Legitimation Challenges in Global Health Governance: The Case of Non-Communicable Diseases

Abstract

Recently there has been an increasing focus on non-communicable diseases (NCDs) within global health governance discussions due to the escalation of NCDs worldwide. However, NCDs have yet to be prioritised on the global agenda. The challenges of political prioritisation are analysed with a focus on legitimation strategies and how an issue area is legitimised in relation to various groups in society, i.e. between ‘authors’ and ‘audiences’ of governance. This article identifies a number of legitimation challenges, such as the difficulties of defining the issue area and communicating it to several audiences with different needs, interests, and perceptions of what is to be prioritised. Other challenges concern the composition of actors in the field, weak legislative frameworks, and vested interests that are both part of the problem as well as the solution. These challenges are played out through normative structures, politics, and power relations, which together affect priority setting in global health.