Decentring health systems: Narratives, agency and resistance in critical public health
Keywords:
Public health, Health systems, decentred theory, narratives, resistanceAbstract
The concept of ‘health systems’ is pervasive in contemporary public health policy and scholarship. Health systems are invoked as objects that can be strengthened, made resilient or reformed through better design, improved governance arrangements or more rational use of evidence. Yet, as much work in critical public health has shown, health systems are not neutral, coherent or stable entities. They are made and remade through the actions of situated actors, drawing on particular historical trajectories, ideas and interests, and they routinely reproduce social and health inequalities. This Special Issue of Journal of Critical Public Health brings interpretive and decentred approaches on public governance to bear on a set of empirical cases that span European economic governance, European Union (EU) meta-regulation, multistakeholder food policy partnerships, housing policy, place-based public health, integrated care reforms and healthcare within prisons. Collectively, the papers ask: what happens when we stop treating health systems as unitary structures or technocratic projects and instead treat them as contingent, contested practices? In doing so, they invite us to rethink how we conceptualise ‘systems’, and what it might mean to pursue more just and inclusive forms of public health.
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