From the Standpoint of Policymakers: An Institutional Ethnography Inquiry into the Policymaking Process to Address Health Equity and Social Determinants of Health in Canada
Bibliographic record
Abstract
The health of a societys population is determined by the way that society distributes its social and economic resources. This is because a high level of inequality and a wide gap in the socio-economic gradient corresponds with peoples experience of poor health. Despite available evidence of increasing socio-economic and health inequities in Canada, health equity (HE) considerations are not filtering through public policies, which may explain the skewing in the distribution of social determinants of health (SDH). Various governmental and non-state actors recognize these increasing social inequalities and have considered pursuing equity in public policies. Evidence shows that Canadian governments do not generally deliver on their pledges to implement HE-promoting policies. Inquiries about the incongruity between the stated institutional goal of pursuing HE in public policies and the persistent lack of it have pervaded public policy discourses. \nThis study attempts to fill the knowledge gap in the public policy arena between the pluralist and institutionalist explanations of inequities to improve our understanding of how and why HE/SDH concepts are not filtering through into health policies. My original contribution to knowledge is an account of how policymakers work processes are drawn into and coordinated by a set of institutional relations of ruling. These institutional relations organize sequences of inter-related policymaking activities that link these activities to the work of others in producing or not producing policies with health equity outcomes. Using Institutional Ethnography as a method of inquiry, the study aims to highlight intrinsic institutional conceptual practices and explicate how work constituting policymaking is performed, influenced, and perceived in multiple institutional sites. Using mapping as an IE device, I map out institutional texts to illuminate the relations of ruling and social organization of policymaking as work. This study concludes that epistemologies rooted in hegemonic biomedical and neoliberal conceptual practices within the selected institutions dominate the ruling relations and the social organization of policymaking as work in these sites; and that, the gap between HE concepts and the governments obligation to equity-driven health policy for actions on SDH demonstrates a lack of commitment to act in an increasingly market-oriented and politicized policymaking environment.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.044 | 0.030 |
| Scholarly communication | 0.014 | 0.005 |
| Open science | 0.004 | 0.009 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".