Here is a comment on the Whitehead model. Her implicit assumption is a rational-actor model of policy-making: decision-makers become aware of a new problem (get new data) and decide to do something or not. It is established knowledge in Policy studies that a policy-process is not linear, starting with the measurement of a problem and finishing with a comprehensive policy (or not). A policy-process is iterative. Policy-makers operate in a 'policy environment', comprising several policy actors, administrative, financial and political constraints. 'New' policy is, more often than not, incremental: it builds on existing arrangements, administrative traditions and state capacities. Policy-makers do not seek to find the best possible solution to a problem (a comprehensive new policy that addresses the problem) but a solution that will be good enough and that will require minimal change to the existing set of arrangements.
It is time we explore the implications, for political strategies used in public health, of such a widely-shared, but totally wrong assumption about the policy process.
Nicole F. Bernier, PhD
Politologue / Political Scientist
Département de médecine sociale et préventive
Université de Montréal
C.P. 6128, Succ. CV
Montréal (Québec) H3C 3J7
Téléphone (514) 343-6135
Fax (514) 343-2207
courriel: [log in to unmask]
-----Message d'origine-----
De : Social Determinants of Health [mailto:[log in to unmask]] De la part de Dennis Raphael
Envoyé : 3 février 2005 13:07
À : [log in to unmask]
Objet : [SDOH] Interactive task - SDOH Listserv Members
I would like to ask members of the listserv to think about where their a)
nation; b) region/state/province; and c) local juridiction "is at" in
explicitly addressing the social determinants of health. I have slightly
modified Margaret Whitehead's "Action Spectrum on Inequalities in Health"
and added numbers to illustrate the different degrees of action. It is
below.
I have also posted it at my website http://www.atkinson.yorku.ca/draphael
as a powerpoint slide if it does not read well below.
When I think about where "Canada, Ontario, and Toronto" is at, I think
about how the media, public health agencies, and elected representatives
address -- or fail -- to address -- the SDOH.
I have some ideas as to where Canada, Ontario, and Toronto are at...
So when you respond -- and please respond to me at [log in to unmask] --
and NOT to the list -- state your jurisidction(s) and frame of reference,
and the # corresponding to level of action. I will collate and send on the
results -- not identifying the contributors -- to the list later.
Action on the Social Determinants of Health
1. Measurement
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2. Recognition
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3. Awareness Raising
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4. Concern | 5. Denial/Indifference
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6. Mental block 7. Will to take action
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8. Isolated Initiatives
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9. More structured developments
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10 Comprehensive coordinated policy
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