Showcasing the contribution of social sciences to health policy and systems research (2022)

This Special Issue represents a critical response to the frequent silencing of qualitative social science research approaches in mainstream public health journals, particularly in those that inform the field of health policy and systems research (HPSR), and the study of equity in health [1,2,3]. The issue is presented by SHAPES, a thematic working group of Health Systems Global (a membership-based society which aims to convene researchers, policymakers and implementers to develop the field ofHSPR) focused on social science approaches.

By bringing together this collection of articles, the special issue highlights the critical contribution of qualitative social sciences including interpretivist, critical, emancipatory, and other relational methods to our understanding ofhealth systems, policies and interventions. Today, political, professional and disciplinary structures continue to privilege positivist research and quantitative methods, attributing greater evidential value to the knowledge produced by these approaches. This issue builds on growing recognition of the complex social nature of health systems [4] and on the understanding that utilizing only positivist research approaches in the study of health and health systems contributes to stripping away human experience and context. Articles in this issue demonstrate the importance of employing qualitative social science methods to explore the perspectives, experiences, relationships and decision-making processes of human actors within health systems, and in so doing, help uncover and explain the impact of vital but difficult-to-measure issues such as power, culture and norms. Through their application of qualitative methods and, in some cases, development of theory, they help build a broader and deeper understanding of the way various health systems function, and simultaneously inform a more people-centred approach to collective efforts to build and strengthen those systems.

Linked by two important themes, this initial collection of six research papers and two commentaries cut across a range of social science approaches and include policy analysis, rapid ethnography, and theory driven sociological enquiry. Future papers will be added to an online thematic collection on a rolling basis.

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Global policies, local realities

The ways in which global health policies are absorbed into national and subnational health systems, and their impact as they interact with local realities is a strong theme running throughthe issue.

Contractor, et al. [5] use rapid ethnography to explore the dissonance between tribal women’s perception of pregnancy and childbirth, and the Indian health system’s approach to maternity care in the context of a national policy that strongly incentivises facility-based birth. Drawing on five months of data collection in Odisha state, this exploratory study used qualitative methods to document how different actors perceived and experienced the policy. Unstructured group discussions explored community perceptions around pregnancy and childbirth; in-depth interviews explored women’s actual experiences and practices of pregnancy and childbirth; key informant interviews with service provides yielded contextual information about the field area and views from within the health system; and observations enabled triangulation and produced first-hand information about the location and conditions of health services and tribal areas. The authors highlight the tensions between priorities embedded within national-level policies and tribal women’s own preferences and needs when it comes to childbirth. Their narratives demonstrate how multiple financial, geographic, social and cultural factors mitigate against uptake of facility-based maternity services, and result in pressure, sometimes coercion, by local health system actors, to comply. The article demonstrates the importance of qualitative methods and grounded analysis for surfacing the unintended consequences of blanket state policies through documentation of its impacts onso-called beneficiaries.

Also focussing on India, Sriram, et al. [6] present a nuanced, contextually rich analysis, reflecting on the way that actors from high-income countries and members of the extended Indian diaspora contribute to socialisation and legitimation of a new medical speciality (emergency medicine). The research draws on a full year of qualitative data collection conducted by the first author including interviews with 76 participants across 11 towns/cities within India, review of 248 documents and observation of 6 meetings. The authors use framework analysis, applying concepts from the literature to insights emerging from the reading of the data, and brought both emic (subject; the first author is a member of the diaspora) and etic (observer) perspectives in making sense of the data. They point to the way power within these networks resulted in the rapid growth of the speciality of emergency medicine, but also influenced its evolution as a highly medicalised, tertiary-level form of care, inaccessible to the majority of Indians for structural reasons including affordability and availability. The authors note that the socialisation of domestic Indian stakeholders in this field ‘flows from a long history of LMIC (low- and middle-income country) stakeholders adopting ideas from high-income countries, driven by undercurrents of globalization and innovations in communication and technology’. Through the personal accounts of stakeholders with a range of perceptions and experiences in relation to the growth of emergency medicine, the authors interrogate and debunk the positive narrative of knowledge flow from high-income countries to LMICs. The qualitativeanalysis presented instead paints a complex picture, in which power influences knowledge transfer, the outcome of which is not always experienced as beneficial or positive.

