A Crisis of Care: Noncommunicable Diseases and the Biopolitics of Exclusion

The world is failing to adequately address noncommunicable diseases (NCDs), particularly amongst the world’s poorest populations. In 2013 in low-income countries, NCDs killed eight million people before they turned sixteen years old. The World Economic Forum projects that NCDs will cause more than $21.3 trillion dollars of economic losses on low-income countries over the next twenty years. NCDs account for 70% of the total burden of disease globally. Yet, despite well-evidenced, cost effective interventions, financing for the care, treatment, and prevention of NCDs amongst the poor accounts for less than 1% of all development assistance for health. What is causing this political blockage?

This paper uses mixed methods including archival-historical research at the World Health Organization (WHO), citation network analysis, expert interviews, and a large survey of global health practitioners to shed light on this important empirical puzzle. I trace the historical emergence of the NCD category in the public health literature and discourse, demonstrate how NCDs are framed and discussed by policy experts and global health practitioners today, and finally, show evidence of the political effects of this historically constructed framing.

It is my argument that key shifts in the structure of the scholarly NCD citation network correspond with important changes in NCDs framing from global health practitioners and leaders at the WHO and other governing bodies. This narrow, scientifically-driven framing has limited the political opportunities that NCDs advocates have had in mobilizing new financing for these important global health problems. Drawing on a biopolitical theoretical framework, these findings could provide insights into why relatively little new policy or new financing have followed from high-level United Nations and WHO political action in recent years.