The Local Health Communication Environment, Domestic
Policy and
International Influences: An Institutional Analytical
Framework
by
Tamara
A. Trownsell
School of International
Service
American University
Washington, DC
Prepared for the
43rd Annual
Meeting of the
Dissolving Boundaries:
The Nexus Between
Comparative Politics And International Relations
Panel:
New Orleans, LA
March 24-27, 2002
DRAFT: Please do not cite.
Questions
and comments are welcome.
Ø Introduction 2
Ø Institutional Analysis and
Health Communication 3
Ø
The Role of Policy 5
Ø
The Three New
Institutionalisms 6
Ø
Institutional Analysis and
Policy 12
§
The regulatory cycle 15
§
Widening the temporal scope 17
Ø
Synthesis 20
Ø
Bibliography 24
Much has been learned about how to plan and
implement successful communication for development; what remains to be
accomplished is that policymakers recognize its importance and provide the
relatively modest resources necessary for it to be the catalyst without which
other development inputs are often wasted.
- Fraser and Restrepo-Estrada[1]
Health
communication is a sub-field of both communication for development and of
public health. Practitioners working in
this field are extremely aware of the environmental, or institutional, factors
that preclude them from being as effective as they wish. At any point along the range of health
communication positions – from working in the communications division at the
headquarters of an international health project to working in a village that
sits three hours by horse from any road – practitioners are challenged daily in
trying to access appropriate information for a given situation or for fostering
better two-way flow of communications between the field and headquarters.
Although enough basic public health knowledge has
been accumulated to decrease infant mortality rates and to increase overall
well-being globally, obstacles prevent this information from getting to “the
last mile.”[2] These obstacles delimit the local health
communication environment. In light of
this challenge, health communication practitioners create communication
strategies to mitigate the negative effects of the variety of obstacles as
effectively as possible. In fact, a
preliminary step to strategy generation is to conduct “reconnaissance” work on
the local communication environment by taking an inventory of the various
factors that affect the potential for reaching the “last mile.” One factor that is often overlooked in these
analyses is the role of policy in shaping the local health communication
environment, primarily because it lies beyond the immediate scope of the health
communication practitioner’s tasks.
This paper argues that more attention should be
given to policy during this inventory stage, as well as on a consistent basis,
due to its significant impact on the local health communication
environment. While the local health
communication environment represents one particular set of institutions within
the global institutional landscape, the institutional environment in which
domestic policy evolves is characterized by a different constellation of
pertinent institutions. Both
institutional ‘sets’ need to be appraised, since the formal and informal
institutions comprising the institutional environment surrounding policy impact
policy outcomes, which in turn affect the extent to which the communication
environment is facilitative or restrictive.
In short, it is within this arena that the practitioner can gauge the
viability of certain strategies as well as determine spaces for action.
The method most likely to contribute to a fuller
understanding of these institutional ‘environments’ would be a combination of
the strains of new institutionalisms: historical institutionalism, sociological
institutionalism (stemming from organization theory), and rational choice
institutionalism. In this paper, the
characteristics of each institutionalism are elaborated after an explanation of
the importance of conducting institutional analyses for health communication as
well as the role of policy therein. Next, the paper discusses the ways in which the various strains
apply to different aspects of the institutional analysis. Where historical institutionalism provides
insight into macrostructural patterns and the given trajectories of
institutions, sociological institutionalism sheds light on the informal
institutions that play a role in the policymaking process. Rational choice institutionalism examines
the impact of institutions on preference ordering at this microfoundational
level.
These contributions are developed through the
elaboration of the phases of the regulatory process and the wider institutional
setting. The scope is widened spatially
to investigate the relevant constellation of institutions that have an impact
on the development of policy and temporally to reveal the past influence of
actors as well as the relevance of path dependency and institutional inertia
for strategy generation. The paper ends
with a prototypical genealogy of the typically mandated daily hour of health
and education television programs post-liberalization and privatization in
condition-bound countries to illustrate how policy plays a key role in the
local health communication environment.[3]
Institutional Analysis and
Health Communication
The
overall purpose of health communication is to facilitate information flows to
and from marginalized populations to enhance overall quality of life and
self-determination. One category of
flows pertaining to this overall goal ensures that health care providers have
access to information that will improve their capacity to provide care at the
local level. In this case, these flows
can include shared information for epidemiological surveillance purposes, for
coordinating public health campaigns or other collaborative projects, for
general research by health professionals, and for improving information
databases at medical schools in developing countries. Another type of health communication is one that has arisen with
the outgrowth of development projects since the 1950s. This very specific genre of health
communication involves the coordination of the health project itself – from
gathering input from the field regarding perceived needs and providing
headquarters with preliminary appraisals to the dissemination of project results. A final type of flow is that of basic public
health messages containing pertinent health content in an appropriate format
for specific populations.
In all three cases, the communication infrastructure
and other structural factors directly impact the ease with which these messages
flow among stakeholders and indirectly shape capacity to improve health status
in the long term. These same conditions
are facilitated or hindered by the efforts of health communication
practitioners, budget setters, and policymakers, whose options are constrained
or expanded based on the structures within which they operate. While this analytical framework should serve
as a reminder to those setting the budget and to policymakers of the
consequences of their choices on the public sphere, this paper is geared toward
practitioners that wish to appraise their environment before generating
communication strategies.
As a result, this paper aims to provide an overview
of resources necessary for building a contextually appropriate analytical
framework, such that the results from the analysis afford practitioners both a
thorough assessment of their particular context and insight into areas of
influence. Simply, surveying the
institutional environment increases awareness of the terrain in which one
operates. This heightened understanding of the ways in which various
institutions interact in the local
context could translate into improved maneuverability and therefore
increase chances of project success. In addition, conducting such an analysis
might ultimately result in innovative approaches that would not have otherwise
occurred to the practitioner. In
general though, one will hopefully be able to trouble-shoot preventively, avoid
dead ends, or at least be prepared for future challenges. For example, one might be better able to pinpoint problems and bottlenecks relevant
when proposing a budget.[4] In any case, the primary concern remains
finding means to increase relevant information access and voice for “the last
mile.”
Keeping this objective in
mind may lead the practitioner, as a result of this analysis, to take on a more
activist stance towards those factors shaping the local communication
environment. Conveniently, this type of
institutional analysis can expose those strategic areas with the greatest
chance of being influenced. In fact, one might say that
the communication practitioner has a responsibility to carry out such an
analysis, since having affordable means for disseminating and retrieving
health-related material is essential for realizing the objectives of health
communication. Ignoring the various
institutional developments and accompanying spaces for action can mean losing
an opportunity to make a crucial difference in the future trajectory of the
local communication environment.
In addition, conducting such an analysis at the
local level is part of a larger project, which consists of gathering such
analyses systematically so that the various institutional settings in which
these communication strategies are operationalized may be compared.[5] The objective is to discern patterns and
similarities in the institutional constellations that elicit certain effects
for their comparison across contexts.
While this particular objective does challenge the sanctity of historical
particularity assumed within the historical institutionalist tradition,
systematizing the lessons learned could potentially help avoid recommitting
similar errors in other contexts. All
of these goals – appraisal for strategy implementation, identification of
spaces for agency, and eventual systematic comparability among analyses –
should feed into the overall purpose of facilitating the physical, social and
psychological well-being of all members in society.[6] Consequently, it should remain at the forefront
of any analysis and subsequent strategy.
The following discussion
constitutes the groundwork for tailoring appropriate analytical frameworks to a
given context and situation when health communication practitioners endeavor to
generate informed communication strategies. It seeks to bring to light both direct and indirect institutional
effects that impact the effectiveness of public health efforts and to stress
the importance of considering macro-level issues when appraising a context for
the overall success of health communication strategies. To make this step, the methodological framework
pulls from three strains of new institutionalism in an attempt to reveal areas
of complementarity and to overcome the shortcomings of using only one approach for
a more nuanced policy analysis. In sum,
conducting such an analysis calls attention to the role of policy as an
institution in the shaping of the local communication environment, to the
impact of external institutions on this policy, and then to the policy’s
effects on the capacity of public interest groups to carry out public
service-oriented communication projects.
