# Session Overview This session explores a theoretical concept that has become increasingly important in the political and social sciences over the last 20 years: the [[transnational expert networks (TENs)]]. Drawing attention to scientific communities, epistemic communities, science associations, think tanks and global policy networks, as different forms of TENs, the session shows how political and social scientists have defined TENs as a community of experts and activists organised around the production and diffusion of a specialist knowledge. Attention is drawn to the practicalities of TENs’ influence on governance: both through knowledge contestation and knowledge creation and advocacy. Using case studies from the field of global health governance and beyond, the session then discusses the organisation and activities that are typical of a TEN. Example cases include the contestation of climate change and the effects the tobacco smoke and the role of TENs in global health governance in relation to health care financing and the issue of maternal survival. ## Objectives By the end of this session, you should be able to: · define the concept of transnational expert network and discuss the role played by such networks in global governance in general and global health governance in particular; · describe the nature, organisation and activities characteristic of different types of transnational expert networks; · apply the conceptual framework of transnational expert networks to the field of global health governance; · critically evaluate the contribution of transnational expert networks to the use of expert knowledge in global policy-making. # 1. Introduction >The role of transnational expert networks may have been overexposed or over-emphasised. Cross (2013) argues that while transnational expert networks play an increasingly important role in an increasingly complex global policy environment, the systematic study of these networks has not progressed conceptually very much since the late 20th century. She therefore proposes that critiques ought to be taken as an opportunity to further develop the transnational expert network conceptual framework and to continue to deepen understanding of the role of knowledge and expertise in global governance studies. # 2. Transnational expert networks conceptual framework [[transnational expert networks (TENs)]] is a collective term, which covers a wide array of associations that utilise knowledge and expertise as their core resource in the pursuit of particular political goals, policies or actions. There are different types of TENs – scientific communities, epistemic communities, science associations, think tanks, civil society organisations comprising expert practitioners (e.g. associations of lawyers), and others. This section will discuss these types of TENs and the functions of TENs in global governance. ## 2.1 Transnational Expert Networks Some authors use the term expert networks interchangeably with epistemic communities or science associations (Haas 1992a: 2; Betsill and Bulkeley 2004: 474), however, some caution is in order before conflating the terms community and network. Every community is a network, but not every network is a community, as the type and level of organisation of the two differs. The actors in communities are much more closely associated and brought together by common values and the pursuit of a common purpose. In the sub-sections below, we will draw attention to a number of different types of TENs to highlight some of these differences. ## 2.2 Scientific Community Sociologists and philosophers of science discussed the concept of a community of scientists in the 1960s and 1970s. In his book The structure of Scientific Revolutions (1962), the American philosopher [[Thomas Kuhn]] defined a scientific community as made of scientists who pursue knowledge that ‘solves problems about the behaviour of nature’; such solutions, however, must be accepted by the members of the community, as a ‘uniquely competent group’ and an ‘exclusive arbiter of professional achievement’ (Kuhn 1996/1962: 168). ==The work of Kuhn’s scientific communities revolves around a shared paradigm.== The notion of a shared paradigm in the field specifically of the natural sciences depicts a very particular type of scientific community – one which rallies around a specific theory or worldview that has clearly defined parameters, ontological and epistemological conceptualisations. In his book Genesis and Development of a Scientific Fact, Ludwig Fleck (1979) discussed the term ‘thought collective’ to define a community of researchers who interact towards the production or elaboration of knowledge using shared norms and practices. ==Meanwhile, the French philosopher Michel Foucault (1966) introduced the Greek term episteme, meaning ‘knowledge’, thus paving the way for contemporary thinking on epistemic communities.