Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
BMC Public Health. 2022 Jul 7;22(1):1302. doi: 10.1186/s12889-022-13538-6.
According to post-structural policy analyses, policies and interventions aiming at reducing social inequalities have been found to be part in producing and reifying such inequalities themselves. Given the central role of health inequalities on the public health policy agenda globally it seems important to examine the way policy on health inequalities may potentially counteract the goal of health equity. The aim of this intersectional policy analysis, was to critically analyze the representation of health inequalities in a government bill proposing a national strategy on alcohol, drugs, tobacco and gambling, to examine its performative power, and to outline alternative representations.
A post-structural approach to policy analysis was combined with an intersectional framework. The material was analyzed through an interrogating process guided by the six questions of the "What's the problem represented to be?" (WPR) approach. Thus, the underlying assumptions of the problem representation, its potential implications and historical background were explored. In a final step of the analysis we examined our own problem representations.
The recommendations found in the gender and equity perspective of the bill represented the problem of health inequalities as a lack of knowledge, with an emphasis on quantitative knowledge about differences in health between population groups. Three underlying assumptions supporting this representation were found: quantification and objectivity, inequalities as unidimensional, and categorization and labelling. The analysis showed how the bill, by opting into these partly overlapping assumptions, is part of enacting a discourse on health inequalities that directs attention to specific subjects (e.g., vulnerable) with special needs (e.g., health care), in certain places (e.g., disadvantaged neighborhoods). It also showed how underlying processes of marginalization are largely neglected in the bill due to its focus on describing differences rather than solutions. Finally, we showed how different intersectional approaches could be used to complement and challenge this, potentially counteractive, problem representation.
The problem representation of health inequalities and its underlying assumptions may have counteractive effects on health equity, and even though some of its strengths are raised, it seems to be profoundly entangled with a system resisting the kind of change that the bill itself advocates for. If carefully used, intersectionality has the potential to support a more comprehensive and inclusive equality-promoting public health policy and practice.
根据后结构政策分析，旨在减少社会不平等的政策和干预措施已被发现是自身产生和强化这些不平等的一部分。鉴于健康不平等在全球公共卫生政策议程中的核心地位，似乎有必要研究健康不平等政策可能对健康公平目标产生的反作用。本交叉政策分析的目的是批判性地分析政府法案中关于减少健康不平等的代表性，该法案提出了一项关于酒精、毒品、烟草和赌博的国家战略，以检验其表现权，并概述替代代表性。
将政策分析的后结构方法与交叉框架相结合。通过由“问题代表什么？”（WPR）方法的六个问题指导的询问过程来分析材料。因此，探讨了问题代表性的潜在假设、其潜在影响和历史背景。在分析的最后一步，我们检查了自己的问题代表性。
法案中的性别和公平视角中的建议将健康不平等问题视为缺乏知识，重点是关于人口群体之间健康差异的定量知识。发现了支持这种代表性的三个基本假设：量化和客观性、不平等的一维性以及分类和标签。分析表明，该法案通过选择这些部分重叠的假设，成为了一种关于健康不平等的话语的一部分，这种话语将注意力集中在具有特殊需求（例如医疗保健）的特定对象（例如弱势群体）上，这些对象处于特定地点（例如贫困社区）。它还表明，由于该法案专注于描述差异而不是解决方案，因此该法案在很大程度上忽略了潜在的边缘化过程。最后，我们展示了如何使用不同的交叉方法来补充和挑战这种潜在的反作用问题代表性。
健康不平等问题的代表性及其潜在假设可能对健康公平产生反作用，尽管它的一些优势被提出，但它似乎与一个抵制法案本身所倡导的那种变革的系统深深地纠缠在一起。如果谨慎使用，交叉性有可能支持更全面和包容的促进平等的公共卫生政策和实践。