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Lodenstein, et al. [7] describe the contradictory role played by traditional leaders in Malawi in the pursuit of improved reproductive health outcomes. They bring attention to the power of traditional leaders, who are regarded as key to facilitating community adoption of positive public health norms including earlier and more frequent attendance at clinic-based antenatal visits. In recent times, the adoption of public health norms in Malawi has been driven by by-laws, set by traditional leaders and with often punitive consequences for those who do not comply; for example imposing fines on women who do not attend antenatal care or whoare not accompanied by their husbands on those visits. While some have heralded the success of suchby-laws, the authorsuse qualitative methods and a gendered perspective to explore these as a social process of norm formulation from the perspective of stakeholders involved in by-lawcreation, as well as the perspective ofthose affected by them. Recognising that norms are expressed in multiple ways (rules, behaviours, narratives and mechanisms of enforcement), the authors collected data fromvarious sources (documents, observations, and interviews), so as to explore this range of expression. They show that although by-laws were meant to strengthen service uptake and improve health outcomes for pregnant women, they alsoresulted in the most vulnerable women bearing the moral and material responsibility for any perceived failure to meet reproductive health policy and targets. This study, which is grounded in rich contextual experience, provides important information to national and global health systems decision makers who may be considering using traditional lines of authority to enhance uptake of public health interventions.

Resources and mechanisms of redress

While the above papers describe, and to differing extents deconstruct, the ways in which health systems interact with and exacerbate broader social and structural inequities, a second harmonizing theme in this collection is the way different resources and mechanisms can be mobilised as a form of redress to suchinequities.

Spanning both themes showcased in this issue, Turcotte-Tremblay, et al. [8] describe the local effects of a globally touted performance-based financing (PBF) policy in Burkina Faso. The authorsexamine the equity measures (such as user fee exemptions available to those holding an indigent card) withinPBF, which were introduced to address inequitableaccess. The study is framed using Rogers’ diffusion of innovations theory. In a comparative case study design across four primary health services, the authors utilise empirical methods, including 93 interviews, discussions, observation and document analysis. Using primary data the authors are able explore the way multiple local actors, including members of local indigent selection committees, re-invented elements of the PBF equity measures over which they had control, to either increase their relative advantage or to adapt to implementation challenges and context. For example, distributing free or very low-cost medications led to financial difficulties and drug shortages at some clinicsand compensatory actions intended to resolve these problems by the ‘street level bureaucrats’ running front-line services led to adverse knock-on impacts for clients. Ultimately, the authors demonstrate how local knowledge of what it means to be indigent, and the power dynamics inherent within the health services, interacted with PBF implementation to result in both ‘uncertain and unequal’ coverage of the policy.

(Video) Supporting the next generation of health policy and systems researchers

Topp, et al. [9] report onan empirical study of a policy-driven effort to improve the social accountability of prison health services in Zambia through the establishment of prison health committees. Locating their work in the discipline of public policy, the authors use a combination of interviews, focus groups and ethnographic observation, and begin by exploring Joshi’s three domains of impact for social accountability interventions: state responsiveness (represented by facility-based prison officials), societal impact (represented in this study by inmates), and state-society relations. (represented by relations between inmates and prison officials). Their analysis reflects on the ways in which power relations became less hierarchical, and how health outcomes improved in one particular prison after the introduction of a staff-inmate committee. A second phase of analysis draws on a more theoretical and (hence) more widely generalisable model comprising three intersecting ‘axes’ of accountability: power, ability and justice [10], using these axes to examine the depth and breadth of committee impact. The authors conclude that in relation to prison health care, local context as well as national level politics and legislative reforms, “will be crucial to support democratic decision-making, authentic engagement and appropriate action” in prison health services in low-income settings.

