Paper short abstract:

This paper examines the challenges in implementing malfunctioning health policies, uncovering epistemic and ideological conflicts in Chile's psychosocial healthcare. Drawing on ethnographic research with healthcare staff, it explores policy execution and ethical dilemmas amid structural injustice.

Paper long abstract:

This paper examines the outcomes of implementing and revising malfunctioning health policies, stemming from conflicts in epistemes, regulations, and ideological forces during the implementation process. Despite Chile's enduring neoliberal policies, measures endorsed by the World Health Organization (WHO) aim to introduce a 'psychosocial' approach, recognizing the importance of psychological and social elements in health understanding. However, in practice, these measures often veer towards individualistic and cost-effective approaches, emphasizing patients' responsibility for health and adaptation. Drawing on ethnographic research conducted in 2018 with occupational health staff evaluating workers’ health claims and ongoing research with psychosocial public healthcare teams in cancer care, the paper explores how policies, originally designed to address healthcare access inequality and power imbalances, can undergo intricate transformations. These adaptations adeptly align policies with dominant political and epistemic frameworks. Through in-depth ethnographic examples, the paper delves into how psychosocial teams in healthcare explore possibilities, make decisions, innovate, refrain, or challenge dominant epistemes and ideologies amidst the broader context of health inequality and social injustice that persists before and after the pandemic. It demonstrates that even when (un)intentionally overlooking historical, social, organizational, and individual factors in a patient's journey, the 'socially complex' is never absent; it subtly permeates, prompting ethical questions and dilemmas among practitioners. Ultimately, the paper seeks to reflect on the dynamic consequences when health practitioners, in the context of structural injustice, do and undo policies stemming from past mistakes, all while seeking future improvements.