Mapping the international field of public health systems' reform (1978-2014): an attempt to go beyond the 'influence' common sense

This paper aims to address the question of “influence” of IOs, by empirically objectivizing the circulation of actors between international organizations (especially OECD) devoted to the promotion of health care policy reforms. The too often idealistically studied question of “influence” is controversial since it raises the problem of causality in social sciences. As a mean to objectivize it, I constructed a database which gathers individuals who have signed as redactors or editors an OECD report on health policy reforms between 1978 and 2014 (around 28 reports and 200 people). For each individual have been entered some scientific background properties (place, date, discipline and supervisor of the PhD), the date and duration of jobs in various international and national institutions, and the types of reports in which he/she has been involved. The very construction of that database methodologically assumes that the considerations about health care policy reforms, and the frames of available recommendations, have been incorporated during socialisation – especially academic studies -, and that they last over a relatively long time (Bourdieu, 1972; see Popa, 2002 for literary studies, Rioufreyt, 2013 for blairism). The relative stability of policy reforms' frames for individuals offers an empirical entry into the question of influence. Circulations of individuals (temporary experts, national servants, servants of the IO) turn out to be an indicator of the circulation of ideas. The in-depth study of reports at various periods (1990, 2001, 2010) counter-factually documents the hypothesis. Although OECD has internalized expertise on public health over time, by creating a durable division (1990), recruiting its own agents instead of systematically appoint extraneous academics, conclusions and advice written in reports are the product of the encounter between the knowledge on public health reforms that has been incorporated by these actors during their academic socialisation (and can be indicated by the university and the supervisor of the individual), and the state of the debate between IOs on the tools and recommendations which have to be considered as most appropriate to reform public health systems. Consequently, the OECD report of 2001 (Health at a glance) appears to be the product of both the controversial report of the World Health Organization of 2000 (Health systems: improving performance) and the specific academic socialisation of the editors of the OECD report (Chorev, 2012). The fact that “moves” (Allison, 1999 [1971]) played by an actor (here the WHO) lead to – while compelling - the “moves” played by another one invites to empirically deepen investigations on the interactions between IOs. Indeed, the circulation of experts' ideas from one organization to another cannot explain all the changes affecting the reports over time. Those changes, albeit appearing to be the product of the socialisation of the actors in IOs, are mediated by the international field on the reform of public health, which this study aims to map.