I think that Bourdieu’s concepts of field, capital, and habitus are very important to be able to understand the history and future of the movement for global health equity, as I’ve written about here.  The challenge I was trying to address in that piece was one of insurgent action and the dynamics of change within fields. Bourdieu’s account of fields of social action biases towards stasis — action is inhibited, or at least structured by the cumulative embodiment of history as habitus.

How does social change happen? This is something that Bourdieu is relatively quiet on in his work and is where McAdam and Fligstein have tried to build on the tradition of “field-based” social theory to account for social change in “meso-level social orders.” The result is their 2012 book, “A Theory of Fields” (TOF).

Doug McAdam is a scholar that I’ve drawn inspiration from for at least the last five years and is someone who has loomed large over the sociology of social movements for decades. His political process model serves as a way to conceptualize and study social movement emergence, growth, and decline is a standard for social movement sociology. He started his professional dialogue with Neil Fligstein, an organizational and political sociologist, decades ago and together they have been trying to understand why so many social scientists of different methodological and theoretical angles have come to a similar set of concepts and ways of interpreting social action. As they put it in the preface for TOF:

“We believe the reason that all of these scholars across so many disciplines, subfields, and methodological and theoretical persuasions have come to find one another is because we have all inadvertently discerned a set of foundational truths about social life. The problem of mesolevel social order and the creation of strategic action fields is the central problem of a social science interested in how people engage in collective action, how they construct the opportunity to do so, the skills they bring to the enterprise, how they sometimes succeed, and if they do succeed, how they seek to stabilize and maintain the resulting order. These issues are central to an understanding of how people make political change, build a new product to take to market, challenge existing laws by lobbying governments, as well as how actors maintain a stable hierarchical order in popular music, haute cuisine, or any other cultural field. It is this deep sociological problem that is at the core of what we are writing about. As such, we are happy to acknowledge our interest in and relation to the wide and voluminous literature that has developed on these topics in recent years. We have learned from these various literatures, borrowed from them, and tried to contribute to them. We have returned to this manuscript in order to clarify some of the literatures’ critical insights and to finally consolidate and elaborate the various strands of our own thinking.” ¹

It’s kind of amazing to just be stumbling upon this book, especially after having written “Opportunities for research and practice in the social movement for the right to health” which was grappling with this same topic through the lens of global health. It’s also thrilling because I think that it provides an useful theoretical framework to study and actually engage in the social movement building work for the right to health; work that does, in fact, link ideas the ground Bourdieu (field, capital, habitus), McAdam (political process model), and Ganz (leadership and community organizing practice in social movements).

McAdam and Fligstein’s theory of fields rests on three clusters of ideas:

1. Strategic action fields (SAFs): Meso-level social orders which serve as the basic structural building block of modern political / organizational life in the economy and civil society. This theoretical treatment allows sociologists to study stability and change dynamics at the field-level a la Bourdieu / Wacquant.²
2. Embeddedness of fields: Fields are embedded within a broader environment of countless other strategic action fields and states (which themselves complex SAFs). Crises and shocks in proximate SAFs are often what create the space and opportunity for change within the SAF under study. SAFs can also be envisioned as if “Russian stacking dolls”: for instance the American economy could be broken down into specific industries, those industries into specific firms, those firms into regional offices / departments / functional units, and those departments into specific teams. Each of these SAF contain actors who make decisions about what to do in relationship to the other actors in the field.
3. Social skill: Finally, M+F’s theory rests on the a microfoundation of an “existential function of the social.” Explaining social action within fields relies on a complex mix of material concerns (power, resources, constraints, opportunities) and also “existential” considerations: human emotions, meaning making, belonging, relationships. By understanding the essentially existential nature of human existence, M+F introduce the concept of “social skill” and “skilled social actors” who know how to bring people together, form relationships, shape meaning making of collective experience, and enable people to work together for shared social aims. Skilled social actors are necessary to create, maintain, and transform strategic action fields. “Put another way, the concept of social skill highlights the way in which individuals or collective actors possess a highly developed cognitive capacity for reading people and environments, framing lines of action, and mobilizing people in the service of broader conceptions of the world and of themselves.” ³

Overall, I think that this approach has much to offer students of institutions and change within global health. One can imagine the field of global health and international development as a somewhat distinct group of collective actors (NGOs, MOHs, foundations, financing organizations) all operating with a set of governing logics that are to some degree imposed by those dominant within the field of strategic action (aka, the financiers; think Gates, USAID, DFID, etc). More often than not, the logics that are imposed are rooted implicitly or explicitly in neoliberalism. This drives the logic of production of  “the good project” by international NGOs as described by Monika Krause. International NGOs, at the mercy of international financing bodies, must conform their work to producing short term, often vertically oriented global health programs that serve relatively easy to serve populations, outside of the public sector, in order to produce statistically significant outcomes / impact in order to appeal to donors’ grant evaluations and requirements.

This is how neoliberal logic is reproduced within well-meaning NGOs⁴ that have goals to advance human rights. More work should be done to extend Krause’s work more specifically from international development NGOs to more specifically global health organizations.

Finally, and this is the work that I hope to be able to do formally in graduate school, I believe there is a huge opportunity to study and understand how rights-based delivery organizations (PIH, Last Mile Health, Project Muso, Possible, etc) are making an insurgent response in the face of these orthogonal logics. How do they keep themselves from adopting the dominant logic and conforming with the resource and power flows within the field? What type of collective action, skilled social actors, meaning making processes, social movement organizing activities enable these organizations to insulate themselves from the broader field? How might these organizations continue to invent new modes of collective action that could actually alter the rules of the game and enable resources to flow in ways that support the public sector’s capacity to protect rights of citizens?