== ## 2.3 Epistemic Community While first used by the sociologist Burkart Holzner in his book Reality Construction in Society (1972), the term ‘epistemic communities’ became the accepted term in the field of international relations to define a community of scientists. Conceptually, the discussion was led by the political scientists Peter Haas, Emanuel Adler, John Ruggie and culminated in the publication of a special issue of International Organization dedicated to epistemic communities and international policy in 1992 (vol. 46, issue 1). The epistemic community, as conceptualised by these scholars, takes a broader view on who constitutes these communities, of what holds these communities together and of the common purpose that they share. These conceptual propositions have been applied to a number of diverse case studies, published in the special issue. [[Peter Haas defines epistemic communities beyond natural sciences. To him, it is a network of professionals with recognised expertise and competence in a particular domain and an authoritative claim to policy-relevant knowledge within that domain]] Haas defines epistemic communities beyond the narrow confines of scientists working in the natural sciences. To him, an epistemic community is a ‘network of professionals with recognised expertise and competence in a particular domain and an authoritative claim to policy-relevant knowledge within that domain or issue area’ (1992a: 3). What defines such a community further, however, is a set of four shared beliefs and goals: (1) shared normative and principled beliefs; (20) shared causal beliefs; (3) shared notions of validity and criteria for weighing and validation knowledge within the domain of their expertise; and (4) a common policy enterprise – in short, ‘common practices associated with a set of problems to which their professional competence is directed’ (1992a: 3). Peter Haas’s introduction to the special issue continues to be one of the leading texts on the subject and his definition of an epistemic community continues to be widely cited as the most authoritative one to date. [[The currency of epistemic communities is their expert knowledge, particularly in the face of complexity, uncertainty and crises]]. This is illustrated through various empirical studies published in the special issue of International Organization (vol. 46 no. 1, 1992), which discuss the mechanisms epistemic communities use to influence policy in diverse areas – from trade negotiations to nuclear arms control, to environmental policies including biodiversity, the protection of the ozone layer, to banking, and others. The novelty of the concept of epistemic communities in the 1990s centred on the recognition of the contribution of [[Non-state actors]] to global policy-making, their ability to influence policy-makers and shape policy outcomes. Such thinking was in sharp contrast to mainstream understandings of inter-state policy-making, premised on the pursuit of power and security, and on thinking about international politics as an arena reserved for state-to-state interaction and negotiations. The continued relevance of these studies resides in an important observation - [[Peter Haas]] ==notes that factors such as the ‘professionalization of bureaucracies and the growing technical nature of problems have fostered an increase in the deference paid to technical expertise and, in particular, to that of scientists’ (Haas 1992a: 11).== Further empirical research confirms the increasingly technical nature of global challenges (see for example Boli and Thomas 1999). Conceptual debates of epistemic communities have not progressed extensively over the intervening decades, as noted by Dunlop (2000) and Cross (2013). In her article, Cross (2013) seeks to advance the discussion of epistemic communities further by refining thinking around the attributes of a successful epistemic community, as scholars note that epistemic communities function with various degrees of success in different areas of global governance and policy-making. ## 2.4 Science Associations Evan Schofer (1999) provides a brief review of the rise of science associations in the course of the 20th century, in the context of what he calls the rationalization and professionalization of science from the late 19th century onward when science became increasing institutionalised through shared norms, accepted scientific principles and the development of infrastructure to support routine scientific practice (1999: 254-55). Schofer uses the term ‘science association’ to refer to international non-governmental organisations (INGOs) devoted to science, which bring together scientists, research consortia, and expert professionals, along with other activists in the pursuit of fundamentally social goals, related to or reliant on the contribution of science (1999: 249-50). The examples given by Schofer include organisations like – the International Organisation of Chemical Sciences in Development, International Union of Biological Science, International Network of Engineers for Global Responsibility and others. These socially oriented science associations differ from professional organisations, as they lack the same level of cohesion, are voluntary and could have a global reach. Science associations are more informal, potentially reliant on diverse sources of private funding, driven by the interests of scientists in richer and poorer countries alike working together to solve particular social problems (1999: 253). Examples of other such organisations include: the International Commission of Jurists (lawyers working on the protection and promotion of human rights globally); the Foundation for International Environmental Law and Development (FIELD) (a collective of lawyers working with small island states on climate