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Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself. We apply this framework to the case of a global initiative to reduce maternal mortality, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's 20th year, 2007, presents opportunities to build political momentum. To generate political priority, advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship. [ABSTRACT FROM AUTHOR]

In 1987 an international conference brought global attention to an issue that previously had been ignored: the world's alarmingly high number of maternal deaths in childbirth. The conference ended with a declaration calling for a reduction in maternal mortality by at least half by the year 2000.As the deadline approached, safe motherhood activists lamented the fact that the world was nowhere near to achieving this objective. They attributed this failure to a variety of causes, but were in agreement that the medical technology was available to prevent maternal deaths in childbirth, and the key was generating the political will to make such technology widely available to women in developing countries.What 'political will' means, however, has been left as an unopened black box. What causes governments to give priority to the issue of safe motherhood, given that national political systems are burdened with thousands of issues to sort through each year? In marked contrast to our extensive knowledge about the medical interventions necessary to prevent maternal death, we know little about the political interventions necessary to increase the likelihood that national leaders pay meaningful attention to the issue.Drawing from a scholarly literature on agenda setting, this paper identifies four factors that heighten the likelihood that an issue will rise to national-level attention: the existence of clear indicators showing that a problem exists; the presence of effective political entrepreneurs to push the cause; the organization of attention-generating focusing events that promote widespread concern for the issue; and the availability of politically palatable policy alternatives that enable national leaders to understand that the problem is surmountable.The paper presents a case study of the emergence, waning and re-generation of political priority for safe motherhood in Indonesia over the decade 1987-1997, to highlight how these four factors interacted to raise safe motherhood from near obscurity in the country to national-level prominence. While there are contextual factors that make this case unique, some elements are applicable to all developing countries. The paper draws out these dimensions in the hope that greater knowledge surrounding how political will actually has been generated can help shape strategic action to address this much neglected global problem. [ABSTRACT FROM AUTHOR]

Does poverty bind developing countries to high levels of maternal death in childbirth? Or, as safe-motherhood advocates claim, do public health and social policy interventions have the potential to accelerate maternal mortality transitions? Globally, almost one in 200 live births leads to the death of the mother, making maternal mortality an issue of critical international import. This article presents an analysis of the determinants of national maternal mortality levels with a view to shedding light on these questions. A cross-national regression of 64 countries shows that wealth indicators explain only a portion of the variance in national maternal mortality levels. Other determinants, including women's educational levels and the proportion of deliveries attended by trained health personnel, are more clearly associated with national maternal mortality levels than are measures of wealth. The results offer grounds for optimism concerning the potential for global safe-motherhood efforts to induce maternal mortality transitions. [ABSTRACT FROM AUTHOR]

In this first paper of The Lancet's Stillbirths Series we explore the present status of stillbirths in the world-from global health policy to a survey of community perceptions in 135 countries. Our findings highlight the need for a strong call for action. In times of global focus on motherhood, the mother's own aspiration of a liveborn baby is not recognised on the world's health agenda. Millions of deaths are not counted; stillbirths are not in the Global Burden of Disease, nor in disability-adjusted life-years lost, and they are not part of the UN Millennium Development Goals. The grief of mothers might be aggravated by social stigma, blame, and marginalisation in regions where most deaths occur. Most stillborn babies are disposed of without any recognition or ritual, such as naming, funeral rites, or the mother holding or dressing the baby. Beliefs in the mother's sins and evil spirits as causes of stillbirth are rife, and stillbirth is widely believed to be a natural selection of babies never meant to live. Stillbirth prevention is closely linked with prevention of maternal and neonatal deaths. Knowledge of causes and feasible solutions for prevention is key to health professionals' priorities, to which this Stillbirths Series paper aims to contribute. [ABSTRACT FROM AUTHOR]

