A critical discourse analysis of national policy agendas for the elimination of asthma disparities

Background and Issues: Asthma management inequities (AMI) between African and White Americans are significant and alarming. AMI policy agendas impacting the delivery of public health and primary care have been suggested with little success. A recent IOM framework on integrating public health and primary care proposes five principles: population health, community engagement, aligned leadership, infrastructural sustainability, and sharing of data. It is unknown how this framework is reflected amongst discourses - the structured systems of text, talk, and action - contained within AMI policy agendas. This study presents a critical discourse analysis of five national AMI policy agendas using this IOM framework. Description: Using a Foucauldian critical discourse analysis, AMI policy agendas were analyzed for discourses which included persons, actions, and events that promoted or omitted aspects on the IOM integration framework. Lessons learned: Individual health discourses (n=9) were emphasized over population health focused discourses (n=5). Community engagement discourses were only promoted in relation to indoor/outdoor air pollution (n=3). Of the documents aligned leadership; MD's (32%), MPH (24%), and PhD's (19%) predominated, and only 4% were PHN's. Infrastructural sustainability discourses (n=10) were the most detailed, but omitted discourses on bias. Discourses on the sharing of data (n=2) were omitted from 3 of the 5 documents. Recommendations: Public health nurses should 1) promote population health agendas, 2) mobilize for air pollution advocacy, 3) mobilize for PHN leadership in policy development, 4) promote anti-bias policies, and 5) introduce discourses on data sharing. Critical discourse analysis provides powerful equity tools for policy analysis.