Modeling Partial Agency Autonomy in Public-Health Policymaking
This Article considers the conditions under which administrative agencies — particularly those with public health-related missions — may obtain partial autonomy from external interests or politicians. In the process, it critiques the proposition that administrative agencies in advanced industrialized countries such as the United States are routinely “captured” by external economic interests. Through case studies and the application of relevant theory from law and the study of political organization, the Article describes how agencies can produce a measure of autonomy by forging coalitions of stakeholders both internal and external to the agency, and considers how partial autonomy may be modeled as a strategic process involving decisions under uncertainty. The Article then investigates how American public-health agencies such as the Food and Drug Administration, the Food Safety Inspection Service, and the Centers for Disease Control have been able to use their partial autonomy to develop significant health policy innovations. Although agencies are by no means guaranteed even a partial degree of autonomy, they are nonetheless capable of affecting their political and legal environment, with consequences not only for public-health policy but also for the legitimacy of the nation-state.