The many meanings of policy instruments: exploring individual and structural determinants in obesity policy
Health inequalities researchers have long advocated for governments to adopt policy instruments that address structural determinants of health rather than targeting individual behaviours. The assumption behind this position is that such instruments might challenge a core neoliberal principle of individualism embedded in the prevailing health policy paradigm. We critique this assumption by highlighting the discursive construction of policy instruments, and their discursive effects. Using the UK’s Tackling Obesity policy as a case study, we demonstrate how instruments designed to target structural determinants of health (such as food advertisement regulation) can actively sustain – rather than challenge, the dominant policy paradigm. We call this phenomenon ‘upstream individualism’, exploring how it relates to tensions in the research-policy relationship, and its relevance beyond health policy. We argue that instruments can shape policy change and continuity, including at a paradigm level, and that ‘upstream individualism’ provides a useful basis for theorising these power dynamics. This article contributes to the constructivist public policy literature by noting how policy instruments meant to challenge the discursive construction of individualism within public health can ultimately reinforce it.
-
Alvaro, C., Jackson, L.A., Kirk, S., McHugh, T.L., Hughes, J., Chircop, A. and Lyons, R.F. (2011) Moving Canadian governmental policies beyond a focus on individual lifestyle: some insights from complexity and critical theories, Health Promotion International, 26(1): 91–99. doi: 10.1093/heapro/daq052
-
Bacchi, C. (2000) Policy as discourse: what does it mean? Where does it get us?, Discourse, 21(1): 45–57.
-
Bacchi, C. (2005) Discourse, discourse everywhere: subject ‘agency’ in feminist discourse methodology, NORA – Nordic Journal of Feminist and Gender Research, 13(3): 198–209.
-
Bali, A. and Halpin, D. (2021) Agenda-setting instruments: means and strategies for the management of policy demands, Policy and Society, 40(3): 333–44. doi: 10.1080/14494035.2021.1955489
-
Bali, A.S., Howlett, M., Lewis, J.M. and Ramesh, M. (2021) Procedural policy tools in theory and practice, Policy and Society, 40(3): 295–311. doi: 10.1080/14494035.2021.1965379
-
Baum, F. (2011) From Norm to Eric: avoiding lifestyle drift in Australian health policy, Australian and New Zealand Journal of Public Health, 35(5): 404–6. doi: 10.1111/j.1753-6405.2011.00756.x
-
Baum, F. and Fisher, M. (2014) Why behavioural health promotion endures despite its failure to reduce health inequities, Sociology of Health & Illness, 36(2): 213–25. doi: 10.1111/1467-9566.12112
-
Bell, K. and Green, J. (2016) On the perils of invoking neoliberalism in public health critique, Critical Public Health, 26(3): 239–43. doi: 10.1080/09581596.2016.1144872
-
Béland, D., Howlett, M. and Mukherjee, I. (2018) Instrument constituencies and public policy-making: an introduction, Policy and Society, 37(1): 1–13.
-
Berman, E.P. (2022) Thinking like an Economist: How Efficiency Replaced Equality in U.S. Public Policy Princeton, Princeton, NJ: Princeton University Press.
-
Bevir, M. and Rhodes, R.A.W. (2003) Interpreting British Governance, London: Routledge.
-
Blyth, M. (2013) Paradigms and paradox: the politics of economic ideas in two moments of crisis, Governance, 26(2): 197–215. doi: 10.1111/gove.12010
-
Boswell, J. (2016) The Real War on Obesity: Contesting Knowledge and Meaning in a Public Health Crisis, London: Palgrave Macmillan.
-
Cairney, P., St Denny, E. and Mitchell, H. (2021) The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies, Open Research Europe, https://open-research-europe.ec.europa.eu/articles/1-23.
-
Cairney, P., Keating, M., Kippin, S. and Denny, E.S. (2022) Public Policy to Reduce Inequalities across Europe: Hope Versus Reality, New York and Oxford: Oxford University Press.
