Young Janette, McGrath Richard
School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
Aust J Prim Health. 2011;17(4):369-77. doi: 10.1071/PY11038.
The Australian National Health Reform agenda includes aims to reduce health disadvantages and provide equitable access. However, this reform will be implemented through state and territory governments, and as such will be built on existing conceptualisations of health as a social justice concept (core to understandings of social determinants). A selection of state and territory health policy documents were analysed within a critical discourse framework focussing on their use of terms relating to social determinants. Analysis revealed that the understandings of social justice concepts vary across Australia and are generally apolitical, belying core concerns inherent in a social determinants understanding. Such differentiation bears recognition by reformers seeking to implement national consistency. This paper also considers how health professionals might become aware of their own cultural enmeshment in neo-liberal frameworks of understanding, recognising a social determinants framework as counter-cultural and hence requiring radical thinking.
澳大利亚国家卫生改革议程旨在减少健康方面的不利因素，并提供公平的医疗服务。然而，这项改革将通过州和地区政府来实施，因此将建立在现有的将健康视为社会正义概念（理解社会决定因素的核心）的概念之上。在一个批判性话语框架内，对一系列州和地区的卫生政策文件进行了分析，重点关注它们对与社会决定因素相关术语的使用。分析表明，澳大利亚各地对社会正义概念的理解各不相同，而且通常不涉及政治，这掩盖了社会决定因素理解中固有的核心问题。这种差异值得寻求全国一致性的改革者认可。本文还探讨了卫生专业人员如何意识到自己在新自由主义理解框架中的文化束缚，认识到社会决定因素框架与主流文化相悖，因此需要激进的思维。
