Understanding change in global health policy: Ideas, discourse and networks

Abstract

How is radical change in global health policy possible? Material factors such as economics or human resources are important, but ideational factors such as ideas and discourse play an important role as well. In this paper, I apply a theoretical framework to show how discourse made it possible for public and private actors to fundamentally change their way of working together – to shift from international public and private interactions to global health partnerships (GHPs) – and in the process create a new institutional mechanism for governing global health. Drawing on insights from constructivist analysis, I demonstrate how discourse justified, legitimised, communicated and coordinated ideas about the practice of GHPs through a concentrated network of partnership pioneers. As attention from health policy analysts turns increasingly to ideational explanations for answers to global health problems, this paper contributes to the debate by showing how, precisely, discourse makes change possible.

Keywords:

• Constructivism
• ideas
• discourse
• networks
• change
• partnerships

Acknowledgements

The author would like to thank the Wall Summer Institute for Research for funding the Retreat ‘What Difference does the Advent of Civil Society Mean to Global Health Governance?’ in London in 2007 where the ideas for this paper were first presented, and to participants at that Retreat for their comments.

Notes

1. Neither space nor probable audience render appropriate an extensive discussion of the differences between ideas, power and interest-based approaches within IR (but see Hasenclever et al. 1997). I acknowledge that there are different sub-types of Constructivism, ranging from rationalist to reflectivist variants (Wendt 2000, Christiansen et al. 2001), which are often described as ‘thin’ or ‘thick’ variants in the literature – where thin constructivists give material forces more of a say in explaining the world than thick constructivists, for whom it is ‘ideas all the way down’. This paper falls within the ‘thin’ constructivist camp, and the empirical analysis and interpretive methodology reflect that bias. Constructivist analysis does not compete with Neo-Realist, Neo-Marxist or Liberal-institutionalist theory; indeed, as constructivists are at pains to point out, Constructivism is not a theory but more accurately described as an ‘approach’.