Doctoral Dissertation Research: Medicine and Inequality in the Welfare State: AIDS Policy-Making in the United States and the United Kingdom

Regents Of The University Of Michigan - Ann Arbor, Ann Arbor MI

Investigators

Abstract

This dissertation aims to answer two central research questions: (1) Why was the U.S., as the first nation to encounter HIV/AIDS, still establishing the first elements of its national response at a time when the U.K. had already embarked on a centralized and coordinated strategy to combat the epidemic? (2) Has this dissimilar policy trajectory continued over the past twenty years, or has there been significant convergence? I suggest that in order to answer these questions we must move beyond the concerns that have thus far dominated the AIDS policy literature - cultural biases against the social groups most affected by AIDS and the ascendance of neoconservative economic philosophies - to consider the formative role of political institutions. Specifically, my dissertation compares the AIDS policy-making trajectories of the U.S. and the U.K. to assess the hypothesis that differences in national responses to AIDS can be explained, in part, by cross-national variation in the institutions of the health system. This research draws on a range of archived materials and original interviews. Starting from a survey of AIDS-related policy proposals from each nation, I will analyze minutes and testimony from involved committees and subcommittees, speeches and debates from the floors of Congress and Parliament, and reports generated in connection with these policy proposals by executive agencies. My interviews with key legislators, staffers, and agency leaders will address issues such as choices made during the policy design phase, the selection of experts to testify at hearings, and the success or failure of various strategies. To understand the agenda-setting stages of the policy-making process, I will also collect key informant interviews, reports, and publications from policy advocacy organizations in each nation. This project will contribute to our understanding of the factors that determine health policy trajectories at the national level, by considering the role of institutional precursors in the health system alongside more commonly addressed cultural and political determinants of health policy, and by weighing the importance of these factors in various national and historical contexts. Because the project compares two similar welfare states with dramatically different health systems, it will also illuminate the relationship between events in health policy and more general trends in social provision. As such, it deepens our understanding of welfare states by questioning the sociological assumption that overarching welfare state regimes determine choices within specific areas of social policy. This research will have the following broader impacts: By enhancing our understanding of the factors that have contributed to the success or failure of recent strategies, it will provide valuable information to researchers and policymakers about the effectiveness of future political efforts to promote specific health policies and about the ways in which differently structured health institutions are able to respond to a health crisis, information that can be factored into future choices about the formation of these institutions.