The view from nowhere? How think tanks work to shape health policy

Abstract

Think tanks seek to shape the business of government by offering policy expertise in a number of areas, including health care. This expertise tends to be presented as ‘the view from nowhere’ – independent, value-neutral expertise that can inform policy. We challenge this view by examining what ‘independence’ means and how it is performed. We present an interpretive policy analysis of data collected from four UK-based think tanks that have sought to influence health policy. Our analysis demonstrates how a sample of healthcare think tanks publicly positioned themselves as ‘independent’ organizations. They drew on technocratic health planning discourse to emphasize a range of knowledge-related activities, artifacts and instrumental language that, informants suggested, allowed them to feed emerging evidence into policy and improve health services. Such positioning seemed to provide them with legitimacy in the eyes of decision makers. A parallel set of think tank activities (e.g., meetings with parliamentarians) took place ‘back-stage’ and focused on influencing health policy and, in the context of recent proposals to reform the English National Health Service, lending broad though not unqualified support to government proposals to extend market principles in health care. Informants appeared to seek to neutralize their presentation of such ‘back-stage’ influencing through a range of discursive strategies.