The issue of the opioid crisis might have several opinions and various interpretations within the political framework according to the frame we associate it with. When it comes to interpreting social policies and government-level decision-making, the discussion could be seen from different perspectives. There are various choices of the lenses through which the political and social processes are viewed. A good starting point for this paper is understanding that the different approaches within the political sphere are not considered to be right or wrong, but rather tools which could be utilized depending on the situation at hand. In the sphere of political theory, there exist several opinions designed in separate approaches to the theorizing about the political process as a whole and the decisive elements in it. Often, such approaches take contrary positions when scrutinizing crucial questions. Since the area of policy-making, political decision-making and agenda-setting is very complex, the debate around it is also characterized by a diversity of theorizations. Pluralism and critical political theory are two approaches to explaining the most crucial processes and elements in governing and policy-making, which utilize opposing perspectives but constitute a substantial basis for political debate. In this essay, the pluralist and critical political theories will be compared and applied to a particular research topic. Also, Kingdon’s agenda-setting theory will be analyzed and applied to an enacted policy. The issues discussed in the essay will be based on relevant scholarly materials and research on the opioid crisis in veterans.
Pluralist and Critical Political Theories
Pluralist political theory entails a view that diverse populations, interests, cultures, and worldviews may coexist within the same society. This approach enables explaining that the pluralism in opinions might be mitigated by non-violent means where everyone has an opportunity to claim his or her interests or needs. Such an opportunity is manifested through free elections that are an immediate element of a democratic society. According to Dahl (2005), freedom of expression for all individuals within a democratic society, elected officials, and the right to be a constituent of a public sphere are the essentials of democracy, which vividly demonstrate pluralistic views. In other words, pluralism explains that within the political process, the government-level decision making is constructed of the opinions of the diverse population arranged into coalitions based on their needs and interests. By such means, everyone is able to reach the authorities and express their views, thus establishing pluralism in public administration.
Moreover, pluralism allows minorities and diversified groups not only to demonstrate their needs and interests but also to include them in the political agenda through elections. Indeed, as Guidry and Sawyer (2003) state, in a pluralist democracy, different groups within a society compete over governmental power with the help of elections. Thus all have equal opportunity to enter the public sphere and pursue their interests, becoming a decision-maker. Consequently, a political sphere becomes a competitive system, the participants in which play by the same rules and are exposed to the challenges on equal terms. As Dahl (1956) states, a pluralistic approach is best manifested within such a political structure as a democratic society. Under such conditions, different parts of the system continuously compete, allowing some of them to win and some to lose. However, they all have an equal opportunity to be included in the process of decision-making.
Importantly, pluralist and critical theories have a significant difference in the perception of the driving forces that influence policy-making. The critical theory identifies two structures, democratic society, and the market. It justifies the lack of equality in meeting the interests of all the groups due to the market forces that define what policies are enacted and which are not. However, the pluralist theory does not recognize the market as a determinant of political processes and concentrates exclusively on democracy. While the pluralist approach justifies an objective view on the way things are in political and social spheres, critical theory, as the title implies, criticizes the power, society, and political process by applying ways of their improvement.
In contrast to the pluralist approach, the supporters of the critical political theory claim that it is impossible to provide the agreeable coexistence of diverse population groups in one political unit and equally satisfy the needs of all. The critical theory emphasizes that only the authority decision-makers who do not necessarily represent the interests of the majority play the leading role in a political system. As Lukes (1974) states, an individual who has power over others might impose his or her opinions, influence the views of others, and even force them to act in a way favorable for the powerful side. Thus, those who have power tend to pursue their own priorities when it comes to the political process and force the governed population to adhere to the requirements of those in power.
Similarly, the process of policy-making is also an issue that critical theory addresses in a different way than pluralism. According to Gilens (2005), the intended equality of population’s influence on the process of policy-making at a state level, which is implied by free elections, fails to match the preferences of the governed with the actual policies prioritized by the government. Under the circumstances of economy-driven governance, the policies enacted by the government in the USA prioritize the interests and needs of the high-income class, thus leaving behind the preferences of the lower class. It could be argued that the critical political theory tends to explain the hidden agenda behind the public policy, where the pluralism of opinions perhaps has no practical manifestation in real life. Therefore, the two approaches are inherently different in viewing the underlying principles of policy-making, although there are several issues that unite the perspectives of the two theories.
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However, both pluralist and critical political theories have some shortcomings when explaining certain issues within the realm of social policy. For example, the pluralist view is not so clear when justifying its claims of equal consideration of the interests of a diverse society when it comes to the process of voting. According to Dahl (1956), not all voters genuinely express their opinions through elections. Therefore, the results of elections might be biased and not represent the views of the majority. In a similar manner, the pluralistic claims of peaceful coexistence of diverse groups within the same political space fall short when considering protests and riots as ways of minorities’ reaction to underrepresentation in government. As for the critical theory, it does not provide a clear vision of how the drawbacks in the policy-making it identifies should be addressed.
