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

• Date: 01 November 2018
• Author: Oliver Bartlett
• DOI: http://doi.org/10.1111/eulj.12216
• Published date: 01 November 2018

ORIGINAL MANUSCRIPT

Power, policy ideas and paternalism in

non‐communicable disease prevention

Oliver Bartlett*

Abstract

Non‐communicable disease prevention is shaped in large part by the ability of political actors to

manipulate policy ideas. Actors that acquire sufficient policy‐making power –usually through build-

ing social legitimacy –can work to ensure that certain ideas become influential in the policy‐making

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 non‐communicable 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 policy‐making 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.

1|INTRODUCTION

Policy‐making is guided by the interaction of ideas and interests. In the field of non‐communicable 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 policy‐making 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.’

1

It is also

recognised that ‘when several persons or organisations are involved in decision‐making, mutual dependencies and the

distribution of power or authorityamong the participants become important dimensions that characterise the process.’

2

In this paper I will investigate the acquisition of power in non‐communicable 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.

1

R.A. Hays, Federal Government and Urban Housing (State University of New York, 3rd edn, 2012), at 1.

2

L. Kørnøv and W. Thissen, ‘Rationality in Decision‐and Policy‐Making: Implications for Strategic Environmental Assessment’(2000)

18 Impact Assessment and Project Appraisal, 191–200, at 194.

DOI: 10.1111/eulj.12216

474 Eur Law J. 2018;24:474–489.wileyonlinelibrary.com/journal/eulj

several weak NCD prevention interventions. I argue that to restore full effectiveness to the policy‐making 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.

2|HOW DOES THE CURRENT ALLOCATION OF POLICY POWER LEAD TO

INEFFECTIVE POLICY OUTPUTS?

In this first section I argue that private interests have been able to seize power in NCD policy‐making, and have used

this power to bring about the dominance of ideas in the policy‐making 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

policy‐making 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 policy‐makers towards ineffective NCD prevention actions.

2.1 |Policy interests and acquiring policy‐making power

The neo‐pluralist theory of power best describes how power is distributed in NCD policy‐making. 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.’

3

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, neo‐pluralism 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.’

4

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 society—for instance,

multinational corporations of sufficient size to have dominance in the global consumer products market—thereby

accruing power within the transnational policy‐making 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.’

5

The fact that the exercise of power is an ability means it must be pos-

sible to acquire power.

6

If it is possible to acquire power, there is therefore a process through which this is

accomplished.

One candidate for such a process could be the practice of building perceptions of social legitimacy.

7

As Buse and

Harmer point out, the possession of innate authority and the strength to act upon it—such as that afforded to

governments by their citizens through democratic elections—does 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.

8

Thus, as Barnett and Finnemore note, a government ‘is powerful and commands

3

K. Buse and A. Harmer, ‘Power to the Partners? The Politics of Public‐Private Health Partnerships’(2004) 47 Development,49–56, at

51.

4

S. Moutsios, ‘Power, Politics and Transnational Policy‐Making in Education’(2010) 8 Globalisation, Societies and Education, 121–141,

at 135.

5

Hays, Federal Government and Urban Housing, above, n. 1, at 1.

6

See P.A.Hall, ‘Policy Paradigms, Social Learning, and the State: The Case of Economic Policymaking in Britain’(1993) 25 Comparative

Politics, 275–296, at 290.

7

Buse and Harmer, ‘Power to the Partners?’, above, n. 3, at 53.

8

Ibid.

BARTLETT 475