Competing Interests: Declaration of interests In the past 5 years, HW received grant funding for gambling-related research by the Economic and Social Research Council, National Institute for Health Research, Wellcome Trust, the Gambling Commission (including their regulatory settlement fund), Office of Health Disparities and Improvements–Public Health England, Greater London Authority, Greater Manchester Combined Authority, Blackburn with Darwen Local Authority, and the Department of Digital Culture Media and Sport; received funding from GambleAware for a project on gambling and suicide in 2018–19; received consulting fees from the Institute of Public Health, Ireland, and the National Institute for Economic and Social Research; received payment for delivery of seminars from McGill University, the University of Birmingham, Johns Hopkins University, and from the British Broadcasting Corporation; has been paid as an expert witness by Lambeth and Middlesborough Borough Councils; received travel costs paid by Gambling Regulators European Forum, the Turkish Green Crescent Society, Alberta Gambling Research Institute, the REITOX Academy (administered through the Austrian National Public Health Institute), and the University of Helsinki; served as Deputy Chair of the Advisory Board for Safer Gambling between 2015 and 2020, remunerated by the Gambling Commission; is a Member of the WHO panel on gambling (ongoing) and provided unpaid advice on research to GamCare for their Safer Gambling Standard (from 2019 until mid-2021); runs a research consultancy for public and third-sector bodies only; has not, and does not, provide consultancy services to gambling industry actors; in researching the gambling industry and their practices, HW declares occasional attendance at events where gambling industry actors are present (including industry-sponsored conferences); as part of her work on the Gambling Survey for Great Britain, HW is required by the Gambling Commission (the funder) to participate in events disseminating research findings to their stakeholders, which includes the industry; her attendance at events where industry is present is independently funded and does not involve collaborations or partnerships with industry. AR discloses grant funding for gambling-related projects from Suicide Prevention Australia, The Winston Churchill Memorial Trust, Australia's National Research Organisation for Women's Safety, Victorian Responsible Gambling Foundation, Federation University Australia, and membership of the WHO panel on gambling; received funding for travel for the 2019 WHO meeting by the Turkish Green Crescent Society; received consultancy funding from WHO to prepare a factsheet on Gambling and conducted a paid peer reviews for Auckland University of Technology and the British Academic Forum for the Study of Gambling, administered via Gambling Research Exchange Ontario and funded through regulatory settlements. VM discloses grant funding for gambling-related projects from the Academy of Finland (projects 349589, 31834), the Finnish Ministry of Social Affairs and Health, and the Finnish Ministry of Justice; as a member of the Gambling Harms Evaluation Committee (2021–ongoing) and the Indicators for Gambling Harms work group (2019–21) under the Finnish Ministry of Social Affairs and Health, she interacts with the Finnish gambling monopoly to evaluate company products and practices and to analyse company data; discloses a fee for delivering a webinar from Bochum University, paid peer review from Routledge, and funding for travel from the Finnish Foundation for Alcohol Studies, University of Bergen, and the Council of Europe; provides consultation for public and third-sector actors, but not the gambling industry. CL discloses funding in the past 5 years for gambling-related research from the Royal Society for Public Health, Australian Research Council, Foundation for Alcohol Research and Education, and Victorian Responsible Gambling Foundation; provided a paid consultancy report on electronic gambling machines gambling for a 2023 appeal against a decision of the Northern Territory (Australia) Licensing Commission to expand electronic gambling machine availability in venues in Alice Springs; received travel support from the Turkish Green Crescent Society to attend a WHO meeting in 2019 and travel support from Monash University to attend the Fourth WHO Forum on Alcohol, Drugs and Addictive Behaviours and to attend a Commission meeting in London; is a member of the WHO panel on gambling and was engaged as a consultant in 2023 to prepare a WHO Technical Brief on gambling and gambling disorder; is an Editorial Board Member of Critical Gambling studies; provided submissions to Royal Commissions and Inquiries into casinos and electronic gambling machine venues in the Australian states of Victoria, New South Wales, and Western Australia, and has been consulted by Ministers and Ministerial staff for the governments of New South Wales, Victoria, and the Australian Government in relation to reform of gambling regulation, in an unpaid capacity; provides policy advice to local governments and non-governmental organisations in relation to reform of gambling regulation (unpaid); does not provide advice to the gambling industry or members of its ecosystem. GR discloses funding for gambling-related projects from The British Academy, the Economic and Social Research Council, the National Institute for Health Research, The Medical Research Council, the Glasgow Centre for International Development, the Department of Culture Media and Sport; acted as an advisor for a project on gambling advertising carried out by the Institute of Social Marketing at the University of Stirling in 2018, funded by GambleAware; was a Commissioner on the Howard League for Penal Reform's Commission on Crime and Gambling Related Harms 2019–22; is currently a member of the WHO panel on gambling and an Associate Editor of the journal Critical Gambling Studies; and received travel and accommodation expenses paid by the Turkish Green Crescent Society, the University of Helsinki Centre for Research on Addiction, Control and Governance–Finnish Ministry of Social Affairs and Health, the University of Sydney (via the Australian Research Council), the University of Bremen, the Ruhr Universität, Bochum, Scottish Parliament, the UK Society for the Study of Addiction, and the Howard League for Crime and Penal Reform's Commission on Crime and Gambling Related Harms (via the Gambling Commission). CB discloses grant funding for gambling-related projects from The British Academy, The Economic and Social Research Council, the National Institute of Health Research, Blackburn with Darwen Local Authority, and the Department of Culture Media and Sport. KS discloses grant funding for gambling-related projects from the Indonesian Ministry of Research and Technology and the University of Indonesia; and is a member of the WHO panel on gambling. RV discloses grant funding for gambling-related