Agonistic Pluralism and Conflicts of Interest: Challenging Consensus-Based Public Health Policymaking in English Local Government.

Local policymakers are faced with a multitude of different, and at times competing, political priorities, interests and mandates within a complex, continually evolving system of multi-level governance. Despite this, local government in England is increasingly governed by a politics of consensus, whereby relevant stakeholders are not just consulted as vested interests in the policy process but are intrinsically involved in the adoption and implementation of policy via differing forms of co-regulation . In a consensus-based system, policy outcomes emerge through a consensus-seeking processes of problem ‘resolution’, grounded in the belief that conflict can be overcome to achieve acceptable outcomes for all relevant policy actors. However, the appropriateness of multi-stakeholder approaches to policymaking is called into question by the presence of private commercial actors, and particularly powerful trans-national corporations, in the development and delivery of public policy, as is increasingly the case in English local governments. In recent years, the legitimacy of business interests’ engagement in health policymaking has been problematised by scholars in the field of commercial determinants of health (CDOH), which examines the harmful impact of industry involvement in public health policy. The CDOH literature has identified consensus-based governance as a pathway for industry influence over health policy. While warning against consensus-based policymaking as an avenue for influence on the policy process, and the conflicts of interest (COI) that this poses, CDOH scholarship has remained largely descriptive in nature and failed to engage on a theoretical level with key concepts from the field of political theory. Such engagement, we argue, can add analytical depth to existing accounts of corporate political influence over health policymaking and inform new models of governance designed to protect the public interest. One such contribution is Mouffe’s (2013) conception of political agonism. Against rationalist and consensus-based models of decision-making, Mouffe calls for us to acknowledge and embrace the irreconcilability of adversaries within the political. In what she terms ‘agonistic pluralism’, Mouffe contends that consensus cannot, and ought not, be the goal of politics. Rather, we must recognise, first, that conflict is inevitable in democratic politics; second, that there are multiple valid positions on any given policy issue; and, third, that within this context democracy can thrive, where political adversaries may disagree and yet adhere to shared democratic values (Mouffe 2013). Seeking to address the theoretical and critical gap in current CDOH scholarship, this paper brings Mouffe’s critique of the politics of consensus and theorisation of agonistic pluralism into discussions on governing COI in contemporary public health policymaking. We draw on a set of interviews with local government officers in England to provide empirical detail to our discussion, enabling us to reflect on how COI may be understood, addressed, and impact within a local government context of consensus-based politics. In doing so, this paper contributes to the theoretical elucidation of conflicts of interest in public policymaking. It provides a nuanced perspective on what ‘counts’ as a competing, legitimate democratic interest in governance regimes that prize multi-stakeholder and public-private partnership approaches to political and policy decision-making.