Kapilashrami and Marsden [11] report a study of access to health-enabling resources by multiply-disadvantaged groups in a deprived part of Scotland. Drawing on human geography and political science, their research uses the theoretical concept of intersectionality – that is, “the multiple interacting influences of social location, identity and historical oppression” – and a combination of standard qualitative tools (interviews, focus groups) and more contemporary and participatory methods (notably collaborative health resource mapping). The authors find that health-enabling resources were variously material, environmental, cultural or affective, with thecombined influence of these resources playing out differently fordifferent individuals. Amartya Sen observed in his health capabilities framework, the need to consider both individual choices and societal chances [12]. Through their use of multiple qualitative methods and the application of intersectionality, the authors demonstrate how individual responsibility, and blame, for health-related behaviour choices is an impoverished explanatory framework because it overlooks the institutional, structural and environmental influences on such behaviours.

While methodologically heterogenous, the articles in this issue showcase just some of the ways in which qualitativesocial science methods generate important new knowledge that is sensitive to context and which can act asa meansto ‘un-silencing’ voices on the margins. Greenhalgh [13] in her commentary highlights these points, discussing the important role of critical social science as an underutilised method of social critique and emancipation of oppressed groups. She notes that methods such as these ask, “whose definitions count?”; “who makes the rules?”; and “whose voice is not being heard?”

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In their commentary too, Lewin and Glenton [14]note that perhaps the key role of qualitative social sciences is to represent “the views and experiences of stakeholders, including vulnerable and marginalised groups who are often not represented directly.” And indeed, this collection represents a clear body of evidence that health policies and system levers require much work. Contractor, et al. [5], Kapilshrami, et al. [11] and Lodenstein, et al.’s [7] articles, in particular, demonstrate how qualitative social science research can surface issues experienced by, and present the voices of, people on the ground, helping to hold to account global and national health systems leaders responsible for health policy and planning. In orderto realise the full value of this type of evidence, however, Lewin and Glenton [14] also argue the need for more investment in our collective capacity to synthesise the knowledge generated, and to work more closely with policy users and other stakeholders to build their capacity for evidence use.

Articles in this issue demonstrate how qualitative social science methods may be used to engage and participate with actors to co-produce knowledge, evidence and even solutions for change [1]. At inception, the idea for this special issue also encompassed ambitious plans to model a participatory and empowering approach through mentorship of early career authors, as well as for those based in LMICs. These ideas align with the values of people-centredness and equity that underpin the broader mission of Health Systems Global. Many of the lead authors in this issue are early career researchers, although most are either based in, or receive substantial support from institutions in high-income settings. We therefore believe more personal and institutional investment in learning opportunities through webinars, online teaching, and one-to-one mentoring needs to be made available. This has been recently modelled through various initiatives undertaken by HSG members, affiliates, and thematic working groups. We also acknowledge the ongoing challenges experienced specifically by health system actors who work in, or alongside, services to find the time or receive the guidance necessary to write about what they do. Questions that arose in the process of collating this issue, and which require more, and deeper examination include: how should rich (practitioner) experiences be documented? Should such documentation be acknowledged as a form of research? And if so, where does it belong in a saturated, but often siloed, publication world?

Critically engaging with issues of inclusion, voice and power is vital to building equitable and people-centred health systems and must be at the heart of the research processes that support these systems. As showcased in this special issue, robust qualitativesocial science research is ideally suited to understanding the social systems that generate or limit opportunities for equity in health, and that must be engaged with and transformed to build truly people-centred health systems.

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How does social science contribute to public health? ›

The contributions of social science research to population health include (but are certainly not limited to): the health consequences of stigma, prejudice, and discrimination (1, 2); the impact of socioeconomic position (3), stress (4), social networks (5), social support (6), and place (7) in shaping health and health ...

