尽管公共卫生学者越来越认识到健康的社会决定因素(SDOH)的重要性,卫生政策产出倾向于强调下游生活方式因素。我们使用自动语料库研究方法来分析荷兰众议院卫生委员会十四年的卫生政策辩论,测试SDOH缺乏关注的三个潜在原因:政治意识形态,来自某些政治取向的国会议员(MP)可以优先考虑生活方式因素而不是SDOH;生活方式的漂移,随着解决SDOH的挑战变得清晰,在问题分析期间对SDOH的早期关注被解决方案开发中的生活方式重点所取代;以及重点活动,政治或社会偶然事件,同时为公众和政治精英所知,支持健康的生活方式观点。我们的分析表明,总体而言,委员会大部分时间都没有讨论SDOH和生活方式:医疗融资和服务提供占主导地位。当提到SDOH或生活方式时,左倾议员更多地提到SDOH,右倾议员更多地提到生活方式。与选举周期相关的时间效应产生了不一致的证据。最后,对生活方式和SDOH的最高关注与正在进行的政治辩论相吻合,而不是外在的,不可预见的聚焦事件,由于对医疗保健的更大和更一致的关注,这些峰值变得相对微不足道。本文为大规模自动分析政策辩论提供了第一步,为健康政治话语的实证研究开辟了新的途径。
Although public health scholars increasingly recognize the importance of the social determinants of health (SDOH), health policy outputs tend to emphasize downstream lifestyle factors instead. We use an automated corpus research approach to analyse fourteen years of health policy debate in the Dutch House of Representatives\' Health Committee, testing three potential causes of the lack of attention for SDOH: political ideology, by which members of parliament (MPs) from some political orientations may prioritize lifestyle factors over SDOH; lifestyle drift, by which early attention for SDOH during problem analysis is replaced by a lifestyle focus in the development of solutions as the challenges in addressing SDOH become clear; and focusing events, by which political or societal chance events, known to the public and political elites simultaneously, bolster the lifestyle perspective on health. Our analysis shows that overall, the committee spent most of its time discussing neither SDOH nor lifestyle: healthcare financing and service delivery dominated instead. When SDOH or lifestyle were referenced, left-leaning MPs referred significantly more to SDOH and right-leaning MPs significantly more to lifestyle. Temporal effects related to election cycles yielded inconsistent evidence. Finally, peak attention for both lifestyle and SDOH coincided with ongoing political debate instead of exogenous, unforeseen focusing events, and these peaks were rendered relatively insignificant by the larger and more consistent attention for health care. This paper provides a first step toward automated analysis of policy debates at scale, opening up new avenues for the empirical study of health political discourse.