Investigating the citing communities around three leading health-system frameworks.

Of numerous proposed frameworks for analyzing and impacting health systems, three stand out for the large number of publications that cite them and for their links to influential international institutions: Murray and Frenk (Bull World Health Organ 78:717-31, 2000) connected initially to the World Health Organization (WHO) and then to the Global Burden of Disease Project; Roberts et al. (Getting health reform right: a guide to improving performance and equity, Oxford University Press, Oxford, 2004) sponsored by the World Bank/Harvard Flagship Program; and de Savigny and Adam (Systems thinking for health systems strengthening, WHO, 2009) linked to the WHO and the Alliance for Health Policy and Systems Research. In this paper, we examine the citation communities that form around these works to better understand the underlying logic of these citation grouping as well as the dynamics of Global Health research on health systems. We conclude that these groupings are largely independent of one another, reflecting a range of factors including the goals of each framework and the problems that it was meant to explore, the prestige and authority of institutions and individuals associated with these frameworks, and the intellectual and geographic proximity of the citing researchers to each other and to the framework authors.

International Health Research and the Emergence of Global Health in the Late Twentieth Century.

An influential policy network emerged from two overlapping developments of the 1970s and 1980s: new research programs focusing on tropical diseases and debates about how to implement the concept of primary health care at the World Health Organization. Participating actors came together in an informal network that, by the late 1980s, expanded advocacy to include the promotion and reorganization of all forms of research that might improve health in the Global South. This goal became associated with a search for new research methods for determining priorities, a quest that reached a peak in the early 1990s when the World Bank entered the picture. The bank brought money, economic analyses, and neoliberal ideology to the research advocacy movement and helped stimulate an upsurge of cost-effective forms of economic thinking in global health (GH) circles. This expanded research network provided some of the conceptual foundations and leadership for several of the most emblematic institutions of the new GH. These included new organizations to bring together and coordinate public and private actors in pursuit of common aims and new forms of economic rationality. The network's advocacy work contributed as well to a massive expansion of GH research at the turn of the century.

The theory of epidemiologic transition: the origins of a citation classic.

In 1971 Abdel R. Omran published his classic paper on the theory of epidemiologic transition. By the mid-1990s, it had become something of a citation classic and was understood as a theoretical statement about the shift from infectious to chronic diseases that supposedly accompanies modernization. However, Omran himself was not directly concerned with the rise of chronic disease; his theory was in fact closely tied to efforts to accelerate fertility decline through health-oriented population control programs. This article uses Omran's extensive published writings as well as primary and secondary sources on population and family planning to place Omran's career in context and reinterpret his theory. We find that "epidemiologic transition" was part of a broader effort to reorient American and international health institutions towards the pervasive population control agenda of the 1960s and 1970s. The theory was integral to the WHO's then controversial efforts to align family planning with health services, as well as to Omran's unsuccessful attempt to create a new sub-discipline of "population epidemiology." However, Omran's theory failed to displace demographic transition theory as the guiding framework for population control. It was mostly overlooked until the early 1990s, when it belatedly became associated with the rise of chronic disease.

What Happened to the Global Forum for Health Research?

The Global Forum for Health Research (GFHR) was founded in 1998. It was the culmination of an advocacy movement started in 1987 to campaign for the expansion and coordination of health research benefitting low- and middle-income countries. It was largely funded by the World Bank and embraced that institution's emphasis on cost effectiveness. But its small budget prevented it from assuming the central role in global health research that its supporters had envisaged. It took on more modest tasks, focusing on advocacy, organising an annual conference and monitoring research funding. In 2010, it was absorbed amid general indifference by another small organization, the Council on Health Research for Development (COHRED) and eventually disappeared from sight. We argue in this paper that its fate had two major causes. First, it resulted from operational and budgetary problem and its inability to attract the new money that was pouring into Global Health (GH). Second, it reflected the aggressive efforts by the WHO to reclaim leadership in this domain. Underlying this failure, however, was the inherent difficulty of coordinating the ideologically fragmented and individualistically oriented GH research domain.

The emergence of clinical practice guidelines.

Clinical practice guidelines are now ubiquitous. This article describes the emergence of such guidelines in a way that differs from the two dominant explanations, one focusing on administrative cost-cutting and the other on the need to protect collective professional autonomy. Instead, this article argues that the spread of guidelines represents a new regulation of medical care resulting from a confluence of circumstances that mobilized many different groups. Although the regulation of quality has traditionally been based on the standardization of professional credentials, since the 1960s it has intensified and been supplemented by efforts to standardize the use of medical procedures. This shift is related to the spread of standardization within medicine and especially in research, public health, and large bureaucratic health care organizations.