Power and the people's health
Power and the people's health
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DOI：
10.1016/j.socscimed.2021.114173
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发表时间：
2021-06-27
影响因子：
5.4
通讯作者：
Baum, Fran
中科院分区：
文献类型：
--
作者：
Friel, Sharon;Townsend, Belinda;Baum, Fran
公共政策在创造和分配关系到卫生公平的日常生活资源和条件方面发挥着核心作用。政策议程倾向于关注医疗保健的提供和个性化干预。问为什么对卫生不平等的结构性驱动因素缺乏政策行动，提出了维持现状的政策系统中权力不平等的问题。在这篇文章中，我们调查了塑造公共政策的权力动态以及对健康公平的影响。利用健康公平权力框架(HEPF)，我们对政府、行业和民间社会参与者进行了158次定性访谈，涉及七个政策案例研究，涵盖宏观经济、就业、社会保障、福利改革、医疗保健、基础设施和土地利用规划等领域。资本主义、新自由主义、性别歧视、殖民主义、种族主义和生物医学主义的结构的影响是广泛明显的，表现在国家、市场和民间参与者的意识形态、行为和话语以及他们占据的制度空间。结构上权力较小的公共利益行为者创造性地利用现有或新的机构空间，并利用网络、话语和道德力量来影响政策，在缓和权力结构和体制形式的不平等方面取得了一些成功。我们希望，这里提供的方法进步和经验数据有助于阐明公共利益行为者如何驾驭政策系统中的结构性权力不平等，以打破现状并推动关于卫生公平的社会决定因素的全面政策议程。然而，这一分析突显了在短期内扭转医疗不平等的不切实际的期望，因为在晚期资本主义下，政策体系中长期嵌入的权力动态和不平等。实现健康公平是一场权力饱和的长期游戏。
Public policy plays a central role in creating and distributing resources and conditions of daily life that matter for health equity. Policy agendas have tended to focus on health care delivery and individualised interventions. Asking why there is a lack of policy action on structural drivers of health inequities raises questions about power inequities in policy systems that maintain the status quo. In this paper we investigate the power dynamics shaping public policy and implications for health equity. Using a Health Equity Power Framework (HEPF), we examined data from 158 qualitative interviews with government, industry and civil society actors across seven policy case studies covering areas of macroeconomics, employment, social protection, welfare reform, health care, infrastructure and land use planning. The influence of structures of capitalism, neoliberalism, sexism, colonisation, racism and biomedicalism were widely evident, manifested through the ideologies, behaviours and discourses of state, market, and civil actors and the institutional spaces they occupied. Structurally less powerful public interest actors made creative use of existing or new institutional spaces, and used network, discursive and moral power to influence policy, with some success in moderating inequities in structural and institutional forms of power. Our hope is that the methodological advancement and empirical data presented here helps to illuminate how public interest actors can navigate structural power inequities in the policy system in order to disrupt the status quo and advance a comprehensive policy agenda on the social determinants of health equity. However, this analysis highlights the unrealistic expectation of turning health inequities around in a short time given the long-term embedded power dynamics and inequities within policy systems under late capitalism. Achieving health equity is a power-saturated long game.