International Journal of Health Policy and Management

International Journal of Health Policy and Management

Towards an Explanation of the Social Value of Health Systems: An Interpretive Synthesis

Document Type : Review Article

Authors
Eleanor Beth Whyle
Jill Olivier
Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
10.34172/ijhpm.2020.159
Abstract
Background
Health systems are complex social systems, and values constitute a central dimension of their complexity. Values are commonly understood as key drivers of health system change, operating across all health systems components and functions. Moreover, health systems are understood to influence and generate social values, presenting an opportunity to harness health systems to build stronger, more cohesive societies. However, there is little investigation (theoretical, conceptual, or empirical) on social values in health policy and systems research (HPSR), particularly regarding the capacity of health systems to influence and generate social values. This study develops an explanatory theory for the ‘social value of health systems.’

 
Methods
We present the results of an interpretive synthesis of HPSR literature on social values, drawing on a qualitative systematic review, focusing on claims about the relationship between ‘health systems’ and ‘social values.’ We combined relational claims extracted from the literature under a common framework in order to generate new explanatory theory.

 
Results
We identify four mechanisms by which health systems are considered to contribute social value to society: Health systems can: (1) offer a unifying national ideal and build social cohesion, (2) influence and legitimise popular attitudes about rights and entitlements with regard to healthcare and inform citizen’s understanding of state responsibilities, (3) strengthen trust in the state and legitimise state authority, and (4) communicate the extent to which the state values various population groups.

 
Conclusion
We conclude that, using a systems-thinking and complex adaptive systems perspective, the above mechanisms can be explained as emergent properties of the dynamic network of values-based connections operating within health systems. We also demonstrate that this theory accounts for how HPSR authors write about the relationship between health systems and social values. Finally, we offer lessons for researchers and policy-makers seeking to bring about values-based change in health systems.

Highlights

 

Supplementary file 1. Data Extraction Sheet.

Supplementary file 2. Meta-Ethnography.

Supplementary file 3. Data Collection and Sampling for the Prior Mixed Methods Review.

 

Keywords
Social Values
Interpretive Synthesis
Health Systems
Complexity
Emergence

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International Journal of Health Policy and Management
Volume 10, Special Issue on Analysing the Politics of Health Policy Change in LMICs
The HPA Fellowship Programme 2017-2019
July 2021
Pages 414-429

  • Received Date 15 April 2020
  • Revised Date 12 August 2020
  • Accepted Date 15 August 2020
  • First Published Date 01 July 2021
  • Published Date 01 July 2021