The Role of Policy
Many students of public health understand the
importance of and encourage further study in the communications arena. Most advocate ensuring health information
access for all to the benefit of the whole society.[7] Some look at health communication as a
concept requiring intersectoral collaboration in community public health
programs.[8] Others perform a more abstract analysis of
the role of communication in health promotion.[9] Still others advocate health information
networks that focus more on interaction among health professionals to bring
about greater effectiveness, creativity, and sustainability of health efforts.[10]
Those works that do focus on policy concentrate primarily on policies arising
out of the health sector, but the structure of the society’s communication
system (as determined by implemented communication policies) is not explicitly
examined. The structure with which one
has to work in public health campaigns is assumed as a ‘given,’ without any
role for health professionals or otherwise to be involved in how it develops.[11]
While the main obstacles
to including communication policy in the pre-strategy appraisal process are
time and resources, not paying attention to policy can have deleterious
consequences, such as contributing to poor planning and unrealistic
expectations by not being aware of policy developments that inadvertently
affect project plans or by missing opportunities to influence the direction of
policies relevant to one’s work.
This paper argues that when health communication
practitioners are looking to generate communication strategies for human health
and development, they must look at the very things that determine the
parameters within which they operate.
Policy sets these parameters, policy implementation determines whether
the parameters will be valid, and regulation enforces them. For example, the breadth and density of the
infrastructure itself as well as the cost to access it (either to receive or to
disseminate information) depend, either directly or indirectly, on policy. In
short, policy constitutes the means through which actors find space to maneuver
(or not) in a system – in this case, in the local health communication
environment. It follows then
that these parameters play a fundamental role in the extent to which either
public services, such as the provision of public health information, reach
marginalized groups in society or citizens have the opportunity to participate
in political deliberations.
In this paper, policy is understood as the complex
of laws and regulations that have an impact on the on the local communication
environment, be it a direct and obvious link or one much more indirect in
nature. Of primary importance to health
communication are three areas of domestic policy. First, the Constitution portrays how the member of society is
conceptualized, be it as citizens or consumers, through expressed rights and
responsibilities. It also reveals how the State conceives of economic
development. Next, the analyst would
look at health policy, and in particular, the rights accorded to the individual
and specific clauses dealing with communication. Finally, since communication conduits include the whole spectrum
of information and communication technologies, relevant communication policies
are those clauses that cover public services, such as universal service
obligations as well as obligatory public health education broadcast hours,
since these are the most important elements for ensuring a positive right to
information.
Examining this range of policy is important for
several reasons. One reason is to
determine the variety of conceptualizations of the individual in society as
they fit within the various spheres of the state domain. Another is to discern those policies (latent
institutions) that were never implemented but that might be “resuscitated” and
called upon when making a claim for accountability. Pointing out contradictory policies can be a source of leverage
for contention as well. Disjunctures in
policy are not uncommon however given the disconnect among government agencies
and the various actors that influence the policy of certain sectors.[12] Yet, these very contradictions give actors
the opportunity to call attention to unfulfilled promises.
Employing the following analytical framework will
allow one to better evaluate which policies should be emphasized to be
fulfilled or changed based on the structural environment in which they would
have to be engaged. For example, the
state might be held more accountable to international finance institutions
(IFIs) with regards to certain policies and not others. Those policies that stand in contradiction
to the policies supported (or even written) by these IFIs will most likely not
be emphasized to ensure a continued flow of funds. Or, over time and through a series of policy implementations, the
state might no longer be able to regulate the original latent policy, which
would mean that it would be useless to concentrate on realizing the potential
of that particular policy.
Alternatively, economic crisis and structural adjustments might make
realizing certain public service policies impossible due to insufficient state
funds.
Discerning the possible is the first step, and
conducting an institutional analysis is an effective means for doing so. Truthfully, this type of analysis cannot
avoid a normative bent. It assumes that
health communication practitioners feel a sense of responsibility in their jobs
to facilitate the flow of information as much as possible to the point where
they would be willing to seek voice to influence the outcomes of certain
policies that in the long-run would truncate the reach of their efforts. Otherwise, there is no purpose in seeking to
understand the environment in which one has to work beyond that which serves
self-interest, in which case such an analysis would be burdensome at best.
The Three New
Institutionalisms
As
we have argued earlier, analysis of the local communication environment
involves examining the institutions that directly or indirectly impact the
environment. The institutional
framework that follows includes various features of historical institutionalism
(HI), sociological institutionalism (SI) and rational choice institutionalism
(RCI) at varying points of the process.
This section first articulates the common base of
these “new institutionalisms.” Then,
these features of each strain with the greatest potential for synergy as they
apply to relevant dimensions of policy are elaborated. After delineating these features, each phase
of the policy cycle is elaborated in light of the analytical framework. That section ends with an illustration of
how institutions affect the creation of policy and the impact of policy
implementation on the local health communication environment.
Common
ground
Scholars
have recently endeavored to compare and contrast the various “new
institutionalisms” that have sprung forth in distinct disciplines as an
alternative to and critique of behavioralism in the search for analytical
complementarity.[13] Dividing the new institutionalisms into
three groups – historical institutionalism, rational choice institutionalism,
and sociological institutionalism – Hall and Taylor lay out a general matrix of
the differences and similarities, which are spelled out by levels of analysis,
distinctive features, strengths, weaknesses, and respective lineages. Immergut, in contrast, seeks to discern the
theoretical core that is common to all three institutionalisms, which, she
concludes, is their common research agenda to “study of institutional effects
wherever, or however, they occur.”[14]
These scholars point out four other salient,
mutually shared characteristics. First,
their common reaction against behavioralism was inculcated by a shared
sentiment that political behavior does not necessarily reveal preferences, that
aggregating preferences is too simplistic and actually distorts the
representation of interests, and that institutions shape political behavior and
collective decision-making.[15] Immergut observes a second common quest: “All
are concerned with the difficulties of ascertaining what human actors want when
the preferences expressed in politics are so radically affected by the
institutional contexts in which these preferences are voiced.”[16] In a similar vein, Hall and Taylor indicate
that all three strains “seek to elucidate the role that institutions play in
the determination of social and political outcomes.”[17] Finally, Immergut explains that
institutionalists prefer to examine “the effects of rules and procedures for
aggregating individual wishes into collective decisions” over employing
individual psychology.[18] Beyond these similarities, new
institutionalists do not share a common definition for “institution,” common
research program, or methodology.[19] Nevertheless, through these differences,
Thelen has advocated finding creative combinations of the three strains “that
recognize and attempt to harness the strength of each approach.”[20]
RCI
emerged originally in the late 1970s from the study of American congressional
behavior. In “International
Institutions: Can Interdependence Work?” Keohane (1998) shows how rational
choice institutionalism evolved out of the realist critique that rational
choice could not explain the inputs into decision-making, including power and
norms. The level of analysis of RCI
remains the micro-foundations of big processes and the primary unit of
analysis, the transaction, in keeping with the rational choice tradition.
One distinctive feature of rational choice
institutionalism listed by Hall and Taylor is that relevant actors are assumed
to “have a fixed set of preferences or tastes,” “behave entirely
instrumentally,” and “do so in a highly strategic manner.”[21] Actors are also seen as engaging in
strategic, calculating interaction with others, which in turn determines
political outcomes.[22] However, since individuals act “to maximize
the attainment of their own preferences,” these political outcomes are likely
to be collectively sub-optimal.[23]
These features are heavily oriented to the actor,
which reminds us of the essential role that the actor plays in political
outcomes and subsequently in structural change. In light of this orientation, institutions are seen as the
“product of human design, outcomes of purposive action by instrumentally
oriented individuals.”[24] In fact, Martin and Simmons argue that
institutions are “both the object of strategic choice and a constraint on
behavior.”[25] They are “simultaneously causes and
effects.”[26] These two characteristics of institutions
are linked by “the ability of actors to anticipate the consequences of
particular types of institutions,” which distinguishes this perspective from
both classical rational choice and historical institutionalism in that the
capacity to anticipate surely affects how the order of preferences is
determined and in that this same capacity plus the assumption that actors can
act deliberately negate the macro-structural bent of historical
institutionalism.[27]
RCI is also based on a functionalist understanding
of the origin and existence of institutions. Martin and Simmons explain how
this applies to the origin of institutions in the domestic setting:
In a rationalist, equilibrium framework, this
statement is obvious and unexceptionable: states choose and design
institutions. States do so because they
face certain problems that can be resolved through institutional
mechanisms. They choose institutions
because of their intended effects. Once
constructed, institutions will constrain and shape behavior, even as they are
constantly challenged and reformed by their member states.[28]
Similarly,
if institutions are not already efficiently fulfilling the function for which
they were created, they should be on their way toward this objective in
RCI. If they are not progressing toward
this end, they drop out of existence.