change, habitat loss, ozone depletion, water pollution); the Danish Medical Group of Amnesty International (an organisation that campaigned for the international prohibition on the use of torture and other cruel, inhuman and degrading treatment or punishment); and the World Medical Association (an association of physicians, created to insure the independence of physicians and promote ethical standards) (Stoeva 2010). ==The term ‘science association’ used in reference to international non-governmental organizations (INGOs), however, can be misleading, in that the focus of these INGOs is the pursuit of social and/or policy-change, and the source of influence of these specific INGOs is professional or scientific expertise, unlike other INGOs. Some authors have referred to these as ‘communities of practice’ (see for example Adler and Pouliot 2011).== But ultimately, neither of these terms is best suited to capture the idiosyncratic nature of these organisations, as they combine elements and characteristics of civil society activism and advocacy networks (Keck and Sikkink 1998), but also bring together scientists and experts (epistemic communities) along with practitioners (communities of practice) such as lawyers, analysts, scientists engaged in applied studies. In his historic analysis of the rise of these organisations, Schofer notes that ‘the impact of socially oriented science INGOs is harder to gauge… (as) they are a rather heterogeneous group of organizations’ (1999: 263) and some may be more effective in the pursuit of their aims – such as lobbying, advocating economic development, the development of codes of professional ethics, etc. – than others. ## 2.5 Think Tanks and Global Policy Networks ‘Think tanks are research, analysis, and engagement institutions that generate policy advice on domestic and international issues, enabling policy-makers to make informed decisions and bridge the gap between government and the public at large’ (McGann 2014: 361). Think tanks, McGann notes, can be for-profit, autonomous and independent, quasi-independent, political party affiliated, university affiliated, and so on – covering a broad spectrum of organisations. Some notable examples of global think tanks include the International Crisis Group, Carnegie Endowment for International Peace, the Brookings Institution, RAND corporation. Some of these organisations focus more on research and analysis, while others actively engage in lobbying, articulating or implementing policy. Again, ==a leading resource for these organisations is expertise and expert knowledge, but also research and information-gathering capacity. Some critiques levelled at think tanks have to do with sources of their funding, which has the potential to influence the research agenda, the lack of or limited representation of low- and middle-income country experts within these, the involvement of governments in setting up think tanks with a view for these to appear independent (McGann 104: 362-3), which all generate concerns about representation, accountability, conflict of interests, influence (Stone 2013).== [[The Lancet is one of the most powerful actors or transnational expert networks in global health governance as they spur action on global health issues]] Some authors suggest ==combining insight from the epistemic community literature with understanding of the influence of policy elites comprising public officials, experts and specialists who are connected with the maintenance of the world economy, in order to more effectively highlight complex policy negotiations and policy-making processes (Lee and Goodman 2002: 102-104)==. Tantivess and Walt draw conceptually on the policy network literature to highlight [[resource mobilisation as one of the defining characteristics of policy networks]], where resources ‘may be finance, knowledge, expertise, technologies, or the capacity to mobilise any of these as well as support from members of the network and outside it’ (2008: 329). More recently, the political scientist Jeremy Shiffman highlighted the key role of the medical journal [[The Lancet]] as one of the most powerful actors in [[global health governance]] since the late 1990s, when it initiated a special series on global health issues and, subsequently, established a number of ‘commissions’ intended to spur action on global health issues such as health and climate change, diabetes in Sub-Saharan Africa, health and conflict, and financing of primary care, Involving large global communities of experts, these commissions have been highly influential in shaping policy in LMICs (Shiffman 2014). ## [[Question]] What are the four function of [[transnational expert networks (TENs)]] in global governance? ### TENS generate expert knowledge compliant with requirements for scientific methodology and rigour. Scientific communities, epistemic communities, think tanks create knowledge and an evidence-base for policy-making through research, analysis and intellectual cooperation among like-minded scientists, experts and professional analysts ### TENS develop standards — including ethical standards for research activity, professional codes of conduct/practice and ethical guidelines, along with technical standards and even international norms. It is usually epistemic communities and science associations (or science-oriented INGOs) that