Analysing power and politics in health policies and systems

Abstract

This special issue of Global Public Health presents a collection of articles that analyse power and its mechanisms in health systems and health policy processes. Researchers have long noted that the influence of power is implicated throughout the global health field, yet theories and methods for examining power-its sources, workings, and effects-are rarely applied in health policy and systems research. By engaging with the social sciences and humanities, contributors to this collection aim to analytically sharpen and thematically broaden the study of power and politics in global health. Contributors analyse the exercise of power by actors typically considered powerful on the global stage as well as actors across the health system who may be powerful in national or local contexts. Additionally, the papers draw attention to actors, interest groups, and practices not usually viewed as politically salient in health policy and systems research in low-and middle-income countries. The papers not only analyse power but also identify ways to counteract it, such as by using human rights-based frameworks to investigate and challenge power asymmetries. Collectively, they show how researchers working on global health issues can theorise power and deepen political analysis of health policy and systems. ARTICLE HISTORY

Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India

“…As a multi-disciplinary field, HPSR draws on a wide variety of research designs, data collection methods (both qualitative and quantitative) and sources of data, pragmatically identifying the research methodologies best able to answer questions generated by real-world problems [93]. In doing so, HPSR frequently adopts research approaches outside mainstream biomedical approaches in order to better understand interaction, perspectives and contexts [13] or issues of power and politics [96].…”

Scaling up population health interventions from decision to sustainability – a window of opportunity? A qualitative view from policy-makers

“…Arguably, a major limitation to scale-up is the unpredictable nature of policy and the personal values of decision-makers. Increasingly, other researchers have acknowledged the influence of power and politics and how key actors that hold that power may change the direction of health efforts [46,47]. This can occur across a wide range of actors whose ideologies or personal values can influence how decisions are made at any level, ranging from high level policy decision-making to local level implementation.…”

Access to care for childhood cancers in India: perspectives of health care providers and the implications for universal health coverage

“…Participants’ individual varied perceptions of government’s efforts, as explained by Gore and Parker (2019), may be reflective of an understated power dynamic that frontline service delivery can risk being made a political issue, such that political positioning could shape how problems are perceived [ 50 ]. Notably, participants who had opinions on government efforts were mostly oncologists, perhaps due to their involvement in high-level management and decision-making, compared to other health worker cadres who are less likely to be involved in system level change, administrative decisions, advocacy or policy dialogues.…”