http://ijhpm.com Int J Health Policy Manag 2017, 6(3), 135–145 doi 10.15171/ijhpm.2016.104 http://ijhpm.com Original Article doi 10.15171/ijhpm.2015.188 Int J Health Policy Manag 2016, 5(2), 117–119 doi 10.15171/ijhpm.2015.188 The Importance of Community ConsultationsCommentary for Generating Evidence for Health Reform in Ukraine Politics and Power in Global Health: The Constituting Role Olena Hankivsky1,2,3*, Anna Vorobyova3, Anastasiya Salnykova3, Setareh Rouhani4 of Conflicts Abstract Comment on “Navigating Between Stealth Advocacy and Unconscious Dogmatism: TheArticle History: Background: The paper presents the results of community consultations about the health needs and healthcare Challenge of Researching the Norms, Politics and Power of Global Health” Received: 7 September 2015 experiences of the population of Ukraine. The objective of community consultations is to engage a community in Accepted: 1 August 2016 which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or Clemet Askheim, Kristin Heggen, Eivind Engebretsen* ePublished: 17 August 2016 informationClemet from Askheim,participants Kristin directly Heggen, affected by Eivind the study Engebretsen subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system Abstract Article History: changes butIn alsoa recent social article, determinants Gorik Ooms of health has drawn (SDH). attention to the normative underpinnings of the politics of Received: 5 September 2015 Methods: globalThe data health. collection We claim consisted that Ooms of isthe indirectly 21 community submitting consultations to a liberal conceptionconducted of in politics 2012 inby elevenframing regions Accepted:of 13 October 2015 Ukraine inthe a mixpolitics of urban of global and healthrural settings.as a question The qualitativeof individual data morality. was coded Drawing in MAXQDA on the theoretical 11 software works and of thematicePublished: 15 October 2015 analysis wasChantal used Mouffe,as a method we introduce of summarizing a conflictual and concept interpreting of the political the results. as an alternative to Ooms’ conception. Results: TheUsing key controversies findings of surroundingthis study point medical out treatment the importance of AIDS of patients the SDH in developing in the lives countries of Ukrainians as a case and we how the residents ofunderline Ukraine the perceive opportunity that health for political inequities changes, and throughpremature political mortality articulation are shaped of an by issue, the circumstancesand collective of their daily lives,mobilization such as: political based on and such economic an articulation. instability, environmental pollution, low wages, poor diet, insufficient View Video Summary physical activity,Keywords: and unsatisfactoryGlobal Health, stateLiberal of publicPolitics, services. Chantal Study Mouffe, participants Conflict, repeatedlyAIDS, Antiretroviral discussed these(ARV) conditions as the reasonsTreatment for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed Copyright: © 2016 by Kerman University of Medical Sciences as well; highCopyright: out-of-pocket © 2016 (OOP) by Kerman payments University and oflack Medical of trust Sciences in doctors appeared as significant barriers in accessing Citation: Askheim C, Heggen K, Engebretsen E. Politics and power in global health: the constituting role of healthcare Citation:services. AskheimAdditionally, C, Heggen the consultations K, Engebretsen highlighted E. Politics andthe economicpower in global and healthhealth: gaps the constituting between residents role of of rural conflicts: Comment on “Navigating between stealth advocacy and unconscious dogmatism: the challenge and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. *Correspondence to: of researching the norms, politics and power of global health.” Int J Health Policy Manag. 2016;5(2):117– Conclusion: The study concludes that any meaningful reforms of the health sector in Ukraine must include a broadEivind Engebretsen 119. doi:10.15171/ijhpm.2015.188 range of factors, including the healthcare system but importantly, must extend to SDH approach and include theEmail: [email protected] prioritization of health promotion, limiting alcohol and tobacco availability and enforcing environmental protection. Keywords: Ukraine, Health Crisis, Community Consultations, Public Perceptions, Citizen Engagement, Civil Participatoryn Approach,a recent contributionSocial Determinants to the ongoing of Health debate (SDH), about Health the Reformtake the political as the primary level and the normative as Copyright: ©role 2017 of