lead such activities. Examples are numerous and vary extensively – codes of medical ethics, bioethics and research ethics, codes of practice for prison officers, codes of practice relating to environmental protection, the International Telecommunications Union, the International Committee of the Red Cross, the International Standardisation Organisation (see Boli and Thomas 1999). A noteworthy recent development is the Brussels Declaration on ethics and principles for science and society policy making (2017). The Declaration lists 20 agreed principles setting expectations about appropriate relationships between policy-makers, scientific communities, the public, media, interest groups to ensure the appropriate and fair use of good science in policy-making. ### TENS apply science and expertise to the pursuit of social and policy change and the improvement of the human condition towards poverty reduction, economic development, the protection and promotion of human rights, protection of vulnerable groups and smaller or weaker states in the international system. TENs contributing to [[global governance]] in this way tend to be the socially oriented science associations, which have a practical focus and rely on expert practice, expertise and knowledge to achieve these goals. It is worth noting here that TENs can apply science and expertise in the pursuit of corporate interests too, which can also demand policy change, seek to amend policy or prevent the development of policy that contradicts their key interests. Science and expertise can be applied for knowledge contestation as will be discussed in the next section ### TENS lobby policy-makers and pursue policy change – it is usually think tanks and global policy networks that act in this capacity, but epistemic communities, particularly in the field of environmental politics have also been documented to lobby, negotiate and engage with policy makers in the pursuit of policy changes. Some empirical studies of such activities include Haas’s (1992b) ‘Banning Chlorofluorocarbons: Epistemic community efforts to protect stratospheric ozone’; Lee and Goodman’s (2002) ‘Global Policy Networks: The Propagation of Health Care Financing Reform since the 1980s’; Smith and Rodriguez’s (2016) ‘Agenda Setting for Maternal Survival: The Power of Global Health Networks and Norms’. ## Activity 9.2 Can you come up with other examples of Transnational Expert Network in your country/field of work, based on the definitions and examples given in this section’s materials? On the discussion forum of this activity, please list some examples of TENs. Choose one TEN (from the materials above or from experience), identify what type of a TEN it is, consider your reasoning why and identify the type of function most accurately associated with this TEN, providing further detail of the work of the organisation if needed. Please comment on the choices and posts of at least two other students. # 3. Transnational expert networks and knowledge contestation > Knowledge is socially produced, but also socially contested. Contestation drives the modification of existing knowledge and the development of new knowledge. Contestation can be premised on genuine motives for progressing, improving and refining existing knowledge, or on the desire to generate doubt and uncertainty, which can undermine policy-initiatives, paralyse political decision-making and action, and generate debates that distract public attention. Scientific uncertainty is often exploited by groups that oppose a particular policy proposal. Such ‘corrupt’ use of expertise has most often been documented in relation to the protection of corporate interests – in the field of tobacco control, alcohol and food regulation, environmental politics including issues such as climate change and pollution control, but also in trade negotiations regarding intellectual property protection, or in development studies regarding particular models of economic development and poverty reduction. Knowledge contestation has also been led by science associations – for example lawyers and social scientists in the Global South taking a critical view of the nature of public international law as a neo-colonial instrument of political oppression or contesting human rights norms and principles as an imposition of liberal views from the North. Knowledge contestation is also in action when civil society organisations questioned corporate lobbying for international norms on intellectual property protection. In this section we will discuss two case studies of knowledge contestation by TENs – the case of contestation of climate change and the case of contesting the connection between cigarette smoke and cancer. Both examples are discussed in detail in Conway and Oreskes’ The Merchants of Doubt (2012). ## 3.1 The role of [[transnational expert networks (TENs)]] in knowledge constetation in the climate change debate In 1965, the US President Advisory Committee head by Roger Revelle from the Scripps Clinic in San Diego concluded that temperatures on earth were increasing- this was in keeping with the initial hypothesis that the earth was experiencing global warming. A similar conclusion was reached by a US National Academy of Sciences’ panel headed by Jule Charney in 1979. More recently, the UN Intergovernmental Panel on Climate Change (IPCC) established