In: Political geography: an interdisciplinary journal for all students of political studies with an interest in the geographical and spatial aspects, Volume 59, p. 72-81
Processes of privatisation and liberalisation around the world would lead us to expect a growth in the private provision of health and social care services, which in turn we would expect to lead to a growth in the international trading of such services. However, the available data are not adequate to allow us to develop a clear and comprehensive picture of the scope and nature of this emerging world market. What data do exist may take a variety of forms and be pitched at different levels of analysis. Such data may be focused at the level of firms providing such services, at the national level; at the level of regional organisations and agreements; or at the level of international organisations and agreements. This article discusses the methodological problems and challenges of attempting to integrate such diverse forms of data and levels of analysis. It is concluded that a comprehensive analysis must not only include all of these levels, but take account of the ways in which processes at different levels may interact to reinforce the tendency towards trade in healthcare services.
Internationalized providers of care services face competing incentives and pressures relating to profit and quality. Case studies of corporate providers of long-term care in the UK demonstrate that their mode of organization has important implications for both user choice and the organization of care work. French Les fournisseurs internationalisés sont soumis à des pressions et à des incitatifs concurrentiels pour produire des profits et de la qualité. Des études de cas portant sur les fournisseurs institutionnels d'assistance à long terme au Royaume-Uni révèlent que leur mode d'organisation a d'importantes répercussions tant au niveau du choix des bénéficiaires qu'au niveau de l'organisation du travail d'assistance. Spanish Los prestadores transnacionales de servicios se enfrentan con incentivos que compiten entre sí y con la tensión entre calidad y ganancia. Se estudian unoscasos de prestadores de cuidados de larga duración en el Reino Unido. Estos demuestran que el modo de organización tiene consecuencias importantes, tanto para opciones abiertas al usuario como para la organización de los cuidados.
This article discusses the nature of, and links between, the academic disciplines of Social Policy and Political Economy. Two core concerns of mainstream Social Policy are identified: firstly, a focus upon the development and operation of the welfare state and, secondly, a concern with concepts such as equity. Political Economy is identified as a discipline based upon the understanding that the production and distribution of wealth can only effectively be studied alongside the operation of power. It is argued that the core concerns of Social Policy are best approached from a Political Economy perspective. Three contemporary trends make this a particularly opportune time to apply the Political Economy approach to the concerns of Social Policy. These are, firstly, the growing importance of processes of 'globalisation', secondly, the increasingly explicit linking of economic and social policies by governments and, thirdly, the emergence of new actors in the social welfare field, particularly for-profit corporations.
Two related concepts have been used to understand the welfare state – 'decommodification' and the 'workfare' or the 'competition' state, as it relates to processes of 'recommodification'. I show how these related literatures may be integrated in order to enhance our understanding of current labour market policies. Applying these concepts to an analysis of the ideas and policies of New Labour leads to the conclusion that state welfare services are being reconfigured to serve more effectively the needs of the market, through a process of 'administrative recommodification'.
The increasing trend towards the internationalization of the world economy coupled with the liberalizing agenda of international institutions and Western governments has profound implications for the delivery of health and other welfare services. As governments pursue policies which extend the scope for the involvement of private companies in the delivery of welfare services, processes of internationalization are likely to become increasingly important to such services as multinational providers emerge. This article begins the process of developing a systematic understanding of the relationships between the structure of welfare states, the social and economic policies of governments and international institutions, and the strategies and interests of private companies. It is argued that it is the particular mix of direct state provision, tax/subsidy, and regulation in the welfare state formation that provides the opportunities for, or barriers to, the expansion of internationalizing private providers of healthcare. This argument is illustrated through a case study of the current process of reform in the British healthcare system, where a relative shift away from direct state provision towards subsidizing and regulating private providers is facilitating a process of internationalization.
This article argues that work is central to Labour's social policy, and that understanding the government's attitudes towards work is a prerequisite of understanding much else that it does. The centrality of work in Labour's social policy is itself explicable in terms of two ideas which have been embraced by New Labour—social exclusion and globalization. The article examines these two key ideas and their logic, and some of their policy implications in two main areas—tax and benefit reform and education. Finally, it argues that these two policy areas also need to be linked to a third in order to fully understand their aims and outcomes— that of the promotion of flexible labour markets. Together, these policies form a strategy aimed at increasing labour market efficiency within the context of international economic competition.
