Framing and the politics of public health: An examination of competing health narratives in Honduras

Abstract

According to the World Bank, Honduras is a health and development success story. Over the past few decades, it has experienced economic growth, expanded public health infrastructure, and improved key health indicators. However, these achievements do not serve as evidence of success for global public health agencies, such as the World Health Organisation (WHO) and the Pan American Health Organisation (PAHO). The WHO has identified Honduras as a ‘priority country’ due to extreme levels of poverty, inequality, indebtedness, and poor health. What accounts for these divergent evaluations, and what are their consequences for vulnerable and marginalised populations? I argue that the framing of health is important and demands examination because it reveals political dynamics and shapes policy options. Furthermore, individual frames are incomplete, differentially inclusive, and ultimately inadequate as explanatory and analytic frameworks.

Keywords:

• global health agenda
• issue framing
• donor prioritisation
• inequality
• reproductive rights

Acknowledgements

The author would like to acknowledge the contributions of colleagues Ana Sanchez and Ellen Mitchell, who provided invaluable feedback on earlier drafts of this manuscript. The author also gratefully acknowledges the research assistance of Laurie Denyer and Kayla Monteiro, and the comments and suggestions of the two anonymous reviewers.

Notes

1. Charges of corruption have plagued all democratic administrations, there have been seven democratically elected Presidents (from both Liberal and National parties) and constituent assemblies since 1981, although, progress has been made towards increased regime legitimacy (see US State Department 2006).

2. According to USAID, the total fertility rate, ‘is interpreted as the number of births a woman would have during her childbearing years if she passed through those years experiencing the observed age-specific rates’ (USAID 2005).

3. See García et al. (2006; concerning family planning in Honduras).

4. See for example, Briggs (1998), Coe (2004) and Miranda and Yamin (2005) (concerning population control in Peru, Brazil and Puerto Rico).