Political economy and public health governance: a comparative study of Hong Kong, Singapore and Taiwanfrom the 19th century to 2000s

Abstract

This dissertation seeks to understand the relationships between the evolving political economies and

modes of public health governance in Hong Kong, Singapore and Taiwan from the 19th century to

nowadays. It is argued that from a political economy perspective, a suitable institutional set-up is

important in providing political resources necessary for the evolution of public health governance.

This dissertation looks specifically at political resources that include authority, legitimacy, finance

and knowledge. The uneven distribution of these political resources across the polity determines the

power gradient amongst different actors. Institutional set-up is also important because it governs the

interaction between different actors who are in various ways dependent upon one another.

From the 19th century, the polity of these three jurisdictions experienced drastic change under the

banner of colonialism. The colonial governments were preoccupied with advancement of colonial

interest. With the unrest in the polity, the colonial governments realised the importance of authority

and knowledge in perpetuating their existence. At the same time however, the ignorance towards

cultural affinity of colonial subject deprived the governments of their ability to regulate the life of the

latter. The contradiction was strongly reflected in the two British colonies where there were clashes

over the application of public health law and regulation. Japan, by contrast, was more able to garner

authority because of her tactics to couple traditional control with modern policing.

In the post-war era, the political economy of these three jurisdictions departed from one another. In

Hong Kong, the colonial set-up shifts from regulatory-led to developmental-led institutional set-up.

Similar tendency can be observed in Singapore and continued after her independence. Bureaucratic

authority became the most available resources for government to mobilise. In strong possession of

authority and finance, the government was increasingly able to introduce expansionary measures.

This is accompanied by the rise of rational planning in Hong Kong and Singapore. As a result, there

witnessed bureaucratisation of public health governance which shaped the dependent interactions

between the authorities and citizen and the sporadic contribution from charities and overseas

organisations.

Taiwan departed significantly from these two jurisdictions. The inception of Kuomintang’s

authoritarian regime attempted to continue the regulatory-led institutional set-up from the colonial

regime in the 1950s. Whilst authority became abundant, financial resources were drained away to

military project. International agents became the key actor to contribute to the functioning of public

health governance.

In the 1970s to 1990s, the fiscal crisis arising from exponential increase of public expenditure and the

international policy discourse of deregulation led to the declining ability of tax-based direct provision

of health care. There displayed a greater willingness to rely on more actors and more instruments to

divest the responsibility of the government. However the negligence about the potential trade-off

between authority and finance limited the dynamics of coordination between different actors.

The sudden outbreak of the SARS episode in 2003 unveiled the problem of underinstitutionalisation

of polity. It unsettled the role of power and authority of government as demonstrated in Singapore

and unleashed the latent power of civil society in the arena of public health as seen in Hong Kong

and Taiwan. It also illuminated the role of knowledge in dealing with uncertainty in an institutional

set-up.