Strategically Constructing a Grand Challenge? The Case of Health Care Undersupply in Rural Germany

Abstract

Grand challenges (GCs) are complex, uncertain, difficult to address and deal with, and affect large parts of a population. In this paper, we argue that some GCs are not only socially but even strategically constructed in order to support organizational goals. Based upon a single case study of the undersupply of health care in rural Germany, we analyze the discourse about this potential GC over 15 years with the help of data from secondary sources and expert interviews. We use Berger & Luckmann’s classic work to show that organizational actors pursue three discursive practices to construct health care undersupply as a GC: forecasting a GC as a future threat, spreading synergetic awareness of a GC, and stressing the consequences of a GC. Moreover, we show that discursive practices can also aim to deconstruct a GC by using comparisons, denying the existence of the GC per se, or highlighting an alternative problem. We thereby aim to add to the knowledge on GCs by illustrating how some of them are strategically (de-)constructed, and thus suggest how the respective struggle can complicate the development of collective goals and practices to address them. Moreover, we show that certain actors strategically construct a GC as they hope to mobilize additional resources, and to protect existing institutions – and, thereby, their own interests.