How pharmaceutical and diagnostic stakeholders construct policy solutions to a public health 'crisis': an analysis of submissions to a United Kingdom House of Commons inquiry into antimicrobial resistance
How pharmaceutical and diagnostic stakeholders construct policy solutions to a public health 'crisis': an analysis of submissions to a United Kingdom House of Commons inquiry into antimicrobial resistance
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DOI：
10.1080/09581596.2022.2026296
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发表时间：
2022-01-24
影响因子：
2.8
通讯作者：
Thompson, Claire
中科院分区：
文献类型：
--
作者：
Glover, Rebecca E.;Petticrew, Mark P.;Thompson, Claire
抗生素耐药性（AMR）通常被描述为一种“危机”，需要公共、私营和第三部门利益相关者采取行动，以实现战略变革。危机叙事是强大的，可能会被有影响力的团体所采纳，以优先解决问题。关于抗生素耐药性，这尤其适用于制药和医疗诊断行业。考虑到公共资金使用效率低下的相关风险，必须重点关注如何构建AMR危机的“解决方案”，以及它们对卫生政策的象征性和实质性影响。我们对英国下议院卫生和社会保障委员会2018年AMR调查的71份书面意见进行了批判性话语分析（CDA）。两名研究人员合作对研究结果进行编码，并对提交的材料进行分类。我们应用政策反乌托邦模型进一步分析了建议的解决方案，并确定了行业提交给委员会的意见书中的话语和工具性论点。我们发现，行业提交部署经济和治理话语战略，阐明三个主要的“市场悖论”的论点：（i）干预，但不干预;（ii）权力，但无能为力;（iii）营利，但不以营利为目的。工业界提交的材料还借鉴了工具性战略，包括：联盟管理、信息管理以及直接参与和影响决策。我们的分析表明，商业利益集团利用危机叙事来倡导涉及市场放松管制和行业补贴的解决方案。因此，向委员会提出的解决办法在很大程度上是由技术-工业复合体决定的。这有助于影响全球AMR政策格局中被视为可能和可接受的内容。
Antimicrobial resistance (AMR) is often characterised as a 'crisis', requiring action by public, private, and third-sector stakeholders to achieve strategic change. Crisis narratives are powerful and may be co-opted to privilege solutions promoted by influential groups. In relation to AMR, this applies particularly to the pharmaceutical and medical diagnostics industries. Given the associated risk of inefficient use of public funds, critical attention must be paid to how the promoted 'solutions' to the AMR crisis are constructed, and their symbolic and material effects on health policy. We conducted a critical discourse analysis (CDA) of the seventy-one written submissions to the UK House of Commons Health and Social Care Committee's 2018 inquiry into AMR. Two researchers collaboratively coded the findings and categorised the submissions. We applied the Policy Dystopia Model to further analyse the proposed solutions and ascertain the discursive and instrumental arguments in the industry submissions to the Committee. We found that industry submissions deployed economic and governance discursive strategies, articulating three main 'market paradoxical' arguments: (i) interference but non-interference; (ii) power but powerlessness; and (iii) for-profit but not-for-profit. The industry submissions also drew upon instrumental strategies including: coalition management, information management, and direct involvement and influence in policymaking. Our analysis suggests that commercial interests deploy crisis narratives to advocate for solutions involving market deregulation and industry subsidies. Thus, the solutions presented to the Committee were heavily shaped by a technocratic-industrial complex. This contributes to influencing what is seen as possible and acceptable in the global AMR policy landscape.