State rescaling, institutionalized state-citizen relationships, and Canadian health policy

Abstract Work on state rescaling has generally argued that economic restructuring is hollowing out the state at the nation-state level. The ambiguity of this formulation, with the displacement of power potentially being recuperated through governance, is accentuated by a thin political analysis. This paper follows Purcell in emphasizing state-citizen relations and institutionalization in the state rescaling process, which constrains changes in scalar relationships even when the state is neoliberalized. The regulation of public health care in Canada provides an example of the relevance of state-citizen relations in shaping state rescaling, as these limited the ability of actors seeking to reduce federal leadership and standardization as part of health privatization.