Williams Oli, Fullagar Simone
Department of Health Sciences, University of Leicester, Leicester, UK.
NIHR CLAHRC East Midlands, Leicester General Hospital, Leicester, UK.
Sociol Health Illn. 2019 Jan;41(1):20-35. doi: 10.1111/1467-9566.12783. Epub 2018 Aug 2.
Despite political change over the past 25 years in Britain there has been an unprecedented national policy focus on the social determinants of health and population-based approaches to prevent chronic disease. Yet, policy impacts have been modest, inequalities endure and behavioural approaches continue to shape strategies promoting healthy lifestyles. Critical public health scholarship has conceptualised this lack of progress as a problem of 'lifestyle drift' within policy whereby 'upstream' social contributors to health inequalities are reconfigured 'downstream' as a matter of individual behaviour change. While the lifestyle drift concept is now well established there has been little empirical investigation into the social processes through which it is realised as policies are (re)formulated and implementation is localised. Addressing this gap we present empirical findings from an ethnography conducted in a deprived English neighbourhood in order to explore: (i) the local context in the process of lifestyle drift and; (ii) the social relations that reproduce (in)equities in the design and delivery of lifestyle interventions. Analysis demonstrates how and why 'precarious partnerships' between local service providers were significant in the process of 'citizen shift' whereby government responsibility for addressing inequity was decollectivised.
尽管在过去25年里英国发生了政治变革，但国家政策前所未有地聚焦于健康的社会决定因素以及基于人群的慢性病预防方法。然而，政策影响有限，不平等现象依然存在，行为方式继续主导着促进健康生活方式的策略。批判性公共卫生学术研究将这种缺乏进展的情况概念化为政策中的“生活方式漂移”问题，即健康不平等的“上游”社会因素在政策中被重新构建为个体行为改变的“下游”问题。虽然生活方式漂移的概念现已确立，但对于在政策（重新）制定和实施本地化过程中其得以实现的社会过程，几乎没有实证研究。为填补这一空白，我们展示了在一个贫困的英国社区进行的人种志研究的实证结果，以探讨：（i）生活方式漂移过程中的当地背景；以及（ii）在生活方式干预措施的设计和实施中重现（不）平等的社会关系。分析表明，当地服务提供者之间的“不稳定伙伴关系”在“公民转移”过程中如何以及为何具有重要意义，在此过程中，政府解决不平等问题的责任被分散。
