Policy Actors

Question 1

What distinguishes government and the state from other actors?

Answer 1

Sovereignty
– the state is unique in being entitled to exercise power over all other sub-systems and all citizens
- i.e.thestatehasalegitimatemonopolyof power (Max Weber)

• The three main ‘pillars’ of the state • Legislature (parliament)
• Executive (ministers or president)
• Judiciary

Question 2

The role of the government

Answer 2

• Usually the most powerful policy actor in a country
• Central to much health policy, though its direct role varies between
countries
• It can and often does:
– set objectives, priorities
– raise finance
– allocate resources
– license practitioners
– deliver health care services
– regulate providers & insurers, set standards & prices
– assure the public’s health (e.g. legislate for clean water & air,
smoking bans)

Question 3

Interest group

Answer 3

• Promote or represent a particular part of society
• Governments are surrounded by a vast range of interest groups covering market and civil society actors
– e.g. of health professionals, hospitals, insurers, suppliers (drugs, equipment, etc.), patients, public
• They aggregate and organise themselves formally and informally into networks

Question 4

Groups

Answer 4

• Target groups
– those whose behaviour is required to change directly
• Beneficiary groups
– those who stand to gain if policy is properly implemented
– usually more numerous, but less easy to organise than target groups
• Third party groups
– those who are indirectly positively or negatively affected

Question 5

The power of the private sector

Answer 5

• Huge resources
– 37 of the top 100 ‘economies’ in the world are corporations, mostly oil companies & banks
– top 10 pharmaceutical companies’ stock market value is greater than gross national income of >50 LICs
– global reach of major companies – large knowledge bases
– pay lobbyists in many countries
• Major contributors to national economies – taxes
– employment

Question 6

Strategies of interest and civil society groups

Answer 6

Insider groups:
• regarded as legitimate by public policy makers
• consultedonregularbasis
• expectedtoadheretothe‘rulesofthegame’ Outsider groups:
• rejectcloseconsultationwithofficials,or
• unabletogainsuchrecognition
Thresholder groups: shift between two positions

Question 7

Regulating TNC: Confrontational strategies:

Answer 7

Consumer boycotts - publicise misconduct & focus high levels of public involvement (Shell in Nigeria)
Public relations wars - attack claims made by companies, require company to defend itself
TNC monitors - organisations devoted to surveillance (Corporate Watch, Multinationals Resource Centre)
Shareholder activism – buy a few shares to access AGM, encourage disinvestment by institutions
Demonstrations and occupations

Question 8

Summary

Answer 8

• The health policy arena is increasingly crowded with more civil society and private actors interacting with more state & international bodies to shape policy
• Policy ‘networks’ are one way of looking at this since most activities are shaped by networks of actors
• Private sector actors are particularly powerful and increasingly globalised
• Civil society actors are prominent and show increasing signs of developing at the global level
• Private not necessarily always ‘bad’ (for public health)
• Civil society not necessarily always ‘good’ (for public health)