For over a decade, beginning in the late 1990s, discussion over softer modes of governance animated academic scholarship in the fields of law, politics, and public policy. This debate was especially pronounced in Europe. Since the late 2000s, however, discussion of this approach has declined precipitously. Is the "soft governance" model dead? Or, more precisely, has the economic crisis killed it? This article argues that, to the contrary, the EU's austerity measures have made softer governance more relevant in two quite distinct ways. Administratively, new mechanisms of health policy coordination are able to provide policy solutions in a much more effective way than could more formal and rigid forms of legal harmonisation. Politically, it establishes a normative perspective which unifies actors across a number of administrative units and challenges the dominant ideological force of the market-based principles upon which the EU's austerity policies are constructed.
The nature of governance in Canada, both horizontally (between federal departments) and vertically (between federal and provincial governments) is changing. Or is it? Two distinct trends seem to have emerged over the past decade: one towards horizontal coordination and one towards vertical collaboration. These trends are perhaps best exemplified by the Public Health Agency of Canada, which depends very emphatically on integrated relationships both with other federal departments and with provincial and territorial governments. Yet in the past year, severe criticisms have emerged regarding the agency's ability to meet its objectives.To what extent are these problems due to the failure of collaborative governance? On a wider level, have decision-makers been too insouciant about making importunate public policy decisions on an assumption of the viability of collaborative governance? This article argues that problems in vertical collaboration in public health have occurred largely due to failures in horizontal coordination within the national government.Sommaire: La nature de la gouvernance au Canada, à la fois horizontalement (entre les ministères fédéraux) et verticalement (entre le gouvernement fédéral et les gouvernements provinciaux), est en évolution. Mais l'est-elle réellement? Deux tendances distinctes semblent avoir vu le jour au cours de la dernière décennie : l'une allant vers la coordination horizontale et l'autre vers la collaboration verticale. L'organisme qui illustre peut-être le mieux ces tendances est l'Agence de la santé publique du Canada, qui dépend énormément des relations intégrées à la fois avec d'autres ministères fédéraux et avec les gouvernements territoriaux et provinciaux. Cependant, au cours de la dernière année, l'Agence a été sévèrement critiquée quant à son aptitude à atteindre ses objectifs. Dans quelle mesure ces problèmes sont-ils attribuables à l'échec de la gouvernance de collaboration? Sur un plan plus vaste, les décisionnaires ont-ils été trop insouciants en prenant des décisions importunes en matière de politiques publiques et en supposant la viabilité de la gouvernance de collaboration? Le présent article soutient que des problèmes en matière de collaboration verticale dans la santé publiques et en survenus principalement en raison d'échecs dans la collaboration horizontale au sein du gouvernement national.
To encourage interprofessional collaboration and to improve the regulation of healthcare providers, Ontario and Nova Scotia, Canada, have each adopted legislation calling for collaboration among the regulators of their self-regulating health professions. Ontario's legislation is "top down": it came from government and stresses the obligation of regulators to collaborate. Nova Scotia's legislation is "bottom up": it was proposed and developed by regulators and emphasizes voluntary regulatory collaboration. This article considers the theoretical strengths and weaknesses of both models. It argues that Nova Scotia's approach may be stronger because of its relative consistency with core strengths of self-regulation and interprofessionalism and its grounding in soft law and a governance approach to collaborative self-regulation and to healthcare policy more broadly.
Health equity (HE) is a central concern across multiple disciplines and sectors, including nursing. However, the proliferation of the term has not resulted in corresponding policymaking that leads to a clear reduction of health inequities. The goal of this paper is to use institutional ethnographic methods to map the social organization of HE policy discourses in Canada, a process that serves to reproduce existing relations of power that stymie substantive change in policy aimed at reducing health inequity. In nursing, institutional ethnography (IE) is described as a method of inquiry for taking sides in order to expose socially organized practices of power. Starting from the standpoints of HE policy advocates we explain the methods of IE, focusing on a stepwise description of theoretical and practical applications in the area of policymaking. Results are discussed in the context of three thematic areas: 1) bounding HE talk within biomedical imperialism, 2) situating racialization and marginalization as a subaltern space in HE discourses, and 3) activating HE texts as ruling relations. We conclude with key points about our insights into the methodological and theoretical potential of critical policy research using IE to analyze the social organization of power in HE policy narratives. This paper contributes to critical nursing discourse in the area of HE, demonstrating how IE can be applied to disrupt socially organized neoliberal and colonialist narratives that recycle and redeploy oppressive policymaking practices within and beyond nursing.
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