projects from Massachusetts Gaming Commission, Connecticut Dept of Mental Health & Addiction Services, the Evergreen Council for Problem Gambling, The University of Massachusetts Donahue Institute, Gambling Research Exchange Ontario, NORC Boston, North Dakota Department of Health & Human Services, British Gambling Commission, Public Health Agency of Sweden, Canadian Centre on Substance Abuse and the Center for Gambling Studies, and Rutgers University; received consultancy fees from for gambling-related research from the National Centre for Social Research (UK), Gambling Research Exchange Ontario, and the Karolinska Institute; received honorarium from McGill University for delivery of a webinar, from the Evergreen Council on Problem Gambling, the Institut fur Glucksspiel und Gesellschaft, and New York State Council on Problem Gambling; and received travel costs from the Alberta Gambling Research Institute in 2022 and 2023 and from the Nigerian National Lotteries Regulatory Commission in 2023. DU discloses funding for gambling-related projects from the Wellcome Trust (via a fellowship award to HW) and Blackburn with Darwen Local Authority. BB discloses funding for gambling-related projects from the Wellcome Trust (via a fellowship award to HW), the National Institute for Health Research, and Blackburn with Darwen Local Authority; and is a member of the Academic Forum for Gambling Research, with remuneration provided by the Gambling Commission, via Gambling Research Exchange Ontario. VK discloses funding for gambling-related projects from the Wellcome Trust (via a fellowship award to HW), the Gambling Commission, and Gambling Research Exchange Ontario; and has received funding for travel from the RANGES network, funded by the Canadian government. JR discloses funding from Canadian Institutes of Health Research, US National Institutes of Health, EU, and WHO; and has received funding for travel from WHO. LD received untied educational grant funding from Indivior and Seqirus for the study of new opioid medications in Australia, in the past 5 years. SS has been a senior advisor to McKinsey Health Institute since 2023 for issues on mental health. JQ is employed by the School of Public Health, University of Hong Kong; the School of Public Health receives funding from the Hong Kong Jockey Club Charities Trust outside of this project. JSY received funding for gambling-related research by the British Academy in 2020. VP was a staff member of WHO until 2024. All other authors declare no competing interests.

The highly decentralized nature of global health governance presents significant challenges to conceptualizing and systematically measuring the agenda status of diseases, injuries, risks and other conditions contributing to the collective disease burden. An arenas model for global health agenda setting was recently proposed to help address these challenges. Further developing the model, this study aims to advance more robust inquiry into how and why priority levels may vary among the array of stakeholder arenas in which global health agenda setting occurs. We analyse order and the magnitude of changes in priority for eight infectious diseases in four arenas (international aid, scientific research, pharmaceutical industry and news media) over a period of more than two decades in relation to five propositions from scholarship. The diseases vary on burden and prominence in United Nations Sustainable Development Goal 3 for health and well-being, including four with specific indicators for monitoring and evaluation (HIV/AIDS, tuberculosis, malaria, hepatitis) and four without (dengue, diarrhoeal diseases, measles, meningitis). The order of priority did not consistently align with the disease burden or international development goals in any arena. Additionally, using new methods to measure the scale of annual change in resource allocations that are indicative of priority reveals volatility at the disease level in all arenas amidst broader patterns of stability. Insights around long-term patterns of priority within and among arenas are integral to strengthening analyses that aim to identify pivotal causal mechanisms, to clarify how arenas interact, and to measure the effects they produce., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

The Quality-of-Care Network (QCN) was conceptualized by the World Health Organization (WHO) and other global partners to facilitate learning on and improve quality of care for maternal and newborn health within and across low and middle-income countries. However, there was significant variance in the speed and extent to which QCN formed in the involved countries. This paper investigates the factors that shaped QCN's differential emergence in Bangladesh, Ethiopia, Malawi, and Uganda. Drawing on network scholarship, we conducted a replicated case study of the four country cases and triangulated several sources of data, including a document review, observations of national-level and district level meetings, and key informant interviews in each country and at the global level. Thematic coding was performed in NVivo 12. We find that QCN emerged most quickly and robustly in Bangladesh, followed by Ethiopia, then Uganda, and slowest and with least institutionalization in Malawi. Factors connected to the policy environment and network features explained variance in network emergence. With respect to the policy environment, pre-existing resources and initiatives dedicated to maternal and newborn health and quality improvement, strong data and health system capacity, and national commitment to advancing on synergistic goals were crucial drivers to QCN's emergence. With respect to the features of the network itself, the embedding of QCN leadership in powerful agencies with pre-existing coordination structures and trusting relationships with key stakeholders, inclusive network membership, and effective individual national and local leadership were also crucial in explaining QCN's speed and quality of emergence across countries. Studying QCN emergence provides critical insights as to why well-intentioned