Health Policy and Politics: Networks, Ideas and Power
Gray, Gwendolyn, Health Sociology Review
HEALTH POLICY AND POLITICS: NETWORKS, IDEAS AND POWER Jenny Lewis East Hawthorn, Victoria: IP Communications 2005, 210 pp, AUD 44.95 ISBN 0 9752374 5 6
The framework which Jenny Lewis develops in this book, allows health decision-making to be viewed from a new perspective. Conventional political science studies tend to focus on the centrality of power, especially that of organised medicine, as a policy determinant, thus emphasising the controversy and clash of interests which characterise the field. Drawing on existing scholarship, but including new ideas from governance and network studies, the author constructs a non-hierarchical portrayal of health decision-making as 'a complex network of continuing interactions between groups of policy actors' (2005:13) which operates within existing structures and discourses.
Five basic elements of the health policy framework are identified: institutions, governance, power and influence, the professions and ideas. Chapter two argues that institutions establish a series of circuits along which policy travels, and that even after radical change, health systems retain many of their pre-existing features because 'a significant amount of the circuitry remains hardwired into them' (2005:39). Readers will find little discussion, however, of the issues raised by institutionalism and path dependence theory. New modes of governance, including managerial and market methods and network governance are examined in Chapter three. It is argued that government has moved from relatively direct, command mode intervention in policy to a more arm's length approach. Chapter four deals with power and influence in policymaking and the roles of actors in networks. Network theories and methods are used to provide 'new insights into which individuals and groups have different types of influence in health policy and how influence is structured through connections' (2005:71). The expertise and authority of the professions is explored in chapter five. There are useful discussions of the conditions giving rise to professional authority and autonomy but the conclusions are probably not generalisable outside the health professions. Health policy discourses are examined in Chapter six, where the concept of 'ideation', discussed further below, is introduced.
The opening chapters are followed by studies which examine selected aspects of selected health systems. The first explores government-profession relations, on the premise that health governance involves coordination, cooperation and joint action. Studies of the medical and nursing professions in Australia, the UK and the Netherlands show a strong relationship between medicine and the state. In Australia and the UK, nursing occupies an inferior, 'culturally gendered' position in the hierarchy, whereas it has a place at the policy table in the Netherlands.
Managed networks in action are the focus of second study. The main premises are that hierarchical approaches to governance have given way to networks and partnerships; and that these newer forms, based on trust, empathy and reciprocity, offer a better way of managing complex policy problems. Local partnerships in the UK are examined, along with Primary Care Partnerships, which were introduced in Victoria, Australia, in 2001. The findings support the claims of the literature that there has been a shift away from both government direction and market mechanisms towards partnerships. …