Risk Perception, Social Learning And Paradigm Shift

After 30-year Reform and Opening, with the high-speed development of economy, the sharp transformation of social structures, and the severe differentiation of social interests, the debates and concerns induced by public policies have become more and more significant for all levels of Chinese governments to implement the scientific concept of development, to construct the harmonious society, and to realize the sustainable development. During the social conflict-prone period, especially in public health area, since 2003 plenty of emergent events such as SARS, Avian Flu, Ev71, the Sanlu milk scandal, and A(H1N1) Flu, took place one after another, which sustainably and deeply shows not only a lagging and weak public health system with defects of input shortage and unequal resource allocation, but also the central and local governments with indifferent awareness, traditional thinking, and out-of-date implement in the domain of public health policy. Therefore, in order to effectively response to the challenge of different kinds of emerging infectious diseases, medicine and food hygiene cases, and to meet the people's need of healthy lives, it has become a prior policy issue for all levels of Chinese governments to seriously face and deal with public health emergencies, reflect their social risk-public crisis evolution process, accelerate the construction of public health emergency management system, and push forward the innovation step of public health policies.Policy paradigm is a notion used by political scientist Peter Hall to explain and describe the adjustment and transition of important public policies in the political life. Determining not only the cognition and settings of policy goals, but also the choices and arrangements of policy instruments, policy paradigms represent the intellectual framework and action standards of policy makers, and have decisive influence on policymaking process. Thus, this dissertation will discuss policy changes in public health since 2003 on the following three key points. First, the "Social Risk-Public Crisis" evolution mechanism in public health emergencies. As regard to anomalies, the triggering factor of paradigm shifts, public health emergencies have predominant advantage on the spread of risk perception. The large scale of victims, the severe physical injuries, and the permanent psychological harms, all of these anomalies in this policy area will always lead to large scale of social public crises, and then trigger policy adjustments and even paradigm shifts. Therefore, taking into account the network and interaction among policymakers, the public, mass media, and other social groups during the "Social Risk-Public Crisis" evolution process, will definitely become the logical starting point to discover policy adjustments and paradigm shifts of Chinese public health policies. Second, the "social learning" process induced by public health emergencies. Social learning is a collective exploration to new ideas of resolving policy problems, during the course of which not only parties, government officials, policy authorities, experts, but also the media, all kinds of social groups and the public will take active part in. Thus, in this process the flow of ideas between state and society actually becomes the most important part of the whole policy network, and directs the final policymaking process and concrete contents. Nevertheless, social learning is also a process of policy evaluation. New ideas will be adopted to direct and make new policies when public health emergencies have declaimed the partly or entire failure of current policies, and then led to policy adjustments and paradigm shifts. Third, the internal mechanism of policy adjustments and paradigm shifts in public health area. Since SARS epidemic broke out in 2003, policy changes in public health area are very obvious and sharp, which is deeply expressed in the new medical and health system reform since 2006. These policy changes have been induced by public health emergencies, and then deepened by the process of social learning. Through the analysis on the contents and steps of policy changes in detail, my dissertation will discuss whether these kinds of policy changes in Chinese public health since 2003 can be concluded as the policy paradigm shift, and elaborate the internal evolution mechanism among this process.Therefore, the Social Amplification of Risk Framework (SARF), historical institutionalism, and social learning theory, are introduced into my dissertation to complement the analysis framework of policy paradigm shift. After a comparative case study between SARS epidemic in 2003 and A (H1N1) Flu in 2009, it is obvious that public health policies have been adjusted, which could be found in so-called three-order change by Hall, that is, changes in overarching goals and ideas of policy, changes in policy instruments, and changes in concrete settings of policy. At this point, my dissertation confirms the existence of paradigm shifts of public health policies. However, this kind of transition has not been accomplished in one step, which includes not only gradual and continuous policy changes, but also stimulus-reaction and sharp policy paradigm shifts. It is hard to satisfy the need of free shift of policy authorities in the prevailing political environments and governmental process, which has been the key factor to hinder policy adjustments and paradigm shifts.Of course, it is only an easy attempt to study Chinese public health policies because of its low ideology in this policy domain, which means that the obstacles to hinder policy adjustments and paradigm shifts are only from financial games between the Central and local governments, and from the interference of some invested interest groups and social organizations. But as regard to other Chinese policy areas, the so-called paradigm shifts perhaps are only a kind of political slogan and mirage. Therefore, the purpose of this dissertation is also to reflect and explore the overall Chinese public policymaking process, and to provide a useful analysis framework and research method.