What is the contribution of social science? ›

It attempts to explain how society works, exploring everything from the triggers of economic growth and causes of unemployment to what makes people happy. Social science is a relatively new field of scientific study that rose to prominence in the 20th century.

What is the contribution of social science in quantitative research? ›

Quantitative analysis is used in social sciences to determine the relationship between an independent variable (a type of quantity that captures observed values of things that can be manipulated) and a dependent variable (the observed results of manipulating the independent variable) in a given population.

What methods are commonly used in health policy research? ›

There are several ways to perform qualitative analysis of Health Care Institutions Policies and Practices (HCIPP), including ethnography, ethnomethodology, phenomenology, action research, grounded theory, critical discourse analysis, and evidence-based science, among others [2].

What is the importance of social science in our health and well being? ›

The Importance of Our Health and Well-Being

By interpreting medical statistics and evaluating health care policies, social scientists can help ensure that our health care systems work at an optimal level.

What are the contributions of science to health? ›

Scientific research has already helped to improve treatment for numerous illnesses and serious health conditions. Trials for medications and methods of treatment have improved the care of many patients and helped to make their recovery less distressing and painful.

How does social science contribute in improving our society? ›

Social science tells us about the world beyond our immediate experience, and can help explain how our own society works – from the causes of unemployment or what helps economic growth, to how and why people vote, or what makes people happy.

How can the social sciences contribute in solving these specific problems? ›

Social science provides empirical data about what the problems are and encourages people to propose possible solutions, and you try them, and some of them work.

What is the most important contribution of science? ›

Science generates solutions for everyday life and helps us to answer the great mysteries of the universe. In other words, science is one of the most important channels of knowledge.

How is quantitative research used in health and social care? ›

Quantitative research methods are frequently applied in health and social care research. They use objective measurements with statistical methods, mathematics, economic studies or computational modelling to enable a systematic, rigorous, empirical investigation.

How important quantitative research is in helping to address the social problems that we have in our society? ›

The strength of quantitative methods is that they can provide vital information about a society or community, through surveys, examinations, records or censuses, that no individual could obtain by observation.

How is social science used in research? ›

The scientific method, as applied to social sciences, includes a variety of research approaches, tools, and techniques, for collecting and analyzing qualitative or quantitative data. These methods include laboratory experiments, field surveys, case research, ethnographic research, action research, and so forth.

What is health systems and policy research? ›

Health Research Policy and Systems covers all aspects of the organisation and use of health research – including agenda setting, building health research capacity, and how research as a whole benefits decision makers, practitioners in health and related fields, and society at large.

What is the official role of the health policy systems research? ›

The field of health policy and systems research (HPSR) seeks to understand and improve how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes to contribute to policy outcomes.

Why is health policy research important? ›

Health Policy research aims to understand how policies, regulations, and practices may influence population health. Translating research into evidence-based policies is an important approach to improve population health and address health disparities.

What is the impact of the development of health and science on society? ›

Science creates a foundation upon which improvements in global health are built. It unlocks discoveries and fuels innovation, informs policies and programs, breaks down barriers, and ultimately advances better, healthier lives for all people.

Why is it important for the nursing students to study applied social science health and illness? ›

If they want to find ways to cater the needs of their patients, nursing students need to understand their experiences with health and illnesses, what's their basis of health, what is it like to live with similar disorder, and how society views of these people.

What is the most important contribution of health research? ›

It plays an important role in discovering new treatments, and making sure that we use existing treatments in the best possible ways. Research can find answers to things that are unknown, filling gaps in knowledge and changing the way that healthcare professionals work.

What is the most important contribution of science and technology with regards to health? ›

The growth in healthcare science and technology has made patient care far superior and more reliable in most cases by providing new machines (such as MRIs), medicines, and treatments that save lives and improve the chance of recovery for many.