Though the institution is assumed to be created intentionally, the
factors shaping perception and decision-making are not
acknowledged. Moreover, this approach
does not address the question of power, even though it acknowledges the
relevance of norms in shaping behavior.
Stemming
from organization theory in sociology, John Meyer is considered the father of
this strain of new institutionalism (with Brian Rowan). In their groundbreaking article, Meyer and
Rowan (1977) demonstrate how institutional environments, through myths, exert
pressure on organizations to seek legitimacy in ways that are not necessarily
efficient, resulting in the creation of a formal organizational structure to
comply with these pressures. The two
primary factors driving the isomorphic tendencies of organizations in the name
of organizational survival are resource dependence and socially constructed
meanings.[29]
Then, in 1983, DiMaggio and Powell proffered a
seminal piece on the new sociological institutionalism in which they attempt to
explain why organizations within an organizational field tend to homogenize
over time.[30] They outlined a taxonomy of isomorphism,
including coercive, mimetic and normative isomorphism. This taxonomy afforded scholars the ability
to look at the nature of power, uncertainty and professionalism respectively to
discern their isomorphic impact among organizations.
Two levels of analysis emerge from the SI
literature. First, the micro-level
constitutes the base for this “theory of practical action.”[31] At this level, tools from cognitive
psychology play the greatest role. SI
can also abstract its level of analysis to “some intermediate level” called an
organizational field due to the cumulative effects of these micro-level
interactions.[32]
Throughout sociological institutionalist analyses
runs a much broader definition of institutions than that espoused by the
others.[33] In fact, when dealing with how institutions
relate to behavior, this more generous definition elucidates how “‘soft
institutions’ can affect the underlying preferences or identities of actors
that rational choice institutionalists must take as given.”[34] Allowing for a wider definition of
institutions perhaps also opens the discourse a greater recognition of
contextual characteristics, including, for example, corruption as an informal
institution to be reckoned with in any analysis regarding policy. Alternatively, Westney contests that
sociological institutionalism “provides a different way of defining and
assessing ‘context’ by focusing on the organizational relationships affected by
the pattern being transferred.”[35] Focusing on this more inclusive definition
and on organizational relationships can also help explain how “processes of
legitimation and social reproduction” spur institutional change over time.[36]
Instead of the proactive creation of institutions to
satisfy some need promoted by rational choice institutionalism, sociological
institutionalism “emphasizes the way in which the existing institutional world
circumscribes the range of possibilities for institutional creation.”[37] At the same time, this approach, according
to Hall and Taylor, “can miss the extent to which processes of institutional
creation or reform entail a clash of power among actors with competing
interests.”[38] Another difficulty that SI presents is the
“challenge of identification and measurement.”[39]
Westney argues that institutionalization is more of a continuum that lacks
specificity, thereby making it difficult to determine when “an organizational
structure or process is in fact institutionalized.” [40]
Descending from a lineage
of group theories and structural functionalism, historical institutionalism was
first coined by Steinmo et al. in 1992.
HI has also incorporated notions deriving from neo-marxist variants of
both, including perceiving the state as a “complex of institutions capable of
structuring the character and outcomes of group conflict.”[41] Katznelson (1997) provides a thorough review
of how classical historical institutionalism developed historically into the
new HI, by highlighting the impact of contributions of primary scholars through
time on the contemporary state of historical institutionalism.
HI’s level of analysis is primarily macro-structural
and the units of analysis are contextual configurations. This focus embraces the view that every
social outcome is embedded within the specific context, including the perceived
interests and objectives of actors.[42] One disadvantage here is that students tend
to overstate the uniqueness of the case, thereby limiting either the spatial or
temporal comparability of the case with other contexts. Furthermore, this “uniqueness” eschews any
falsification of the argument.[43]
Nevertheless, one advantage is that since political
processes are seen as a temporal evolution of contextual constellations and the
interaction among institutions within these constellations, this perspective
radically deviates from rational choice institutionalism by understanding the
creation of institutions in the causally opposite order.[44] Thelen explains, “Historical
institutionalists are more likely to reverse the causal arrows and argue that
institutions emerge from and are sustained by features of the broader political
and social context.”[45] This position assumes that “the various institutional
arrangements that make up a polity emerge at different times and out of
different historical configurations,” whose parts in the end “do not
necessarily fit together into a coherent, self-reinforcing, let alone
functional, whole.”[46]
In keeping with this ontological view of
institutions, the notions of path dependency and feedback effects play a
central role in explaining institutional trajectories and their impact over
time. For example, because historical
institutionalists “step back to ask how groups originally got constituted in
the particular ways they did, then to consider how this affects the groups’
understanding and pursuit of their interests,” historical institutionalists are
able to demonstrate how ideas play a role in the development of institutions.[47] Moreover, analyzing the feedback effects
within institutions can also reveal the extent to which institutional bias over
time can be deleterious to public service objectives. In short, both perspectives give insight into the constraints on
agency.
Institutionalisms
compared
This
paper has a heavier bent towards historical institutionalism for two reasons
outlined in Kathleen Thelen’s comparison of historical institutionalism to
rational choice institutionalism.[48] First, this paper begins with the “empirical
puzzle” of needing to analyze the external influences on the local health
communication environment, whereas rational choice institutionalism starts with
its generalized theories and then looks for deviations.[49] This point also fits with the difference
that historical institutionalists aim to engender mid-range theories, where
rational choice institutionalists aspire for higher levels of generality. Yet, since less attention has been paid in
historical institutionalism to “developing a sophisticated understanding of
exactly how institutions affect behavior,” SI and RCI can still make
substantial contributions to the analysis.[50] Obviously, a combination of these methods
will not lead to direct answers but to a variety of ideas of how to proceed.[51]
In spite of the fact that rational choice
institutionalism is most closely related to international politics in terms of
the literature, both HI and SI embody a more complementary epistemological
nature to constructivist approaches, which explain more readily the complex,
embedded character of the institutional setting that is rich in meaning and in
which the local health communication environment is formed. Determining the relationship between the three
new institutionalisms and various strains of constructivism is germane to
understanding the bounds of the institutional method.
Most generally, the various constructivisms and
institutionalisms complement each other.[52] Constructivism seeks to expose that which is
taken-for-granted, be it a concept, institution or system, by examining the
construction of meaning through intersubjective exchange. Constructivism is particularly useful for
understanding the contribution of one institution within an institutional
environment – be it formal or informal, because the meanings of those
institutions and the symbolic power thereof can be derived and analyzed within
that organizational field.
Institutionalism, in contrast, examines the impact of interacting
institutions on political outcomes within a given environment. In both cases, institutions mediate
perception. In constructivism, this
mediation is an initial assumption. In institutionalism, it is a conclusion
after examining institutional interactions.
With both approaches having evolved in sociology,
sociological institutionalists logically see their work as enhanced by the work
done in social constructionism.
