How do actors with asymmetrical power assert authority in policy agenda-setting? A study of authority claims by health actors in trade policy

doi:10.1016/j.socscimed.2019.112430

Social Science & Medicine

Volume 236, September 2019, 112430

https://doi.org/10.1016/j.socscimed.2019.112430 Get rights and content

Highlights

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How non-state actors attempt to exert authority in health governance is underexplored.
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Using the trade domain as a case example of the commercial determinants of health.
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We combine framing analysis with authority claims in policy actor submissions.
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We identify four claims to authority; institutional; networked; legal; and expert.
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We show differences in how market and public interest actors use authority claims.

Abstract

How health advocates and industry actors attempt to assert their authority as a strategy of influence in policymaking remains underexplored in the health governance literature. Greater exploration of the kinds of authority sources used by health actors vis-à-vis market actors and the role ideational factors may play in shaping access to these sources provides insight into advocates' efforts to exert influence in policy forums. Using the trade domain in Australia as a case study of the way in which the commercial determinants of health operate, we examined the different ways in which health, public interest and market actors assert their authority. Drawing on a political science typology of authority, we analysed 87 submissions to the Australian government during the Trans-Pacific Partnership negotiations. We identify four types of authority claims; institutional authority, derived from holding a position of influence within another established institution; legal authority through appeals to legal agreements and precedents; networked authority through cross-referencing between actors, and expert authority through use of evidence. Combining these claims with a framing analysis, we found that these bases of authority were invoked differently by actors who shared the dominant neoliberal ideology in contrast to those actors that shared a public interest discourse. In particular, market actors were much less likely to rely on external sources of authority, while health and public interest actors were more likely to appeal to networked and expert authority. We argue that actors who share strong ideational alignment with the dominant policy discourse appear less reliant on other sources of authority. Implications of this analysis include the need for greater attention to the different strategies and ideas used by industry and public health organisations in trade policy agenda-setting for health, which ultimately enable or constrain the advancement of health on government agendas.

Section snippets

Main text

The recent research attention to the commercial determinants of health, that is, the study of the “strategies and approaches used by the private sector to promote products and choices that are detrimental to health” (Kickbusch et al., 2016, e895) has revealed a number of mechanisms used by corporations to promote greater uptake of their products and undermine public health regulation (Buse et al., 2017; Collin et al., 2017). Documented strategies include lobbying and donating to political

Methods

We initially conducted a framing analysis of publicly availably submissions made by non-state actors to the Australian Government during its participation in the Trans-Pacific Partnership (Townsend et al., 2018). Australia initiated a formal submission process during its participation in the negotiations for receiving submissions i. e policy-oriented documents from non-state actors expressing their position on the negotiations and what they did or did not want the government to agree to. This

Results

We identified four kinds of authority claims (networked, institutional, legal, and expert) evident in the submissions by both market and public interest actors. However, we identify differences in both the frequency and use of these claims to authority by the two framing groups. In particular, we show that market actors relied less than public interest actors did on claims to other sources of authority. In the following sections we outline each authority claim and contrast its use by the two

Discussion

Our analysis of non-state actors' submissions in trade policy identified four common sources of authority claims; networked; institutional; legal; and expert. Combining this analysis with a framing analysis of submissions allowed us to compare the differing uses of these authority sources by market-oriented and public health/public interest actors respectively. In this section we discuss these differences in the use of authority claims in turn, and then reflect on the use of the Avant et al.'s

Conclusion

Our analysis adds a novel application of authority claims from political science to the health governance literature. In doing so, we reveal how health advocacy/public interest and market actors use multiple bases to assert their authority as one strategy to attempt to enhance their influence over policymaking. The case of trade policy was chosen because it is a key domain for the commercial determinants of health where the governance of economic policies can directly and indirectly affect

Acknowledgements

This work was supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in the Social Determinants of Health Equity: Policy research on the social determinants of health equity (APP1078046). The NHMRC had no role in the conduct of this research.

The authors thank Professor Susan Sell, one of the original authors of the authority typology, for her useful feedback on the method and coding scheme used in this study.

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View full text

How do actors with asymmetrical power assert authority in policy agenda-setting? A study of authority claims by health actors in trade policy

Highlights

Abstract

Section snippets

Main text

Methods

Results

Discussion

Conclusion

Acknowledgements

Soc. Sci. Med.

Soc. Sci. Med.

The Lancet

Assessing the health impact of transnational corporations: a case study on McDonald's Australia

Glob. Health

Submission to the Australian Government Department of Foreign Affairs and Trade on the Trans-Pacific Partnership, on File with Authors

Tobacco Plain Packaging Legislation

Free Trade Agreements

Who governs the globe?

Trade and investment liberalization and Asia's noncommunicable disease epidemic: a synthesis of data and existing literature

Glob. Health

The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis

Glob. Health

Power Asymmetries, Policy Incoherence and Noncommunicable Disease Control

Health people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reduced risk exposure

Glob. Health

Can public health reconcile profits and pandemics? An analysis of attitudes to commercial sector engagement in health policy and research

PLoS One

‘Half-cut’ science: a qualitative examination of alcohol industry actors' use of peer-reviewed evidence in policy submissions on Minimum Unit Pricing

Evid. Policy J. Res. Debate Pract.

When the weak bargain with the strong: negotiations in the World Trade Organization

Int. Negot.

A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement

Globalization and Health

Shaping the discourse: what has the food industry been lobbying for in the Trans Pacific Partnership trade agreement and what are the implications for dietary health?

Crit. Public Health

An expose of the realpolitik of trade negotiations: implications for population nutrition

Public Health Nutr.