Michael Calnan - Health Policy, Power and Politics: Sociological Insights
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In the context of substantial changes in health service policy and public health policy in England over the last two decades, Health Policy, Power and Politics fills an important gap by providing an up-to-date and accessible account of recent trends in health policies and a sociological analysis of why these policies have taken the shape they have.
This book provides a theoretically informed analysis of key recent policy changes in England and how the interplay of powerful structural interests has influenced policy in health. It includes chapters on recent reforms in the NHS and the drift towards privatisation, policies aimed at enhancing public and patient involvement, the regulation of the drug industry, medicalisation and mental health policy, the role and effect of the media and recent changes in social and environmental health policy. The analysis examines the influence of the State, professional medicine, the media, commercial interests such as those of the pharmaceutical, food and fossil fuel industries, patients groups and the wider global environment.
While the key focus of the book is on England, the analysis drawn on by the author comes from a plethora of policy examples in health systems in high and low to middle income countries across the world. This widened context shines a light on the influence of globalisation and highlights both the distinctive character of health policy in England, as well as the common themes it shares in a world-wide context.
This book provides a theoretically informed analysis of key recent policy changes in England and how the interplay of powerful structural interests has influenced policy in health. It includes chapters on recent reforms in the NHS and the drift towards privatisation, policies aimed at enhancing public and patient involvement, the regulation of the drug industry, medicalisation and mental health policy, the role and effect of the media and recent changes in social and environmental health policy. The analysis examines the influence of the State, professional medicine, the media, commercial interests such as those of the pharmaceutical, food and fossil fuel industries, patients groups and the wider global environment.
While the key focus of the book is on England, the analysis drawn on by the author comes from a plethora of policy examples in health systems in high and low to middle income countries across the world. This widened context shines a light on the influence of globalisation and highlights both the distinctive character of health policy in England, as well as the common themes it shares in a world-wide context.
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Michael Calnan
Sara E. Wilensky
Lynne Friedli
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Health Policy, Power and Politics
Sociological Insights
Praise for Health Policy, Power and Politics
Professor Calnan is very well qualified to write on health policy, power and politics in the UK, in which he has a national and international reputation. This book is solidly grounded on his recent teaching and distinctively and revealingly adopts a sociological perspective in addressing several key facets of the UK policy agenda. It provides important insights for all those interested in this agenda in a range of cognate fields from professionalism and public engagement to mental health policy and social inequalities.
Mike Saks, Emeritus Professor, University of Suffolk
Health Policy, Power and Politics is an excellent book ideal for students undertaking health policy modules. It is effectively a course text in its own right, one that clearly draws on Michael Calnans years of teaching, researching and writing on and around this topic. Indeed, this strength also makes the book a most useful resource for the post-graduate student and researcher.
What is particularly distinctive about this book is its critical sociological approach, one that is well grounded in recent research. It gives comprehensive coverage and analysis of all the key challenges for health policy particularly relating to the English NHS. The books importance, for me, is its clear-headed, critical and theoretically based analysis of policies that are too often treated too prescriptively; whether we are talking about hospital performance, professional governance, patient choice, or digitalization, or any of the other topics in this text.
While predominately NHS focused the book does place this institution within an international context, for example, critically comparing NHS performance internationally. This is no mere add-on but integral to the books review and analysis of health policy, power and politics today.
Given the fast changing policy environment we are now in, I would expect a revised, updated version will be needed fairly quickly, certainly following the 2019 general election. But even so, the essential analyses and evidence provided will, if anything, be likely to become of greater pertinence than before.
Mike Dent, Emeritus Professor, Staffordshire University
Health Policy, Power and Politics
Sociological Insights
Michael Calnan
University of Kent, UK
United Kingdom North America
Japan India Malaysia China
Japan India Malaysia China
Emerald Publishing Limited
Howard House, Wagon Lane, Bingley BD16 1WA, UK
Howard House, Wagon Lane, Bingley BD16 1WA, UK
First edition 2020
Copyright 2020 Michael Calnan
Published under an exclusive licence
Published under an exclusive licence
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No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters suitability and application and disclaims any warranties, express or implied, to their use.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
A catalogue record for this book is available from the British Library
ISBN: 978-1-83909-397-5 (Print)
ISBN: 978-1-83909-394-4 (Online)
ISBN: 978-1-83909-396-8 (Epub)
ISBN: 978-1-83909-394-4 (Online)
ISBN: 978-1-83909-396-8 (Epub)
Contents
Acknowledgements
Acknowledgements
This book is based on undergraduate and postgraduate teaching that I have carried out over the last 10 years in the School of Social Policy, Sociology and Social Research at the University of Kent, and I would like to thank all the students for their contributions over the years to the discussion and analysis of the themes covered in this book. This book also draws on evidence from a number of research projects which I have been involved with in recent years, so I would also like to thank those who I have collaborated with for their respective contributions. Thanks to the three anonymous reviewers who provided constructive comments on the proposal for this book. Finally, thanks must go to my partner Sian for her continued support and encouragement in helping ensure that I completed the work on time.
Michael Calnan,
January 2020
January 2020
An Introduction
This book focuses on recent developments in health policy in the UK. The focus is on the UK, although it will include comparison with health systems in other countries to show what might be distinctive about the UK approach and what it shares with health systems associated with different socio-political and cultural values (Hunter, 2016). However, more emphasis will be placed on policy developments in England because in the early part of this century, there was some element of devolution with the four countries of the UK tending to adopt their own distinctive and diverging health policies (Prior, Hughes, & Peckham, 2012).
It must be remembered that health in itself is a contested concept (Baggott, 2015; Blaxter, 2010) in that it can be conceptualised in terms of the absence of disease and illness with health policy focusing in a limited way on health services. However, health policy can also embrace more broader or positive definitions of health which take into account the social, economic, political and environmental processes that influence public health. Before the general approach taken in this book is discussed, there is a need to characterise what health policy is and what it covers.
What is health policy? There are many definitions of health policy, but one of the most succinct is that offered by Baggott (2015) as:
The political process that underlie the emergence of health issues, the formulation of policies and their implementation. (p. 2)
Why is health policy important? Health in itself is important both at the individual and population levels, but it can also be seen as a resource for participating in social and economic life (WHO, 1984). In the UK, many of us were born in a National Health Service (NHS), and the NHS is the fifth largest employer in the world. It is also one of the most expensive parts of the welfare state, and thus, a relatively large proportion of taxpayers money is invested in it at least compared with other areas of welfare such as social care. The health policy-making process has been characterised in a number of ways (Alaszewski & Brown, 2012; Baggott, 2015) emphasising both the rational nature of policy making in terms of means ends relationships and as an adaptive learning process which can only be understood over a long period of time. In terms of policy change, it might be characterised as a radical change in approach or perhaps more commonly, at least in the context of England, as a change which occurs in small increments building on each other. In contrast, the nonlinear and messy nature of policy making might lead to the policy process being characterised as muddling through (for example, see ), to appear to decisively respond to a problem although they might prefer to take little to no action.
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