Students of historical institutionalism, in response to its apparent
structurally deterministic limitations, have recently endeavored to align it
more with its constructivist elements as well.[53] Rational choice institutionalists too pull
from the constructivism of international relations theory, because it allows
for the endogenization of changes in actors’ goals.[54]
For individual action, sociological
institutionalists are more likely to see both “interests and actors as
themselves constituted by institutions.”[55] Hall and Taylor affirm that in SI
“institutions influence behavior by providing the cognitive scripts…because
without them the world and the behavior of others cannot be interpreted.”[56] Furthermore, the relationship between
institutions and individual action is characterized by a “highly interactive
and mutually constitutive” nature.[57]
Pushing past the individual, Ruggie’s constructivist
work on multilateralism demonstrates the need to move beyond choices and
physical institutions. He suggests that
we can do so “by recovering the principled
meanings of multilateralism from actual historical practice, by showing how and why those
principled meanings have come to be institutionalized throughout the history of
the modern interstate system, and by exploring how and why they may perpetuate
themselves today even as the conditions that initially gave rise to them have
changed.”[58]
In addition to looking to other disciplines to
fortify the institutionalist approach, Thelen has most prominently advocated
seeking out ways to bridge these strains of new institutionalism
themselves. To illustrate, the works of
Robert Jervis (1998) and Allison and Zelikow (1999) have introduced the
psychological and organizational aspects into state and international agency
decision-making – an important step towards bridging the RCI and SI
literatures.[59] The organizational
behavior paradigm advanced by Allison
and Zelikow offers a new way of looking
at the behavior of governments faced with a particular issue by moving beyond
the rational actor model to looking at policymaking in an environment where
multiple influences affect this process, ranging from the influence of
organizational culture on state agencies to the multiple levels of aggregation
and negotiation within the state. Other
distinctive features of each strain as well as areas of overlap will be
delineated throughout the following analysis.
Institutional
Analysis and Policy
Conceptually,
two distinct institutional “sets” deserve attention in this analysis. The most immediate institutional set
consists of those institutions that most directly shape the local health
communication environment. Since policy
plays a formative role in this environment, it follows that the analysis should
attempt to discern this impact.[60] To achieve this objective, however, requires
looking at a second institutional set – that which influences both the
institutionalization of policy as well as its reproduction through
implementation and regulation.
The next section outlines the three general
dimensions of policy that most inform strategy-generation while taking into
account both institutional landscapes.
The first dimension of policy to be examined is the second set of
institutions, or the constellation of institutions in which policy formulation
is embedded. The next dimension focuses
on the microfoundations of policy: the regulatory process itself. This dimension reveals the steps during
which the institutional environment most impacts policy. Thirdly, the scope is expanded temporally to
study how policies have developed through time and their potential future
trajectories. Each strain of new
institutionalism, based on its strengths and weaknesses, will be more able to
inform the analysis of some phases of the regulatory cycle more than others.
The
on-going need for policy
Before addressing the three dimensions of policy, it
is important first to understand how each institutionalism sees how the need
for policy arises. Both historical
institutionalism and sociological institutionalism uphold that institutions
emerge or are inserted into an environment already replete with institutions
that endure even if their function has expired for all intents and purposes in
society. In such an environment,
institutions stand in dialectical tension with each other, such that “change in
one arena affects other ongoing processes.”[61] With the level of analysis of historical
institutionalism, we are reminded of the dialectical relationship of the extant
institutions to the new institution inserted into the institutional
landscape. Structurally speaking, this
insertion creates new relationships, new tensions, and therefore new contexts
which spur the creation of new collective action problems requiring the
formulation of new policy.
This description portrays a process offering many
points for beginning an examination.
From one cut, new structures can be seen in the long run and at the
macro level as “emerging from” these dialectical interactions over time. This point, reminiscent of structural
functionalism, reflects the tenets of historical institutionalism. However, for practicality purposes, this
portrayal is overly structurally deterministic and as such denies actors the
ability to strategize.
Instead, I argue that the agent still plays an
essential role in the process of institutional change, which leads us to the
next point of examination: the human reaction to the resulting challenges
presented by structural change through time.
This reaction involves many actors and levels of formality and
culminates with the institutionalization of policy. Beginning the examination at this point in the process of
structural change behooves “explanations that rest on firm micro-foundations.”[62] This is precisely where rational choice
institutionalism’s emphasis on the behavior of policymakers and sociological
institutionalism’s emphasis on meaning and perception offer useful tools of analysis.[63]
For this starting point, policy cannot be regarded
as a monolithic entity. Instead,
policymaking consists of a cycle of phases that are equally crucial, from
conceptualization and creation to implementation and regulation.[64] The
regulatory cycle, reflective of on-going dialectical institutional interactions
and contextual changes, provides a window into the micro-foundations of this
process. Throughout the process, ideas
stemming from theoretical traditions and acting as filters of perception and
understanding are embedded.
Additionally, institutions, both formal and informal, serve as mediators
of perception – so even if an individual is thinking and acting strategically,
what they perceive to be the problem and consequent alternatives for action are
mediated by institutions. This point is
in keeping with the sociological institutionalist perspective, where, according
to Powell and DiMaggio, “institutions do not just constrain options: they
establish the very criteria by which people discover their preferences. In other words, some of the most important
sunk costs are cognitive.”[65] They also hold that environments in SI “are
more subtle in their influence; rather than being co-opted by organizations,
they penetrate the organization, creating the lenses through which actors view
the world and the very categories of structure, action, and thought.”[66]
Before dissecting the stages in the policy process,
it is important to take an inventory of both the actors involved in this
regulatory process as well as other institutions occupying the institutional
environment within which policy is formulated.
Another pertinent dimension of policy is the wider
institutional environment in which policies are made and from which policy, an
institution itself, is inextricable.
This environment encompasses both the domestic system within which
policy is realized and the international system of actors.
Within the domestic realm, pertinent institutions
range from the political regime-type itself to the various federal agencies
that create, approve, implement and regulate policy. The first thing to consider in the political structure is its
relative stability, since this impacts the dynamic among all of the
factors below. The political regime determines
the extent of channels for voice and agency.
Another consideration is the number of political parties participating
in the regime, which can obstruct the ability to deliberate and move through
various issues. Furthermore, the level
to which the various ministries and governmental agencies are coordinated
affects the extent of contradictory policies that are implemented and the
extent to which resources are committed to efforts redundantly occurring across
agencies.
Fraser and Restrepo-Estrada elaborate on the effects
of the dislocation between national media and national development, as
indicative of this agency disconnect:
It is indeed curious how governments almost never
link the objectives of their communication sector with their social, human, and
economic development objectives. In
most countries, ministries of information and/or communications confine their
concerns to the development and maintenance of telecommunication
infrastructures, running of state-owned broadcasting systems, and granting
licences and frequencies to commercial broadcasters. Their work seldom, if ever, takes into account the broader social
issues that the communication sector could influence.[67]
This
disconnect coupled with the limited capacity of regulatory bodies to both
regulate and prosecute in condition-bound countries debilitates the extent to
which public services can be provided effectively. Other pertinent obstacles include the increased cost of
corruption as an informal institution as well as the owners of the message
conduits and their interests. This last
“non-political” institution plays a key role in shaping how societal challenges
are portrayed, which in turn can impact how those operating in the political
process perceive the challenge as well.
Usually, reference to national policy assumes an
autonomous domestic setting within a nation-state. However, while policy is the general governing institution of a
domestic environment – in this case a domestic communication environment – it
hardly signifies that the state is innocuous to external influences. In fact, in this particular population of
nation-states, external influences seem to have a disproportionate impact. One could even say that discerning that
which could be considered formally autonomous is much more difficult since the
development of policy itself is more intertwined with and not as clear-cut from
interactions with intergovernmental organizations.[68] For example, institutions operating at a
level higher than that of the nation-state exert a certain amount of influence
first in how the problem is conceptualized and then in the perceived range of
policy possibilities that could be implemented.[69]
These institutions range across sectors and affect
different points in the policy process.
IFIs, such as the International Monetary Fund and the World Bank, play
an immense role in policymaking since often their aid is accompanied by
conditions prescribing sectoral reforms.
These conditions are often accompanied by the offer for free policy
consulting from groups such as the International Finance Corporation and
private consulting companies.[70] Other institutions that apply more normative
or even coercive pressure on condition-bound countries include bilateral
organizations, such as the U.S. Trade Representative or the Department of
Commerce, and multinational corporations, such as AT&T and Time
Warner. A less direct influence on the
process of policymaking is the provision of “official” information by what are
considered to be expert sources. These
sources include intergovernmental organizations (IGOs) like the World Trade
Organization, World Health Organization, World Intellectual Property
Organization, and the United Nations, as well as international development
institutions (IDIs), such as USAID, DANIDA, DFID, and AusAID.