in 1988 has reasserted that the earth’s climate was changing as a result of human activity. Scientists project that temperatures will rise but the rise will not be consistent and uniform across the world, instead they warn of climate change, which will affect different parts of the world differently, but is likely to have most significant and damaging consequences for countries that are already poor and disadvantaged. > Even though scientific evidence of climate change is clear and scientific projections of global climate change are proving accurate, climate change science cannot guarantee with certainty what the consequences of climate change will be across the world. Scientists are warning that a global warming above 2oC will set in motion catastrophic and irreversible changes in the global environment with high potential for more frequent and damaging extreme weather events (see, for example, Steffen et al 2018). It is this uncertainty that has been exploited by ‘climate sceptics’. It is worth noting here that technical knowledge regarding climate change was constructed by scientific communities in cooperation with businesses (e.g. renewable energy companies, insurance companies), INGOs and expert panels organised by inter-governmental organisations (IOs) (Stoeva 2010: 131). ==Conway and Oreskes (2012) argue that the reason for the continued confusion among both policy makers and the general public is the doubt purposefully generated by a distorting expert network.== This network comprises a variety of members - some are scientists such as Bill Nierenberg (Director of the Scripps Institute of Oceanography at the University of San Diego), Fred Singer (a physicist and rocket scientist at the University of Virginia who also sought to deny the reality of acid rain and, later, the ozone hole), Patrick Michaels (physicist) and Frederick Seitz (a physicist who was also a key member of the pro-tobacco network). Most of these scientists directed their efforts to fighting what they called ‘alarmist environmentalists’, whom they saw as working under the cover of global warming to weaken American power based on science and technology. The network also comprises economists like Thomas Schelling, William Nordhaus and Gary Yohe, most of whom are ==free-market apologists==. While they do not necessarily reject the reality of climate change, they disagree that it is a problem, by noting the uncertainties and complexities of climate change’s future effects. Some argue that it is probable that human beings will be able to adapt to some of the effects of climate change through migration and technology development, ==but also that the free market will encourage research and development of alternative, cleaner sources of energy like solar or wind power==. The network also comprises technology advocates such Julian Simon and Bjorn Lomborg, for whom environmentalists are ‘doom crying opponents of progress’. They argue that through technology humanity will solve global warming and continue towards increased progress and happiness. Finally, the climate sceptics’ expert network includes advocates of the fossil fuel industry (e.g. Exxon Mobile; American Petroleum Institute) as well as oil producing countries (e.g. Saudi Arabia; Kuwait). Their interest is fairly straight-forward: climate change would mean reducing CO2 emissions and would thus directly threaten trade in fossil fuels. These businesses have thus poured millions in trying to deny the reality of climate change. The network is organised around a series of institutional forms, including think-tanks like the [[American Enterprise Institute]] (a [[neoliberalism|neo-liberal]], pro-market think-tank), the Cato Institute (also a neo-liberal, pro-market think-tank), the Heartland Institute (also a neo-liberal, pro-market think-tank) and the George C. Marshall Institute (an institute created by Frederick Seitz and Fred Singer in 1984 to defend US President Regan’s Strategic Defence Initiative against other scientists and which was later transformed to fight ‘environmental alarmists’ and deny the reality of both acid rain and the ozone hole; members include Bill Nierenberg and Patrick Michaels). It also includes political alliances like the pro-industry Global Climate Coalition as well as media platforms. Like the pro-tobacco group explored below, the aim of this network is to create doubt and controversies about the reality of climate change and thus prevent possible regulation. Their strategies include cherry-picking and distorting the existing data, as well as overexposing uncertainties – e.g. regarding the causality between human activity and climate change, or the uncertainties about the scale and precise consequences of climate change. Sceptical experts advocating against action in the face of scientific uncertainty. ## [[transnational expert networks (TENs)]] and knowledge constetation of the harmful effects of tobacco ### Cast doubt In 1964, the American Surgeon General published its first report on the topic where it concluded that, after consulting over 7000 scientific papers, there was no doubt that smoking caused cancer and other degenerative diseases (CDC 2018). As a consequence, a growing number of people started to call for regulatory interventions from increased taxes to advertising bans in order to curb the use of tobacco. Similarly, there