Indeed, voting might be a biased matter, especially when the opinions of underrepresented groups are excluded by elites. According to Piven and Cloward (1978), people’s movements or protests are used as a tool to persuade the minor interests and needs of the underrepresented population by means of structured protests. It is claimed that formalized movements cannot achieve global restructuring and eliminating the power of elites. Instead, they can only attract the attention of the decision-makers to the problem to address them on a local basis. However, the idea expressed by Roach and Roach (1978) denies uncontrolled movements as appropriate means of influencing the political process and emphasizes the importance of engagement in organized labor. Thus, though the public is given opportunities to influence policy-making, there are different means that might be used for different outcomes.
When placing research on the influence of the opioid crisis on veterans in the USA in the context of the pluralist and critical theories, one should state that military veterans constitute a minority group, which is a population that involves a relatively small number of individuals connected by the same features within the realms of occupation area, socio-economic status, health care needs, and others. Since they are not as numerous as the majority, which is a dominating population, their needs are seldom prioritized by the government. This might justify the approach of the critical theory, according to which the interests of the majority are considered in the first place. The particular needs of military veterans impacted by the epidemic become addressed in state and federal policies around the time the scope of opioid-related situation reaches the national level, and many population groups become impacted. On the other hand, the pluralist theory applies to the topic of the opioid crisis in veterans via the consideration of multiple organizations, agencies, and associations, which promote the interests of veterans by occupying a respective place in public space. The very participation of the minority group in the political process justifies the provision of pluralist views in the state.
Kingdon’s Agenda-Setting Theory
One of the purposes of Kingdon’s (1984) agenda-setting theory is to incorporate various elements that influence the political processes in a given state. According to Kingdon (1984), the process of public policy-making depends on the contribution of participants both inside and outside of government. Attempting to theorize on the patterns in public administration, the author elaborates on the reasons why some issues become a part of the political agenda, and others do not in the conditions of the complexity of problems in a democratic society. Different forces combine in a manner that enables shaping a particular social condition into a tentative political problem relevant for governmental consideration on a national scale. The author’s approach validates some of the ideas of the pluralist theory because it shows that the contribution of minorities might play a significant role in the agenda-setting process when accompanied by favorable factors.
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The process of policy-making starts with the identification of a specific condition. When such a condition becomes pertinent for a significant number of individuals, reaches the influential level, is addressed by various participants outside and inside the government, and finally enters the national political agenda. Overall, Kingdon (1984) states that three political streams come into action and define if an issue becomes a part of the agenda. These three streams include problem, policy, and politics. A problem enters the political agenda only when all three streams connect, which does not happen randomly but is subject to a series of co-dependent events and decisions (Kingdon, 1984). Therefore, the process of policy-making takes time, effort, and co-occurrence of multiple factors.
Firstly, an idea for a policy originates from a specific condition that is important for a specific group. Within the first stream, this idea can be recognized as a problem upon a change of indicators, a focusing event, and feedback. When some condition in public sphere gains a shift in expenditures, is justified by such focusing events as protests, increased level of incidence or else, and gains population’s feedback, the decision-makers might notice it and recognize it as a problem that requires attention. That is why only some problems are addressed by the most influential decision-makers and enter the national agenda, while others remain irrelevant. The participants outside of government promote a condition to the level where it might be defined as a problem, and participants inside the government (President, congress, and civil servants) make decisions concerning the issue by reflecting the interests of the majority.
Secondly, the policy stream entails the alternatives to the decisions on how to address the identified problem. At this level, Kingdon (1984) states, the contribution of the participants outside of government comes to force. They include public opinion, researchers, media, academics, and interest groups who provide an objective view on the problem and suggest ways of resolving the problem at the level of policy-making; they represent the alternatives to agenda. These participants have a more objective vision of the relevant problems and often influence policy-making on a governmental level. The coexistence of multiple ideas concerning the solutions creates a so-called policy primeval soup, through which more relevant and strong ideas remain while weaker ones lose their influence. In such a manner, the technical feasibility and value acceptability are tested, and the best policy options have a chance to reach the national agenda.
Thirdly, within the political stream, the policy is negotiated and validated through a series of processes. With the emergence of policy entrepreneurs who represent the idea within the government, spend time and effort on validating the rationale of the policy under discussion, a problem comes closer to the agenda. However, another important issue within the political stream is required. It is a policy window that opens when a change in administration coincides with national mood and a definition of a problem. Thus, the whole process from a condition to a nationally applicable policy requires the coordination of multiple factors within the three streams.
