1 University of California-Davis, Davis, CA, USA.
J Health Soc Behav. 2019 Jun;60(2):138-152. doi: 10.1177/0022146519843935. Epub 2019 Apr 25.
Comparative-historical research on medicalization is rare and, perhaps for that reason, largely ignores political institutions, which tend to vary more across countries than within them. This article proposes a political-institutional theory of medicalization in which health care policy legacies, political decentralization, and constitutionalism shape the preferences, discourses, strategies, and influence of actors that seek or resist medicalization. The theory helps explain why abortion has been more medicalized in Britain than the United States. The analysis finds that the American medical profession, unlike its British counterpart, focused on defending private medicine rather than protecting its power to "diagnose" the medical necessity of abortions; that American political decentralization aided the establishment of abortion on request by encouraging strategic innovation and learning that shaped social movement strategies, medical issue avoidance, and the growth of nonhospital clinics; and finally, that constitutionalism promoted rights discourses that partially crowded out medical ones.
医学化的比较历史研究很少见，也许正因如此，它在很大程度上忽略了政治制度，而政治制度往往在国家之间的差异大于国家内部的差异。本文提出了一种医学化的政治制度理论，其中医疗政策遗产、政治权力分散化和立宪主义塑造了寻求或抵制医学化的行为者的偏好、话语、策略和影响力。该理论有助于解释为什么堕胎在英国比在美国更容易被医学化。分析发现，与英国同行不同，美国医学界专注于捍卫私人医疗，而不是保护其“诊断”堕胎医学必要性的权力；美国的政治权力分散化通过鼓励战略创新和学习，帮助建立了按需堕胎，这些创新和学习塑造了社会运动策略、回避医疗问题以及非医院诊所的发展；最后，立宪主义促进了权利话语，部分排挤了医学话语。
