Law and Public Policy

D17 - Hearts and Minds: Ideas and Public Policy

Date: Jun 1 | Time: 10:30am to 12:00pm | Location: Classroom - CL 345 Room ID:15737

Chair/Président/Présidente : Amy Zarzeczny (University of Regina)

Discussant/Commentateur/Commentatrice : Cheryl Camillo (University of Regina)

Session Abstract: How can we trace the emotional and cognitive impact of ideas on actors’ behaviour, and on public policy? When change occurs within an organization, when and how do participants adapt their ideas to the new institutional context? How is expertise defined and redefined as policies change? Finally, how do different groups of participants in a policy process negotiate debates about goals, instruments, and core concepts like evidence, legitimacy, and the appropriate subjects of policy intervention? This panel gathers papers that examine the links between ideas and institutions across policy domains and over time, and explore how participants in a range of policies understand the policy process. The papers consider both regulation and service delivery, and address the roles and ideas of experts, policy makers, patients, and members of the public. They ask how changes in participants’ interpretations of a policy affect the way a policy works and opportunities for its reform.

Like Mother: “Women of Childbearing Age” in Canadian Public Health Policy: Alana Cattapan (Johnson-Shoyama Graduate School of Public Policy)
Abstract: Since the 1970s, medical research investigating women’s “preconception health” and the rise of public policy to address fetal rights has resulted in the uncritical acceptance of “women of childbearing age” as a legitimate group on which public health policy is implemented. Between early onset puberty and the use of reproductive technologies, however, women may be of “childbearing age” for most of their lives. At the same time, differences in sexual activity and orientation, fertility, and desire to have children mean that some women are never engage in biological reproduction. Although the operationalization of “women of childbearing age” may have been intended to move away from the assumption that all women are reproductive subjects, in practice, the concept has worked to reify paternalistic assumptions about inherent reproductive capacity. This paper traces the emergence of the concept of “women of childbearing age” as a specific population of interest for public health policy. By tracing the evolution of Health Canada’s guidelines for medical professionals engaged in maternal care (from 1968 to 2017), the paper identifies how early iterations of these guidelines emphasized the roles of couples (addressing both women and men) and health providers during pregnancy and afterward, giving way to an exclusive focus on the behaviours of women prior to and during pregnancy. In doing so, the paper provides an example of a subtle ideational change that has had immense consequences through the slow and seemingly innocuous reframing of existing policy actors.

Getting Past ‘Talking Past Each Other’: Learning, Framing Contests, and Policy Making: Adrienne Davidson (University of Toronto), Heather Millar (University of Toronto), Linda White (University of Toronto)
Abstract: Why are policy innovations adopted in some cases but not others? This paper focuses on the adoption of universal kindergarten/pre-kindergarten (UPK) in Canada and the United States. Our previous research demonstrates that social investment policies—controversial social policy areas that require budgetary investments—can trigger norm contests, both over the appropriateness of the policy and over the state’s role in funding and delivering it. Drawing on an extended case analysis of the UPK legislative process in Florida, with Alberta, California, and Ontario as shadow cases, this paper examines the conditions under which policy makers can shift policy debates away from framing contests over policy goals to more concrete discussions about policy implementation.  In this paper, we identify two necessary conditions: (1) social investment policy framing; and (2) institutions that give policy makers autonomy to act. In both the positive cases of Florida and Ontario, these conditions inoculated the public learning process – in the case of Florida an expert panel and in Ontario a Premier’s advisory process – against normative backlash. This enabled both policy makers and the public to shift focus from contests over policy goals to substantive discussion of policy instruments and settings. In the shadow cases of Alberta and California, in contrast, at least one of these necessary conditions was absent and the public learning process got derailed. These cases thus provide important lessons regarding the institutional mechanisms that enable policy makers (and publics) to move beyond talking past each other to adopt policy innovations.

(Re)defining legitimacy? Expertise and Public and Patient Involvement in Canadian Drug Assessment: Katherine Boothe (McMaster University)
Abstract: Public drug plans in Canada rely on drug assessment committees (both provincial and national) to review clinical and economic evidence about new drugs, and to make recommendations about which drugs should be publically reimbursed. Starting in 2006, these committees that were previously entirely made up of technical experts – clinicians, pharmacists, economists and ethicists – began to include patients and members of the public. This paper asks how technical members understand the goals, strengths and challenges of public and patient involvement (PPI) in health technology assessment, and whether and how their ideas have changed after more than ten years’ experience with PPI. My previous research suggests that although there has been some change in experts’ ideas, there are still important tensions between concepts of legitimacy that are linked to the inclusiveness of the policy process and which drive PPI, and moral-scientific concepts of legitimacy that are linked to objectivity and specific norms of scientific evidence. The paper uses interviews with technical members of a range of Canadian drug assessment committees as well as early reports of participants’ views contained in reports by consultants and a parliamentary committee to analyze stability and change in experts’ ideas. It responds to calls in the literature for more rigorous measurement of ideas and ideational change, and develops hypotheses about links between ideational and institutional change that may apply to other policy areas, particularly those that involve highly specialized knowledge and questions about legitimacy and public values.