On the side of criticizing the theory, one might identify one aspect where Kingdon’s (1984) framework fails to illustrate the fairness of the political process. It is claimed that a chain of conditions behind the agenda-setting represents the most relevant and pertinent problems that resonate with the majority and, therefore, become nationally applicable policies. However, under the circumstances when the power might manipulate national moods, fabricate focusing events, and artificially provoke a change in indicators, it is possible to pursue policies that are of primary interest of that power but do not genuinely reflect the preferences of the public.
Overall, the theory is a fundamental tool for analyzing various political and social processes. Indeed, the scope of the framework and its universal approach to the interpretation of various aspects of policy-making enhances its utility in multiple settings. The analysis of the policies in medical, educational, cultural, and other spheres might be carried out within the factors identified in the three streams. Therefore, the framework introduced by Kingdon more than three decades ago remains a relevant theoretical foundation for research in the sphere of social policy.
The Application of Kingdon’s Agenda-Setting Framework to an Enacted Policy
It is relevant to illustrate how Kingdon’s framework applies to the research on the opioid crisis in the veteran population. Since the core of the theory lies in the idea that any issue has to undergo a series of phases under the influence of various factors to become a part of the national agenda, the same pattern might be applied to the formulation of policies in the sphere of health care. Having originated as a narrow issue that began affecting more people with time people, the opioid addiction and its adverse implications needed to become a publicly recognized problem. That is why the opioid crises in veterans were characterized by a change in indicators, focusing events, and feedback. The indicators comprise of the increased number of cases of opioid misuse and overdose, which are estimated of 562,000 US veterans who suffer from mental disorders, health impairments, and mortality (2018 National survey on drug use and health: Veterans, 2018). Statistical data indicate that veterans are prevalently prescribed opioids to relieve pain, since chronic pain is the most frequently observed health issue in this group (Hudson et al., 2017). This caused additional expenditures on the health care sphere since costs needed to be allocated to a large number of impacted people seeking treatment. As for the focusing event, as soon as the opioid-related morbidities and mortality rates reached a level of epidemic, the participants outside and inside of the government declared it a significant problem.
The fact of attracted attention to the problem from various participants helped to focus the decision-making efforts on the opioid crisis. The public’s feedback and continuous complaints on the harmful addictive effect of opioid medications on vulnerable populations contributed to the formulation of the problem. The increased need for veterans to obtain a qualified help with overcoming opioid addictions was addressed through different social media and news sources. Also, veterans’ organizations began to raise awareness about the issue attracting the attention of the public. Thus, the inclusion of veterans into a larger population impacted by the opioid crisis enabled to address the needs of this particular group. The condition became a nationally recognized problem due to the inclusion of the elements of the problem stream.
The increased attention toward the problem from the media, researchers, and the public induced the creation of ideas for the policies capable of eliminating the problem. Within the policy stream, multiple ideas introduced by different participants of the political process became validated and tested by time, feasibility, and value acceptability. Such ideas included efforts tackling the problem from different perspectives, including community-based interventions, therapy, restrictions in opioid prescriptions, and the introduction of alternative pain management techniques (Bennett, Elliott, & Golub, 2015). After floating in a primeval policy soup, the best options such as the substitution of opioid pain relief medications with different ones, increased funding for the elimination of the impact caused by the crises, some educational, and promotional policies were negotiated at the level of decision-making (Hudson et al., 2017). Ultimately, with the change in state administration, the national mood demanding the resolution of the crisis, and the official formulation of the problem as a national epidemics enabled the entrance of the policy into the national agenda.
For the purpose of analyzing a specific enacted policy within Kingdon’s framework, one might use a public policy that became a law, which is the SUPPORT for Patients and Communities Act. Overall, the law aims at preventing the opioid crisis by means of allocating medications for treatment and funding the interventions for those at a high risk of impact (“H.R.6 – SUPPORT for Patients and Communities Act,” 2018). The political environment of the time when the policy was introduced and passed its way toward enactment was marked by the intensified confrontation between the Democratic Party and the President. This situation obstructed the opportunities for Donald Trump to pursue controversial immigration-related policies and shifted the focus of attention on other domestic issues. One of such was the growing concern related to the threats of the opiate crisis.
Enacted in 2018 by Trump’s administration, the policy addresses the issues of the opioid crisis across the United States. This includes stopping overprescribing of opiate medications, additional payment for specialists working with substance addiction, government’s support of research in the sphere of the opioid crisis, and application of technologies to the opiate prescription monitoring program (“H.R.6 – SUPPORT for Patients and Communities Act,” 2018). Although it elaborates on the actions required to eliminate the problem within all populations in general, the needs of the veteran population are relevantly addressed. Being a social condition for many years, opioid misuse passed the stages of change in indicators, was accompanied by such focusing events as community mobilization and the increased number of cases of mortality, as well as public’s feedback on the urgent need for stopping the epidemics. In such a manner, the attention of the participants inside and outside of the government was attracted to the problem, and the search for effective policy options began.
