Center for Health and the Social Sciences, University of Chicago, 5841 S. Maryland Avenue, MC 1005, Suite M200, Chicago, IL 60637, USA.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
Health Policy Plan. 2018 May 1;33(4):611-621. doi: 10.1093/heapol/czy008.
Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We undertook a two-stage process to identify these resources. First, we conducted a collaborative exercise involving crowdsourcing and participatory validation, resulting in 24 proposed articles. Second, we conducted a structured literature review in four phases, resulting in 38 articles reviewed. We present the 10 selected resources in the following categories to bring out key facets of the literature on power and health policy and systems-(1) Resources that provide an overarching conceptual exploration into how power shapes health policy and systems, and how to investigate it; and (2) examples of strong empirical work on power and health policy and systems research representing various levels of analyses, geographic regions and conceptual understandings of power. We conclude with a brief discussion of key gaps in the literature, and suggestions for additional methodological approaches to study power.
权力是理解和改变卫生政策和体系的关键概念。权力在地方、国家和全球多个层面上隐性或显性地显现，并存在于每个行为体的相互作用中，因此塑造了所有的行动、过程和结果。分析和参与权力对于增进我们对不平等根本原因的理解，以及提高我们促进透明度、问责制和公平性的能力，具有重要的潜力。然而，权力在卫生政策和体系中的作用的研究和分析，特别是在中低收入国家的背景下，一直缺乏。为了促进卫生系统和政策领域的研究人员和实践者更多地参与权力概念，我们广泛概述了权力的概念，并列出了 10 个关于中低收入国家卫生政策和体系中权力的优秀资源，涵盖了典范框架、评论和实证工作。我们采用了两阶段的方法来确定这些资源。首先，我们进行了一次协作活动，涉及众包和参与式验证，产生了 24 篇拟议文章。其次，我们进行了四轮结构化文献综述，共审查了 38 篇文章。我们按照以下类别呈现这 10 个选定的资源，以突出权力与卫生政策和体系文献的关键方面：（1）提供权力如何塑造卫生政策和体系以及如何研究权力的全面概念性探讨的资源；（2）权力与卫生政策和体系研究的有力实证工作的例子，代表了各种分析层次、地理区域和权力概念理解。最后，我们简要讨论了文献中的关键差距，并提出了研究权力的其他方法学方法的建议。