was also a mounting number of people filing lawsuits against cigarette producers for making them sick. Unsurprisingly, the tobacco industry viewed these developments as a threat to its lucrative business. To defend its product and challenge the charges, America’s major cigarette producers, RJ Reynolds, American Tobacco, Benson and Hedges, Philip Morris, etc. came together in the 1950s and set up a strategy to counter-act these threats to their business. As discussed in [[GHM102 Session 07 Corporations and global health policy]] on transnational corporations, their strategy included the creation of a network of scientists and PR experts whose aim was to challenge and create reasonable doubt about the causal link between tobacco and cancer so as to avoid regulatory interventions and lawsuits. The network was organised around foundations, PR firms, think tanks and ‘rogue’ scientists. One of the PR firms that formed part of this network was Hill and Knowlton, one of America’s largest and most effective PR firms, which set up and led a campaign to deny the harmful effects of tobacco, lasting until the end of the twentieth century. A further key element of the campaign was the creation of think tanks like the Tobacco Industry Research Committee (later the Council for Tobacco Research), which together with the PR firms, developed a series of strategies to challenge the mounting scientific evidence against tobacco. First, they enrolled well-known and respected scientists who were happy to defend theories that contradicted or cast doubt on the existence of a causal link between smoking and cancer. These scientists were happy to do so for a variety of reasons. Clarence Little, for example, was a renowned geneticist who genuinely thought that cancer was not due to tobacco but to genetic predispositions. Another example was Frederick Seitz, a well-known and influential physicist who seemed to have joined the ranks of the tobacco industry because of the grudges he bore against the scientific establishment which he saw as too liberal. ### Fund biomedical research that would deflect attention from the main event and supply new, genuine data, hypotheses and interpretations that focused on alternative causes of chronic diseases Another strategy used by the network to cast doubt about the scientific evidence against tobacco was to fund biomedical research that would deflect attention from the main event and supply new, genuine data, hypotheses and interpretations that focused on alternative causes of chronic diseases such as genetic inheritance, stress, exposure to asbestos and so on. Between 1950 and 1985, the tobacco industry is said to have given over USD 100 million to biomedical research. For example, RJ Reynolds launched a 45 million dollar research programme into the causes of generative diseases headed by Frederick Seitz in 1979 in collaboration with top universities like Harvard, University of California and Rockefeller University. In the 1990s Philip Morris, British American Tobacco, RJ Reynolds, Imperial, Rothmans, Reemtsma spent millions of dollars on research to manipulate the findings of the largest European study into the relationship between environmental tobacco smoke and lung cancer, undertaken by the International Agency for Research on Cancer (Collin et al 2002). ### Cherry pick existing data against tobacco and question the details By asking questions about these aspects (Why do cancer rates vary greatly between cities even if smoking rates are similar? Do other environmental changes, such as increased air pollution, correlated with lung cancer?), the members of the network could create controversies and perpetuate debates about the harmful effects of tobacco. Distributing pamphlets to the media, policy makers and the general public was another strategy adopted by [[transnational actors (TNAs)|transnational]] tobacco corporations. These pamphlets, often written by the scientists, outlined alternative explanations for the rise in lung cancer and questioned the existing evidence linking cancer to smoking. A fifth and final strategy of the pro-tobacco collective was to undermine the reputation and work of scientists whose research showed a link between smoking and cancer. This was done through articles in the press that questioned their integrity or their methods. # 4. Transnational expert networks and global health governance The health-related subfield of global governance has a very particular architecture, compared to other subfields – such as security, trade, human rights, etc. This is in part due to the character of the subject matter of health-related governance - namely, health and disease, which is heavily reliant on expert knowledge, scientific input, research and development, expert practice, and the need for significant investment. As a result, the health-related subfield of global governance is defined by a multitude of actors, many of whom non-state, able to mobilise significant resources in the pursuit of particular policy goals, and relying on some form of expertise – practical or scientific. As such, TENs play a central role in global health governance – either through working with states, advising states, creating coalitions with other non-state actors, lobbying states and inter-governmental organisations and so on. The following two cases studies provide