Department for Health, University of Bath, Bath, UK.
School of Environment and Life Sciences, University of Salford, Salford, UK.
Sociol Health Illn. 2019 Oct;41 Suppl 1(Suppl 1):31-49. doi: 10.1111/1467-9566.12980.
Informed by a discourse analysis, this article examines the framing of equity within the UK's digital health policies between 2010 and 2017, focusing on England's development of NHS Digital and its situation within the UK Government's wider digital strategy. Analysis of significant policy documents reveals three interrelated discourses that are engaged within England's digital health policies: equity as a neoliberal imaginary of digital efficiency and empowerment; digital health as a pathway towards democratising health care through data-sharing, co-creation and collaboration; and finally, digital health as a route towards extending citizen autonomy through their access to data systems. It advances knowledge of the relationship between digital health policy and health inequalities. Revealing that while inclusion remains a priority area for policymakers, equity is being constituted in ways that reflect broader discourses of neoliberalism, empowerment and the turn to the market for technological solutionism, which may potentially exacerbate health inequalities.
本文通过话语分析,考察了 2010 年至 2017 年英国数字健康政策中公平的框架,重点关注英格兰国民保健署数字化的发展及其在英国政府更广泛的数字战略中的地位。对重要政策文件的分析揭示了英格兰数字健康政策中涉及的三个相互关联的话语:作为数字效率和赋权的新自由主义想象的公平;数字健康是通过数据共享、共同创造和合作实现医疗民主化的途径;最后,数字健康是通过让公民访问数据系统来扩展其自治权的途径。本文推进了对数字健康政策与健康不平等之间关系的认识。研究结果表明,尽管包容仍然是政策制定者的优先事项,但公平正在以反映更广泛的新自由主义、赋权和转向市场寻求技术解决方案主义的话语的方式构成,这可能会加剧健康不平等。