Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, UK; SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK.
Soc Sci Med. 2021 Nov;289:114451. doi: 10.1016/j.socscimed.2021.114451. Epub 2021 Sep 30.
Collaboration between governments and non-state actors has emerged as the dominant mode of policy making to address a wide range of public and global health issues, particularly via public-private partnerships and multi-stakeholder platforms. Despite its paradigmatic status in contemporary health governance, political claims and promises of partnership approaches as more effective than state regulation have received limited attention. This study addresses this gap by tracing negotiations over a calorie reduction 'pledge' within the Public Health Responsibility Deal: a public-private partnership between the UK Department of Health, food industry and civil society organisations focusing on obesity policy. It demonstrates how political claims-making by the Department of Health that a public-private partnership as an effective substitute for legislation, contrasted with protracted and conflictual negotiations with food industry business associations. Employing Erving Goffman's distinction between frontstage and backstage interaction and the concept of informal governance, this study traces a shift to informal back stage governance as a mechanism to cope with acute tensions between economic interests and nutrition policy goals. The study illustrates how this shift to the back stage had substantive public health implications, privileging commercial sector perspectives and marginalising civil society participation. Informalization served to reframe calorie reduction from industry-focused to personal responsibility for lifestyle behaviours, in the process reducing its effectiveness. The results suggest that, while partnership and multi-stakeholder approaches are widely promoted as a legitimate tool in health governance, visible tensions between commercial sector and public health interests challenge political claims about public-private collaboration as consensus-oriented and effective. Informal governance, when used as a coping mechanism to manage tensions public health and commercial sector interests, may be symptomatic of wider dysfunctions and conflicts of interest in partnership approaches. This suggests that there may be limited scope for effective policy innovations where commercial sector actors perceive core interests as threatened.
政府与非国家行为体之间的合作已成为解决广泛的公共和全球卫生问题的主导政策制定模式，特别是通过公私伙伴关系和多方利益攸关方平台。尽管这种伙伴关系方法在当代卫生治理中具有典范地位，但将其作为比国家监管更有效的政治主张和承诺却没有得到多少关注。本研究通过追溯英国卫生部、食品行业和民间社会组织之间的公私伙伴关系——公共卫生责任交易（Public Health Responsibility Deal）中关于减少卡路里的“承诺”的谈判来解决这一差距，该交易主要关注肥胖政策。研究表明，卫生部的政治主张是，公私伙伴关系是立法的有效替代品，而与食品行业商业协会的旷日持久和充满冲突的谈判形成鲜明对比。本研究运用欧文·戈夫曼（Erving Goffman）关于前台和后台互动的区别以及非正式治理的概念，追溯了向非正式后台治理的转变，这是一种应对经济利益和营养政策目标之间的紧张关系的机制。研究表明，这种向后台的转变对公共卫生产生了实质性影响，使商业部门的观点占据了优势，使民间社会的参与边缘化。非形式化将卡路里的减少从以行业为重点重新定义为对生活方式行为的个人责任，从而降低了其效力。研究结果表明，虽然伙伴关系和多方利益攸关方方法被广泛推广为卫生治理的合法工具，但商业部门和公共卫生利益之间明显的紧张关系挑战了关于公私合作以共识为导向和有效的政治主张。当非正式治理被用作管理公共卫生和商业部门利益之间紧张关系的应对机制时，它可能是伙伴关系方法中更广泛的功能障碍和利益冲突的症状。这表明，在商业部门参与者认为核心利益受到威胁的情况下，可能没有有效的政策创新的空间。
