Abstract
In the last two decades, global action to address noncommunicable diseases (NCDs) has accelerated, but policy adoption and implementation at the national level has been inadequate. This analysis examines the role of rationalities of governing, or governmentality, in national-level adoption of global recommendations. Critical discourse analysis was conducted using 49 formal institutional and organizational documents obtained through snowball sampling methodology. Text were coded using a framework of five forms of governmentality and analyzed to describe the order of discourse which has emerged within the global NCD policy domain. The dominant political rationality used to frame NCDs is rooted in risk governmentality. Recommendations for tobacco control and prevention of harmful alcohol use rely on a governmentality of police mixed with discipline. The promotion of physical activity relies heavily on disciplinary governmentality, and the prevention of unhealthy diet mixed disciplinary measures, discipline, and neoliberal governmentalities. To translate global NCD prevention and control strategies to national action, acceptability for the political rationalities embodied in policy options must be nurtured as new norms, procedures, and institutions appropriate to the political rationalities of specific interventions are developed.
Highlights
In the last 20 years, non-communicable diseases (NCDs) have emerged as a priority policy and governance area in global health
Critical discourse analysis (CDA) is the analytical method used to examine the positioning of governmentalities in the construction of the global NCD prevention and control policy domain
The Moscow Declaration [36], and follow-up documents, such as the United Nations (UN) Outcome Document of the High-Level Meeting of the General Assembly on the Review of the Progress Achieved in the Prevention and Control of NCDs [37]
Summary
In the last 20 years, non-communicable diseases (NCDs) have emerged as a priority policy and governance area in global health. The World Health Report 1997 [1] provided the impetus for the. World Health Assembly (WHA) to issue a resolution to develop a global strategy for the prevention and control of NCDs as part of health sector reform [2]. In 2000, the World Health Organization (WHO). Global Strategy for the Prevention and Control of NCDs was adopted by the WHA, representing the first effort to find a governance solution to the NCDs problem and to provide recommended actions to Member States and other international organizations [3]. An array of resolutions, political declarations, global strategies, action plans, and progress reports have been published to hasten progress on shared governance for NCDs and related risk factors. Public Health 2020, 17, 4413; doi:10.3390/ijerph17124413 www.mdpi.com/journal/ijerph
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