top-down global health networks may not materialize in some country contexts and have relatively quick uptake in others, and has implications for a network's perceived legitimacy and ultimate effectiveness in producing stated objectives., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Shawar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The relative priority received by issues in global health agendas is subjected to impressionistic claims in the absence of objective methods of assessment of priority. To build an approach for conducting structured assessments of comparative priority health issues receive, we expand the public arenas model (2021) and offer a framework for future assessments of health issue priority in global and national health agendas., Methods: We aimed to develop a more comprehensive set of measures for conducting multiyear priority comparisons of health issues in six agenda-setting arenas by identifying possible measures and data sources, selecting indicators based on feasibility and comparability of measures and gathering the data on selected indicators. We applied these measures to four communicable diseases-tuberculosis (TB), malaria, diarrhoeal diseases and dengue fever-given their differing impressionistic claims of priority. Where possible, we analysed the annual and/or 5-year trends from 2000 through 2022., Results: We observed that TB and malaria received the highest priority for most periods in the past two decades in most arenas. However, a stagnation in development funding for these two conditions over the last 8-10 years may have fuelled the neglect claims. Despite having a higher disease burden, diarrhoea has been slipping in global priority with reduced spending, fewer clinical trials and stagnating publications. Dengue remains a low-priority condition but has witnessed a sharp rise in attention from the pharmaceutical industry., Discussions: We expanded the arenas model by including a transnational arena (international representation) and additional measurements for various arenas. This analysis presents an approach to enable comparative trend analysis of the markers of agenda status over a multiyear period. More such analyses can bring much-desired objectivity in understanding how attention to global or national health issues changes over time in different arenas, potentiating a more equitable allocation of resources., Competing Interests: Competing interests: None declared., (© World Health Organization 2024. Licensee BMJ.)

The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) aims to work through learning, action, leadership and accountability. We aimed to evaluate the effectiveness of QCN in these four areas at the global level and in four QCN countries: Bangladesh, Ethiopia, Malawi and Uganda. This mixed method evaluation comprised 2-4 iterative rounds of data collection between 2019-2022, involving stakeholder interviews, hospital observations, QCN members survey, and document review. Qualitative data was analysed using a coding framework developed from underlying theories on network effectiveness, behaviour change, and QCN proposed theory of change. Survey data capturing respondents' perception of QCN was analysed with descriptive statistics. The QCN global level, led by the WHO secretariat, was effective in bringing together network countries' governments and global actors via providing online and in-person platforms for communication and learning. In-country, various interventions were delivered in 'learning districts', however often separately by different partners in different locations, and pandemic-disrupted. Governance structures for quality of care were set-up, some preceding QCN, and were found to be stronger and better (though often externally) resourced at national than local levels. Awareness of operational plans and network activities differed between countries, was lower at local than national levels, but increased from 2019 to 2022. Engagement with, and value of, QCN was perceived to be higher in Uganda and Bangladesh than in Malawi or Ethiopia. Capacity building efforts were implemented in all countries-yet often dependent on implementing partners and donors. QCN stakeholders agreed 15 core monitoring indicators though data collection was challenging, especially for indicators requiring new or parallel systems. Accountability initiatives remained nascent in 2022. Global and national leadership elements of QCN have been most effective to date, with action, learning and accountability more challenging, partner or donor dependent, remaining to be scaled-up, and pandemic-disrupted., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Djellouli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Though vital to health policymaking processes, little is known about the distribution of attention to issues global health journals focus on or their alignment with commitments to health equity. We developed a new framework and methods to help address these analytical gaps. We used content analysis to systematically identify and novel methods to measure attention to themes, subthemes and geographies represented in more than 2,000 research articles published in two of the longest-running multidisciplinary global health journals, Bulletin of the World Health Organization and Health Policy and Planning , between 2004 and 2018. We found four major themes-health systems and conditions received the most attention, followed by population groups and policy dynamics. Finer grained analysis shows that the broad-based journals feature many common themes and some, including subthemes like communicable diseases, financing and children, are heavily favoured over others, such as workforce and noncommunicable diseases. It reveals publishing gaps for some highly marginalised groups and shows attention to health equity fluctuates. The new framework and methods can be used to (1) check the distribution of publishing attention for consistency with global health and specific journal aims and (2) support inquiry into priority setting dynamics in the broader research publishing arena.

