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Problematizations in Health Policy

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  • Carol Bacchi

Abstract

This article directs attention to the significance, for health promotion advocates, of reflecting on how “problems†are constituted, or brought into existence, as particular sorts of problems, within policies and policy proposals. To this end, it introduces a poststructural analytic strategy called “What’s the Problem Represented to be?†(WPR approach), and contrasts this perspective to the ways in which “problems†are commonly conceptualized in health policy analyses (e.g., “a problem stream,†“wicked problems†). Such a perspective offers a significant rethinking of the conventional emphasis on agenda setting and policy-making processes in considering the meaning of success or failure in health policy initiatives. The starting point is a close analysis of items that are “successful,†in the sense that they make the political agenda, to see how representations of “problems†within selected policies limit what is talked about as possible or desirable, or as impossible and undesirable. This form of analysis thus enables critical reflections on the substantive content of policy initiatives in health policy. The article takes a step back from policy process theories, frameworks, and models to offer reflections at the level of paradigms. Highlighting potential dangers and limitations in positivism, interpretivism, and critical realism, it uses international, Australian, and South Australian examples in health policy to explore what poststructural policy analysis contributes to understanding the broad political influences shaping contemporary modes of rule.

Suggested Citation

  • Carol Bacchi, 2016. "Problematizations in Health Policy," SAGE Open, , vol. 6(2), pages 21582440166, June.
  • Handle: RePEc:sae:sagope:v:6:y:2016:i:2:p:2158244016653986
    DOI: 10.1177/2158244016653986
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    References listed on IDEAS

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    1. Embrett, Mark G. & Randall, G.E., 2014. "Social determinants of health and health equity policy research: Exploring the use, misuse, and nonuse of policy analysis theory," Social Science & Medicine, Elsevier, vol. 108(C), pages 147-155.
    2. Marmot, M. & Allen, J.J., 2014. "Social determinants of health equity," American Journal of Public Health, American Public Health Association, vol. 104(S4), pages 517-519.
    3. Krieger, N., 2008. "Proximal, distal, and the politics of causation: What's level got to do with it?," American Journal of Public Health, American Public Health Association, vol. 98(2), pages 221-230.
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