key: cord-1011553-pogd199p
authors: Stabile, Bonnie
title: The Persisting Importance of Rhetoric and Equity in Health Policy and Outcomes
date: 2020-06-24
journal: World Med Health Policy
DOI: 10.1002/wmh3.344
sha: 8a4e63dffc69e1b7ccb11ec4661c4da9384ccc24
doc_id: 1011553
cord_uid: pogd199p

This editorial considers the persisting importance of rhetoric and equity in health policy analysis, implementation, and outcomes. It argues that employing social determinants of health, and intersectional and rhetorical frames, can improve life and health outcomes, as measured by morbidity and mortality. The pertinence of these frames with regard to the crises brought on by the COVID‐19 pandemic is discussed, and the plan for a special issue on disparties and COVID‐19 is announced.

As Italian Political Scientist Giandomenico Majone has noted, and we see playing out in the public response to the current pandemic, policy analysis, and the policy process it is meant to inform, have "less to do with proof and computation than with the process of argument" (Majone, 1989, p. 23) .

How such argument is articulated can importantly advance or stymie policy action, with tangible consequences for people's lives, as measured in the stark metrics of morbidity and mortality. And missteps or a failure to act in the current pandemic, as in other crises, disproportionately affect the already disadvantaged, exacerbating existing inequities (Van Dorn, Cooney, & Sabin, 2020) .

The insight of the social determinants of health (SDOH) framework, as advanced by Sir Michael Marmot, is that the conditions of daily life-"the conditions in which people are born, grow, live, work, and age; and inequities in power, money, and resources" are responsible for health inequities within and between countries (Marmot, 2017) .

Considering questions of justice, and applying an intersectional framework in the context of health policy, can lead to structural innovation and have transformative effects for advancing equity, and thereby improve health outcomes in the society (Hankivsky et al., 2014) . To that end, World Medical & Health Policy continuously strives to encourage the examination of issues with the assistance of relevant frameworks such as those that employ social determinants, and intersectional and rhetorical lenses.

World Medical & Health Policy Volume 12, Issue 3 is planned as a special issue devoted to understanding the differential impacts of COVID-19, consisting of both empirical and reflective articles considering the complex relationship between social determinants and health disparities in the context of the present-day pandemic.

In the current issue of World Medical & Health Policy Volume 12, Issue 2, Skinner, Strawhun, and Gomes help us to conceptualize rhetorical arguments in the media comparing Canadian and American health-care models over the last decade. Identifying five main rhetorical frames, the authors find a "policy environment in which nuance and imperfection cannot be acknowledged, which forestalls problem solving." This article carries forward the important work featured in World Medical & Health Policy Volume 11, Issue 4 in December 2019, which focused on the Rhetoric of Medical and Health Policy (Lawrence & Stabile, 2019) .

In her study on social class and obesity in the current issue, Buder notes that "obesity has a direct impact on occupational prestige for women, thus adding to the burden of obesity" in a study that "helps solidify the notion that obesity-related discrimination is most pronounced in females." While maternal and reproductive issues remain preeminent when topics of women's health are raised, World Medical & Health Policy's virtual issue on Women's Health in Global Perspective also considers topics that transcend those confines, such as gender as a cross-cutting issue in food security in Ethiopia (O'Brien et al., 2016) , and refugee women's health in Syria (Samari, 2017) . Here, too, Buder's investigation highlights an issue of inequity that can have far-reaching consequences for women's health, well-being, economic viability, and political power in a way that is not exclusively tied to their reproductive role.

Using a content analysis approach, Sajadi, Kashi, and Majdzadeh examine Iran's General Health Policies (GHPs) and find that equity emerges as a critical principle among core goals of "improving health outcomes, equity, quality, efficiency and effectiveness" and "offer a country-specific map to accelerate progress toward sustainable development" goals.

Schintler and McNeely also underscore the importance of equity to a "culture of health," which, they say, calls for "transforming dominant and encompassing patterns of stratification and mobility that generate and reflect societal disparities; it calls for the disruption of institutionalized societal patterns of haves and have-nots; it calls for a rewriting of the social contract and realizing ideals of equity and wellbeing in practice and application."

In their consideration of the use of choice-based reminder cues in an mHealth study to improve tuberculosis (TB) treatment adherence among the urban poor in India, Das Gupta et al. implicitly address the role of what Schintler and McNeely call these "institutionalized societal patterns of haves and have nots" by investigating "social stigma and lack of social support; … socioeconomics (the inability to travel to a health center due to travel time and cost and the opportunity cost of missing work) and … treatment and health-systems experiences." Such factors, we know from social determinants of health and intersectionality policy frames, can often lead to inequities in outcomes, as evidenced by a heavier burden of morbidity and mortality, among impoverished or otherwise marginalized populations across an array of health areas globally. 

An Intersectionality-based Policy Analysis Framework: Critical Reflections on a Methodology for Advancing Equity

Collaborative Paths and Contexts: An Introduction to the Special Issue on Rhetoric of Medical and Health Policy

Evidence, Argument and Persuasion in the Policy Process

The Health Gap: The Challenge of an Unequal World

Gender as a Cross-Cutting Issue in Food Security: The NuME Project and Quality Protein Maize in Ethiopia

Syrian Refugee Women's Health in Lebanon, Turkey, and Jordan and Recommendations for Improved Practice

Illness as Metaphor and AIDS and Its Metaphors

COVID-19 Exacerbating Inequalities in the US

Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing

Military Metaphors Distort the Reality of COVID-19