This very complex vision of those institutions
playing a part either directly or indirectly in the elaboration of policy,
which in turn has short- and long-term ramifications for the local health
communication environment, can be better understood by looking at the specific
phases of the regulatory process and determining at which points these forces
play a more substantive role. Again,
this inventory and analysis aim to provide the local actor with a better sense
of strategic areas of action.
The
regulatory cycle[71]
The
regulatory process is comprised of phases leading to the institutionalization
and then the reproduction of policy.
First, various actors perceive and acknowledge the collective action
problem and then conceptualize a variety of solutions. In the process of conceptualization, a
theoretical framework (mental set) mediates the perception and subsequent
definition of the problem as well as the determination of possible
alternatives.[72] This mental set is comprised of socialized
understandings of meaning as well as various models on the role of regulation
in society and on the extent to which public service objectives are considered
state responsibility.
This process is also limited by several factors
including particular knowledge on the topic by decision makers and time
allotted to make the decision.[73] In affirmation, Immergut contributes
that, instead of being the true
expression of preferences, behavior is seen as actually resulting from “the
various coping devices that individuals adopt to overcome their cognitive
limits” in the tradition of sociological institutionalism.[74] The historical institutionalists also deny
the rational approach by viewing political results “not as resultants of
preferences but as consequences of different representations of interests.”[75]
Nevertheless, RCI does offer an informational model
delineated by Martin and Simmons for revealing the “the ways in which legislative
structures allow legislators to learn about the policies they are adopting,
thus avoiding inefficient outcomes.”[76] In this model, institutions play a
significant role in the provision of information and in the learning
process. Moreover, the information
provided is most influential when sources are relatively independent and
considered to be ‘experts’ and “when such information is scarce and valuable to
states.”[77]
In short, informational models “can lead to
predictions about the conditions under which international institutions can
effectively provide policy-relevant information to states, about the kinds of
institutions that can provide credible information, and about the effects of
such information provision on patterns of state behavior.”[78]
Therefore, it could reveal the
institutional information sources that are regarded as legitimate, which could
then be analyzed with regards to these institutions’ normative agenda. The concept of international regimes could
be included here as well. The one
shortcoming of the model is that it assumes that the information will reveal
the most pertinent information to decision-makers and that the process is
efficient, which belies its functional orientation.[79]
Second, policy is semantically formulated through a
process of negotiation. While all of
the above concepts apply here as well, it is important to remember that the
language employed in the subsequent formulation of policy is inextricable from
certain mental frames, which then in turn, impacts individuals’ perceptions
when interpreting and working with the policy in the future. These frames are best analyzed through the
constructionist leanings of SI as well as through DiMaggio and Powell’s concept
of normative isomorphism, where professionalization as a process of sharing
certain mental models concerning a particular organizational field exerts a
normalizing influence on conceptualization and negotiation.[80] Furthermore, it is important to note in
analysis which semantic choices carry more weight. DiMaggio and Powell’s concepts of coercive and mimetic
isomorphism inform this process in that when information is limited in a
context of uncertainty, mimetic processes are likely to be adopted in terms of
policy. Alternatively, institutions may
enjoy more “weight” in influence on the formulation process, primarily because
they are providing the loans to carry out these reforms, in which case this
isomorphic process could be considered coercive.
The distributional models from rational choice
institutionalism also speak to this particular phase in the process. Even though the models problematically
assume that “information is not all that problematic,” they do draw attention
to the process of negotiation among players.[81] Almost constituting a corporatist portrayal
of politics, rational choice institutionalists contend that preference outliers
usually participate on those committees (again, this derives from studies of
interactions in the U.S. Congress) that are most influential in the policy
formulation process. The belief is that
mutual gains will be achieved out of an interest in future favors.[82] While the generalizability of these models
to the legislative organisms of other countries – particularly
IMF-condition-bound countries – is dubious, one observed behavior may be
pervasive sociologically speaking: the capture of domestic institutions or
agencies by preference outliers and by those willingly representing these
groups, which often translates into policy capture (or capture of its
“reproduction”). As Martin and Simmons
comment, “this situation is likely to arise when some actors, such as those
looking for particularistic benefits, find it easier to organize than do actors
more concerned with the welfare of the average citizen.”[83] Consequently, particularistic interests
dominate in representation over interests for the general welfare. What is crucial here is that health
communication is one such concept belonging to that general welfare category.
Third, the negotiations result in convergence (or
not). When conceptualizations of
solutions do converge into consensus that is officially registered as policy,
it becomes formally institutionalized.
This stage does not offer much room for maneuverability due to its
concrete, written form, but this concreteness is not static for long. The next step, implementation, immediately
re-submerges the concrete into a dynamic process of interpretation. In other words, this is the first point
post-institutionalization at which the policy is “reproduced.” Thelen argues that this is the most
important aspect for analysis. She
contends, “It is not just a question of whether policies are more locked in or
less [in terms of their embeddedness as institutions], but rather of the different
ways in which the policies are reproduced, which makes them vulnerable to
different kinds of pressures.”[84]
The re-interpretation of policy through the process of implementation is what
really determines its impact, part of which is the extent to which the final
phase, regulation, can be realized.
This particular phase also highlights a common
perspective espoused by both sociological institutionalism and historical
institutionalism – that responses in the form of policy to challenges are necessarily
suboptimal and elicit unanticipated institutional effects.[85] These unanticipated effects are the outcome
of the extant institutions making adjustments to the new institutional
constellation during the same period post-introduction. The suboptimality of outcomes is comparable
to the tension between public and private interests that keeps any political
strategy from serving exclusively one or the other and therefore results in the
suboptimal realization of either. The
institutional landscape into which policy is introduced is not efficient, nor will
it ever be, due to the same pressures.
The effectiveness of the final phase, regulation, is
limited by several factors. First, the
semantic choice during policy formulation in effect draws the parameters within
which the policy can be implemented and, in turn, can either reinforce or
diminish a state’s capacity to regulate the policy.[86] Second, various institutions in the
environment that the policy is supposed to mitigate as well as the particular
formation of governmental agencies that are supposed to carry out the
regulation also affect long-term regulatory capacity. Third, other policies can preclude or facilitate regulation.
In sum, ideas play a role throughout the regulatory
process. Moreover, different kinds of
ideas as well as various sources are seen as more legitimate in some phases
than in others. Being aware of which
sources and kinds of ideas are more influential during particular phases
informs strategy generation. One final
consideration for finding spaces of agency is to examine the historical
development of policy (and therefore ideas) through time.
Widening
the temporal scope
Widening
the temporal scope is relevant to policy analysis in several ways. First, institutional constellations are
constantly changing, so when the policy is analyzed, the analyst has to remain
aware of the processes of change through time.
The constant interaction between agents and institutions as well as
among institutions – characterized by tension, reactions, and change – needs to
be kept in mind. In addition, what the
policy means changes through time as it is “reproduced.”
Second, to complement this
focus on change, one should also examine that which has remained consistent
through time. For example, while each point in the regulatory
process represents an opportunity of influence, the degree to which the
trajectory is set pre-determines the range of options available at each
stage. The trajectory, reinforced by
path dependency, will also shape the alternatives available in the strategy.
Lastly, one must compare
temporalities. Often, the time it takes
to go through the regulatory process is often longer than the rate at which new
challenges arise or new technologies are innovated.[87] This gap not only reflects the limits in
state capacity (of which any analyst must remain aware), but it is also often
the most immediate focus of policymakers, thereby detracting attention from the
more chronic issues, including health communication.
In sum, policy cannot be analyzed in isolation. The scope of analysis must be widened both
spatially and temporally, by looking at the contextual constellation of
institutional vectors and its historical development through time. Doing so will allow one to distinguish the various
external actors, the influence they exert in the development of policy, and the
reasons for this leverage that they wield over national policy (e.g.
legitimacy, uncertainty).
Utilizing a longer timeline is also useful for
considering future policy, since pervasive political instability renders a
shorter timeline devoid of analytical value.