What is the importance of science with respect to the advancement of technology research and health? ›

Scientific results are linked to the development of new products and new technologies, and contribute greatly to economic and medical progress, and to other real social and economic activities.

Why is it important for the social sciences to use scientific methods in research? ›

The scientific method provides a systematic, organized series of steps that help ensure objectivity and consistency in exploring a social problem. They provide the means for accuracy, reliability, and validity. In the end, the scientific method provides a shared basis for discussion and analysis (Merton 1963).

What is the main concern of the social science and how do the social sciences study society? ›

The social sciences are all about how society works. Social scientists examine institutions like the government, the economy, and family; they also study how individuals and groups interact with one another and what drives human behavior.

What are some applied social sciences processes that have great impacts What are these impacts? ›

The effects of the applied social sciences vary and they include increased awareness and knowledge of oneself and others, attitude and value change, behavioural changes, and structural changes.

What are the two main contributions of science? ›

Science and technology has two functions: crea- ting new knowledge such as elucidating unknown phenomena that surround us and discovering new laws and principles; and using the knowledge gai- ned in the real world.

What is the most impactful effect of science and technology to human life essay? ›

The discovery of new planets and the establishment of satellites in space is because of the very same science and technology. Similarly, science and technology have also made an impact on the medical and agricultural fields. The various cures being discovered for diseases have saved millions of lives through science.

What is research methods in health and social care? ›

Research methods are the strategies, processes or techniques utilised in the collection of data or evidence for analysis in order to uncover new information or create better understanding of a topic.

How is qualitative research used in health and social care? ›

Qualitative research helps to understand the patterns of health behaviors, describe illness experiences, design health interventions, and develop healthcare theories. The ultimate strength of the qualitative research approach lies in the richness of the data and the descriptions and depth of exploration it makes.

Why is quantitative research important in health care? ›

Quantitative research usually aims to provide precise, unbiased estimates of parameters of interest for the entire population which requires a large, randomly selected sample.

How can research be useful or relevant to solve simple everyday problems? ›

Research empowers us with knowledge

We get to know the way of nature, and how our actions affect it. We gain a deeper understanding of people, and why they do the things they do. Best of all, we get to enrich our lives with the latest knowledge of health, nutrition, technology, and business, among others.

What type of research talks about the societal problems or issues finding ways to make positive changes in the society? ›

Social Research is conducted by following a systematic plan of action which includes qualitative and quantitative observation methods.

What is the most important method of social research? ›

Surveys and questionnaires

This method involves asking many people the same set of questions in order to determine the statistical proportions of the answers given by people within the testing group.

What are the goals and purposes of social sciences research? ›

The aim of social research, like research in natural sciences, is to discover new facts or verify and test old social facts. It tries to understand human behaviour and its interaction with the environment and social institutions.

What are the main objectives of social science research? ›

This article throws light on the five major objectives of social research, i.e,(1) Manipulation of Things, Concepts and Symbols, (2) Generalization, (3) Verification of Old Facts, (4) Extension of Knowledge, and (5) Knowledge May be Used for Theory Building or Practical Application.

What is the main focus of study of social science and why is it important? ›

Thus, social sciences help people understand how to interact with the social world—how to influence policy, develop networks, increase government accountability, and promote democracy. These challenges, for many people around the world, are immediate, and their resolution can make a vast difference in people's lives.

What is the main purpose of a health policy? ›

Goal: Use health policy to prevent disease and improve health. Health policy can have a major impact on health and well-being. Healthy People 2030 focuses on keeping people safe and healthy through laws and policies at the local, state, territorial, and federal level.

What are the 4 key purposes of research in health and social care? ›

provide life-changing treatments. prevent people from developing conditions. improve health and care for generations to come. ensure everyone has a better quality of life.

