Institutional Ethnography as Critical Policy Analysis

Abstract

The use of the term health equity (HE) has increased dramatically in the past decade in Canada and globally. However, there is limited evidence that explosive growth in the use of the term is reflected in HE policy outcomes. In this paper we argue that the methodology of institutional ethnography (IE) is useful in understanding how policy outcomes (including, notably, policy inaction) are constructed. Applying IE methodology in critical policy analysis (CPA), we analyze how the discursive utilization of HE neutralizes effective policy change. The point of our analytical approach is to explain how three complex areas of investigation (HE, IE, CPA) may be usefully integrated to enhance policy action to tackle the structural, root causes of health inequities. We demonstrate how an integration of IE in CPA provides a deeper understanding of how the political forces shaping policy outcomes manifest themselves in discursive relationships and textually mediated sites of power.