The rapid spread of COVID-19 throughout the world in early 2020 created unprecedented challenges for national governments. Policies developed during the early months of the pandemic, before the first mRNA vaccines were authorized for emergency use, provide a window into national governments' prioritization of populations that were particularly vulnerable. We developed the COVID-19 Health Justice Policy Tracker to capture and categorize these policies using a health justice lens. In this article we present the results of a preliminary analysis of the tracker data. The tracker focuses on policies for six population groups: children, the elderly, people with disabilities, migrant workers, incarcerated people, and people who were refugees or were seeking political asylum. It includes 610 policies, most targeting children and the elderly and providing financial support. National governments also prioritized measures such as policies to ensure access to mental health care and social services, digital and teleservices, continuity of children's education, and food security. The tracker provides a resource for researchers and policy makers seeking model language and tested policy approaches to advance health justice during future crises.

The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) is intended to facilitate learning, action, leadership and accountability for improving quality of care in member countries. This requires legitimacy-a network's right to exert power within national contexts. This is reflected, for example, in a government's buy-in and perceived ownership of the work of the network. During 2019-2022 we conducted iterative rounds of stakeholder interviews, observations of meetings, document review, and hospital observations in Bangladesh, Ethiopia, Malawi, Uganda and at the global level. We developed a framework drawing on three models: Tallberg and Zurn which conceptualizes legitimacy of international organisations dependent on their features, the legitimation process and beliefs of audiences; Nasiritousi and Faber, which looks at legitimacy in terms of problem, purpose, procedure, and performance of institutions; Sanderink and Nasiritousi, to characterize networks in terms of political, normative and cognitive interactions. We used thematic analysis to characterize, compare and contrast institutional interactions in a cross-case synthesis to determine salient features. Political and normative interactions were favourable within and between countries and at global level since collective decisions, collaborative efforts, and commitment to QCN goals were observed at all levels. Sharing resources and common principles were not common between network countries, indicating limits of the network. Cognitive interactions-those related to information sharing and transfer of ideas-were more challenging, with the bi-directional transfer, synthesis and harmonization of concepts and methods, being largely absent among and within countries. These may be required for increasing government ownership of QCN work, the embeddedness of the network, and its legitimacy. While we find evidence supporting the legitimacy of QCN from the perspective of country governments, further work and time are required for governments to own and embed the work of QCN in routine care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Akter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Tens of millions of children lack adequate care, many having been separated from or lost one or both parents. Despite the problem's severity and its impact on a child's lifelong health and wellbeing, the care of vulnerable children-which includes strengthening the care of children within families, preventing unnecessary family separation, and ensuring quality care alternatives when reunification with the biological parents is not possible or appropriate-is a low global priority. This analysis investigates factors shaping the inadequate global prioritization of the care of vulnerable children. Specifically, the analysis focuses on factors internal to the global policy community addressing children's care, including how they understand, govern, and communicate the problem., Methods: Drawing on agenda setting scholarship, we triangulated among several sources of data, including 32 interviews with experts, as well as documents including peer-reviewed literature and organizational reports. We undertook a thematic analysis of the data, using these to create a historical narrative on efforts to address children's care, and specifically childcare reform., Results: Divisive disagreements on the definition and legitimacy of deinstitutionalization-a care reform strategy that replaces institution-based care with family-based care-may be hindering priority for children's care. Multiple factors have shaped these disagreements: a contradictory evidence base on the scope of the problem and solutions, divergent experiences between former Soviet bloc and other countries, socio-cultural and legal challenges in introducing formal alternative care arrangements, commercial interests that perpetuate support for residential facilities, as well as the sometimes conflicting views of impacted children, families, and the disability community. These disagreements have led to considerable governance and positioning difficulties, which have complicated efforts to coordinate initiatives, precluded the emergence of leadership that proponents universally trust, hampered the engagement of potential allies, and challenged efforts to secure funding and convince policymakers to act., Conclusion: In order to potentially become a more potent force for advancing global priority, children's care proponents within international organizations, donor agencies, and non-governmental agencies working across countries will need to better manage their disagreements around deinstitutionalization as a care reform strategy., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society., Competing Interests: Declaration of interests PA reports a grant from Children's Investment Fund Foundation, during the conduct of the study. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: GJH, JEL, REB, SA, NK, UA, PA, and MT are authors of the Lancet Small Vulnerable Newborn Series. AM, JSi, and MT report consulting fees from Tampere University, Finland. JSh reports travel costs from Tampere University. NK and PA report a grant from the Children's Investment Fund Foundation (CIFF), grant number 2004-04635. HN reports an MRC/UKRI/FCDO/EDCTP African Research Leader fellowship. KEAS reports funding from the Bill & Melinda Gates Foundation and is Co-chair of MoNITOR (advisory group to WHO on maternal and newborn health metrics). EVL works for the Partnership for Maternal, Newborn & Child Health (PMNCH) and WHO. These funding sources have had no role in the writing of or decision to submit this Comment for publication. We declare no other competing interests.

