| 1) Ideas: the way the health challenge is understood and communicated |
HIV is one disease and was a new and highly visible health threat ART was widely understood to be highly effective – its impact was described as “Lazarus-like”, returning people from the brink of death. Disparities in access to ART were starkly visible. HIV was framed as a threat to development and security, as it visibly affected young, working-age people and destabilized economies HIV is commonly framed as a humanitarian crisis by civil society
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NCDs are a collection of diseases, not perceived as novel threats NCD treatment varies from condition to condition; treatment effectiveness is also variable; therapeutic nihilism about the feasibility of treatment for some NCDs was prevalent Incorrectly considered “diseases of the elderly” and “diseases of the wealthy,” the NCD threat is poorly recognized NCDs are often perceived as a secondary issue to infectious diseases, “a crisis for future generations”
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| 2) Actor power: the strength of the individuals and organizations concerned with the issue |
Grassroots community activism led by those affected by HIV arose to dispel stigma and AIDS denialism In 1996, Joint United Nations Programme on HIV/AIDS (UNAIDS) formed as a dedicated UN branch to tackle the HIV/AIDS epidemic, offering crucial central leadership and organizing power
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Generally low awareness and demand from patients, and low civil society involvement, especially in low-resource settings where healthcare is organized around HIV Multisectoral partnerships (e.g., NCD Alliance and GACD in 2009) have organized to unite policy makers, donors, researchers and civil society organizations; WHO GCM/NCD was established in 2014 to coordinate global efforts and improve accountability to NCD targets
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| 3) Political context: the environments in which actors connected with the issue operate |
In 1980s, dominantly conservative US politics emphasized personal responsibility and abstinence, effectively blaming HIV-infected persons and stagnating HIV efforts HIV UNGASS occurred in the context of global economic growth and increased funding scale and diversity Long-term financial commitments were demonstrated by the Global Fund, PEPFAR and other international initiatives HIV, and other infectious diseases (e.g., malaria and tuberculosis) were explicitly included in 2000 MDG targets
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NCDs currently perceived as largely “diseases of preventable individual behaviors,” placing responsibility on populations affected NCD UNGASS occurred during global economic crisis, with reduced funding availability To date, no large-scale dedicated funding commitment for NCDs akin to PEPFAR for AIDS NCD targets were omitted from MDGs but included in SDGs in 2015
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