Problematizations in Health Policy

Carol Bacchi

doi:10.1177/2158244016653986

Abstract

This article directs attention to the significance, for health promotion advocates, of reflecting on how “problems” are constituted, or brought into existence, as particular sorts of problems, within policies and policy proposals. To this end, it introduces a poststructural analytic strategy called “What’s the Problem Represented to be?” (WPR approach), and contrasts this perspective to the ways in which “problems” are commonly conceptualized in health policy analyses (e.g., “a problem stream,” “wicked problems”). Such a perspective offers a significant rethinking of the conventional emphasis on agenda setting and policy-making processes in considering the meaning of success or failure in health policy initiatives. The starting point is a close analysis of items that are “successful,” in the sense that they make the political agenda, to see how representations of “problems” within selected policies limit what is talked about as possible or desirable, or as impossible and undesirable. This form of analysis thus enables critical reflections on the substantive content of policy initiatives in health policy. The article takes a step back from policy process theories, frameworks, and models to offer reflections at the level of paradigms. Highlighting potential dangers and limitations in positivism, interpretivism, and critical realism, it uses international, Australian, and South Australian examples in health policy to explore what poststructural policy analysis contributes to understanding the broad political influences shaping contemporary modes of rule.

Highlights

What is a “problem”?1 When the term is used in health policy analysis—and it is used frequently—what is meant by it? And, are these presumed meanings relevant in some way to the cogency of our political analyses?
I make the case that it is important to alert policy researchers generally and health promotion advocates in particular to the implications of the meanings they attribute to the concept problem, and to possible inconsistencies in usage
In the place of tracking policies through “stages” of development, it recommends critical analysis of the categories and knowledges that shape current governing practices. To instigate this form of investigation, it promotes the study of problematizations—how “problems” are constituted within policies and policy proposals

Summary

Introduction

What is a “problem”?1 When the term is used in health policy analysis—and it is used frequently—what is meant by it? And, are these presumed meanings relevant in some way to the cogency of our political analyses?. The language of problems is often adopted without problematizing the term, implying a pre-existing condition or set of conditions exogenous to or outside of the policy process that must be addressed (Koon et al, 2016) Such a claim needs to reflect on the place of problem definition and frame theory within these perspectives, as will be done below. A second section, headed “Applying WPR,” directs attention to health policy analyses that ask questions about how “problems” are conceptualized within policy texts It proceeds to contrast these approaches with a WPR form of analysis, using examples from Australian public policy. The article concludes with brief reflections on the possible uses and feasibility of including a WPR form of policy analysis in health policy research

Objectives

Conclusion