Recent calls for global health decolonization suggest that addressing the problems of global health may require more than 'elevating country voice'. We employed a frame analysis of the diagnostic, prognostic, and motivational framings of both discourses and analyzed the implications of convergence or divergence of these frames for global health practice and scholarship. We used two major sources of data-a review of literature and in-depth interviews with actors in global health practice and shapers of discourse around elevating country voice and decolonizing global health. Using NVivo 12, a deductive analysis approach was applied to the literature and interview transcripts using diagnostic, prognostic and motivational framings as themes. We found that calls for elevating country voice consider suppressed low- and middle-income country (LMIC) voice in global health agenda-setting and lack of country ownership of health initiatives as major problems; advancing better LMIC representation in decision making positions, and local ownership of development initiatives as solutions. The rationale for action is greater aid impact. In contrast, calls for decolonizing global health characterize colonialityas the problem. Its prognostic framing, though still in a formative stage, includes greater acceptance of diversity in approaches to knowledge creation and health systems, and a structural transformation of global health governance. Its motivational framing is justice. Conceptually and in terms of possible outcomes, the frames underlying these discourses differ. Actors' origin and nature of involvement with global health work are markers of the frames they align with. In response to calls for country voice elevation, global health institutions working in LMICs may prioritize country representation in rooms near or where power resides, but this falls short of expectations of decolonizing global health advocates. Whether governments, organizations, and communities will sufficiently invest in public health to achieve decolonization remains unknown and will determine the future of the call for decolonization and global health practice at large., Competing Interests: The authors have read the journal’s policy and have the following competing interest: RN was an independent consultant for MOMENTUM on a different topic during a portion of this study. The authors declare that they have no other competing interests. This does not alter adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Kunnuji et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: 'Resilience', 'self-reliance' and 'increasing country voice' are widely used terms in global health. However, the terms are understood in diverse ways by various global health actors. We analyse how these terms are understood and why differences in understanding exist., Methods: Drawing on scholarship concerning ideology, framing and power, we employ a case study of a USAID-sponsored suite of awards called MOMENTUM. Applying a meta-ethnographic approach, we triangulate data from peer-reviewed and grey literature, as well as 27 key informant interviews with actors at the forefront of shaping these discourses and those associated with MOMENTUM, working in development agencies, implementing organisations, low-income and middle-income country governments, and academia., Results: The lack of common understanding of these three terms is in part a result of differences in two perspectives in global health-reformist and transformational-which are animated by fundamentally different ideologies. Reformists, reflecting neoliberal and liberal democratic ideologies, largely take a technocratic approach to understanding health problems and advance incremental solutions, working within existing global and local health systems to effect change. Transformationalists, reflecting threads of neo-Marxist ideology, see the problems as inherently political and seek to overhaul national and global systems and power relations. These ideologies shape differences in how actors define the problem, its solutions and attribute responsibility, resulting in nuanced differences among global health actors in their understanding of resilience, self-reliance and increasing country voice., Conclusions: Differences in how these terms are employed and framed are not just linguistic; the language that is used is reflective of underlying ideological differences among global health actors, with implications for the way programmes are designed and implemented, the knowledge that is produced and engagement with stakeholders. Laying these distinct ideologies bare may be crucial for managing actor differences and advancing more productive discussions and actions towards achieving global health equity., Competing Interests: Competing interests: The second author was an independent consultant for MOMENTUM on a different topic during a portion of this study. There are no conflicts of interest for the other listed authors., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Child sexual abuse (CSA) is widespread. Few countries, however, prioritize the issue. The United Kingdom is an exception, ranked first in its response to the issue in a 2019 country comparison. In 2015, Prime Minister David Cameron designated the issue one of three national threats. Funding commitments and policies to address CSA followed., Objective: To investigate how CSA emerged as a national political priority in the United Kingdom, and to identify insights for proponents seeking to advance priority for addressing the issue., Participants and Setting: Documents were analyzed and semi-structured interviews conducted with actors in the United Kingdom central to CSA advocacy, research, and/or programming, as well as with