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Social Determinants of Health

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From:
"Bernier Nicole F." <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Fri, 4 Feb 2005 11:08:06 -0500
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In the 1960s and 1970s political scientists made efforts to develop theories of decision-making more closely approximating the actual behaviour of decision-makers. The debates then were between the 'incremental' and 'rational' models of policy-making. The mainstream position was that the 'rational' model was a model of how decision OUGHT to be taken, while the 'incremental' model best described the ACTUAL practice of decision-making in governments. 

The credit for developing the incremental model of public decision-making is attributed to Yale University political scientist Charles Lindblom. See his classical text 'The Science of Muddling Through' Public Administration Review 19 (1959) 79-88. Other classics include Simon, Herbert 'A Behavioral Model of Rational Choice' Quarterly Journal of Economics 69 1 (1955) 99-118.  See also Etzioni, Amitai, 'Mixed-Scanning: A "Third" Approach to Decision-Making", Public Administration Review 27 (1967) 385-92. For an updated version of the debate, any textbook entitled "Introduction to Policy Analysis" or so will address this.

It is time public health scientists and practitioners adopt a realist perspective on the policy-process (as opposed to normative, idealist) to further advance their cause.  This is where the new generation of students in public health is going, watch it 10-15 years from now.


Nicole 



-----Message d'origine-----
De : Social Determinants of Health [mailto:[log in to unmask]] De la part de Ken Hoffman
Envoyé : 4 février 2005 10:55
À : [log in to unmask]
Objet : [SDOH] Interactive task

This is a very interesting discussion.  I believe that the policy
development process is indeed iterative, but I think the most important
part of the discussion as it relates to SDOH relates to the boundaries
placed on analysis of the "problem" and "acceptable solutions", which
are inherently political and ideological.  This is an exercise in
bounded rationality.

One approach to the issue of hunger, for example, is to treat this as a
temporary lack of access to food, and to look for a charitable solution
through food banks.  A slightly more progressive response looks at the
system of social assistance (inadequate though it is) and
redistribution.  The more radical analysis sees the problem as a lack of
opportunity for employment and other means of generating adequate income
- at least partly attributable to systemic barriers - and looks to
address those barriers.  This is the more threatening approach because
it starts to look at the way power is distributed in society, and it
means actually changing some systems.

I believe that the sort of "denial/indifference" that Dennis speaks of
comes from the ideological glasses that are worn when looking at the
data that describe a problem, or considering a solution.  And because we
like to think of ourselves as "objective", we often don't want to
acknowledge the ideology that frames the way we look at issues, or the
way we even choose to study a particular problem.


Ken Hoffman
Community Health Consultant
and Associate, The Alder Group
... promoting health and innovation

phone: 613.729.0308   fax: 613.729.0920

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