Power in Global Nutrition Governance: A Critical Analysis of the Establishment of the Scaling Up Nutrition (SUN) Partnership.

Author:Lie, Ann Louise
 
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1 Introduction

Since the 1990s, various forms of global public-private partnerships (GPPPs) have proliferated, complementing traditional multilateral processes of global governance. This proliferation has been particularly pronounced in global health, including nutrition, providing the private sector with considerable po litical influence. (1) One of the largest partnerships in nutrition is the Scaling Up Nutrition (SUN) Movement that has been described as "an example for ways in which, over time, the Sustainable Development Goals can best be imple mented." (2) Since its establishment in 2010, SUN has grown from being a loose platform of cooperation between state and nonstate actors in the area of child undernutrition to becoming an increasingly institutionalized GPPP, with its own secretariat and executive committee, working toward ending child malnu trition globally and within its sixty developing country members. In addition to its member countries, SUN's partners involve hundreds of civil society organi zations and businesses, philanthropic foundations, bilateral donors, and all the main UN agencies involved in food and health. It aims to see the establishment of multistakeholder partnerships for nutrition within its member countries and focuses its work around advocacy, capacity building, and resource mobiliza tion. (3)

While GPPPs are promoted as necessary and effective mechanisms to solve development challenges, they reflect a shift in authority away from states in favor of nonstate actors, raising issues about legitimacy. In global health, crit ics argue that their proliferation has increased fragmentation and advanced the special interests of powerful private actors, such as philanthropic foun dations and corporations, thereby undermining democratic governance and challenging the authority of organizations like the UN. (4) The increased agenda-setting power of private actors has also shifted priorities away from addressing complex health issues rooted in political and socioeconomic inequities, toward quick fixes and market-based technological solutions. (5)

SUN claims to address many of these criticisms. It describes itself as a collec tive "country-led" effort that promotes a comprehensive approach to nutrition, seeking to reduce fragmentation in global nutrition governance. (6) Despite its broad membership, SUN's establishment provoked considerable contestation within the international nutrition community. Certain actors still contest its legitimacy and describe it as a donor-driven and top-down initiative. (7) Others again see it as a corporate-led platform used by multinational businesses to push for market-based solutions to nutrition problems. (8)

The purpose of this article is to examine how and why SUN came about, focusing particularly on the power, interests, and normative beliefs that shaped SUN's formation. So far, few studies have demonstrated the importance of power relationships in global health governance. (9) According to Preslava Stoeva, the broad variety of actors, public and private, involved in the politics of global public health makes it a field particularly predisposed for power strug gles and conflicting interests. (10) This also holds for nutrition where the multisectoriality of the issue (involving sectors such as health, agriculture, food, sanitation, and environment) has led to a leadership vacuum, nationally and at the global level. The lack of an institutional home for nutrition has made the issue prone to conflicts and power struggles between a broad variety of actors. (11)

Nevertheless, few empirical studies of global health within international relations (IR) critically explore sources of power among nonstate actors and few analyze how power asymmetries shape identities, interests, values, and norms. Meanwhile, public health scholars pay little attention to the politi cal character of global health institutions. While some studies apply various public policy frameworks to explain how actor power, political context, and ideas shape health agendas and policies, (12) these studies often focus on the domestic level and on policy implementation processes in developing coun tries, leaving global power dynamics relatively unscrutinized. Similarly, most studies of nutrition partnerships assess short-term opportunities, benefits, and challenges, often at country level, rather than examining power dynamics and politics. (13) While some recent studies, which explore the emergence and influ ence of global health networks, recognize the importance of power, they do not explicitly engage with theories of power. (14)

In this article, I address this gap in the literature by applying a multidimen sional power framework to understand how public and private, state and non-state actors shaped SUN's development though the exercise of instrumental, structural, and discursive power. By paying attention to the different types of power at play, I reveal the complexity and multifaceted ways that global actors seek to influence global policy processes and, hence, shape norms and institu tions at the global level. I ask: Which kinds of power, interests, and normative beliefs drove SUN's formation and how were these distributed and contested between the actors involved? How did the process shape what SUN is today and its role within global nutrition governance?

My findings show that SUN's rhetoric of collaboration and country lead ership masks normative disagreements and power asymmetries shaping its development. SUN was the outcome of an intense power struggle between two global coalitions of state and nonstate actors with competing interests and normative views on how undernutrition should be solved, and how authority should be exercised at the global level. The instrumental power of the most resourceful coalition was effectively translated into structural and discursive power, serving to establish SUN as a GPPP, rather than as a UN-led entity with limited private sector involvement. Whether SUN has reduced fragmen tation within global nutrition governance is questionable as its establishment increased the number of global coordinating entities for nutrition, strength ened divisions within civil society, and blurred responsibilities between public and private actors in the field. Contrary to its claim of being country led, devel oping countries had little influence over SUN's development. Over time, their influence has increased, but powerful actors from the investment coalition still dominate its governance. As critics suggest, SUN has certainly opened the space for private sector influence in global nutrition governance and is today contributing to the promotion of market- and technology-based solutions to nutrition problems. While corporate actors were not the main drivers of SUN, states, international organizations, and private actors supporting private sec tor involvement in global governance stood behind its creation. This mirrors developments of other GPPPs and exemplifies the complexities behind the increased institutionalization of private sector interests within global gover nance.

In the rest of this article, I first set out my theoretical framework and method ology before I illustrate in the empirical section how public and private actors exercised different types of power to advance their interests in the processes leading up to SUN's establishment.

2 Instrumental, Structural, and Discursive Power in Global Governance

Doris Fuchs defines power in terms of actors' ability to successfully pursue a desired political objective. (15) Within IR research, a power-based perspective on the role of nonstate actors in processes of global governance recognizes that power can be derived from a variety of sources that can be expressed at differ ent levels and take on a range of forms. (16) I draw on a multidimensional theo retical power framework distinguishing between instrumental, structural, and discursive power. (17) This distinction allows me to analyze both direct observable relationships of power between actors, often facilitated by material resources, and more indirect forms of power expressed through discursive approaches or as a consequence of the structural context in which actors operate. This frame work also acknowledges the complex interaction between different types of power, and how power combinations translate into political influence.

Instrumental power refers to the direct power of one actor over another to affect political outcomes or policies. (18) This power is often derived from actor-specific material resources such as finance, information, technology, and human resources. Instrumental power can be brought to bear through financ ing political campaigns, lobbying, and participating in PPPs to provide influ ence in policymaking. (19) Instrumental power can also be exerted through the financing of knowledge production on which politicians or others base their decisions. Global health research has drawn attention to how private foun dations use their economic resources to create evidence in support of their agendas--for instance, through funding research published in highly influen tial and authoritative academic journals. (20)

Structural power reflects the ability of actors to shape political agendas by virtue of governments' or other actors' dependence on their material resources, such as investments, expertise, or funding, but also as a consequence of the actors' positions within institutional processes. (21) With governments and inter national organizations increasingly dependent on external funding and exper tise, private actors increasingly shape political agendas. (22) In 2016, the Bill and Melinda Gates Foundation (Gates Foundation) was the second-largest donor (after the United States) to the World Health Organization (WHO), endowing it with considerable agenda-setting power. (23) Actors can also exercise struc tural power by influencing actual rule...

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