"Never mind the logic, give me the numbers": Former Australian health ministers' perspectives on the social determinants of health
"Never mind the logic, give me the numbers": Former Australian health ministers' perspectives on the social determinants of health
复制标题
DOI：
10.1016/j.socscimed.2013.03.033
复制
发表时间：
2013-06-01
影响因子：
5.4
通讯作者：
MacDougall, Colin
中科院分区：
文献类型：
--
作者：
Baum, Frances E.;Laris, Paul;MacDougall, Colin
尽管有强有力的证据和道德论据表明健康和健康公平的社会决定因素的重要性，但并没有导致采取相应的行动来解决这些问题。当一个问题被视为一个问题、政策制定和完善以及采取行动的政治意愿同时出现时，政策窗口就会打开。我们报告了对20名前澳大利亚联邦，2011年9月至2012年1月期间，州或地区卫生部长进行了一次调查，了解他们对在其任期内如何以及为何打开了或没有打开《战略发展战略》政策机会之窗的看法。卫生部长们意识到健康不平等和SDH的存在，但其复杂性意味着这种意识很少具体化为一个明确的问题，而不是把重点放在高需求群体，特别是土著人身上。交叉组合结构、政策企业家以及审查和报告中的证据有助于制定关于可持续发展的政策。SDH政策的复杂性、医疗力量和范式的主导地位以及政策共同体倡导SDH的薄弱性阻碍了SDH的发展。当总体意识形态氛围支持再分配政策时，政治潮流是有利的，卫生保健部门没有被认为处于危机之中，政府首脑和内阁同事支持采取行动，没有强大的游说团体反对。在过去的25年里，澳大利亚的卫生政策中有一些解决SDH问题的例子，但这些例子很少，而且使它们成为可能的机会之窗并没有持续很长时间。(C)2013爱思唯尔有限公司保留所有权利。
The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure.Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long. (C) 2013 Elsevier Ltd. All rights reserved.