a Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.
Glob Public Health. 2019 Apr;14(4):542-554. doi: 10.1080/17441692.2018.1457705. Epub 2018 Apr 4.
Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. We explore medical power in national health policymaking for child survival in Niger (late 1990s-2012) and emergency medicine specialisation in India (early 1990s-2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking. Medical doctors, mainly specialists, utilised their power to shape policy differently in each case. In Niger, a small, connected group of paediatricians pursued a policy of task-shifting after a powerful non-medical actor, the country's president, shifted the debate by enacting broad health systems improvements. In India, a more fragmented group of specialists prioritised tertiary-level healthcare policies likely to benefit only a small subset of the population. Compared to high-income settings, medical power in these cases was channelled and expressed with greater variability in the profession's ability to organise and influence policymaking. Taken together, both cases provide evidence that a concentration of medical power in health policymaking can result in the medicalisation of public health issues.
医学专业人员影响卫生政策制定，但在中低收入国家，人们对他们所行使的权力了解甚少。我们探讨了尼日尔国家儿童生存卫生政策制定（20 世纪 90 年代末至 2012 年）和印度急诊医学专业化（20 世纪 90 年代初至 2015 年）中的医学权力。这两个案例研究都使用了文件审查、深入访谈和非参与观察；综合分析追踪了政策进程，并围绕权力建立了理论类别，以构建卫生政策制定中医学权力的概念框架。在每个案例中，医生，主要是专家，以不同的方式利用他们的权力来塑造政策。在尼日尔，一小群有联系的儿科医生在一位强有力的非医学行为者——该国总统——通过颁布广泛的卫生系统改善措施转移辩论焦点后，推行了任务转移政策。在印度，一个更加分散的专家群体更优先考虑三级医疗保健政策，这些政策可能只使一小部分人口受益。与高收入环境相比，在这些情况下，医学权力在该行业组织和影响决策制定的能力方面具有更大的可变性。总的来说，这两个案例都表明，卫生政策制定中医学权力的集中可能导致公共卫生问题的医学化。
