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Nudges in Health Care Science at a Crossroads and the Obstacles it Faces

This article addresses the role of science and science advisory bodies in modeling practices for the support of policy-making procedures in the Netherlands in the field of health care. The authors show, based on a detailed investigation of a prestigious interdisciplinary modeling project in which an economic care model was developed for governmental use, that science advisory bodies are entangled with the policy actors they advise in what we call boundary configurations. Boundary configurations are strongly situated interconnections between science advisory institutes and policy institutions that share a specific approach to problem definitions and methods and that are embedded in (and at the same time embed) specific social, discursive, and material elements. Importantly, as the case study shows, such boundary configurations shape the kind of science, and related, the kind of social and political theories about the world, that is effectuated in modeling practices. In this case study, the boundary configuration in which economic experts and policy makers participated contributed to the articulation of health care in terms of a market-based policy program for the health care sector.

Health care is attacked in many contemporary conflicts despite the Geneva Conventions. The war in Syria has become notorious for targeted violence against health care. This qualitative study describes health care workers' experi-ences of violence using semi-structured interviews (n = 25) with professionals who have been working in Syria. The participants were selected using a snow-ball sampling method and interviewed in Turkey and Europe between 2016– 2017. Analysis was conducted using content analysis. Results revealed that the most destructive and horrific forms of violence health care workers have experienced were committed mostly by the Government of Syria and the Islamic State. Non-state armed groups and Kurdish Forces have also committed acts of violence against health care, though their scope and scale were con-sidered to have a lower mortality. The nature of violence has evolved during the conflict: starting from verbal threats and eventually leading to hospital bomb-ings. Health care workers were not only providers of health care to injured demonstrators, they also participated in non- violent anti-government actions. The international community has not taken action to protect health care in Syria. For health workers finding safe environments in which to deliver health care has been impossible. ; Peer reviewed