(In)sufficient institutionalization? Norm articulation in the World Health Organization and infectious disease prevalence across the global South

Recent work in the neoinstitutional tradition has sought to clarify the mechanisms by which global norms diffuse across the world system. Prior work highlights the role of organizational linkages between world society and the nation-state—especially international nongovernmental organizations (INGOs)—in the process of spreading policies, practices, and ideas cross-nationally. Although prior empirical studies ask whether diffusion occurs, this study examines the conditions under which such effects are stronger versus weak (or absent). To do so, we use the strategic case of norm articulation in the World Health Organization (WHO) and its relationship to infectious disease prevalence across the global South. Our research design leverages variation in the extent to which issues garner attention within this intergovernmental organization. We begin by identifying four infectious diseases with variable degrees of prominence on the WHO agenda. In the descending order, they are HIV, tuberculosis, leprosy, and Guinea-worm disease. We then estimate the impact of organizational links to world society (operationalized as health INGOs) on disease prevalence and compare results across each of the four outcomes. Results support the neoinstitutional argument that diffusion is conditional on the extent to which norms are articulated in the prevailing global institution. We find that, for the most part, world society links are associated with lower rates of infectious disease. However, the size and significance of the relationship depends on a disease’s relative priority on the WHO agenda. In the absence of sufficient norm articulation, results show that integration into world society is unrelated to infectious disease prevalence.