Doctoral Dissertation Research: Medicine and Inequality in the Welfare State: AIDS Policy-Making in the United States and the United Kingdom

博士论文研究：医疗与福利国家的不平等：美国和英国的艾滋病政策制定

• 批准号: 0425418
• 负责人: Renee Anspach
• 金额: $ 0.75万
• 依托单位: Regents of the University of Michigan - Ann Arbor
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2006-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0425418&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Medicine; Inequality

This dissertation aims to answer two central research questions: (1) Why was the U.S., as the first nation to encounter HIV/AIDS, still establishing the first elements of its national response at a time when the U.K. had already embarked on a centralized and coordinated strategy to combat the epidemic? (2) Has this dissimilar policy trajectory continued over the past twenty years, or has there been significant convergence? I suggest that in order to answer these questions we must move beyond the concerns that have thus far dominated the AIDS policy literature - cultural biases against the social groups most affected by AIDS and the ascendance of neoconservative economic philosophies - to consider the formative role of political institutions. Specifically, my dissertation compares the AIDS policy-making trajectories of the U.S. and the U.K. to assess the hypothesis that differences in national responses to AIDS can be explained, in part, by cross-national variation in the institutions of the health system. This research draws on a range of archived materials and original interviews. Starting from a survey of AIDS-related policy proposals from each nation, I will analyze minutes and testimony from involved committees and subcommittees, speeches and debates from the floors of Congress and Parliament, and reports generated in connection with these policy proposals by executive agencies. My interviews with key legislators, staffers, and agency leaders will address issues such as choices made during the policy design phase, the selection of experts to testify at hearings, and the success or failure of various strategies. To understand the agenda-setting stages of the policy-making process, I will also collect key informant interviews, reports, and publications from policy advocacy organizations in each nation. This project will contribute to our understanding of the factors that determine health policy trajectories at the national level, by considering the role of institutional precursors in the health system alongside more commonly addressed cultural and political determinants of health policy, and by weighing the importance of these factors in various national and historical contexts. Because the project compares two similar welfare states with dramatically different health systems, it will also illuminate the relationship between events in health policy and more general trends in social provision. As such, it deepens our understanding of welfare states by questioning the sociological assumption that overarching welfare state regimes determine choices within specific areas of social policy. This research will have the following broader impacts: By enhancing our understanding of the factors that have contributed to the success or failure of recent strategies, it will provide valuable information to researchers and policymakers about the effectiveness of future political efforts to promote specific health policies and about the ways in which differently structured health institutions are able to respond to a health crisis, information that can be factored into future choices about the formation of these institutions.

本论文旨在回答两个核心研究问题：（1）为什么美国，作为第一个遭遇艾滋病毒/艾滋病的国家，在英国已经开始采取集中和协调的战略来防治这一流行病？ (2)这种不同的政策轨迹在过去20年中是否持续存在，或者是否存在显著的趋同？ 我认为，为了回答这些问题，我们必须超越迄今为止主导艾滋病政策文献的关注-对受艾滋病影响最严重的社会群体的文化偏见和新保守主义经济哲学的优势-考虑政治制度的形成作用。 具体来说，我的论文比较了美国和英国的艾滋病政策制定轨迹。评估一种假设，即各国对艾滋病的反应的差异可以部分地由卫生系统机构的跨国差异来解释。 这项研究利用了一系列存档材料和原始访谈。 从各国艾滋病相关政策提案的调查开始，分析有关委员会和小组委员会的会议记录和证词、国会和议会的发言和辩论，以及行政机构就这些政策提案所做的报告。 我与主要立法者、工作人员和机构领导人的访谈将涉及政策设计阶段的选择、在听证会上作证的专家的选择以及各种战略的成败等问题。 为了了解政策制定过程中的决策阶段，我还将收集各国政策倡导组织的关键信息提供者访谈、报告和出版物。 该项目将有助于我们了解在国家一级决定卫生政策轨迹的因素，通过考虑卫生系统中的机构前体的作用，以及更常见的卫生政策的文化和政治决定因素，并通过权衡这些因素在各种国家和历史背景下的重要性。 由于该项目比较了两个类似的福利国家与显着不同的卫生系统，它也将阐明事件之间的关系，在卫生政策和更普遍的趋势，在社会提供。 因此，它加深了我们对福利国家的理解，质疑社会学假设，即总体福利国家制度决定了社会政策特定领域的选择。 这项研究将产生以下更广泛的影响：通过加强我们对促成最近战略成败的因素的了解，它将为研究人员和决策者提供宝贵的信息，使他们了解未来促进具体卫生政策的政治努力的效力，以及结构不同的卫生机构能够如何应对卫生危机，这些信息可以作为今后选择这些机构的因素。