-
Cancer Research UK (2020) New obesity strategy is a ‘landmark day for the nation’s health’ and our ambition to beat cancer, https://news.cancerresearchuk.org/2020/07/27/new-obesity-strategy-is-a-landmark-day-for-the-nations-health-and-our-ambition-to-beat-cancer/.
-
Capano, G. and Howlett, M. (2020) The knowns and unknowns of policy instrument analysis: policy tools and the current research agenda on policy mixes, SAGE Open, 10(1): 1–13. doi: 10.1177/2158244019900568
-
Carey, G., Malbon, E., Crammond, B., Pescud, M. and Baker, P. (2017) Can the sociology of social problems help us to understand and manage ‘lifestyle drift’?, Health Promotion International, 32(4): 755–61. doi: 10.1093/heapro/dav116
-
Carters-White, L., Chambers, S., Skivington, K. and Hilton, S. (2021) Whose rights deserve protection? Framing analysis of responses to the 2016 Committee of Advertising Practice consultation on the non-broadcast advertising of foods and soft drinks to children, Food Policy, 104: 102139. doi: 10.1016/j.foodpol.2021.102139
-
Collin, J. and Hill, S. (2015) Industrial epidemics and inequalities: the commercial sector as a structural driver of inequalities in non-communicable diseases, in K.E. Smith, C. Bambra and S.E. Hill (eds) Health Inequalities: Critical Perspectives, Oxford: Oxford University Press.
-
Crosbie, E., Thomson, G., Freeman, B. and Bialous, S. (2018) Advancing progressive health policy to reduce NCDs amidst international commercial opposition: tobacco standardised packaging in Australia, Global Public Health, 13(12): 1753–66. doi: 10.1080/17441692.2018.1443485
-
Crouch, C. (2011) The Strange Non-death of Neoliberalism, Cambridge: Polity Press.
-
Dekker, R. (2017) Frame ambiguity in policy controversies: critical frame analysis of migrant integration policies in Antwerp and Rotterdam, Critical Policy Studies, 11(2): 127–45. doi: 10.1080/19460171.2016.1147365
-
Department of Health and Social Care (2020) Tackling Obesity: Empowering Adults and Children to Live Healthier Lives, London: The Stationery Office.
-
Dunlop, C.A., Kamkhaji, J., Radaelli, C.M., Taffoni, G. and Wagemann, C. (2020) Does consultation count for corruption? The causal relations in the EU-28, Journal of European Public Policy, 27(11): 1718–41. doi: 10.1080/13501763.2020.1784984
-
Entman, R.M. (1993) Framing: toward clarification of a fractured paradigm, Journal of Communication, 43(4): 51–58. doi: 10.1111/j.1460-2466.1993.tb01304.x
-
Foli, R., Béland, D. and Fenwick, T.B. (2018) How instrument constituencies shape policy transfer: a case study from Ghana, Policy and Society, 37(1): 108–24. doi: 10.1080/14494035.2017.1377987
-
Freudenberg, N., Lee, K., Buse, K. and Collin, J. (2021) Defining priorities for action and research on the commercial determinants of health: a conceptual review, American Journal of Public Health, 111(12): 2202–2211. doi: 10.2105/AJPH.2021.306491
-
Gane, N. (2021) Nudge economics as libertarian paternalism, Theory, Culture & Society, 8(6): 119–42. doi: 10.1177/0263276421999447
-
Godziewski, C. (2022) The Politics of Health Promotion in the European Union, London: Palgrave Macmillan.
-
Hajer, M.A. (2009) Authoritative Governance: Policy Making in the Age of Mediatization, Oxford: Oxford University Press.
-
Hajer, M. and Laws, D. (2006) Ordering through discourse, in M. Moran, M. Rein and R.E. Goodin (eds) The Oxford Handbook of Public Policy, Oxford: Oxford University Press, pp 249–66.
