Values underlying the National Service Framework for coronary heart disease in England: a discourse analysis.
OBJECTIVE
The National Service Framework (NSF) for Coronary Heart Disease--published by the English Department of Health in 2000--sets out how those within the health service should seek to prevent and treat coronary heart disease and care for people with the disease. Its prescriptions are partly based on what is known about coronary heart disease and partly on its underlying 'values'. This paper seeks to identify those values.


METHODS
An analysis of the discourses within the text of the NSF based on critical discourse analysis.


RESULTS
Three different discourses can be identified: the managerial, the clinical and the political. The managerial discourse is dominant. Each discourse has its own values. The main 'aspirational' values within the NSF are efficiency, effectiveness, autonomy (choice), universalism and equity. Some aspirational values--particularly equity--appear to be largely rhetorical and lead to few recommendations or prescriptions. Some values that might have been expected to underlie the framework, such as compassion and democracy, are largely absent.


CONCLUSIONS
Discourse analysis provides a more systematic and transparent method of describing the values behind health care policy than the methods that have been used previously.
Rayner
Mike
M
British Heart Foundation Health Promotion Research Group. mike.rayner@dphpc.ox.ac.uk
Scarborough
Peter
P
Allender
Steven
S
D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy*; D004739:England; D006078:Government Programs; D006801:Humans; D013222:State Medicine