Anthropology has a long tradition of explaining how global processes, including international agreements in health, affect communities on the ground. However, it has less to say about the processes in which these agreements are produced. Here I argue that Victor Turner’s frameworks on social dramas, rituals and symbols are relevant to explicating the processes by which such agreements are reached.
The formation of such agreements is part of the mandate of the World Health Organization (WHO), which was founded in 1946 as the UN specialized agency for health. Each year, delegations from the WHO’s 194 member states meet in Geneva at the World Health Assembly (WHA) to formally discuss and adopt resolutions and international agreements. These delegations include individuals from national Ministries of Health, Development, Foreign Affairs and others; the formation of WHO policy is not simply a matter for doctors and health professionals, but also for diplomats who represent broader national interests and priorities.
These agreements include binding international laws, including those that cover infectious disease control. Others include “softer” resolutions and recommendations. Although these agreements are all distinct from a legal perspective, there are commonalities in how they were developed and finalized. Such commonalities are considered here with a focus on how the WHO has addressed childhood obesity.
Childhood Obesity and the WHO
In 2012, the Organization published “A Framework for Implementing the Set of Recommendations on the Marketing of Foods and non-Alcoholic Beverages to Children.” As its name suggests, this document was developed as a guide to the “Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages,” a document adopted by WHA in 2010 with the aim of “reducing the impact of foods high in saturated fats, trans- fatty acids, free sugars, or salt” on children. The idea is that governments would receive both documents as a toolkit with policy recommendations to tackle this public health issue in their own countries.
In the course of my PhD fieldwork, I interned at the organization’s headquarters in Geneva, Switzerland, where I worked alongside WHO staff members in drafting part of the implementation framework. Through this process, I became intimately familiarized with the recommendations themselves. As a companion to the Set of Recommendations, the Implementation Framework refers to the precursor document and mirrors it in phrasing and style. This is because the Set of Recommendations—and their wording—was endorsed by the WHA and thus became the legitimised way in which to discuss the issues. Accordingly, I had to ensure that the wording between the two documents was consistent and that that any policy recommendations in the Implementation Framework was in line with the spirit of the Set of Recommendations.
Understanding the spirit of the Set of Recommendations also meant understanding the background to the document. The formal narrative states that in past decade there has been increasing recognition of the importance of addressing obesity and non-communicable diseases, such as heart disease and diabetes. There has also been increasing concern over the role that marketing (such as commercials, sponsorship of children’s sports and toys in fast food meals) plays in increasing rates of childhood obesity. Starting in 2000, the organization has developed a number of strategies and resolutions in response and the Set of Recommendations ultimately came out of this broader work. Specifically, over a three-year period, the WHO held two sets of consultations with the private sector, including food and beverage companies, and with NGOs working on non-communicable disease and consumer affairs. They also convened a group of independent experts on the issue who reviewed evidence on the effects of marketing on children and consulted on a regional level with a number of member states. Finally, the Set of Recommendations was passed via a resolution at the World Health Assembly in 2010.
During interviews, informants told me their stories of the drafting process: for example, informants described lengthy discussions over specific words and phrases in the document and discussed what worked well in the consultation process and how it could have been improved. They also described the wider issue of childhood obesity in their countries and the controversy over the responsibility of the private sector.
This wider narrative of experience that was condensed into one document would be very difficult for someone on the ‘outside’ to infer from reading it. Yet, if one is on the “inside” one can see references to these stories throughout the document.
International Law, Symbols and Turner
Anthropologists and sociologists, such as Sally E Merry and Annaliese Riles describe international law as produced by negotiations and consensus-building which takes place in global conferences, meetings, declarations, conventions. They write of how norms are created and conflicts resolved via complicated procedures. The data begs for a Turnerian analysis: an international agreement is produced by ritual processes that are situated in a wider social drama; the agreement effectively becomes the symbol around which to orient action.
Specifically, Turner focused on four main characteristics of symbols: action, reference, condensation and opposition. Firstly, symbols are not intangible clouds of meaning but rather are instigators of social action. Symbols are simultaneously referential and condensational. They refer to other symbols and serve to represent a range of ideas, beliefs, values and experiences. That is, these ingredients condense into a single symbol. Symbols tend to be oppositional, meaning that they refer to two binary concepts. However, symbols cannot be understood in and of themselves, but must be considered in relation the wider narrative in which they are situated.
International Agreements as Symbols
In her ethnographic work on UN environmental policy-making, Lauren Eastwood describes UN environmental texts as “the sites of key struggles taking place” which are “organized around practitioners’ attempts to influences the meaning of terms that are integral to the making of environmental policy.” She also notes how particular terms or phrases stood in for the range of experiences that the stakeholders brought to the negotiations.
I found this as well: the “Set of Recommendations on the Marketing of Food and Non-Alcoholic Beverages to Children” represents the narrative of how an assemblage of actors—diplomats, WHO staff members, academic experts, civil society and private sector actors—brought a range of ideas, beliefs, values and experiences to the drafting and negotiation processes. All of these experiences are boiled down or condensed, to use Turner’s term, into a symbol or “parcel of meaning” in the form of the document that sets out a norm on how the marketing of food to children should be handled by national governments. This narrative is condensed into consensually agreed upon language that frames the issue in a certain way. The Set of Recommendations is also referential in that it builds upon precedent, citing and incorporating language from prior resolutions and documents. Finally, the document is binary or oppositional in that, to some actors, it juxtaposes the narratives of the private sector and consumer interest NGOs in the causes of and solutions to childhood obesity.
To Turner, social dramas themselves are about renegotiating metaphors and symbols and action revolves around these symbols. Literally, we see policy-making as a process in which texts are negotiated and re-negotiated. More abstractly, these processes create global health norms (and thus, meaning within global health). Finally, analyzing agreements and the norms they encompass as symbols also elucidates an understanding of power within global processes: within this negotiation of shared meaning, certain voices, experiences and narratives are excluded or diluted in the process.
Rachel Irwin is a researcher in the Global Health and Security Programme at the Stockholm International Peace Research Institute in Sweden. She is also a PhD candidate at the London School of Hygiene and Tropical Medicine where her research focuses on the rituals of global health policy-making at the WHO.