-
Hall, P. (1993) Policy paradigms, social learning, and the state: the case of economic policymaking in Britain, Comparative Politics, 25(3): 275–96. doi: 10.2307/422246
-
HM Government (2010) Healthy Lives, Healthy People: Our Strategy for Public Health in England, London: The Stationery Office.
-
Hood, C. and Margetts, H.Z. (2007) The Tools of Government in the Digital Age, Basingstoke: Palgrave Macmillan.
-
Howlett, M. (2000) Managing the ‘hollow state’: procedural policy instruments and modern governance, Canadian Public Administration, 43(4): 412–31. doi: 10.1111/j.1754-7121.2000.tb01152.x
-
Hulst, M.van and Yanow, D. (2014) From policy ‘frames’ to ‘framing’: theorizing a more dynamic, political approach, The American Review of Public Administration, 46(1): 92–112.
-
Jones, R., Pykett, J. and Whitehead, M. (2013) Changing Behaviours: On the Rise of the Psychological State, Cheltenham: Edward Elgar.
-
Katikireddi, S.V., Higgins, M., Smith, K.E. and Williams, G. (2013) Health inequalities: the need to move beyond bad behaviours, Journal of Epidemiology and Community Health, 67(9): 715–16. doi: 10.1136/jech-2012-202064
-
Krieger, N. (2008) Proximal, distal, and the politics of causation: what’s level got to do with it?, American Journal of Public Health, 98(2): 221–30. doi: 10.2105/AJPH.2007.111278
-
Lascoumes, P. and Le Galès, P. (2007) Introduction: understanding public policy through its instruments – from the nature of instruments to the sociology of public policy instrumentation, Governance, 20(1): 1–21. doi: 10.1111/j.1468-0491.2007.00342.x
-
Laws, D. and Rein, M. (2003) Reframing practice, in M. Hajer and H. Wagenaar (eds) Deliberative Policy Analysis: Understanding Governance in the Network Society, Cambridge: Cambridge University Press.
-
Leggett, W. (2014) The politics of behaviour change: nudge, neoliberalism and the state, Policy & Politics, 42(1): 3–19.
-
Li, Y. and Wagenaar, H. (2019) Revisiting deliberative policy analysis, Policy Studies, 40(5): 427–36. doi: 10.1080/01442872.2019.1618813
-
Lynch, J. (2017) Reframing inequality? The health inequalities turn as a dangerous frame shift, Journal of Public Health, 39(4): 653–60.
-
Lynch, J. (2020) Regimes of Inequality: The Political Economy of Health and Wealth, Cambridge: Cambridge University Press.
-
McKee, M. and Stuckler, D. (2018) Revisiting the corporate and commercial determinants of health, American Journal of Public Health, 108(9): 1167–70. doi: 10.2105/AJPH.2018.304510
-
McMahon, J. (2015) Behavioral economics as neoliberalism: producing and governing homo economicus, Contemporary Political Theory, 14(2): 137–58. doi: 10.1057/cpt.2014.14
-
Mukherjee, I. (2021) Rethinking the procedural in policy instrument ‘compounds’: a renewable energy policy perspective, Policy and Society, 40(3): 312–32. doi: 10.1080/14494035.2021.1955488
-
Mykhalovskiy, E., Frohlich, K.L., Poland, B., Di Ruggiero, E., Rock, M.J. and Comer, L. (2019) Critical social science with public health: agonism, critique and engagement, Critical Public Health, 29(5): 522–33. doi: 10.1080/09581596.2018.1474174
-
Obesity Health Alliance (2020) OHA response to government’s new obesity strategy, http://obesityhealthalliance.org.uk/2020/08/07/statement-uk-governments-new-obesity-strategy-27-july-2020/.