What are examples of policies in healthcare? ›

10 important healthcare policies for your facility
  • Patient care policies. ...
  • Workplace health and safety policies. ...
  • Information security policy. ...
  • Data privacy and IT security. ...
  • Drug handling. ...
  • Administrative and HR policies. ...
  • Social media policies. ...
  • BYOD policy.
22 Dec 2020

Why is research important in the health care industry provide an example? ›

Clinical research is what allows doctors to decide how to best treat patients. It is what makes the development of new medicines, new procedures and new tools possible. Without clinical research, we would not be able to decide if new treatments are better than our current treatments.

What is the role of research in policy making and development? ›

They can identify critical problems, research the benefits and harms of policy solutions, estimate the costs and consequences of policy proposals, and actively participate in the policy process to aid real-time decision making. The role of research in informing policy begins by defining the contours of a problem.

What is the purpose of a research policy? ›

To ensure high level of efficient and effective support system to facilitate faculty and researchers in their research activities. Ensure publications in quality journals, indexed in Scopus/Web of Science and/or with impact factor.

What is policy and policy relevant research? ›

Policy relevance refers to how effectively research findings inform decisions made by decision-makers. In other words, policy relevance is determined by how applicable and practical research findings are to decisions that need to be made on policy priorities.

Why is science important in public health? ›

Public Health Science deals with dangers to the public health of a population, whether small or large (i.e. populations of a continent) to improve the quality of health and the quality of life in through detecting and preventing disease and other physical and mental health conditions, promoting health behaviors, ...

Does public health come under social science? ›

Public health as an interdisciplinary subject encompasses a number of social science disciplines like sociology, anthropology, economics, geography, demography, politics, law, along with environmental health, occupational health, epidemiology, biostatistics, nutrition, health education and mental health etc.

Is public health part of social sciences? ›

clear and unequivocal: public health is an applied social science (1, 2).

How did science improve public health? ›

Science has also made it possible for us to protect ourselves against deadly diseases via vaccines. This is why federal organizations, like the CDC, and state laws promote the vaccination of the U.S. population.

What is the purpose of health and human sciences What is the purpose of health and human services? ›

The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.

What is the relationship between social science and public policy? ›

Social science and public policy have always been connected, to varying degrees of success. In an ideal world, understanding the mechanisms behind social processes — both good and bad — would directly inform the creation of policies that promote social benefits and reduce consequences.

What is social science in health? ›

Study the consequences of health and illness at the family, community, and societal levels. Study the social, cultural, and institutional factors influencing the nature and extent of consequences for individuals.

What do you think are some of the greatest contributions of the social sciences to society? ›

Social science helped people understand the consequences and application of the new technologies of the age, such as steam power. The growth of railways and factories not only transformed the economy and the world of work, but also changed forever the way people organised their family lives and leisure.

What does the science of public health and healthcare study? ›

“Public health and healthcare” is a medical science that studies the patterns of public health, an impact of social conditions and environmental factors on public health with the purpose of developing a strategy and tactics of health care and improving medical care for the population.

Which of the following disciplines contribute to health research? ›

Epidemiology plays an integral role in the application of medical research to populations, interacting with almost every other specialism. Epidemiology studies the incidence, causes, consequences and control of disease, as well as people, patients and populations.

What are the most important contributions to improving the health of the public that public health administration can make today? ›

The areas of public health responsibility include (1) assuring an adequate local public health infrastructure, (2) promoting healthy communities and healthy behaviors, (3) preventing the spread of communicable disease, (4) protecting against environmental health hazards, (5) preparing for and responding to emergencies, ...

What are three ways science improves health? ›

From using weather patterns to forecast the risk of insect-borne disease outbreaks, to employing genomics and evolutionary theory to predict how bacteria will become resistant to antibiotics, to advancing new hybrid systems that combine crowdsourced data with traditional disease surveillance, science is helping us ...

Why is science important in policy making? ›

Scientists produce evidence, which policy makers then use for decisions. In return, policy makers provide scientists with evidence requirements and resources for research. The approach has an intuitive, common sense logic. In practice, there are problems—evidence based policy does not always work.


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