Recognizing rhetoric in health care policy analysis

Area of Science:

• Health Policy
• Political Science
• Sociology

Background:

• Critiques of the 'naïve rationalist' model of policy-making are prevalent in social sciences.
• Health care policy debates remain dominated by evidence-based medicine (EBM) assumptions.
• EBM's assumptions constrain policy thinking by separating facts from values and viewing policy as decision science.

Purpose of the Study:

• To redefine health care policy-making beyond the rationalist model.
• To highlight the role of ideas, values, and rhetoric in policy.
• To propose a rhetorical perspective for analyzing policy construction.

Main Methods:

• Drawing on political science and philosophy theory.
• Utilizing innovative empirical work in the health care sector.
• Applying rhetorical theory to analyze policy discourse.

Main Results:

• Policy-making is fundamentally a struggle over ideas and values, enacted through language and social situations.
• Research evidence selection, evaluation, and implementation are part of, but not equivalent to, the policy process.
• A rhetorical perspective reveals the importance of 'naming and framing' problems, audience engagement, and persuasive language.

Conclusions:

• Health care policy-making requires a broader definition of rationality, including plausibility and audience persuasion.
• Future research should focus on the language, arguments, and discourse of policy construction.
• Moving beyond 'getting evidence into practice' is crucial for understanding policy enactment.