-
Parkhurst, J.O. and Abeysinghe, S. (2016) What constitutes ‘good’ evidence for public health and social policy-making? From hierarchies to appropriateness, Social Epistemology, 30(5–6): 665–79. doi: 10.1080/02691728.2016.1172365
-
Rein, M. and Schön, D. (1996) Frame-critical policy analysis and frame-reflective policy practice, Knowledge and Policy, 9(1): 85–104. doi: 10.1007/BF02832235
-
Rein, M. and Schön, D. (1977) Problem setting in policy research, in C.H. Weiss (ed) Using Social Research in Public Policy Making, Lanham, MD: Lexington Books.
-
Schmidt, V.A. (2011) Speaking of change: why discourse is key to the dynamics of policy transformation, Critical Policy Studies, 5(2): 106–26. doi: 10.1080/19460171.2011.576520
-
Schmidt, V.A. (2016) The roots of neo-liberal resilience: explaining continuity and change in background ideas in Europe’s political economy, The British Journal of Politics and International Relations, 18(2): 318–34. doi: 10.1177/1369148115612792
-
Schön, D. and Rein, M. (1977) Problem setting in policy research, in C.H. Weiss (ed) Using Social Research in Public Policy Making, Lexington, MA: Lexington Books.
-
Schön, D.A. and Rein, M. (1994) Frame Reflection: Toward the Resolution of Intractrable Policy Controversies, New York: Basic Books.
-
Scott-Samuel, A. and Smith, K.E. (2015) Fantasy paradigms of health inequalities: Utopian thinking?, Social Theory & Health, 13(3–4): 418–36.
-
Shaw, S.E. (2010) Reaching the parts that other theories and methods can’t reach: How and why a policy-as-discourse approach can inform health-related policy, Health, 14(2): 196–212. doi: 10.1177/1363459309353295
-
Smith, K. (2012) Fools, facilitators and flexians: academic identities in marketised environments, Higher Education Quarterly, 66(2): 155–73. doi: 10.1111/j.1468-2273.2012.00513.x
-
Smith, K. (2013) Beyond Evidence Based Policy in Public Health: The Interplay of Ideas, Basingstoke: Palgrave Macmillan.
-
Stone, D.A. (1989) Causal stories and the formation of policy agendas, Political Science Quarterly, 104(2): 281–300. doi: 10.2307/2151585
-
Sunstein, C.R. and Thaler, R.H. (2009) Nudge: Improving Decisions About Health, Wealth and Happiness, London: Penguin.
-
Theis, D.R.Z. and White, M. (2021) Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992–2020, The Milbank Quarterly, 99(1): 126–70. doi: 10.1111/1468-0009.12498
-
Voß, J.P. and Simons, A. (2014) Instrument constituencies and the supply side of policy innovation: the social life of emissions trading, Environmental Politics, 23(5): 735–54.
-
Wagenaar, H. (2011) Meaning in Action: Interpretation and Dialogue in Policy Analysis, New York: Routledge.
-
Whitehead, M. and Popay, J. (2010) Swimming upstream? Taking action on the social determinants of health inequalities, Social Science & Medicine, 71(7): 1234–36.
-
Williams, O. and Fullagar, S. (2019) Lifestyle drift and the phenomenon of ‘citizen shift’ in contemporary UK health policy, Sociology of Health & Illness, 41(1): 20–35. doi: 10.1111/1467-9566.12783
-
Woll, C. (2008) Firm Interests: How Governments Shape Business Lobbying on Global Trade, Ithaca, NY: Cornell University Press.
-
Wood, M. (2015) Puzzling and powering in policy paradigm shifts: politicization, depoliticization and social learning, Critical Policy Studies, 9(1): 2–21. doi: 10.1080/19460171.2014.926825
-
Yanow, D. (1996) How Does a Policy Mean?: Interpreting Policy and Organizational Actions, Washington, DC: Georgetown University Press.
-
Yanow, D. (2003) Constructing Race and Ethnicity in America, London: Routledge.
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