Doctoral Dissertation Research: Local-level Effects of Centrally Mandated Change

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Social scientists contribute to understanding the complex dynamics of particular areas of social behavior by attending to the larger contexts in which they occur. Currently, one potentially fruitful arena for developing new theory of mandated change is the worldwide concern about the causes of differential health outcomes. Observers have noted that unprecedented resources are being poured into funding healthcare initiatives, yet serious disparities persist. Efforts to alter this situation give social scientists valuable opportunities for investigating the causal relationships in social systems at multiple interacting levels of scale. Findings from such investigations have important implications for developing new social science theory as well application in many social spheres.In this research project, Yale University doctoral student Gabriela E. Morales, with the guidance of Dr. P. Sean Brotherton, will undertake research on one such natural experiment of planned, top-down change. It is occurring in Bolivia where the government has proposed to end health inequalities by creating an expansive new national health policy. The new policy increases low-cost, rural primary healthcare that also incorporates indigenous worldviews, including an unusual holistic model of health and well being, community decision-making, and intercultural care. This is a fascinating opportunity for social science investigation. The changes are only now underway and the smaller-scale of the Bolivian context makes intensive research feasible. The researcher will first study policy making and the training of health care providers in the capital city and then investigate local implementation of the new program in a rural district. Data will be collected using a range of social science methodologies including: semi-structured interviews, oral histories, therapeutic narratives, participant-observation, archival investigations, and document analysis. By drawing on these ethnographic methodologies, this research links large-scale processes of social change with a fine-grained analysis of implementation and on-the-ground effects. Lessons learned will useful for those concerned with many areas of planned social intervention.