TY - JOUR
T1 - A framework for medical power in two case studies of health policymaking in India and Niger
AU - Dalglish, Sarah L.
AU - Sriram, Veena
AU - Scott, Kerry
AU - Rodríguez, Daniela C.
N1 - Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2019/4/3
Y1 - 2019/4/3
N2 - Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. We explore medical power in national health policymaking for child survival in Niger (late 1990s–2012) and emergency medicine specialisation in India (early 1990s–2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking. Medical doctors, mainly specialists, utilised their power to shape policy differently in each case. In Niger, a small, connected group of paediatricians pursued a policy of task-shifting after a powerful non-medical actor, the country’s president, shifted the debate by enacting broad health systems improvements. In India, a more fragmented group of specialists prioritised tertiary-level healthcare policies likely to benefit only a small subset of the population. Compared to high-income settings, medical power in these cases was channelled and expressed with greater variability in the profession’s ability to organise and influence policymaking. Taken together, both cases provide evidence that a concentration of medical power in health policymaking can result in the medicalisation of public health issues.
AB - Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. We explore medical power in national health policymaking for child survival in Niger (late 1990s–2012) and emergency medicine specialisation in India (early 1990s–2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking. Medical doctors, mainly specialists, utilised their power to shape policy differently in each case. In Niger, a small, connected group of paediatricians pursued a policy of task-shifting after a powerful non-medical actor, the country’s president, shifted the debate by enacting broad health systems improvements. In India, a more fragmented group of specialists prioritised tertiary-level healthcare policies likely to benefit only a small subset of the population. Compared to high-income settings, medical power in these cases was channelled and expressed with greater variability in the profession’s ability to organise and influence policymaking. Taken together, both cases provide evidence that a concentration of medical power in health policymaking can result in the medicalisation of public health issues.
KW - LMICs
KW - Power
KW - equity
KW - health policy
KW - medicalisation
UR - http://www.scopus.com/inward/record.url?scp=85044973306&partnerID=8YFLogxK
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U2 - 10.1080/17441692.2018.1457705
DO - 10.1080/17441692.2018.1457705
M3 - Article
C2 - 29616876
AN - SCOPUS:85044973306
SN - 1744-1692
VL - 14
SP - 542
EP - 554
JO - Global public health
JF - Global public health
IS - 4
ER -