The power Author(s); in global Published health, by GorikKerman Ooms University emphasizes of Medical Sciences.secondary, This isor an derived open-access from article the political? distributed underthe normative the terms underpinningsof the Creative Commonsof global Attributionhealth politics. License (http://creativecommons.org/licenses/That is what we will try to do here, by introducing an IHe identifies three related problems: (1) a lack of agreement alternative conceptualization of the political and hence free by/4.0), whichIHe identifies permits unrestrictedthree related use, problems: distribution, (1) anda lack reproduction of agreement in any medium,alternative provided conceptualization the original work of is the political and hence free properly amongcited. global health scholars about their normative premises, us from the “false dilemma” Ooms also wants to escape. Citation:(2) Hankivsky a lack O,of Vorobyovaagreement A, between Salnykova global A, Rouhani health S. Thescholars importance and of community“Although consultations constructivists for generating have emphasized *Correspondence how underlying to: evidence policy-makersfor health reform regarding in Ukraine. the Int Jnormative Health Policy premises Manag. 2017;6(3):135–145. underlying doi:normative10.15171/ijhpm.2016.104 structures constitute actors’Olena Hankivskyidentities and Email: [email protected] policy, and (3) a lack of willingness among scholars to interests, they have rarely treated these normative structures clearly state their normative premises and assumptions. This themselves as defined and infused by power, or emphasized Key Messagesconfusion is for Ooms one of the explanations “why global how constitutive effects also are expressions of power.”2 This health’s policy-makers are not implementing the knowledge is the starting point for the political theorist Chantal Mouffe, Implicationsgenerated for policy by makersglobal health’s empirical scholars.” He calls and her response is to develop an ontological conception of • Communityfor greater consultations unity between conducted scholars in Ukraine and in between 2012 revealed scholars public’s awarenessthe political, of how wherewider social “the determinantspolitical belongs – beyond to our the ontologicalhealthcare systemand – policy-makers,shape the quality concerningof their health. the underlying normative condition.”3 According to Mouffe, society is instituted • Citizenspremises are eager and togreater provide openness their input when into governmentit comes to decisions advocacy. that1 affectthrough their health; conflict. it is recommended “[B]y ‘the political’ that policy-makers I mean the dimensionconsult with of the broader public on how their health and healthcare experiences could be improved. We commend the effort to reinstate power and politics in antagonism which I take to be constitutive of human societies, • This study brings to attention of policy-makers the importance of various research methods and different forms of evidence; it specifically global health and agree that “a purely empirical evidence-based while by ‘politics’ I mean the set of practices and institutions underscoresapproach the is importancea fiction,” and of community that such consultations.a view risks covering up through which an order is created, organizing human • It canapproach also aid is policy-makers a fiction,” and and that healthcare such a viewprofessionals risks covering to identify up importantthrough areas whichof perceived an orderhealthcare is needscreated, for developingorganizing effective human “the role of politics and power.” But by contrasting this fiction coexistence in the context of conflictuality provided by the programs“the role and of policies. politics and power.” But by contrasting this fiction coexistence in the context of conflictuality provided by the 3 • Thewith health global crisis healthin Ukraine research cannot “driven be solved by bycrises, means hot of reformingissues, and only thepolitical.” delivery of An healthcare issue or services. a topic needs to be contested to become • In additionthe concerns to modernizing of organized the deliveryinterest ofgroups,” health services,as a “path the we reform are of thepolitical, health sector and suchin Ukraine a contestation should include concerns actions public in the action areas andof healthytrying living to movepromotion, away alcohol from,” and Ooms tobacco is submitting control, and to environmental a liberal protection.creates a ‘we’ and ‘they’ form of collective identification. But conception of politics