Having passed the stages of policy and political streams, the best ideas for policy-making emerged in a combination of actions capable of eliminating the problem. The participants in policy-making were researchers, academics, health care professionals, public organizations, civil servants, and administration, whose efforts contributed to the development of a feasible and reliable policy. Overall, the policy has a positive effect on the Social Welfare area since it both utilizes the research findings on the problem and establishes a nation-wide practical implementation of strict measures aimed at stopping the opioid epidemics from spreading.
Importantly, the needs of the veteran population are met through the application of interventions and initiatives for the general population impacted by opioid misuse. However, the particular provisions concerning veterans concentrate on improving the conditions of doctors involved at the Department of Veteran Affairs to track the prescriptions and identify the risk factors to enable further prevention of the crisis (“H.R.6 – SUPPORT for Patients and Communities Act,” 2018). Also, relevant attention is paid to the issue of mental health problems that accompany opioid addiction in veterans. Despite providing a legislative basis for combating opioid epidemics on a national scale, the policy will have to obtain sufficient funding and practical implementation to demonstrate anticipated results.
SUPPORT for Patients and Communities Act enlists an array of prioritized actions on both state and federal levels aimed at providing necessary support for the general public exposed to the harmful effect of the opioid epidemics. The act provides strategic foundations for improvement of quality of care for such populations as older people and young adults with substance use disorder. Also, it prioritizes systematic advancement in the sphere of education and professional workforce provision for the facilities responsible for opioid-related care. However, despite positive expectations and current results, the discussed policy has some significant unintended consequences. For example, restricted prescriptions and limited doses of opioid pain relief medications impose the threat of unmanaged pain for people who are out of addiction risk but who suffer from chronic illnesses. Also, the increased level of the attention attracted by the anti-opioid policy minimizes the level of caution in relation to other forms of drug abuse. Overall, it will be possible to judge whether the policy was effective when the rate of mortality caused by opioid overdoses will be lower than the epidemic point.
When viewing the problem of the opioid crisis in veterans and the enacted policy from the perspective of the political theorists, one might anticipate that Dahl (2005) might see the problem and the attempts of its solution as a manifestation of democracy. Guidry and Sawyer (2003) might also recognize the claimed needs of the veteran community as the provision of pluralism in the democratic society. Since this minority has an opportunity to be heard at the state policy-making level, pluralism of opinions works in America. However, Gilens (2005) and Lukes (1974) would take a contrary position claiming that the opioid problem is tackled perhaps only at the time favorable for the administration and under the circumstances when the mortality rate has reached the level of epidemics. Within the realm of Stone’s (1989) perspective, the attention of media and the resonance in the society have contributed to the recognition of the problem. Finally, Piven and Cloward (1978) would suggest that the policy cannot be sufficient unless veterans join in a protest and require full-scale addressing of their needs. Thus, the issue of the opioid crisis might have several opinions and various interpretations within the political framework according to the frame we associate it with.
References
Bennett, A. S., Elliott, L., & Golub, A. (2015). Veterans’ health and opioid safety-contexts, risks, and outreach implications. Federal practitioner: For the Health Care Professionals of the VA, DoD, and PHS, 32(6), 4-7. Web.
Dahl, R. A. (1956). American hybrid. In A preface to democratic theory (pp. 124-151). Chicago, IL: The University of Chicago Press.
Dahl, R. A. (2005). What political institutions does large-scale democracy require? Political Science Quarterly, 120(2), 187-197.
Gilens, M. (2005). Inequality and democratic responsiveness. The Public Opinion Quarterly, 69(5), 778-796.
Guidry, J. A., & Sawyer, M. Q. (2003). Contentious pluralism: The public sphere and democracy. Perspectives on Politics, 1(2), 273-289
H.R.6 – SUPPORT for Patients and Communities Act. (2018). Web.
Hudson, T. J., Painter, J. T., Martin, B. C., Austen, M. A., Williams, J. S., Fortney, J. C., … Edlund, M. J. (2017). Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans. Pain, 158(6), 1039-1045.
Kingdon, J. W. (1984). Agendas, alternatives, and public policies. Boston, MA: Little, Brown & Co.
Lukes, S. (1974). Power: A radical view. London, England: Mcmillan.
2018 National survey on drug use and health: Veterans. (2018). Web.
Piven, F. F., & Cloward, R. A. (1978). Poor people’s movements: Why they succeed, how they fail. New York, NY: Vintage Books.
Roach, J. L., & Roach, J. K. (1978). Mobilizing the poor: Road to a dead end. Social Problems, 26(2), 160-171.
Stone, D. A. (1989). Causal stories and the formation of policy agendas. Political Science Quarterly, 104(2), 281-300.