To illustrate, when a new administration takes over through upheaval,
staff is swiftly changed out and much pre-existing institutional learning is
often “wiped clean.” In this sense,
policies are prone to change depending on the administration du jour,
and institutional capacity to regulate is questionable. Moreover, these transitions are usually
consistent with economic crisis, which in itself creates a total state of flux.
Generally, widening the
scope of analysis exposes the variety (and varying intensities) of
institutional pressures that converge on the state, which are often incongruous
to the local institutional setting. These pressures, according
to SI, create conflicting isomorphic pulls. Since these pulls always exist (due to an environment already
replete with other institutions), it is often a question of fostering
flexibility within the system to accommodate such pulls.[88] For example, one could say that states are
driven to adopt similar formal structures due to resource dependency and the
need to be legitimated within the global political economy.[89]
Resource dependency becomes explicit once a country
engages in taking out a loan from an IFI. The conditionality of these loans
results in structural adjustments that are most likely to be foreign-conceived
(and perceived to be detrimental) to both formal and informal, internal
institutions. If the friction created
by this incongruity threatens to build to the point of failure (depending on
the degree of incongruity), countries or state-agencies will often engage in
loose coupling whereby the internal activities of an organization loosely
reflect the formal structure. These
tendencies can be seen in the following illustration of a typical trend in
broadcast policy. The illustration
itself might be considered more as a prototypical genealogy, since a similar
story has been told in many countries.
Deregulation,
liberalization and privatization of the air and radio waves – originally
outcomes of institutional interactions – now constitute institutions in the
form of norms and conditions. As part
of structural adjustment programs, one of the objectives of deregulation,
liberalization and privatization in general has been to reduce federal
government spending. With regards to
both the communications and health sectors, each of these processes has
incurred its own set of institutional effects on the health communication
environment.
On the side of the state, the first
activities cut were public-service industries such as health and education and
other state-owned enterprises, such as the communications infrastructure. In addition, decentralization of
responsibilities and tasks necessarily emerged in response to decreased
spending in the various ministries and agencies. The private media industry, in contrast, has experienced
industrial capital accumulation and a substantial emphasis on innovation. This technological push was enabled by the
benefits of capitalism: research and development that could only be funded
through sufficient capital accumulation.
One concrete
illustration involves a particular development in broadcast policy that
resulted from these processes and the ensuing changes through time. The policy of focus is the mandated, daily
“free public service hour” of television found in many countries that have
undergone these processes (except the U.S.) whose content must be geared
towards health and education. This policy
has emerged and has been institutionalized as one of the conditions in the
process of privatization of air and radio waves. Generally, this policy did not specify a particular time of day
during which these programs were to be aired.
Also, programs were initially still produced by the state.
One of the first
measures taken by the private companies in a competitive environment was to
move the airing of these programs to times that would not perjure their
competitive standing, especially since private sector innovation sector
buttressed by capital accumulation over time outstripped the quality of the
programs produced by the state.[91] Two logical responses of governments to the
disparity in programmatic quality were to seek out ways to collaborate with the
private broadcasting corporations in the production of the programs and to
either contract out the whole production of the programs to these groups or to
create ministry-specific parastatals that performed the same function. Fraser and Restrepo-Estrada note that this
trend was accelerated as well by the emerging “conviction that [state]
communication units must aim to become financially autonomous.”[92]
These responses
elicited two consequences. First, since
the market dictates content in many respects, there has been a shift of focus
from the public provision of information, albeit at a lower entertainment
quality, to an improvement in entertainment value in the form of an
informercial.[93] This transformation has essentially
undermined the potential provision of health-oriented content that is focused
on well-being and free from market interests.
Second, the decentralization and decreased funding of federal agencies
led to the logical strategy of trying to find opportunities for
collaboration.
This “opportunity”
paved the way for the involvement of international development institutions in
the funding and development of public health projects.[94] The active inclusion of IDIs into this
particular institutional constellation has elicited some crucial structural
change. For example, IDIs themselves
have gradually changed from being theme-oriented to project-oriented, which
changes how funding is dispersed.
Project funding is usually provided in five- or six-year periods, which
re-orients project implementors to focus on the funding cycle instead of on
fostering long-term strategies.
Moreover, funding is accompanied by the mandate to show results, which
often starts within six months. This
new emphasis necessarily precludes a local, participatory approach based on
institutional constraints. Finally,
budgetary allocations reveal the low priority on the communication aspect of
projects, though it is not necessarily in keeping with stated strategic
objectives and intermediate results. The true question becomes whether these
projects are interested in fostering locally generated development strategies
at all in spite of the narrative that is told.
The long-term
ramifications of the “rapid assessment,” cultivated by institutional and
financial constraints, and the homogenizing tendency this practice has on the
elaboration of a health project can best be explained by organizational theory
(SI). Meyer and Rowan’s work provides
particular theoretical insight into the inherent contradiction in promoting
“grassroots” forms of development with the totalizing isomorphic qualities of
resource dependency in the institution of international development.[95] The only “outlet” for generating a locally
owned concept of what it means to foster development is through decoupling, in
which the formal institutional structure is created with enough “cushion” for
actual activity to be carried out as desired locally.
A final observation:
The centralizing trend in the fiscal power of media owners and transnational
conglomerates stands in stark contrast to the decentralization of those bodies
responsible for the provision of public services.[96] What is most interesting is that while
decentralization has resulted from both neoliberal structural adjustments and
the search of both IFIs and IDIs to find other means of getting funds to the
grassroots, it has been portrayed as a viable way for enabling grassroots
development and self-determination.
However, the general weakening of public communication capabilities has
resulted in an undermining of self-determination in more subtle ways. The aforementioned changes in the
communication sector have resulted in a bias of the types of information that
are made available. Essentially, health
information, which in some policy circles and academic arenas is portrayed as a
public good, has been commodified.[97] Worse yet, these trends stem from
institutions whose international legitimacy ensures their inertia.
Needless to say, the
sum of these trends creates a dim picture for those hoping to foster a two-way
communicative approach to the deliberation of internationally funded health
projects. This wave of cumulative
institutional interactions has also led to the incapacity of any public-service
oriented project to afford the implementation of a public health campaign that
is as effective as a tobacco sales campaign, for example, using such privately
owned media.
This prototypical chain of events in many
condition-bound countries highlights just a few of the changes that have
affected health communication in general.
Moreover, it shows how policy plays a substantial role in the
facilitation of information. Policy, in
many ways, acts as a preliminary floodgate, yet the illustration also
demonstrates the ‘fragility’ of public-service-oriented policy, particularly in
states where policy is mandated from the exterior or in contexts where other
actors wield more economic power than the state itself. Even if most (even ninety-five percent) of a
state’s policy is geared toward public services, that majority can be
undermined by the five percent geared toward private interests, especially when
the state delegates the provision of such public services to the private
sector. This has become apparent in a
variety of arenas in most countries that have undergone structural adjustments
– from the education sector to hospitals and from universal service objectives
in telecommunications to broadcast programs.
Synthesis
In general, this paper has focused on the relevance
of policy to the extent that it facilitates or inhibits the flow of
(market-free) health-related information in the local communication
environment. Each new institutionalism,
based on its particular scope of analysis, is more appropriate for certain aspects
of policy analysis than the others.
These aspects include the regulatory cycle, the wider institutional
environment from which policy emerges, and the historical development of policy
through time.
The regulatory cycle encompasses the
conceptualization of the problem and generation of strategies, the formulation
and convergence on a formal policy, followed by its reinterpretation through
implementation and finally its enforcement through regulation. Organizational theory and rational choice
institutionalism are the most appropriate strains of new institutionalism for
determining which phases of the regulatory cycle offer the greatest spaces for
agency. RCI does this by considering
the impact of institutions on preference ordering at this microfoundational
level and offers the means of determining the ‘legitimate’ sources of
information used by legislators through informational models. Also, distributional models help explain the
negotiation process of policy formulation by looking at the participants on the
decision-making committees. SI, in
turn, stresses the importance of the intersubjective construction of meaning
and as such endogenizes ideas and identity into research on
decision-making. By offering a means to
examine the role that informal institutions play in the policymaking process,
SI provides more nuanced insight for advocacy.
