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Policy Change and the Politics of Obesity in Germany and the United States of America

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Policy Change and the Politics of Obesity in Germany and the United States of America POLICY CHANGE AND THE POLITICS OF OBESITY IN GERMANY AND THE UNITED STATES OF AMERICA A Dissertation submitted to the Faculty of the Graduate School of Arts and Sciences of Georgetown University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Government By Renu Singh, M.S. Washington, DC April 14, 2020 Copyright © 2020 by Renu Singh All Rights Reserved ii POLICY CHANGE AND THE POLITICS OF OBESITY IN GERMANY AND THE UNITED STATES OF AMERICA Renu Singh, M.S. Dissertation Co-Advisors: Hans Noel, Ph.D. and Jeffrey Anderson, Ph.D. ABSTRACT What drives policy change and innovation when food policy meets health promotion and prevention? My dissertation studies contemporary and historical policy change in the context of obesity-related food and public health policies in Germany and the United States from 1990 to the present. It frames the question in the context of existing literature on policy entrepreneurship and theories of policy change, and it builds on them to develop a typology of policy change based on the entrepreneurs’ motives and levels of issue salience and better understand the role of partisanship and public health institutions in driving policy change. To illustrate the typology’s application and analyze the role of partisanship and institutions, I use a multi-method approach involving internet search data, original observational and experimental survey data, archival research of legislation and health records, and process tracing via elite interviews of various governmental and non-governmental actors. The dissertation serves to improve understanding of the mechanisms at play in bringing about policy change generally, and specifically with regard to low salience issues like obesity. INDEX WORDS: Dissertations, Government, Political Science, Public Health, Obesity, Germany, United States iii DEDICATION To R.B.S. iv ACKNOWLEDGMENTS Transitioning to life as a political scientist after spending years in the natural sciences has been an illuminating experience, and one that would not have been possible without a number of people I have met along the way. It takes a village to write a dissertation, and I am incredibly thankful to everyone who has helped me with this process. First, I would like to thank my committee. Hans Noel and Jeffrey Anderson were supportive of my fledgling ideas since the very beginning of graduate school, and I have benefitted from their feedback and guidance as my dissertation co-chairs. I also am incredibly thankful for the role that Marc Howard, Kimberly Morgan, and Irfan Nooruddin have played in the development of the dissertation at each of its stages. Each in their own way also helped me address the non-academic challenges that occur so often in graduate school, and I am very grateful for that. Within the greater Georgetown community, I would also like to thank the numerous Department of Government faculty who were always happy to schedule and have impromptu chats about joining in a friendly PhD versus Profs departmental soccer match and any number of questions I have had about academia, political science, and life. In particular, I want to thank Diana Kapiszewski for going above and beyond to provide advice and support on everything from how to organize qualitative fieldwork data, engage with interviewees in the field, never forget to back up files, and find inspiration in adversity. Lastly, thank you to Angela Jenkins and David Myles for all of the laughs and love. I am also incredibly grateful to a number of friends and mentors in the greater academic community. In particular, I would like to thank Boris Shor for being my v “shadow committee member,” Ryan Bakker for his everlasting humor and honest advice, Mark Vail for his openness and forthcoming mentorship, Kenneth Scheve for sponsoring my visit at Stanford, and Hannah Walker for everything that she is. The research required for this project would also not be possible without generous funding and support from Georgetown University, the Fulbright Program, and the German Fulbright Commission. In addition, I am very thankful for the community at my sponsoring institution while on the Fulbright – the Hertie School of Governance – for their assistance, encouragement, and camaraderie during fieldwork. It has been a privilege and a pleasure to be an honorary member of the Hertie PhD family, and I cannot thank my colleagues enough for their insightful comments, lively discussions, moral support, and levity at Mensa lunchbreaks. Finally, none of this would be possible without the love and support from my friends and family. I am indebted to them for their unconditional and unwavering enthusiasm and encouragement throughout this whole process. My big sister, Rashmi, could not have been happier when graduate school brought me back to the United States, and her sage advice at the best and worst of times have made all of the difference. My parents might have been the only two even happier to have me back across the pond, and I draw my academic and personal inspiration and motivation from the tradition that they started by moving to the United States in the pursuit of education. To my fiancé, Scott Williamson, thank you for being a steadfast partner in crime as we both have navigated this process together. And last but not least, to my baby brother Rishi Singh, who has been my best friend since the beginning, this dissertation is dedicated to you. vi TABLE OF CONTENTS Chapter 1: Introduction ....................................................................................................................1 Chapter 2: Low Salience Policy Change and Policy Idealists .......................................................29 Chapter 3: The Policymaking Context in the United States and Germany ....................................57 Chapter 4: What Makes a Changemaker? Policy Idealists in the United States and Germany .....88 Chapter 5: Partisanship, Elite Cues, and Support for Obesity-Related Policies in Germany and the United States ..................................................................................................................160 Chapter 6: Historical Determinants of Public Health Institutions in Germany and the United States ...............................................................................................................................185 Chapter 7: Conclusion..................................................................................................................215 Appendix ......................................................................................................................................217 Bibliography ................................................................................................................................219 vii LIST OF FIGURES Figure 1.1 Relative obesity issue salience in Germany and the US ...............................................14 Figure 1.2 The obesity problem in the US .....................................................................................16 Figure 1.3 Importance levels of issues when voting in an election in the US ...............................16 Figure 1.4 The obesity problem in Germany .................................................................................17 Figure 1.5 Importance levels of issues when voting in an election in Germany ...........................18 Figure 5.1 Correlates of supporters for obesity-related policies in the US ..................................171 Figure 5.2 Correlates of supporters for obesity-related policies in Germany ..............................172 Figure 5.3 Partisan subgroup effects for Michelle Obama ..........................................................178 Figure 5.4 Partisan subgroup effects for Renate Künast ..............................................................179 Figure 5.5 Partisan subgroup effects of hypothetical elite cues in the US ..................................181 Figure 5.6 Partisan subgroup effects of hypothetical elite cues in Germany ...............................181 Figure 5.7 Support for obesity policies by legislator’s level of government in the US ...............182 Figure 5.8 Support for obesity policies by legislator’s level of government in Germany ...........183 Figure A1 Salience of obesity compared to NASA in the US .....................................................217 Figure A2 Salience of obesity compared to other issues in the US .............................................217 viii LIST OF TABLES Table 3.1 State obesity policy index ..............................................................................................72 Table 4.1 The policy change typology ...........................................................................................96 Table 4.2 Obesity-related public health policy within the typology ..............................................96 Table 5.1 Support for obesity-related policies in the US .............................................................168 Table 5.2 Support for obesity-related policies in Germany .........................................................169 Table 5.3 Correlates of support for individual obesity-related policies in the US ......................173 Table 5.4 Correlates of support for individual obesity-related policies in Germany ...................174 Table 6.1 Land-level public health institutions: State ministries .................................................202 Table 6.2 State-level public health institutions: Public health departments
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