What will affect health inequality?
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Political and economic factors, such as power, do not directly cause health inequality, but have a strong power to maintain or change the current situation on the ground. Power permeates norms and perceptions through social theories such as capitalism and gender discrimination, or through specific paradigms such as biomedical models, and limits policymakers' choices, resulting in a bias in public policy. In addition, the structural power of expertism continues public health policies that focus only on individual health promotion behaviors and health delivery systems by focusing on the results of alleviating or enhancing the health status of already vulnerable populations, rather than dealing with the 'conditions' that create a public health crisis. As such, power inequality exacerbates health inequality by deepening the institutional path of national and market dominance in health policies and causing resource inequality.
Then, how can citizens challenge this power structure? How can we change the strong power to maintain the existing state and develop public policy to achieve health equity? The research I'm going to introduce today started with these questions.(☞ Shortcut: Power and Citizens' Health) The Friel team interviewed a total of 158 key actors in each of Australia's seven policy cases and identified how civil society actors have achieved structural changes to improve health equity.
Based on case analysis, the authors presented three strategies for the structural weak to achieve the goal of health equity. The first is to utilize a new space. According to the study, public policy tends to be discussed and determined in a closed manner, mainly by state bureaucrats, companies, and some experts. When the existing institutional arena is closed to civil society actors, these actors can achieve their goals by revealing that there is a hidden place for citizens to make harmful policy decisions, demanding new space for citizens' participation and deliberation, or deliberation. The second is the use of discourse power. Civil society actors were able to challenge the existing dominant hegemony by accumulating their professional and moral power and presenting convincing new narratives or frames.
A good illustration of the first and second strategies is the case of the Paid Parent Leave (PPL) movement. In Australia, PPL has long been regarded as a thorough labor-management relationship, and under this relationship, businesses/employers have used their power to oppose it. It was difficult to intervene effectively here because the field of labor-management relations was closed to external actors. Accordingly, the labor union discussed and attracted organizations/people outside labor-management relations, such as human rights organizations and women's organizations, making PPL an issue on a broader social agenda. As the involvement of new subjects other than labor and management became possible and the forum for discussion became open, PPL discussions could gain momentum in Australia. In addition, the inclusion of new frames on gender equality, reproductive health and child health, women's working values and productivity in this process also contributed to the promotion of the introduction of PPL.
The third strategy is to form a network. The network is an important factor that makes it possible to utilize the existing closed institutional process or to create a new process. For example, Australia's indigenous leaders and communities created a space for resistance by creating various types of community-led organizations to form networks. These organizations were also able to enter the federal government's institutional politics by becoming government policy partners and receiving funding through the closing the gap policy. Of course, power inequality within the partnership and the resulting limitations persist, but the continued resistance of these organizations is still creating important social changes.
Consideration of power is essential in the long-term battle to achieve health equity, and to coordinate power inequality must be able to disrupt and change the power to maintain existing power structures in various types, forms, layers, and places of power. Of course, you can't achieve everything with one attempt, and the attempt is not always successful. Nevertheless, creative struggles around the world to reduce the influence of countries and businesses and make the voices of more citizens audible are certainly making positive changes. Let's unite and join our fellow citizens in order to go to greater change.
Writer: Yeyoung Jeon