’ This frame mobilized publics for behaviors like social distancing. But it also enabled some governments to justify human rights abuses, and it contributed to panic-buying, stock sell-offs, risking healthcare workers’ lives without adequate protective equipment, and demonizing and scapegoating people believed to carry the virus like Asian-Americans.…”

“…11 Productive power undergirds how policy-makers and publics framed the pandemic and then responded. As discursive tools, frames enable individuals to 'simplify and make sense of the world around them, ' 12 and they 'determine automatically and repetitiously' subjective perceptions of reality. 8 They can galvanize action, particularly when they manifest frame coherence, or consensus among experts about the problem and its solutions, and when that consensus resonates with the public and policy-makers.…”