When widening the spatial scope to examine the types
of influences various external actors play in the development of policy, both
sociological and historical institutionalism can make the greatest contributions
to the analysis. Both emphasize that
policy, as a response to collective action challenges, is necessarily
sub-optimal and elicits unanticipated institutional effects, expressly because
it is introduced into an already thick constellation of institutions. Furthermore, because sociological
institutionalists start with the question of why institutions start to resemble
each other over time, they have developed useful concepts and a taxonomy of
isomorphism to describe how and why institutional convergence occurs. Also, because these ‘isomorphic pulls’
(toward convergence) tend to create internal tensions that could lead to
institutional failure, sociological institutionalists also study the phenomenon
of loose coupling, whereby a formal external structure is erected that
represents convergence while internal operations remain consistent with
indigenous organizational practices.
The political and economic instability of many of
these environments behooves one to widen the temporal scope to look more for
long-term institutional effects and long-term patterns or cycles of
change. In fact, a longer analytical
timeline used to monitor the effects of precedents set by prior policies can
show how the trajectory of certain policies wears down state capacity to
regulate. It is also useful for
considering future policy, since political instability in condition-bound
countries truncates the utility of shorter timelines. For this task, historical institutionalism proffers the best
approach, since it focuses on macrostructural patterns in the longue durée
and explicitly seeks to discern institutional trajectories.
In short, each of the new institutionalisms provides
unique insights into this more complex approach toward strategically examining
the local health communication environment.[98] Hopefully, their distinct contributions can
be creatively combined for a fuller understanding of institutional effects on
behavior and outcomes in accordance with the institutional sets that are
determined to be most relevant to the particular local environment.
Of course, identifying the most pertinent
institutions shaping the local health communication environment would be most
effective if it were carried out by the local health communication practitioner
already working in that particular communication context. Yet, discerning the most relevant
institutional set and learning of the predominant policies that shape the local
environment takes a considerable amount of time and dedication. This
is truly the most complicating factor for this type of analysis since health communication practitioners do not
normally have the time or resources to contemplate these institutional effects
themselves or how they might interact more proactively with them.[99]
One way of alleviating this
burden could be to divide the labor by opening spaces for collaboration with
researchers. This, of course, would
require that communication practitioners be open to interacting with
researchers who do have the time and funding to carry out an institutional
inventory and analysis. Nonetheless,
even though this type of analysis does not result in easy formulations or
prescriptions of what needs to be done next but does illuminate potential
spaces for agency, strategic action must still be driven by those affected at
the local level.
In sum, health communication is a public good whose
content is contingent upon the local context.
An environment in which health information is readily accessed allows
groups or individuals to make more informed decisions regarding their
health. At the same time, communication
also implies ensuring a platform for voice such that projects aiming to improve
public health in marginalized areas can also take the indigenous knowledge into
consideration to generate appropriate strategies for the local context. Many factors impede the efforts of those
working in the field to facilitate this type of communication. To discern effectively those factors that
behoove the most tactical attention, conducting an institutional analysis has
been promoted. This paper has attempted
to push the analysis to encompass external factors not normally considered in a
communication strategy, such as communication and health policy, because
sometimes these factors have the greatest delimiting effect on one’s efforts.
One of the most salient points that an institutional
analysis makes apparent is that policy does not operate in a vacuum, but
instead is contingent on the ways in which it is interpreted and implemented by
actors in the environment, whose own perception is mediated by other
institutions. In fact, policy would have no effect on the environment if people
did not act on or according to it. This
does not mean that policy should not be analyzed; it simply means that
examining the constellation of actors as well as the surrounding context, both
spatially and temporally, is essential for a more complete understanding of its
impact on the local communication environment.
Additionally, policy, as an institution in itself and in the way in
which it is carried out, is illustrative of all institutional pressures within
the system (even though some delimit a given context more than others).
An institutional analysis also indicates the risks
one takes in assuming sovereignty when theorizing about domestic policymaking
and its implementation. If anything, it
shows just how permeable the borders, a symbol of sovereignty, are in most
post-colonial territories.[100] This point reminds us to consider
‘realistically’ the extent to which states have the capacity to either carry
out public service clauses or react to the strategic targeting of unrealized or
contradictory policies. One might seek
recourse in other organizations deemed legitimate at the international level
that might support one’s efforts to advocate for the fulfillment of promises
formally made by the state in the form of legislation. However, in spite of the seeming futility of
relying on the state and its ability to protect public interests, it remains
the primary mechanism for creating, implementing and regulating the policy that
continues to have such a delimiting influence on the local health communication
environment. For this reason alone, the
state should remain a strategic focal point with which one should engage to
both foster health-related information flows as well as mitigate the
deleterious effects of accumulated private interests in the communication and
health sectors.
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[1] Fraser and Restrepo-Estrada (1998), 235.
[2] At the international videoconference entitled “Universal Access to Health Information,” wide consensus was expressed among attendees that all the information needed for basic public health exists; it is just a matter of getting it, as well as the means for implementing it, to “the last mile.” The conference, jointly organized by The Exchange Programme, INASP-Health and the Interactive Health Network, with support from the Department for International Development (DFID), was synchronously held in London, Nairobi, Sao Paulo, Washington, DC, and Cape Town, 18 July 2001.
[3] An understated focus of this paper is on the condition-bound nature of countries that are typically called “developing.” While one may argue that no state exists that is not “condition-bound,” the conditions binding this particular category of countries are usually formally imposed and enforced by the IMF. This qualifier is used instead of “developing” at times to begin to reshape how the notion of ‘developing countries’ is conceptualized.
[4] However, having effective arguments for accessing bigger budgets does not alleviate the fact that communication costs are constantly increasing nor that the mandate from those providing the funding that reaching as many people as possible per dollar is priority, results in an overemphasis on those populations concentrated in urban areas that already live in closer proximity to general access.
[5] Immergut insists on setting sights on fostering a cumulative impact of this work, which depends on an eventual systematization and comparison of the various analyses (27). She also avers that this approach will help avoid exaggerating the uniqueness of each case, an issue addressed below.
[6] In working to fulfill this objective, it should be remembered that the greatest beneficiary of such efforts is the society as a whole.
[7] Beltrán (1994), Bezanson (1998), Chen et al. (1999), Pellegrini (1999), and Polo Torres (1994, 1996).
[8] Marshall and Albarracín (1994).
[9] Beltrán (1994), Contreras-Budge (1994), Huerta (1996), Polo Torres (1994, 1996), Safar Ganahl (1993), Tilson et al. (1997), and Torres (1998).
[10] Bezanson (1998), Mayobre (1994), Pellegrini (1998, 1999), and Roncagliolo (1994).
[11] While the work of Piotrow et al. (1997) is an excellent practical review of strategic planning, providing an ‘exhaustive’ list of angles to consider when planning for a reproductive health campaign, there is a gaping absence of any acknowledgment on the importance of looking beyond the immediate environment to discern the external factors shaping that environment which could be influenced given awareness and effort. In contrast, Fraser and Restrepo-Estrada in Communicating for Development focus on the communication challenges faced in development projects and provide an overview of the plethora of challenges communicators face today, among which both communication policy and the way in which communication budgets are allocated in these projects are found.
[12] For example, in 1995, Bolivia had opposing mass media policies and national development policies. Fraser and Restrepo-Estrada observe, “Despite the potential importance of community radio in the country’s new policy circumstances, the government passed a new Telecommunications Law in August 1995 under which, in future licences will be granted only to radio and television stations of a commercial character” (240-1).
[13] Hall and Taylor (1996); Thelen (1999); and Immergut (1988).
[14] Immergut (1988), 25.
[15] Immergut (1988), 6-8. Hall and Taylor (1996) also acknowledge this common origin.
[16] Op.cit, 25. This point belies their common theoretical heritage from the contributions of Jean-Jacques Rousseau where “Rousseau viewed preferences, such as the desire to accumulate property, not as universal postulates on which one could found a scientific theory of politics but as products of society – its norms and institutions. Law and custom shaped men’s preferences and institutionalized power and privilege, thus converting natural inequalities into more pernicious social inequalities” (8-9).
