Lundy P
School of Social & Community Sciences, University of Ulster, Magee College, Londonderry, Northern Ireland.
Soc Sci Med. 1996 Feb;42(3):313-24. doi: 10.1016/0277-9536(95)00153-0.
Sociologists and, more recently, critical medical anthropologists have been arguing for a refocusing of the analysis of health and health care towards a perspective which considers the broader global political economy. In the context of the debt crisis and IMF/World Bank-inspired structural adjustment policies, the political economy theoretical perspective is becoming even more relevant in the analysis of health underdevelopment in many 'Third World' countries. This study focuses on the direct and indirect effects of the Jamaican debt crisis and structural adjustment programmes on health care services and health standards. In this paper it is argued that there are methodological problems using quantitative data when studying the effects of structural adjustment. In addition to providing a limited account of the effects, it is argued that the basic problem is a matter of the availability and reliability of the quantitative data in many 'Third World' countries. It is argued that some of these problems could be overcome by the application of qualitative micro-level analysis. This type of methodology is important to ascertain the effects of global processes at the grass roots level and to gain insights into what those working in the health sector are experiencing and what they perceive as the effects, if any, of structural adjustment policies. This has often been missing from the impersonal accounts offered by quantitative research on the subject to date.
社会学家，以及最近的批判性医学人类学家，一直在主张将健康与医疗保健分析的重点重新转向一种考虑更广泛全球政治经济的视角。在债务危机以及国际货币基金组织/世界银行推动的结构调整政策的背景下，政治经济理论视角在分析许多“第三世界”国家的健康发展不足问题时变得愈发重要。本研究聚焦牙买加债务危机和结构调整计划对医疗保健服务与健康标准的直接和间接影响。本文认为，在研究结构调整的影响时使用定量数据存在方法上的问题。除了对影响的描述有限之外，还认为根本问题在于许多“第三世界”国家定量数据的可得性和可靠性。有人认为，应用定性微观层面分析可以克服其中一些问题。这种方法对于确定全球进程在基层的影响以及深入了解卫生部门工作人员的经历以及他们所认为的结构调整政策的影响（如果有的话）非常重要。迄今为止，关于该主题的定量研究提供的客观描述往往缺少这一点。
