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

本文旨在回答两个核心研究问题：(1)为什么美国作为第一个遇到艾滋病毒/艾滋病的国家，在英国已经开始采取集中和协调的战略来对抗这一流行病的时候，还在建立其国家应对措施的第一个要素？(2)这种不同的政策轨迹在过去二十年中是否持续存在，或者是否存在显著的趋同？我建议，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担忧——对受艾滋病影响最大的社会群体的文化偏见和新保守主义经济哲学的优势——来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，以评估一个假设，即国家对艾滋病的反应差异可以部分地通过卫生系统机构的跨国差异来解释。这项研究借鉴了一系列存档材料和原始访谈。我将从对各国艾滋病相关政策提案的调查开始，分析相关委员会和小组委员会的会议记录和证词、国会和议会的演讲和辩论，以及行政机构就这些政策提案提出的报告。我对主要议员、工作人员和机构领导人的采访将涉及政策设计阶段的选择、听证会作证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的议程设定阶段，我还将收集每个国家政策倡导组织的关键线人访谈、报告和出版物。该项目将有助于我们理解在国家层面上决定卫生政策轨迹的因素，通过考虑卫生系统中机构前体的作用，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不同国家和历史背景下的重要性。由于该项目比较了两个相似的福利国家，但卫生系统截然不同，因此它还将阐明卫生政策事件与社会提供的更普遍趋势之间的关系。因此，它通过质疑社会学假设，即总体福利国家制度决定特定社会政策领域的选择，加深了我们对福利国家的理解。这项研究将产生以下更广泛的影响：通过加强我们对导致近期战略成功或失败的因素的理解，它将为研究人员和决策者提供宝贵的信息，了解未来促进具体卫生政策的政治努力的有效性，以及不同结构的卫生机构能够应对卫生危机的方式，这些信息可以考虑到未来关于这些机构形成的选择。

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.