International ideas and actors in a multilevel perspective: the role of international organisations in Latin American long-term care policies

The recognition of long-term care as a topic for public policies is a comparably recent phenomenon, especially in regions outside Europe, such as Latin America. While the attention paid to care policies is not only growing in governments and national politics, the topic is also increasingly entering the international discourse within international organisations. In this framework paper I analyse how international organisations’ ideas as well as international actors shape policies on long term care at different levels, namely the global level, the regional level of Latin America and the national level in Uruguay. Therefore, this dissertation covers three articles, the first compares international organisations’ ideas at the global level, the second compares regional international organisations’ ideas on long-term care at the regional level, and the last looks into the interaction of international actors with national actors in shaping longterm care policies at the country level. At the international level we analyse ideas formulated by the United Nations in comparison with the European Union, finding that the early United Nations discourse in the 1980s and 19990s rather viewed long-term care as a private issue for families, with the state only bearing little responsibility for supporting them, while the European Union emphasised state responsibility early on. In the early 2000s the United Nations changed its position, and began to emphasise that states should be responsible for public long-term care policies, with families only assuming a supplementary role. Within Latin America we analyse how regional international organisations provide proposals on long-term care and compare them to healthcare. We find both, intra-organisational differences in positions on both policy fields, as well as differences between regional international organisations in how they formulated their proposals for each field. Interestingly, the way in which long-term care was addressed differed between organisations, with one subsuming it under healthcare policy, and the other considering it a policy field in its own right. Finally, addressing the role of international actors in national policy making, I demonstrate how international actors were engaged in coalition formation with national actors based on shared beliefs, previous cooperation and relationships at the institutional and personal level between different actors. Furthermore, I show how the coalition of national and international actors shaped care policy in Uruguay significantly, as the actors were able to translate their beliefs regarding gender equality and rights into the final structures of the care system. Building on previous research but also on these findings, in this summery report I develop a conceptional framework that seeks to understand international organisations’ role at different levels by emphasising on the one hand how the maturity of a policy field affects IOs ideas, and on the other hand how ideas are framed differently depending on the level where they are formulated.