The Road to the United Nations High-Level Meeting on the Prevention and Control of Non-Communicable Diseases

Date of Award

Summer 8-27-2021

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Political Science


Klotz, Audie


global governance, global health

Subject Categories

International Relations | Political Science | Social and Behavioral Sciences


This project examines the global response to the non-communicable disease epidemic by exploring the complicated framing of the NCD problem, transnational advocacy, and global level agenda-setting. The prevalence of NCDs has risen considerably over the past 25 years, and the implications of the epidemic are especially acute for low- and middle-income countries embedded in a global economy that often drives local consumption patterns. NCDs are particularly pronounced among the urban poor, further highlighting the social and economic drivers of disease. Although the extent of this global health crisis is well documented, a number of barriers to action prevented its firm placement on the agenda. This changed in September 2011, when the United Nations hosted the first UN High Level Meeting on the Prevention and Control of NCDs. Is the 2011 United Nations High-Level Meeting (UN HLM) evidence that NCDs finally landed in a prominent place on the global health agenda and, if so, how? If not, why not?Using the theory of network emergence and effectiveness by Jeremy Shiffman et al., complemented by Deborah Stone on causal stories and policy agendas, I argue that the emergence of the NCD advocacy network that ultimately facilitated the UN HLM is supported by regional action by Caribbean states via their regional organization, CARICOM. The unique features of the issue, coupled with the unique vulnerabilities of the region, led to the surprising leadership of a community of states traditionally understood to be less powerful in global politics. While a network of actors with a vested interest in the NCD problem did emerge and coalesce around CARICOM issue-framing, the extent to which the network was effective is a matter of debate, particularly with respect to long-term objectives such as the procurement of NCD-specific development assistance, the creation of related global targets and accountability mechanisms and, ultimately, improvements to public health. I address the central question in three stages. First, I consider the conditions that set the stage for advocacy network emergence highlighting the implications of the neglect of NCDs in the Millennium Development Goals, limited efforts by WHO on NCDs, and the confounding effects of competing causal stories in framing the nature of the NCD crisis and the delineation of politically expedient policy solutions. Second, I evaluate the role of CARICOM in detail, demonstrating that the transition of some economies in the region to middle- and high-income status resulted in a critical drop in health development assistance at a time when these same countries are contending with the financial (and other) implications of climate change – this was a driving force in network emergence. Third, I show that even as allies joined network advocacy efforts to position NCDs as a matter of global priority, debates related to the role of corporate actors as either allies or opponents, combined with the omission of affected patients and their families, undermined network effectiveness in pursuit of their objectives beyond the UN HLM. This project demonstrates the iterative nature of agenda-setting, the importance of the feasibility of implied policy solutions in issue framing, and the mitigating impacts of a lack of network cohesion on these points. The rise of NCDs worldwide, and particularly in economically developing countries, presents an extremely complicated, vitally important policy problem. This is exacerbated by the problem's placement in a complex web of competing causal narratives, global actors, and resource flows, which I seek to explore, delineate and connect through this project.


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