Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
Paul H. Nitze School of Advanced International Studies, Washington, DC, USA.
Int J Health Policy Manag. 2018 Oct 1;7(10):879-884. doi: 10.15171/ijhpm.2018.71.
Global health networks-webs of individuals and organizations linked by a shared concern for a particular condition-have proliferated over the past quarter century. In a recent editorial in this journal, I presented evidence that their effectiveness in addressing four challenges-problem definition, positioning, coalitionbuilding and governance-shapes their ability to influence policy. The editorial prompted five thoughtful commentaries that reflected on these and other challenges. In this follow-up editorial, I build on the commentaries to suggest ways of advancing research on global health networks. I argue that investigators would do well to consider three social theory-influenced global governance debates pertaining to agency-the capacity of individuals and organizations to act autonomously amidst structural constraints. The three debates concern the relationship between agency and structure, the power of ideas vis-à-vis interests and material capabilities, and the level of influence of non-state actors in a global governance system that most scholars identify as state-dominated. Drawing on these debates, I argue that rather than presume global health network influence, we need to find more robust ways to investigate their effects. I argue also that rather than juxtapose agency and structure, ideas and interests and non-state and state power, it would be more productive to consider the ways in which these elements are intertwined.
在过去的四分之一个世纪里，关注特定疾病的个人和组织通过共同关注而联系在一起的全球卫生网络已经大量涌现。在本刊最近的一篇社论中，我提出了证据表明，它们在应对四个挑战方面的有效性——问题定义、定位、联盟建设和治理——决定了它们影响政策的能力。该社论引发了五篇深思熟虑的评论文章，这些文章对这些和其他挑战进行了反思。在这篇后续社论中，我基于这些评论文章提出了推进全球卫生网络研究的方法。我认为，研究人员最好考虑与机构相关的三个受社会理论影响的全球治理辩论，机构是指个人和组织在结构约束下自主行动的能力。这三个辩论涉及机构与结构之间的关系、思想相对于利益和物质能力的力量，以及大多数学者认为以国家为主导的全球治理体系中非国家行为体的影响力水平。借鉴这些辩论，我认为，我们需要找到更有力的方法来调查它们的影响，而不是假设全球卫生网络的影响力。我还认为，与其并列机构和结构、思想和利益以及非国家和国家权力，不如考虑这些因素相互交织的方式，这将更具成效。
