HLTC02 Articles Study Notes.docx

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Health Studies
Toba Bryant

WEEK 11: Role of knowledge in public health and health promotion policy change (Toba Bryant) Intro Public health and health promotion have tended to rely on traditional scientific forms of knowledge to guide policy and programmes. o Usually associated with medical/clinical/epidemiological expertise o Led to an emphasis in lifestyle issues (behavioural model) Therefore detracts attention from political and socioeconomic issues Notion of Policy Change Policy change: a new direction in public policy 2 patterns of policy change o Normal/routine policy change: only makes minor/slight variations (aka incremental change) o Paradigmatic policy change: fundamentally new direction in state policy. Represents new paradigm (way of thinking) Eg. The shift from a focus on hospitals and diagnosistic services to a health promotion and disease prevention focus Policy change occurs within a social, economic and political context AND it involves competition in policy community Sabatiers key concepts: o Belief system All members of an advocacy coalition share a set of beliefs or ideology Consists of 3 structural categories The deep Normative core (consists of fundamental ontological beliefs) The near policy core (consists of coalitions policy positions) Secondary aspects related to instrumental decisions o Change in the larger system Many things can influence an advocacy group and its activities Stable influence: legal and resource related (can affect their activities) Dynamic influences: external changes or events in global socioeconomic conditions Personnel changes of senior level people in the government can also have an impact o Policy Oriented learning This refers to enduring changes in thought or behaviour that were learned from previous policy experience (ie. Learning from theirs or others mistakes) This learning is crucial and instrumental to having a positive lasting impact An Alternative Framework of Policy Change This framework is developed by experts, community members and politically active groups of civil society A professional policy analyst is a person whose job is focused on policy change activities citizen activists are people who may also participate in policy change processbut do so from the outside of the expert policy community Both engage in knowledge creation The experts usually highly education (grad school or above education) highly specialized. Also seen to possess objectivity See FIGURE 1 on pg 92 if youre interested (probably wont be tested im guessing) In contrast, Citizen Activists tend to address issues that have affected them personally, usually perceived to be self-interested. Not always the case. Eg. Citizen activists could have a genuine concern for homelessness but they may not be homeless or have the risk of becoming homeless Instrumental knowledge (aka expert knowledge) is knowledge created by experts. Usually objective, scientific, quantitative research method etc Interactive (or lay) knowledge comes from lived experience (anecdotal evidence) Critical knowledge is reflective knowledge. Considers the role of social structures, power relations in reinforcing inequalities and disempowering people Collaboration v. Isolation o When professional policy analysts and citizen activists dont communicate their knowledge remains isolated (usually what ends up happening) sometimes there is collaboration (which occurs when they carry our cooperative analyses ) Case studies of recent Health and social policy changes in Toronto, ON Tenant protection Act 1997-which introduced Vacancy decontrol o This enables landlord to increase rent at any time without restriction ONCE a tenant has left the apartment. o Also allowed landlords to use income criteria to determine potential tenants o Housing is a health issue in Toronto o Homelessness has skyrocketed Torontos Womens College Hospital in 95-98 faced closure b/c provincial gvmnt was trying to cut costs. Called Health Services Restructuring Commision. They wanted to merge it with Sunnybrook Health Sciences Centre Data Collection and Analysis Methods In-depth interviews of key actors (cabinet ministers, city counsellors etc) Interviews recorded and transcribed Different Ways of knowing about a social issue In both case studies, instrumental and interactive knowledge was used to present critical knowledge (see above definitions) Deteriminats of Government Receptivity to policy messages Womens college Hospital was more successful than tenants in realizing their political objectives Shows how important political identity is. MEANING: the tenants who were low-income did not have political influence and they did not attract any public attention-whereas the women hospital did because it had institutional status Discussion: Implications and Future Directions Although they (case studies) were not entirely successful in achieving their policy objectives they did demonstrate how important interactive and anecdotal evidence is a powerful political tool Cases also showed that ideology can influence types of knowledge and evidence According to World Health Org , public health activities should: o Enable individuals and communities to gain more power over personal, socioeconomic and envrio factors that affect their health o Involve everybody who is concerned about an issue in ALL stages of project planning, implementation, and evaluation o Be driven by a concern for equity and social justice This will require collaboration
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