[17] Hall and Taylor (1996), 936
[18] Immergut
(1988), 25.
[19] Op.cit., 5.
[20] Thelen, 380.
[21] Hall and Taylor (1996), 944-945.
[22] Ibid. Hall and Taylor also note that “this calculus will be deeply affected by the actor’s expectations about how others are likely to behave as well” (945).
[23] Ibid.
[24] Powell and DiMaggio (1991), 8.
[25] Martin and Simmons (1998), 743.
[26] Ibid.
[27] Op.cit., 749.
[28] Ibid.
[29] From cognitive psychology, the Carnegie School also substantively contributed to these ideas through their critique of rationality. See Powell and DiMaggio (1991) and Immergut (1988) for a more thorough explanation.
[30] Westney notes that “defining the boundaries of an organizational field raises significant methodological problems,” which constitutes a weakness of this strain (57).
[31] Powell and DiMaggio (1991), 22.
[32] Westney (1993), 56.
[33] Hall and Taylor (1996), 947.
[34] Op.cit, 951.
[35] Westney (1993), 71.
[36] Powell and DiMaggio (1991), 27. This trend has existed from Meyer and Rowan to Powell and DiMaggio and beyond.
[37] Hall and Taylor (1996), 953.
[38] Op.cit., 954.
[39] Westney (1993), 57.
[40] Ibid.
[41] Hall and
Taylor (1996), 938.
[42] Zysman (1994), 244.
[43] It is argued that this is not the objective of such traditions, yet this point does preclude one from ensuring that the story being told is based on rigorous standards of scholarship.
[44] Thelen (1999), 388.
[45] Op.cit., 384. This point implies a grave consequence for rational choice institutionalism’s ontology.
[46] Op.cit., 382.
[47] Thelen (1999), 395.
[48] Thelen only discusses the relationship between RCI and HI. One could say that the penchant of this paper equally emphasizes sociological institutionalism.
[49] Thelen (1999), 373.
[50] Hall and Taylor (1996), 954-5.
[51] Ensuring that the analysis remains ontologically and epistemologically consistent is nevertheless key.
[52] For an excellent comparison of the off-shoots of constructivism, see Hacking (1999).
[53] Immergut (1988), 17.
[54] Martin and Simmons (1998), 743.
[55] Powell and DiMaggio (1991), 14.
[56] Hall and Taylor (1996), 948. Wittgenstein (1958) illustrates this process throughout Philosophical Investigations.
[57] Hall and Taylor (1996), 948.
[58] Ruggie, 7. Emphasis added by author.
[59] This is one of the primary reasons why Powell and DiMaggio (1991) clearly distinguish between an institutionalist strain in international relations and a rational choice strain.
[60] Piotrow et al. (1997) provide an excellent review of the variety of institutions to consider when taking an inventory of this local environment – except policy.
[61] Thelen (1999), 383.
[62] Thelen (1999), 370. Thelen observes, “Although much macro-historical work was already implicitly sensitive to these issues, articulating the micro-foundational logic of the arguments offered was not always a top priority” (370). Moreover, focusing on this level of analysis is very much tied to a normative agenda: if there were not room for maneuverability, which history has shown, then seeking to improve health information access through policy would be useless. However, we have already seen the impact of policy – constructed by agents interacting with each other as well as with the structure – on the public sphere through the effects of liberalizing the communication sectors, which buttressed barriers faced by local health communication efforts.
[63] It must be noted that attempts to endogenize the political construction of interests to historical institutionalist models can be seen as misleading. It is important to recognize however that the explanation provided soley by historical institutionalism is both insightful and yet insufficent especially with regards to an empirically evident problem that behooves mitigation. The structurally deterministic nature of this approach can push actors into a passive corner.
[64] In fact, dissecting the regulatory process in such a way can reveal the specific phases in which the greatest spaces for agency are found.
[65] Powell and DiMaggio (1991), 11.
[66] Op.cit., 13.
[67] Fraser and Restrepo-Estrada (1998), 240.
[68] This stands in contrast to other nation-states that have been stably defined as such since the seventeenth century.
[69] This stance is corroborated by all three strains of new institutionalism.
[70] The IFC is a subsidiary branch of the World Bank. Also, to illustrate, when Ecuador was undergoing structural adjustments in 2000, the two largest contributors to their new telecommunications policy were the IFC and Solomon Smith Barney.
[71] During the following analysis, it must be noted that SI and RCI are the primary theoretical contributors, since the analysis focuses on the micro-level.
[72] This perspective is most consonant with sociological institutionalism.
[73] Immergut contends, “Time and information are not sufficiently abundant to allow individuals to calculate their preferences based on a full weighing of all alternatives and their consequences”(14).
[74] Immergut (1988), 14-15.
[75] Immergut (1988), 26.
[76] Martin and Simmons (1998), 740.
[77] Ibid., 742.
[78] Ibid., 740.
[79] Ibid.
[80] It could also be argued that Meyer and Rowan first contributed the concept of “myth” as a way to understand how or why actors choose to embrace certain institutionally accepted norms.
[81] Martin and Simmons (1998), 741.
[82] Ibid.
[83] Ibid., 748.
[84] Thelen (1999), FTNT 28, 297. Emphasis added by author.
[85] These basic tenets stand in contrast to rational choice institutionalism, whose ontology assumes that the current state of institutions is one phase on the road to efficiency. Other contrasting points proffered by Hall and Taylor and that weaken rational choice institutionalism’s ability to contribute completely to this analysis include the fact that it tends to be functionalist, intentionalist, and voluntarist, giving entirely too much agency to the individual in light of the structural pressures at play (952).
[86] This is not to say, however, that the meaning of the chosen language is not open to contestation. It is just that the range of contested meaning of each word delimits the range of possibilities.
[87] The rate of technological innovation and the need for standardization represent a particularly difficult challenge for developing countries.
[88] Westney, 61.
[89] See Meyer and Rowan (1977) for a more complete version of this argument.
[90] This trend first became apparent to me in my field research on communication policy in Ecuador in the Spring, 2000. It has been wholly corroborated in the research of Fraser and Restrepo-Estrada (1998).
[91] Fraser and Restrepo-Estrada bring attention to the fact that the poor timing of the programs then became a demotivating factor for the producers of the program, since they knew that no one would really be watching anyhow (251).
[92] Fraser and Restrepo-Estrada (1998), 258.
[93] For example, many political economic considerations go into the production of these programs such as the fact that violence and sex are cheaper to translate than thick context-specific spots. Moreover, getting backing from pharmaceutical companies or producers of sports equipment make for an obvious choice when having to produce this type of program. In fact, the “lucky ones” have been able to have these companies not only underwrite but completely produce these mandated programs.
[94] These institutions range from IGOs, like the WHO and World Bank, and bilateral organizations, such as USAID and DANIDA, to transnational NGOs. A fairly recent development in this constellation has been the for-profit collaborating agencies, to whom IDIs have contracted the responsibility of implementing these projects.
[95] It must be noted that this particular type of exchange was not explicitly addressed in Meyer and Rowan; but the concept is still relevant. DiMaggio and Powell have termed this particular isomorphic tendency as coercive isomorphism. The layman’s term I suggest for this behavior is the “Who’s your daddy?” principle.
[96] Beyond affordability, coordinating the timing, production, and backstopping in a decentralized environment becomes even more inefficient and burdensome.
[97] See Heilbroner (1985); Comor (1998).
[98] This is in spite of their potentially conflicting ontological and epistemological assumptions.
[99] At the state level, Fraser and Restrepo-Estrada (1998) suggest developing “a written mandate for communicators working within the framework of a national policy of communication for development”(253). They continue, “This mandate would explain that their task was to use communication skills, techniques, and media specifically for participatory situation analysis and planning, for training, and for institutional communication within the framework of change and development”(253).
[100] Again, this is not to say that ‘core’ territories have impermeable borders. It is just that these countries’ borders are more porous with regard to external pressures. It also does not mean that any country lacks the capacity to make a decision and act upon it.