Analysing boundaries of health and social care in policy and media reform narratives: the epic and tragic narratives of policy reform.

Duijn Bannink NiesSarah van Duijn, Duco Bannink & Henk Nies

When we wrote this blog, Ukraine had not yet been invaded by Russia. However, it would feel inappropriate to us to publish this blog without acknowledging it. We are aware that we are no experts in the field of geopolitics or international relations. However, we cannot help but remark that the strategies we found in our article have become amplified in the rhetoric that surrounds the war in Ukraine. Indeed, the epic-tragic mechanism is part and parcel of democratic processes – as we show in our article – but it is also a part of incomparably worse phenomena such as (threats of) war.

The war in Ukraine involves an obvious struggle over boundaries and who is legitimate in deciding where they are supposed to be. We see epic and tragic tales being devised on both sides. Epic tales to create support or keep up morale, and tragic tales to illustrate the damage done by the opposing force. The contradiction between epic and tragic tales become magnified in war rhetoric. This points to something that is also important for us to remember in ‘everyday life’: a tragic tale is always disruptive for an epic storyteller. Still, it is important to remain open to tragic narratives – even if they sadden us. These tragic tales are not just narratives. They are actual tragedies that befall citizens. We empathise with the victims of war, and almost long for the time when we originally wrote our article, when this dynamic was part of a democratic process in which the tragic tale was also heard. 

Analysing boundaries of health and social care in policy and media reform narratives: the epic and tragic narratives of policy reform 

No story is completely true – but which story is the most convincing?

If we want to get something done, we need a good story to create support. Since ancient times we know both epic and tragic stories can be effective in convincing an audience of a certain argument. Epic stories are abstract and future-oriented stories of how a hero overcomes complicated obstacles. Tragic stories, on the other hand, are more precise and draw on spectacle to arouse emotion in the audience, to show that achieving the desired situation may be impossible.

In our recent research article published in Policy & Politics, we understand these narratives as actors’ attempts to reconfigure boundaries between actors in policy design and implementation. We critically analysed the discourse in policy and media narratives on the 2015 Dutch long-term care (LTC) reform in order to understand how these tales informed the boundaries that divide field actors across groups.

The LTC-reform was among the most significant change in domestic governance in decades in the Netherlands. Generally speaking, the reform consisted of dividing tasks that previously were the responsibility of one stakeholder, across three stakeholders. This demanded the implementation of new boundaries between these actors, in the form of three different care Acts and financial streams. Collaboration between the new stakeholders across these same boundaries was also required, given that citizens were not supposed to be burdened by the existence of these different care Acts. All in all, the LTC-reform was supposed to make the care system both more efficient and of higher quality.

Our analysis revealed two contrasting narratives surrounding the LTC reform. One was the government’s epic tale, which focused on saving the healthcare system from disaster while, in the process, making it more efficient, contemporary, and ‘better’. The second, narrated by the media, was a tragedy centered on how the LTC reform would eventually lead to the demise of the care system.

The central government devised a narrative in terms of systems and abstract groups in which they shared how the reform would overcome the contemporary issue of continuously growing healthcare costs. In this story, no questions were posed about the legitimacy of the newly formed boundaries and the responsibilities of the actors within them. Citizens, for example, were assumed to be just as well-organised and well-informed as formal parties.

The media, by contrast, devised a tragic narrative which questioned the legitimacy of the central government’s re-design of boundaries across the healthcare system. It was dramatic and drew on anecdotal evidence of how the reform had impacted different actors within the healthcare system. As such, their tragic tale undermined the abstract ideas in the narrative of the central government.

From our research, we share the implications of these epic and tragic stories on the configuration of actors across the health and social care system. We also reveal how the discursive reconfigurations created paradoxical requirements from the actors involved – which complicated the implementation of the reform.

Our findings make a scholarly contribution to the literature on boundary work. They also have important implications for policy design and its local implementation, given the tension-ridden position of local actors caught between symbolic boundaries demanding integration and social boundaries imposing differentiation.

You can read the original research in Policy & Politics

Sarah van Duijn, Duco Bannink & Henk Nies (2022) Analysing boundaries of health and social care in policy and media reform narratives Policy and Politics DOI: https://doi.org/10.1332/030557321X16420783121324

If you enjoyed this blog post, you may also be interested to read:

Evaluating the role of bricolage in US Health Care policy reform

Drivers of health policy adoption: a political economy of HIV treatment policy

Government’s social responsibility, citizen satisfaction and trust

The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of Policy & Politics, the Policy Press and/or any/all contributors to this site.

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