Self-inflicted. Deliberate. Death-intentioned. A critical policy analysis of UK suicide prevention policies 2009-2019

Purpose With encouragement from the World Health Organisation, national suicide prevention policies have come to be regarded as an essential component of the global effort to reduce suicide. However, despite their global significance, the construction, conceptualisation and proposed provisions offered in suicide prevention policies have, to date, been under researched; this study aims to address this gap. Design/methodology/approach we critically analysed eight contemporary UK suicide prevention policy documents in use in all four nations of the UK between 2009 and 2019, using Bacchi and Goodwin’s post-structural critical policy analysis. Findings The authors argue that across this sample of suicide prevention policies, suicide is constructed as self-inflicted, deliberate and death-intentioned. Consequently, these supposedly neutral definitions of suicide have some significant and problematic effects, often individualising, pathologising and depoliticising suicide in ways that dislocate suicides from the emotional worlds in which they occur. Accordingly, although suicide prevention policies have the potential to think beyond the boundaries of clinical practice, and consider suicide prevention more holistically, the policies in this sample take a relatively narrow focus, often reducing suicide to a single momentary act and centring death prevention at the expense of considering ways to make individual lives more liveable. Originality/value UK suicide prevention policies have not been subject to critical analysis; to the best of the authors’ knowledge, this study represents the first attempt to examine the way in which suicide is constructed in UK suicide prevention policy documents.

Why Personal Dreams Matter: How professionals affectively engage with the promises surrounding data-driven healthcare in Europe

Recent buzzes around big data, data science and artificial intelligence portray a data-driven future for healthcare. As a response, Europe's key players have stimulated the use of big data technologies to make healthcare more efficient and effective. Critical Data Studies and Science and Technology Studies have developed many concepts to reflect on such overly positive narratives and conduct critical policy evaluations. In this study, we argue that there is also much to be learned from studying how professionals in the healthcare field affectively engage with this strong European narrative in concrete big data projects. We followed twelve hospital-based big data pilots in eight European countries and interviewed 145 professionals (including legal, governance and ethical experts, healthcare staff and data scientists) between 2018 and 2020. In this study, we introduce the metaphor of dreams to describe how professionals link the big data promises to their own frustrations, ideas, values and experiences with healthcare. Our research answers the question: how do professionals in concrete data-driven initiatives affectively engage with European Union's data hopes in their ‘dreams’ – and with what consequences? We describe the dreams of being seen, of timeliness, of connectedness and of being in control. Each of these dreams emphasizes certain aspects of the grand narrative of big data in Europe, makes particular assumptions and has different consequences. We argue that including attention to these dreams in our work could help shine an additional critical light on the big data developments and stimulate the development of responsible data-driven healthcare.

Straight to the (Revenue) Source: Contextual and Individual-Level Determinants of Attitudes Toward Local Taxes

In this article, we investigate the relative roles of local tax policies and respondent attitudes and characteristics in shaping support for local taxes. Using a unique set of survey data collected across dozens of cities over several years, combined with contextual data on local tax systems, we can offer a comprehensive picture of who supports, and who opposes local taxes. The contributions of our approach are three-fold: We use measures of satisfaction with local taxes, using data gathered across dozens of localities; we incorporate measures of the local tax systems to help account for city-to-city variation in local tax attitudes; and we incorporate measures of racial attitudes to account for an important non-material element heretofore not incorporated in studies of local tax attitudes. Integrating these factors into an explanation of local tax policies rounds out and offers a more realistic understanding of attitudes in this critical policy area.

Health Inequity and Institutional Ethnography: Mapping the Problem of Policy Change

Health equity (HE) is a central concern across multiple disciplines and sectors, including nursing. However, the proliferation of the term has not resulted in corresponding policymaking that leads to a clear reduction of health inequities. The goal of this paper is to use institutional ethnographic methods to map the social organization of HE policy discourses in Canada, a process that serves to reproduce existing relations of power that stymie substantive change in policy aimed at reducing health inequity. In nursing, institutional ethnography (IE) is described as a method of inquiry for taking sides in order to expose socially organized practices of power. Starting from the standpoints of HE policy advocates we explain the methods of IE, focusing on a stepwise description of theoretical and practical applications in the area of policymaking. Results are discussed in the context of three thematic areas: 1) bounding HE talk within biomedical imperialism, 2) situating racialization and marginalization as a subaltern space in HE discourses, and 3) activating HE texts as ruling relations. We conclude with key points about our insights into the methodological and theoretical potential of critical policy research using IE to analyze the social organization of power in HE policy narratives. This paper contributes to critical nursing discourse in the area of HE, demonstrating how IE can be applied to disrupt socially organized neoliberal and colonialist narratives that recycle and redeploy oppressive policymaking practices within and beyond nursing.

THE TEMPORALITIES OF POLICY TRANSLATION IN THE SEMI-PERIPHERY: REVISITING THE EUROPEANISATION OF WELFARE REFORMS IN CENTRAL AND SOUTH EAST EUROPE

This article seeks to conceptualise time and temporality in the context of semi-peripheral social relations, with a particular focus on the transnational dimensions of policy translation. In particular, we show how, albeit within the co-existence of multiple temporalities, ‘policy time’ and ‘time in policy’ tends to enable and privilege particular kinds of policy processes over others. Revisiting a number of themes from our ethnographic work on social policy reform drawn, mainly, from the post-Yugoslav and Hungarian context and relating, mainly, to so-called ‘Europeanisation’ processes, allows us to foreground the spatio-temporal dimensions of policy processes. The text explores some key challenges in terms of how to treat time within critical policy studies.