policymakers., Methods: Drawing on the multiple streams public policy model, a thematic analysis was conducted on collected documents (n = 160) and 21 interview transcripts., Results: Our analysis delineates three critical developments that led to national prioritization for addressing CSA. First, high-profile scandals and the re-framing of CSA survivors as deserving of support raised public awareness of the problem. Second, champions concerned with CSA developed evidence-based and politically-feasible solutions. Third, the Prime Minister's concern and other political developments opened a policy window., Conclusions: The case provides insights for proponents on generating political priority for addressing CSA. Proponents need to (1) ensure survivors are not seen as culpable but rather as deserving of support, (2) be ready with solutions and (3) cultivate high-level political support, so that when policy windows open they can jump to push the issue onto the national agenda., (Copyright © 2022. Published by Elsevier Ltd.)

Health issues vary in the amount of attention and resources they receive from global health organisations and national governments. How issues are framed could shape differences in levels of priority. We reviewed scholarship on global health policy making to examine the role of framing in shaping global health priorities. The review provides evidence of the influence of three framing processes-securitisation, moralisation, and technification. Securitisation refers to an issue's framing as an existential threat, moralisation as an ethical imperative, and technification as a wise investment that science can solve. These framing processes concern more than how issues are portrayed publicly. They are socio-political processes, characterised by contestation among actors in civil society, government, international organisations, foundations, and research institutions. These actors deploy various forms of power to advance particular frames as a means of securing attention and resources for the issues that concern them. The ascription of an issue as a security concern, an ethical imperative, or a wise investment is historically contingent: it is not inevitable that any given issue will be framed in one or more of these ways. A health issue's inherent characteristics-such as the lethality of a pathogen that causes it-also shape these ascriptions, but do not fully determine them. Although commonly facing resistance, global health elites often determine which frames prevail, raising questions about the legitimacy of priority-setting processes. We draw on the review to offer ideas on how to make these processes fairer than they are at present, including a call for democratic representation even as necessary space is preserved for elite expertise., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Every country is affected by some form of malnutrition. Some governments and nutrition experts look to public-private partnerships (PPPs) to address the burden of malnutrition. However, nutrition-related PPPs face opposition, are difficult to form, and there is limited evidence of their effectiveness., Methods: We conducted a literature review and 30 semi-structured interviews with individuals involved in or researching nutrition-related PPPs to identify the factors that shape their creation and effectiveness in food systems., Results: Several factors make it difficult to establish nutrition-related PPPs in food systems: a lack of understanding of the causal pathways behind many nutrition problems; a weak architecture for the global governance of nutrition; power imbalances between public and private sector nutrition actors; and disagreements in the nutrition community on the advisability of engaging the private sector. These complexities in turn make it difficult for PPPs to be effective once established due to goal ambiguity and misalignment, resource imbalances, and weak accountability., Conclusion: If effective nutrition-related PPPs are to be established, private sector conflicts of interest must be addressed, trust deficits between private and public sector actors must be surmounted, and evidence must be assessed as to whether PPPs can achieve more for public health nutrition than private and public sector actors working separately., (© 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Introduction: The high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped the priority of global emergency care and highlight potential responses by emergency care advocates., Methods: We conducted semistructured interviews with key experts in global emergency care practice, public health, health policy and advocacy. We then applied a policy framework based on political ethnography and content analysis to code for underlying themes., Results: We identified problem definition, coalition building, paucity of data and positioning, as the main challenges faced by emergency care advocates. Problem definition remains the key issue, with divergent ideas on what emergency care is, should be and what solutions are to be prioritised. Proponents have struggled to portray the urgency of the issue in a way that commands action from decision-makers. The lack of data further limits their effectiveness. However, there is much reason for optimism given the network's commitment to the issue, the emerging leadership and the existence of policy windows., Conclusion: To improve global priority for emergency care, proponents should take advantage of the emerging governance structure and build consensus on definitions, generate data-driven solutions, find strategic framings and engage with non-traditional allies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Commercial gambling is increasingly viewed as being part of