by Robert Ralston, Charlotte Godziewski and Lauren Carters-White
How can obesity policy move away from individual-centred blaming or nudging and meaningfully address the political-economic root causes of poor diets? For many health inequalities researchers, policy instruments that regulate industry are seen as a promising way to target those root causes. More than a simple tweak, such policy instruments are implicitly expected to finally move public health policy away from a focus on individual responsibility characteristic of neoliberal governance. But is a change in policy instrument – even a substantive one – capable of sparking change in the underlying policy paradigm? Does proposing structure-targeting instruments (eg. industry regulation) necessarily mean that policymakers now think differently about the policy issue? This is the puzzle we explore in our article recently published in Policy & Politics entitled The many meanings of policy instruments: exploring individual and structural determinants in obesity policy. Our research focuses on the case of the UK’s 2020 Tackling Obesity Strategy. This strategy has been welcomed precisely because it proposes ‘harder’ regulation of commercial actors. While this may sound promising to many, we argue that the Tackling Obesity Strategy unfortunately lacks the radical change of past strategies.
To understand how the Obesity Strategy fails to challenge the underlying neoliberal policy health paradigm, we analyse the discursive construction of instruments in the policy document. This reveals that, while many instruments proposed are substantively targeted at what public health researchers would refer to as upstream factors (such as industry regulation), the discourse within which these instruments are embedded is still very much one of individual responsibility (understood as downstream factors). The strategy’s instruments regulating industry are discursively constructed as tools for individual self-control, and a way to improve the ‘choice architecture’ for consumers. While the strategy demonstrates a political commitment to implementing policy instruments targeted at regulating industry practices, the discourses mobilised to represent the problem and solutions turn the structural into the individual, the upstream into the downstream. Consequently, we argue that the strategy reasserts what is deemed modifiable and what is not, selectively emphasising individualised responsibility and minimising the active role of markets and the commercial sector.
The main finding of our article is that policy instruments can be discursively constituted to fit a dominant policy paradigm, even if they seem initially incompatible with it. In our empirical case, policy instruments that target structural (‘upstream’) determinants of health end up reinforcing the neoliberal paradigm focused on individual responsibility. We call this phenomenon ‘upstream individualism’. The implications of our findings are twofold: (1) building on the growing literature on ‘instrument constituency’, they stress the importance of studying the relationship between instruments and paradigms from an interpretivist perspective. (2) they help explain the resilience of neoliberalism in public health policy. Upstream individualism offers insights into why advocating for upstream instruments without engaging with discursive power and policy paradigms, fails to bring about meaningful change. This points to tensions in the research-policy relationship, particularly the limits of depoliticised approaches to advocating for policy change.
In summary, our research demonstrates how instruments designed to target structural determinants of health (such as food advertisement regulation) can actively sustain – rather than challenge, the dominant policy paradigm. Our concept of ‘upstream individualism’ helps explain this phenomenon. It sheds light on the durability of policy paradigms in instances where new instruments are adopted that appear to cut against an existing paradigm. We argue that this concept has relevance beyond health policy, providing a basis for theorising the stickiness of paradigms, the role of discourse, and how governments can find ways of discursively manipulating instruments so that they fit the goals of an existing paradigm.
You can read the original research in Policy & Politics:
Ralston, R., Godziewski, C., & Carters-White, L. (2023). The many meanings of policy instruments: exploring individual and structural determinants in obesity policy, Policy & Politics, 51(2), 295-313 from https://doi.org/10.1332/030557321X16762984942169
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If you enjoyed this blog post, you may also be interested to read:
Bates, G., Ayres, S., Barnfield, A., & Larkin, C. (2023). What types of health evidence persuade policy actors in a complex system?, Policy & Politics (published online ahead of print 2023). [OPEN ACCESS] from https://doi.org/10.1332/030557321X16814103714008
Hill O’Connor, C., Smith, K., & Stewart, E. (2023). Integrating evidence and public engagement in policy work: an empirical examination of three UK policy organisations, Policy & Politics, 51(2), 271-294 from https://doi.org/10.1332/030557321X16698031794569
Heinmiller, B. T. (2023). Advocacy coalitions, power and policy change, Policy & Politics, 51(1), 28-46 [OPEN ACCESS] from https://doi.org/10.1332/030557321X16569341758199
