TY - JOUR
T1 - Contextualizing obesity and diabetes policy
T2 - Exploring a nested statistical and constructivist approach at the cross-national and subnational government level in the United States and Brazil
AU - Gómez, Eduardo J.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background: This article conducts a comparative national and subnational government analysis of the political, economic, and ideational constructivist contextual factors facilitating the adoption of obesity and diabetes policy. Methods: We adopt a nested analytical approach to policy analysis, which combines cross-national statistical analysis with subnational case study comparisons to examine theoretical prepositions and discover alternative contextual factors; this was combined with an ideational constructivist approach to policy-making. Results: Contrary to the existing literature, we found that with the exception of cross-national statistical differences in access to healthcare infrastructural resources, the growing burden of obesity and diabetes, rising healthcare costs and increased citizens’ knowledge had no predictive affect on the adoption of obesity and diabetes policy. We then turned to a subnational comparative analysis of the states of Mississippi in the United States and Rio Grande do Norte in Brazil to further assess the importance of infrastructural resources, at two units of analysis: the state governments versus rural municipal governments. Qualitative evidence suggests that differences in subnational healthcare infrastructural resources were insufficient for explaining policy reform processes, highlighting instead other potentially important factors, such as state-civil societal relationships and policy diffusion in Mississippi, federal policy intervention in Rio Grande do Norte, and politicians’ social construction of obesity and the resulting differences in policy roles assigned to the central government. Conclusion: We conclude by underscoring the complexity of subnational policy responses to obesity and diabetes, the importance of combining resource and constructivist analysis for better understanding the context of policy reform, while underscoring the potential lessons that the United States can learn from Brazil.
AB - Background: This article conducts a comparative national and subnational government analysis of the political, economic, and ideational constructivist contextual factors facilitating the adoption of obesity and diabetes policy. Methods: We adopt a nested analytical approach to policy analysis, which combines cross-national statistical analysis with subnational case study comparisons to examine theoretical prepositions and discover alternative contextual factors; this was combined with an ideational constructivist approach to policy-making. Results: Contrary to the existing literature, we found that with the exception of cross-national statistical differences in access to healthcare infrastructural resources, the growing burden of obesity and diabetes, rising healthcare costs and increased citizens’ knowledge had no predictive affect on the adoption of obesity and diabetes policy. We then turned to a subnational comparative analysis of the states of Mississippi in the United States and Rio Grande do Norte in Brazil to further assess the importance of infrastructural resources, at two units of analysis: the state governments versus rural municipal governments. Qualitative evidence suggests that differences in subnational healthcare infrastructural resources were insufficient for explaining policy reform processes, highlighting instead other potentially important factors, such as state-civil societal relationships and policy diffusion in Mississippi, federal policy intervention in Rio Grande do Norte, and politicians’ social construction of obesity and the resulting differences in policy roles assigned to the central government. Conclusion: We conclude by underscoring the complexity of subnational policy responses to obesity and diabetes, the importance of combining resource and constructivist analysis for better understanding the context of policy reform, while underscoring the potential lessons that the United States can learn from Brazil.
KW - Diabetes
KW - Obesity
KW - Policy-making
KW - Subnational Government
UR - http://www.scopus.com/inward/record.url?scp=85031299315&partnerID=8YFLogxK
U2 - 10.15171/ijhpm.2017.13
DO - 10.15171/ijhpm.2017.13
M3 - Article
AN - SCOPUS:85031299315
VL - 6
SP - 639
EP - 648
JO - International Journal of Health Policy and Management
JF - International Journal of Health Policy and Management
IS - 11
ER -