us with empirical insight into these political dynamics. ## 4.1 The Case of Health Care Financing Reform Lee and Goodman (2002) examine the role of transnational policy expert networks in the reform of global health care financing between 1978 and 2000. As the authors explain, the financing of healthcare in developing countries began to be understood as a problem in the late 1970s - early 1980s. Indeed, it is then, in a climate of economic hardship for developing countries due to the oil crisis and falling prices for primary commodities, that health economists began arguing that there was a gap between the cost of providing healthcare in developing countries and the resources available to these countries. They estimated the worldwide resource gap at over US$ 50 billion per year. By doing so, these economists constructed a new problem that had not been considered previously. Indeed, until then, ==it was simply assumed that national governments around the world had to provide health care, whether they had sufficient resources or not. As Lee and Goodman show, economists developed and offered solutions to this new problem==. These solutions for financing health care were varied. They included user fees (whereby patients were required to pay for part of their healthcare, thus decreasing the amount that governments had to pay) and insurance schemes. The above solutions were progressively disseminated in developing countries, in particular in Africa, through the work of the [[World Bank (WB)]], [[UNICEF]] and both the British and American developing agencies. As Lee and Goodman argue, both the construction of this new problem and the development and dissemination of solutions were the work of a network of experts located mainly in the Global North. These experts generally held PhDs in health economics (a new discipline than began to emerge in the 1970s), but there were also epidemiologists and scientists trained in more than one discipline (e.g. economics and public health). The network within which these experts operated was articulated around different organisational forms. The transnational expert network, thus, included experts who held academic positions at universities in the USA or the UK. These universities included: the London School of Economics, the London School of Hygiene and Tropical Medicine (LSHTM), Harvard University and John Hopkins University. Some of these institutions even had specialised research programmes focused on health care financing - the LSHTM ran a Health Economics and Financing Programme from 1989 to 2002, and Harvard University ran a Data for Decisions Making Project from 1991 to 1999. The network further included development agencies from the Global North - in this case, the UK’s Department for International Development (DfID) or the US’ Agency for International Development. These agencies funded research into health care financing, with DfID, for example paying for the LSHTM programme on health economics and financing. They also hired experts from the group to put in place in developing countries some of the health care financing schemes they had devised. Third, there were international organisations like the World Bank, UNICEF and, later and to a much lesser extent, the WHO. They allowed members of the network to conduct further research into health care financing. They also allowed the members to publish widely distributed reports discussing health care financing. The [[World Bank (WB)]], for example, published many such reports, including: Paying for Health Services in Developing Countries (1985); Financing Health Services in Developing Countries (1987); World Development Report: Investing in Health (1993). Fourth and finally, there were private consultancy firms like John Snow Incorporated and Abt Associates. These firms allowed the thought collective to implement particular health care financing projects for the World Bank, UNICEF and development agencies. As Lee and Goodman also show, this expert network held in common a belief that health care financing was a problem. For the members of the collective, this problem had to be researched and quantified (e.g. calculating the gap in financing) and innovative financing solutions had to be developed and implemented in low- and middle-income countries. ==They also shared a preference for a neoliberal form of governance, which sought to deregulate the state and introduce a free market approach to health care.== Interestingly, for Lee and Goodman (2002), the power and influence of this thought collective raises questions about the democratic nature of [[global health governance]]. Indeed, they argue that while expertise and evidenced-based approaches to policy are important, the power of experts and [[transnational expert networks (TENs)]] is problematic as it deprives communities and weaker states from having a say in the proposed reforms. ## 4.2 The case of agenda setting for maternal survival Smith and Rodriguez (2016) explore the role and power of global health networks and norms in relation to the problem of reducing rates of maternal mortality. The study is part of a bigger project exploring networks that have mobilised to address six distinct global health problems – maternal survival being one of the six. The authors raise important questions about why networks consolidate around some issues, but