The Institutionalization of Community
Action in Public Health
Mark Wolfson and Maria Parries
The relationship between states and social movements has been a fixture in social movement theory and research. This relationship has been conceptualized in a number of ways. First, the state is often an explicit target of movements. Movements deploy a variety of strategies and tactics to gain state recognition and concessions (Tilly 1978; Gamson 1990). Second, the state represents a system of opportunities and constraints that movements must negotiate. This conception focuses on structural features of political systems that are related to their degree of permeability by “outside” agents, such as social movement actors and organizations (McAdam, Tarrow, and Tilly 2001). Finally, the state has been conceived as a facilitator or repressor of movements (Gamson 1990; Barkan 1984; Jenkins and Eckert 1986; della Porta 1996).
These conceptions have come under strain in the past five to ten years. It is widely recognized that each of them captures part of the reality of the relationship between states and social movements. However, these three perspectives also miss a critical dimension of that relationship. Increasingly, analysts have painted a picture of overlapping interests, and active cooperation and interplay, of state and movement actors and organizations. For example, in a case study of the tobacco-control movement, the relationship was described as follows: “Subdivisions of the state are often active participants—even collaborators, and sometimes instigators—in the movement’s efforts to obtain desired changes in public policy” (Wolfson 2001: 188). The study of Health Social Movements (HSMs), in particular, has shown that “insiders … frequently prove central to the political processes by which institutions become forced