Power and the people's health.
| dc.contributor.author | Friel S. | |
| dc.contributor.author | Townsend B. | |
| dc.contributor.author | Fisher M. | |
| dc.contributor.author | Harris P. | |
| dc.contributor.author | Freeman T. | |
| dc.contributor.author | Baum F. | |
| dc.date.accessioned | 2024-11-19T05:30:19Z | |
| dc.date.available | 2024-11-19T05:30:19Z | |
| dc.date.copyright | 2021 | |
| dc.date.issued | 2021-07-28 | en |
| dc.description.abstract | Public policy plays a central role in creating and distributing resources and conditions of daily life that matter for health equity. Policy agendas have tended to focus on health care delivery and individualised interventions. Asking why there is a lack of policy action on structural drivers of health inequities raises questions about power inequities in policy systems that maintain the status quo. In this paper we investigate the power dynamics shaping public policy and implications for health equity. Using a Health Equity Power Framework (HEPF), we examined data from 158 qualitative interviews with government, industry and civil society actors across seven policy case studies covering areas of macroeconomics, employment, social protection, welfare reform, health care, infrastructure and land use planning. The influence of structures of capitalism, neoliberalism, sexism, colonisation, racism and biomedicalism were widely evident, manifested through the ideologies, behaviours and discourses of state, market, and civil actors and the institutional spaces they occupied. Structurally less powerful public interest actors made creative use of existing or new institutional spaces, and used network, discursive and moral power to influence policy, with some success in moderating inequities in structural and institutional forms of power. Our hope is that the methodological advancement and empirical data presented here helps to illuminate how public interest actors can navigate structural power inequities in the policy system in order to disrupt the status quo and advance a comprehensive policy agenda on the social determinants of health equity. However, this analysis highlights the unrealistic expectation of turning health inequities around in a short time given the long-term embedded power dynamics and inequities within policy systems under late capitalism. Achieving health equity is a power-saturated long game.Copyright © 2021 Elsevier Ltd | |
| dc.description.grant | Organisation: (CTG) China Three Gorges Corporation Organisation No: 100015524 Country: China | |
| dc.description.grant | Organisation: (PHC) Providence Health Care Organisation No: 100012453 Country: Canada | |
| dc.identifier.citation | Social Science & Medicine. Vol.282, 2021. | |
| dc.identifier.doi | https://dx.doi.org/10.1016/j.socscimed.2021.114173 | |
| dc.identifier.institution | (Friel, Townsend) Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Fellows Road, Canberra ACT 2601, Australia | |
| dc.identifier.institution | (Fisher, Freeman, Baum) Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia | |
| dc.identifier.institution | (Harris) Centre for Health Equity Training, Research & Evaluation, Australia Research Centre for Primary Health Care & Equity, University of New South Wales, Liverpool, NSW 1871, Australia | |
| dc.identifier.pubmedid | 34192622 [https://www.ncbi.nlm.nih.gov/pubmed/?term=34192622] | |
| dc.identifier.uri | https://lowitja.intersearch.com.au/handle/1/726 | |
| dc.relation.ispartof | Social Science & Medicine | |
| dc.subject.keywords | Health policy | |
| dc.subject.keywords | Public health | |
| dc.title | Power and the people's health. | |
| dc.type | Article | |
| dc.type.studyortrial | Qualitative study |