Beyond Isomorphism: The Uneven Diffusion in France of International Public Health Innovations

The paper addresses the issue of uneven dissemination of therapeutic innovations and devices among Western countries and within the same countries, comparing three public heath fields: drug addiction, obesity and overweight, and cancer treatment. Beyond traditional neo-institutionalist theories stressing the role of isomorphic processes, but also in complement to more recent studies paying careful attention to the role of agency, to individual and social skills of actors (framing), to the inherent ambiguity of institutions, to the peculiar social position actors are located in and to the internal functioning of organizations (structure of governance, identity, etc.), this paper will elaborate on the many ways social structures (both within and between organizations) mediate institutional pressures for adoption; and eventually help understand differential acceptance and resistance to innovations.