not others and the question of why some networks are more successful at influencing policy than others. Consider the conclusions reached by these scholars, the evidence and reasoning that they provide. ## Activity 9.4 Read and reflect on the findings in the article by Smith and Rodriguez (2016). Provide short answers to the following questions: · What are the three categories of factors that shape policy and public health effects? · What are the four factors that shape the effectiveness of networks and actors? · How did the issue of maternal mortality make it on to the international agenda – what role did expert networks play? What other factors influenced the rise of the issue on the agenda? · What strategies and tools did expert networks use to influence the agenda? · Do you agree with the conclusions drawn by Smith and Rodriguez? Why or why not? # 5. Conclusion This session reviewed the concept of transnational expert network and its relation to global health governance. The materials discussed different types of transnational expert networks and the subtle differences between them, along with the key functions of TENs in global governance. Examples of the work of TENs were explored in relation to different types of activities undertaken by TENs in global governance and in global health governance – i.e. knowledge contestation, knowledge generation, lobbying and the pursuit of policy change. Transnational expert networks play an increasing role in contemporary global health-related policy making and more broadly. Their role is in part defined by the increasing demand for knowledge and technical solutions to complex global problems. There is a growing need for conceptual and evidence-informed debates of TENs to be taken to the next level, as we continue to rely on key concepts from the 20th century. Scientific knowledge and expertise, however, are not neutral – they are context-specific, value-associated – and must therefore be handled with care. Knowledge can be used to promote or block policy change. The practice of some scientists may not meet common accepted standards of methodology and scientific inquiry. As funding is always required in the development of knowledge and expertise, the source of funding can colour findings and the resulting knowledge. As trained professionals, therefore, we have a responsibility to be aware of the potential for misuse of science, but also of the potential for bad science. # 6. Integrating activity The Brussels Declaration is a statement of ethical principles for the conduct of science and its use in policymaking, which was launched formally at the American Association for the Advancement of Science in February 2017. While the Declaration emphasises the need for research integrity and transparency, questions have arisen about its own origins and funding, and the interests of those involved. Read through the Brussels Declarations (available here: https://www.sci-com.eu/main/docs/Brussels-Declaration.pdf). From this see if you can answer the following questions, making written notes of your responses: 1. Who are members of the network? What are the disciplinary and professional profiles of the members? Have all members participated fully and equally in the development of the Brussels Declaration? Do some actors appear more prominent or influential in the network? 2. What are the main issues raised by the Brussels Declaration? What does it call for or seek to achieve? 3. How does it seek to establish its credibility, and give itself the appearance of scientific integrity? 4. Does the network, its objectives or its membership appear problematic in any way? 5. Does the Brussels Declaration Institute demonstrate the characteristics of a corrupt transnational expert network as described in Session 9? Now read the commentary on the Brussels declaration by McCambride et al. (available here: https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2018/05/25/tobaccocontrol-2018-054264.full.pdf). Revisit the questions above and your answers. What, if anything, has changed in your thoughts about the Brussels Declaration? Post your views on the issues raised here and discuss with fellow students in the Moodle form. # 7. References ## 7.1 [[Essential readings]] Cross, Mai’a K. Davis (2013) Rethinking Epistemic Communities Twenty Years Later. Review of International Studies 39(1): 137–60. Smith, Stephanie, and Mariela Rodriguez (2016) Agenda Setting for Maternal Survival: The Power of Global Health Networks and Norms. Health Policy and Planning 31: i48–59. Lee, Kelley, and Hilary Goodman (2002) Global Policy Networks: The Propagation of Health Care Financing Reform since the 1980s. In Kelley Lee, Kent Buse and Suzanne Fustukian (eds.) Health Policy in a Globalising World. Cambridge: Cambridge University Press: 97-119. ## 7.2 [[Recommended reading]] Hass PM (1992a) Introduction: Epistemic Communities and International Policy Coordination. International Organization 46(1):1-35 Haas, Peter M. (1992b) Banning Chlorofluorocarbons: Epistemic Community Efforts to Protect Stratospheric Ozone. International Organization 46(1): 187–224. Tantivess, Sripen and Gill Walt (2008) The role of state and non-state actors in the policy process: the contribution of policy networks to the scale-up of antiretroviral therapy in Thailand. Health Policy and Planning, 23: 328-338.