BACKGROUND: Article 5.3 of the World Health Organization's Framework Convention on Tobacco Control (FCTC) requires Parties to the agreement to take proactive measures to protect health policy from the vested interests of the tobacco industry. Parties to the FCTC are required to submit periodic reports to the Convention Secretariat on the efforts undertaken to implement it. Previous analyses of national compliance with the FCTC suggest that Article 5.3 implementation is piecemeal and insufficient in many contexts, with governments relying on general transparency and other existing policies for the purpose of Article 5.3 implementation. No in-depth study of Article 5.3 compliance within the European Union (EU) - a signatory to the Convention - has been undertaken. This study seeks to assess the extent of Article 5.3 compliance in European Union institutions, through an analysis of the mechanisms in place in the European Commission and European Parliament. It analyses EU documents relevant to Article 5.3 compliance, as well as semi-structured interviews with policy actors in the EU institutions and the field of tobacco control. RESULTS: As with many national governments, Article 5.3 compliance within EU institutions is partial and incomplete. Much of the compliance activity cited in EU reports is derived from general codes of conduct for EU staff and the Juncker Commission's transparency agenda. Interview respondents reveal widespread lack of knowledge about the existence of the FCTC and Article 5.3 amongst key policy actors across the institutions. Within the Commission policies vary greatly between Directorates General, and issues surrounding the conceptualisation of the role of Members of the European Parliament affect implementation in that context. While there is growing awareness of the issue in both the Commission and the Parliament, in large part as a result of the experience of lobbying over the Tobacco Products Directive, there remains considerable resistance in both institutions to further substantive action to implement Article 5.3. CONCLUSIONS: We recommend that a binding and comprehensive policy and code of conduct, specifically designed for the implementation of Article 5.3 and based on the World Health Organization's guidelines, be created to cover the activities of all employees of all EU institutions. Crucially, such guidelines would need to deal explicitly with third parties acting for the tobacco industry.
European Union (EU) law is based upon a liberalising imperative, the goal of which is to construct a single market between member states. Yet, the EU is no ordinary trade pact, incorporating as it does a range of supranational political institutions and common policies in a range of areas beyond simple market building. Scholars have nevertheless noted a distinction between 'positive' integration (the formulation of common policies applying to all member states) and 'negative' integration (the removal of national-level regulations acting as barriers to market integration). In the context of debates about the implications of trade law and corporate activity for health, this article poses three related questions. First, to what extent does EU law afford corporations opportunities to challenge national-level health regulations? Second, to what extent do EU legal and political processes provide opportunities for positive pro-health supranational regulation, including that which might offset the effects of negative liberalising integration? Third, how do EU market-building processes differ from those of more narrowly drawn trade agreements and organisations in their implications for health? We analyse and compare two recent sets of health-related legal proceedings under EU law, the first of which challenges legislation passed by the Scottish Government to introduce minimum unit pricing for alcohol, and the second of which addresses the legality of specific aspects of the EU's 2014 Tobacco Products Directive. We find, first, that EU law offers ample opportunities for corporations to challenge national health regulations; second, that there is significant scope for pro-health supranational regulations, but that these must be couched in the language of facilitating the single market, and are dependent on the political commitment of key policy actors; and, third, that this (albeit limited) scope for pro-health supranational regulation distinguishes EU legal and political processes from those of other trade agreements and organisations.
Despite a growing literature on corporations as political actors, relatively little is known about how alcohol industry actors attempt to influence public policy. In the context of contemporary debates about the minimum pricing of alcoholic beverages, and drawing on semi-structured interviews with a range of key informants, this article investigates the means by which alcohol industry actors gain access to policy makers and the strategies used to influence policy. It finds that the strategies of alcohol industry actors are focused on long-term relationship building with policy makers, involving the provision and interpretation of information and the promotion of various forms of self-regulation.