Ideology, alcohol and Bradford : the impact of ideology on developing alcohol harm reduction policies for a local population

This qualitative study examines the processes associated with the local implementation of the Alcohol Harm Reduction Strategy for England (AHRSE, 2004) by a Primary Care Trust. The research's specific premise is to assess if ideology, as against evidence, is more important in developing and applying such health-related policy, and as such. the impact of this balance on potential policy effectiveness and appropriateness. The PCT selected is Bradford South and West PCT. A key aspect of examining this local application is to clarify whether there is potential conflict in the PCT role of being accountable for applying national policy and identifying and meeting local health needs, and how this influences measures to reduce alcohol harm. With this in mind, particular attention is paid to the issue of health inequality, which is a significant factor impinging on health in Bradford, and hence whether local evidence, including health inequality aspects, is of importance in determining the local interpretation of national approaches. Methodologically, the study combines realist and hermeneutic perspectives: the former providing an understanding of the policy makers' world which privileges the importance of structure and agency and the influence of contingent factors, in recognition of the NHS practitioner's world. Hermeneutics, in giving weight to the importance of an individual's interpretation of the world based on his/hers values and feelings, is used to examine the local interpretations of nationally produced ideas and approaches, and how these impact on the local end-product. The study uses two methods to explore these issues; namely, Contents and Discourse Analysis. Both techniques are applied to the two primary data sources, a selection of policy texts and a time-series of semistructured interviews. The textual analysis facilitates a comparison of national and local policies, and their respective use of ideology and evidence. The interview process is applied to three groups of alcohol policy professionals in Bradford to examine progress over the research time period; namely, with PCT policy-makers, Primary Care practitioners (GPs and Practice Nurses); managers/practitioners in a specialist third sector agency. The key aspects to emerge are: That the balance between ideology and evidence in national policy (AHRSE) considerably favours ideology, to the extent of ignoring, concealing or rejecting evidence. In a clear recognition of this, local policy practitioners have adjusted their own local policy responses to favour certain evidence-based approaches, specifically the links between alcohol misuse and population-based morbidity and mortality, and between alcohol and health inequality. However, ideological elements are being adopted and enhanced at local level. There are also significant indications of resistance within the local policy community, and evidence of individuals accessing alternative values and approaches to guide and determine their interpretations and consequent action.EThOS - Electronic Theses Online ServiceGBUnited Kingdo