The 2 P’s of Priority Setting

Are there ‘too many cooks’ in global health? In other parts of the world, perhaps there aren’t enough. In that vein, based on the perspectives of a political science expert, a ‘social constructionist,’ and a humanitarian/physician, here are the two P’s or “powers” that emerge in their independent discussions on priority setting in global health.

The first “P” in priority setting is the power of institutions. From eradicating polio to fighting Ebola, concerted efforts that are backed by or linked to a powerful organization has a greater potential to influence global health priorities. Jeremy Shiffman, broadly defines “institution” as the “rules, norms and strategies adopted by individuals operating within or across organizations.” He points out that many global health issues out there are endorsed by powerful institutions (e.g. the World Bank, United Nations) who are able to generate resources, implement programs, and that ultimately have negotiating power.

An example of the power of institutions can be observed in the recent press release on the World Bank’s commitment of $400 million to treat and contain Ebola. Using its institutional position, the Bank links the underlying factors of the Ebola crisis as a problem of unequal access to care and income inequality, while also reframing the Bank’s goal to eradicate extreme hunger and poverty by 2015.

This brings us to the second “P” in priority-setting, the power of framing. Given the limited bandwidth of politicians and the public, framing is a powerful tool. Reich, Shiffman, and Farmer allude to the importance of being able to strategically communicate your issue with your audience. A good rule of thumb in framing is suggested by Reich’s expectation of the political calculations involved–weighing the political benefits (feasible and visible) versus the political costs (slow to change, difficult to measure). Paul Farmer provides an interesting use of framing in his narrative about visiting Russian prisons where many young detainees were being left untreated for tuberculosis. Looking back, he had strategically framed his role going into the scenario as a physician, that enabled him and his colleagues to do more for the neglected rights of the prisoners than if they were to embark on their visit in the pure scope of human rights.

The powers of institutions and framing alone are not the only variables to consider in priority setting. However, they provide as important strategies for individuals and organizations in global health to consider in moving their agendas forward.

1. Shiffman J. A social explanation for the rise and fall of global health issues. Bull World Health Organ. 2009 Aug;87(8):608-13.
2. Reich MR. The politics of agenda setting in international health: child health versus adult health in developing countries. J Int Dev. 1995 May-Jun;7(3):489-502.
3. Farmer P. Pathologies of power: rethinking health and human rights.  Am J Public Health. 1999 Oct;89(10):1486-96.


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