The social construction of global health priorities: an empirical analysis of contagion in bilateral health aid

Donors of development assistance for health typically provide funding for a range of disease focus areas, such as maternal health and child health, malaria, HIV/AIDS, and other infectious diseases. But funding for each disease category does not match closely its contribution to the disability and loss of life it causes and the cost-effectiveness of interventions. We argue that peer influences in the social construction of global health priorities contribute to explaining this misalignment. Aid policy-makers are embedded in a social environment encompassing other donors, health experts, advocacy groups, and international officials. This social environment influences the conceptual and normative frameworks of decision-makers, which in turn affect their funding priorities. Aid policy-makers are especially likely to emulate decisions on funding priorities taken by peers with whom they are most closely involved in the context of expert and advocacy networks. We draw on novel data on donor connectivity through health IGOs and health INGOs and assess the argument by applying spatial regression models to health aid disbursed globally between 1990 and 2017. The analysis provides strong empirical support for our argument that the involvement in overlapping expert and advocacy networks shapes funding priorities regarding disease categories and recipient countries in health aid.