School of Public Policy and Global Affairs, The University of British Columbia, Vancouver, British Columbia, Canada
School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Glob Health. 2023 Sep;8(9). doi: 10.1136/bmjgh-2023-012661.
Associations, unions and other organised groups representing health workers play a significant role in the development, adoption and implementation of health policy. These representative health worker organisations (RHWOs) are a key interface between employers, governments and their members (both actual and claimed), with varying degrees of influence and authority within and across countries. Existing research in global health often assumes-rather than investigates-the roles played by RHWOs in policy processes and lacks analytical specificity regarding the definitional characteristics of RHWOs. In this article, we seek to expand and complicate conceptualisations of RHWOs as key actors in global health by unpacking the heterogeneity of RHWOs and their roles in policy processes and by situating RHWOs in context. First, we define RHWOs, present a typology of RHWO dimensions and discuss perceived legitimacy of RHWOs as policy actors. Next, we unpack the roles of RHWOs in policy processes and distinguish RHWO roles in regulation from those of regulatory agencies. The final sections situate RHWOs in political and labour relations contexts, and in sociohistorical contexts, with attention to institutional frameworks, professional hierarchies and intersectional factors such as race, gender, sexuality, class, caste and religion. We conclude by outlining research gaps in the study of RHWOs and policy, and by encouraging global health researchers and practitioners to incorporate an expanded focus on these actors. Taking this approach will generate a wider range of strategies to better engage these organisations in policy processes and will ensure stronger health workforce policies globally.
代表卫生工作者的协会、工会和其他有组织的团体在卫生政策的制定、采用和实施中发挥着重要作用。这些代表性的卫生工作者组织（RHWOs）是雇主、政府与其成员（实际成员和声称成员）之间的关键接口，在国家内部和国家之间具有不同程度的影响力和权威。全球卫生领域的现有研究往往假设（而不是调查）RHWOs 在政策过程中所扮演的角色，并且缺乏关于 RHWOs 的定义特征的分析特异性。在本文中，我们试图通过剖析 RHWOs 的异质性及其在政策过程中的作用，并将 RHWOs 置于具体情境中，来扩展和复杂化 RHWOs 作为全球卫生主要行为者的概念化。首先，我们定义 RHWOs，提出 RHWO 维度的类型学，并讨论 RHWOs 作为政策行为者的感知合法性。接下来，我们剖析 RHWOs 在政策过程中的作用，并区分 RHWOs 在监管中的作用和监管机构的作用。最后部分将 RHWOs 置于政治和劳工关系背景以及社会历史背景中，关注制度框架、专业等级以及种族、性别、性取向、阶级、种姓和宗教等交叉因素。最后，我们概述了 RHWOs 研究和政策研究中的空白，并鼓励全球卫生研究人员和从业者扩大对这些行为者的关注。采取这种方法将产生更广泛的策略，以更好地使这些组织参与政策过程，并确保全球范围内更有力的卫生人力政策。
