Power, policy ideas and paternalism in non‐communicable disease prevention

Date01 November 2018
Published date01 November 2018
Power, policy ideas and paternalism in
noncommunicable disease prevention
Oliver Bartlett*
Noncommunicable disease prevention is shaped in large part by the ability of political actors to
manipulate policy ideas. Actors that acquire sufficient policymaking power usually through build-
ing social legitimacy can work to ensure that certain ideas become influential in the policymaking
process, thus making it more likely that their own interests are reflected in policy outcomes. This
paper will argue that private actors, specifically multinational corporations, have been effective in
achieving this to the extent that noncommunicable disease policy has become dominated by ideas
that are likely to lead to ineffective outcomes, thus reflecting private interests. It is therefore argued
that efforts are needed to shift the balance of policymaking power back towards public interests.
This would, it is argued, lead to an increase in regulation that could be accused of being paternalist
an eventually that can however be justified both ethically and legally.
Policymaking is guided by the interaction of ideas and interests. In the field of noncommunicable disease preven-
tion, this mixing of ideas and interests is especially complex, and policy outcomes are often heavily influenced by
the balance of power within the process.
The concept of power in policymaking processes has been studied extensively. Power can be understood as the
ability of a political actor to influence the behaviour of others in such a way as to gain a preferred outcome.
It is also
recognised that when several persons or organisations are involved in decisionmaking, mutual dependencies and the
distribution of power or authorityamong the participants become important dimensions that characterise the process.
In this paper I will investigate the acquisition of power in noncommunicable disease (NCD) prevention policy
making. I will argue that private interests have been able to gain policy power through building perceptions of social
legitimacy, and have used this power to promote the dominance of policy ideas that have led to the creation of
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This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and
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© 2018 The Authors. European Law Journal Published by John Wiley & Sons Ltd.
Lecturer in Law, Liverpool School of Law and Social Justice.
R.A. Hays, Federal Government and Urban Housing (State University of New York, 3rd edn, 2012), at 1.
L. Kørnøv and W. Thissen, Rationality in Decisionand PolicyMaking: Implications for Strategic Environmental Assessment(2000)
18 Impact Assessment and Project Appraisal, 191200, at 194.
DOI: 10.1111/eulj.12216
474 Eur Law J. 2018;24:474489.wileyonlinelibrary.com/journal/eulj
several weak NCD prevention interventions. I argue that to restore full effectiveness to the policymaking process,
different policy ideas must gain traction, and for this to be possible the policy power of private interests must be
weakened. I further argue that, should this be achieved, the result is likely to be more regulation that could be
considered paternalistic, yet that such a development is justifiable.
In this first section I argue that private interests have been able to seize power in NCD policymaking, and have used
this power to bring about the dominance of ideas in the policymaking process that have prompted weak policy out-
puts. These interests are primarily multinational corporations that market alcohol, tobacco and unhealthy foods, the
consumption of which are risk factors for NCD development. I will first outline what it means to have power in the
policymaking process and how power is generated. I will then analyse how the exercise of power by private interests
has led to the rise of policy ideas that direct policymakers towards ineffective NCD prevention actions.
2.1 |Policy interests and acquiring policymaking power
The neopluralist theory of power best describes how power is distributed in NCD policymaking. This theory recog-
nises that multiple pressure groups operate within society [yet] the agenda is, or is in danger of becoming, biased
towards specific individuals and groups.
Drawing on network theories of governance, which suggest that decisions
on how to manage issues can be taken by a variety of different stakeholders with a common interest, rather than sim-
ply by governments, neopluralism posits that the irreversible process of globalisation means important decisions for
societies are taken within transnational economic and political networks rather than by national or local institutions
of representation.
Actors with sufficiently high levels of resources (financial or otherwise) who operate within those
networks are able to command great influence over crucial pressure points within globalised societyfor instance,
multinational corporations of sufficient size to have dominance in the global consumer products marketthereby
accruing power within the transnational policymaking space.
As noted above, power can be understood as the ability of a political actor to influence the behaviour of others
in such a way as to gain a preferred outcome.
The fact that the exercise of power is an ability means it must be pos-
sible to acquire power.
If it is possible to acquire power, there is therefore a process through which this is
One candidate for such a process could be the practice of building perceptions of social legitimacy.
As Buse and
Harmer point out, the possession of innate authority and the strength to act upon itsuch as that afforded to
governments by their citizens through democratic electionsdoes not automatically generate true power for actors.
Instead, it is the existence of a perception that strength has been used in line with authority and in a socially legitimate
way that gives an actor power.
Thus, as Barnett and Finnemore note, a government is powerful and commands
K. Buse and A. Harmer, Power to the Partners? The Politics of PublicPrivate Health Partnerships(2004) 47 Development,4956, at
S. Moutsios, Power, Politics and Transnational PolicyMaking in Education(2010) 8 Globalisation, Societies and Education, 121141,
at 135.
Hays, Federal Government and Urban Housing, above, n. 1, at 1.
See P.A.Hall, Policy Paradigms, Social Learning, and the State: The Case of Economic Policymaking in Britain(1993) 25 Comparative
Politics, 275296, at 290.
Buse and Harmer, Power to the Partners?, above, n. 3, at 53.

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