the unhealthy commodities industries, in which products contribute to preventable ill-health globally. Britain has one of the world's most liberal gambling markets, meaning that the regulatory changes there have implications for developments elsewhere. A review of the British Gambling Act 2005 is underway. This has generated a range of actions by the industry, including mobilising arguments around the threat of the "black market". We critically explore industry's framing of these issues as part of their strategy to resist regulatory change during the Gambling Act review. We used a predefined review protocol to explore industry narratives about the "black market" in media reports published between 8 December 2020 and 26 May 2021. Fifty-five articles were identified and reviewed, and themes were narratively synthesised to examine industry framing of the "black market". The black market was framed in terms of economic threat and loss, and a direct connection was made between its growth and increased regulation. The articles mainly presented gambling industry perspectives uncritically, citing industry-generated evidence ( n = 40). Industry narratives around the "black market" speak to economically and emotionally salient concerns: fear, safety, consumer freedom and economic growth. This dominant framing in political, mainstream and industry media may influence political and public opinion to support the current status quo: "protecting" the existing regulated market rather than "protecting" people. Debates should be reframed to consider all policy options, especially those designed to protect public health.

Objective: To determine the reasons for the lack of priority given to addressing violence against children, and to identify the challenges that proponents must address to improve prioritization of this issue., Methods: We reviewed relevant literature to identify experts to interview. We carried out a thematic analysis of the literature and interview transcripts. We iteratively developed data coding on the many characteristics of violence against children, on the framing of the issue by proponents, and on the problem of governance - that is, how proponents organize themselves for collective action., Findings: The analysis of our data sources reveals many obstacles for global prioritization of addressing violence against children, including the forms of violence considered, inadequate data to describe prevalence and a lack of evidence of the effectiveness of proposed solutions. There exists fundamental disagreement among proponents on the recently introduced frame of violence against children, including differences in the types of violence that should be prioritized and in the proposed solutions (e.g. prevention or remediation). On governance, competition between networks focused on specific forms of violence is hampering efforts to create strong governing institutions., Conclusion: Despite the complex challenges identified, proponents have made some progress in global prioritization of addressing violence against children. To improve this prioritization further, proponents must resolve framing tensions and strengthen governance mechanisms to promote shared goals, while ensuring that networks focused on particular forms of violence are able to maintain their distinct identities., ((c) 2021 The authors; licensee World Health Organization.)

Background: The global health agenda is ill-defined as an analytical construct, complicating attempts by scholars and proponents to make claims about the agenda status of issues. We draw on Kingdon's definition of the agenda and Hilgartner and Bosk's public arenas model to conceptualize the global health agenda as those subjects or problems to which collectivities of actors operating nationally and globally are paying serious attention at any given time. We propose an arenas model for global health agenda setting and illustrate its potential utility by assessing priority indicators in five arenas, including international aid, pharmaceutical industry, scientific research, news media and civil society. We then apply the model to illustrate how the status of established (HIV/AIDS), emergent (diabetes) and rising (Alzheimer's disease) issues might be measured, compared and change in light of a pandemic shock (COVID-19)., Results: Coronavirus priority indicators rose precipitously in all five arenas in 2020, reflecting the kind of punctuation often caused by focusing events. The magnitude of change varied somewhat by arena, with the most pronounced shift in the global news media arena. Priority indicators for the other issues showed decreases of up to 21% and increases of up to 41% between 2019 and 2020, with increases suggesting that the agenda for global health issues expanded in some arenas in 2020- COVID-19 did not consistently displace priority for HIV/AIDS, diabetes or Alzheimer's disease, though it might have for other issues., Conclusions: We advance an arenas model as a novel means of addressing conceptual and measurement challenges that often undermine the validity of claims concerning the global health agenda status of problems and contributing causal factors. Our presentation of the model and illustrative analysis lays the groundwork for more systematic investigation of trends in global health agenda setting. Further specification of the model is needed to ensure accurate representation of vital national and transnational arenas and their interactions, applicability to a range of disease-specific, health systems, governance and policy issues, and sensitivity to subtler influences on global health agenda setting than pandemic shocks.

The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000-2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)