Analyzing the Global Health Agenda: Trends in Research Attention, 2004-2018

• In Event: Deepening Global Health Politics: Policies, Agendas, and Democratic Complexity

Abstract

This project addresses needs for conceptual and analytical clarity concerning the ‘global health agenda’. Scholarship invoking the global health agenda tends to follow traditions in political science that emphasize which issues get what, when and how, primarily in the sphere of governments. But what does it look like to conceptualize and analyze the agenda status of issues in a global governance arena that lacks centralized authority? Drawing on agenda setting scholarship in other social science traditions, we propose an arenas model for global health in which the agenda is conceived as resource allocations from a set of interacting international agency, aid, civil society, media, research and industry arenas alongside policy attention from governments. Within each arena, actors engage in similar activities and offer comparable types of resources. The model rests on assumptions that relevant problems are defined, attention develops and resources are allocated in competitive environments within multiple interacting collectivities of institutions.

The present study explores the research arena, asking how publishing trends in two journals changed during a recent 15-year period. This is a first effort to advance research methods for detecting such trends. We focus on the research arena for several reasons. First, agenda setting scholarship suggests that evidence of problems and viable solutions are typically necessary if not sufficient conditions for issues to attract policy attention; researchers and the journals they publish in are significant arbiters of such information. Second, there is some precedent for using bibliographic trends to assess the status of global health issues (Bump, Reich and Johnson 2012; Footman et al. 2014). Lastly, this body of scholarship holds promise for developing a framework for the thematic analysis of global health issues across arenas and over time. Global health issues are often thought of in terms of diseases, conditions and risk factors; we draw on the well-established Global Burden of Disease framework to track these types of issues while also analyzing research attention to health systems, policy and governance issues. We use inductive and deductive analytical approaches to develop a more detailed set of categories to facilitate comparative analysis of priority for global health issues in the future.

We analyze bibliographic trends in Bulletin of the World Health Organization and Health Policy and Planning. We selected these journals for four primary reasons: they publish on a wide range of global public health issues; they expressly incorporate work on low- and middle-income countries to enhance their global scope; their impact factors (6.818 Bulletin and 2.717 HPP in 2018) suggest their contents are appreciated in global public health research circles; and they have been published for a sufficient time period to facilitate trend analysis. We conducted a census of research studies and systematic reviews published in these journals between 2004 and 2018, analyzing titles and abstracts deductively and inductively. Standard procedures were used to ensure consistent coding. Our inquiry is supplemented with a search of the PubMed database as a check on broader publication trends and our framework for categorizing global public health issues.

Preliminary results using raw counts show that research attention is focused on a limited set of diseases, conditions and risk factors. Three issues stand out, including: maternal disorders (N=194); HIV/AIDS (N=168); and neonatal disorders (N=132). Issues rounding out the top ten include: tuberculosis (N=76); malaria (N=67); other neglected tropical diseases (N=36); smoking (N=33); diarrheal diseases (N=29); cardiovascular disease (N=25); and sexually transmitted diseases (N=23). Smoking is the only risk factor to make the top ten. Research attention to health systems and policy issues is even more pronounced, with heavy emphasis on: the delivery of effective safe quality health interventions (N=560); evaluation research (N=419); economics and finance at the systems level (N=309); medical products, vaccines and technologies (N=235); workforce management, including community health workers, professionals and other workers (N=219); economics and finance at the individual and household levels (N=103); and health insurance (N=83).

We plan to weight the results to show proportional attention across the range of issues over time, and to juxtapose the diseases, conditions and risk factors with their mortality and morbidity burdens. We will also compare our results with those of a survey of the PubMed database, which captures a wider range of medical research. We aim to illuminate ways in which attention to problems develops and resources are allocated in research collectivities comprising an arena for global health agenda setting as part of a broader effort to advance conceptual clarity and analytical rigor.

Authors

• Stephanie L. Smith, Virginia Tech

• Jeremy Shiffman

• Yusra Ribhi Shawar, Johns Hopkins University

• Andrew Cho

• Sarah Rosenberg