The Perspective Changer: Bloomberg Distinguished Professor Jeremy Shiffman on Shaping the Global Health Agenda

What makes a health issue rise to a national or global agenda? Why have conditions such as HIV/AIDS in the past received considerable resources, while high-burden noncommunicable diseases attracted few, especially in low-income countries? Questions like these drive Jeremy Shiffman’s research. He uses political and other social science theories to understand how governments, international organizations and civil society and advocacy groups shape health policymaking in low-income countries. Trained as a political scientist, he chose to research health policy in particular, he says, “because I wanted to focus on a social justice concern.” With joint appointments at the Bloomberg School and the School of Advanced International Studies, Shiffman is positioned to draw on the schools’ complementary strengths in ways that he hopes “will produce research that advances both knowledge and social equity.”

In this Q&A, Shiffman explains how applying theories can both improve our analysis of health policy and more effectively influence its development.

Global health networks are a big part of your research. Could you define those in the context of health and global health policy?

If you pick any major global health problem—from HIV/AIDS to diabetes to newborn survival to the provision of primary health care—you’ll notice globally linked networks of individuals and organizations actively trying to secure attention and resources for their particular concern.

This is a relatively new phenomenon in global health. Fifty years ago, most international health issues were handled by national governments working with a few international organizations, especially the World Health Organization. But now, in addition to these and other actors, you have a plethora of these networks, all pushing for attention, to the point that it has become an intense competition for scarce resources.

I became interested in these networks because of these imbalances in resource allocations across conditions. I wondered [about] the extent to which that had to do with the effectiveness of these global networks and their advocacy. I use political ethnographic methods to study the internal dynamics of these networks, talking to and observing the people involved, to understand the strategies they use to attract resources for their particular concerns.

In addition to these global studies, I’ve also done many investigations of health policymaking within countries at national and community levels, including in Asia, Africa and Latin America.

Social science theories drive your work. Tell us about one that’s really central for you.

I draw especially on theories grounded in social constructivism: that is, ones that recognize how our shared perceptions shape social reality. Let me give you an example. Prior to 2000, most health experts believed that very sick newborn babies in low-income countries could not be saved in the absence of high-tech, hospital-based care. Newborn survival advocates managed to change perceptions of national policymakers and the leaders of global institutions such as the Gates Foundation, arguing that even in the absence of such care we could make a dent in the problem. As a result, foundations and governments began to prioritize the issue. The proponents deliberately facilitated a shift in perceptions away from a sense of fatalism and toward an understanding that we can make a difference.

I see a lot of what goes on in global health this way: proponents engaged in an effort to alter the way we perceive the world, and by doing that, they change what’s possible.

Do you think a fair number of people in global health are changing the frames people have, even without knowing this paradigm?

They have a sense of what they’re doing, but they don’t describe it in those terms. For example, there is a global network of surgeons concerned with ensuring the provision of surgical care in low-income countries, but they face the problem that national policymakers often perceive surgical care to be expensive and therefore not worth investing in. As a social scientist, I have spoken with surgeons and encouraged them to work on reframing the issue to get people to understand that provision of surgical care is not a luxury good; it’s cost-effective in low-income countries. I emphasize to them that they need to alter the perceptions of policymakers and others.

What kind of reception do you get?

At first they are skeptical that they need to do more than produce evidence. But in the end, they usually come around and tell me that, “Oh, I see what you’re saying. It’s not enough to produce this objective evidence … we have to fundamentally change the way policymakers think about the importance of the issue.”

Is there a project you have ongoing or on the horizon that you’re really excited about?

One is to analyze how to generate national and global priority to address violence against children, a project I am undertaking with Yusra Shawar, a colleague at the Bloomberg School. We are being funded by the Oak Foundation. The issue of violence against children doesn’t get the attention it deserves; often, even within the area of child well-being, you see violence prevention being pushed aside in favor of health or education.

Another initiative I’m undertaking is facilitating connections among scholars from low- and high-income settings who apply social science theory to analyze health policymaking and problems in low-income countries. I’m particularly interested in building connections across social science disciplines, including anthropology, sociology, political science, economics, history and psychology. Too often we work in our disciplinary silos, which inhibits valuable fertilization of ideas across disciplines.

Any last thoughts?

I’ll just say one more thing. As a BDP, I’m a joint appointment between the Bloomberg School and SAIS. This School has an outstanding Department of International Health, and SAIS is an outstanding school of international affairs. And Johns Hopkins has a number of world-class researchers working on health policy analysis concerning low-income countries. An exciting aspect of my job is to try to facilitate linkages across the two schools. By doing this, we can better support capacity building in low-income settings for health policy analysis, and at the same time advance Hopkins’ reputation as a global hub for this kind of research.