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AGP - Summary chapter 2-10. Final grade 7,5
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Chapter 2 – Power and the Policy Process Differentiate between three dimensions of power and apply each to health policy
making
Contrast theories which account for the distribution of power in society and
understand their implications for who determines health policy
Define a political system, distinguish between regime types, and understand their
implications for participation in policy making
Contrast theories of decision making based on an appreciation of the role of power in
the policy process
The outcome of any conflict depends on the balance of power between the individuals and
groups involved, and the processes or rules established to resolve those conflicts.
Understanding policy making requires an understanding of the nature of power, how it is
distributed and the manner through which it is exercised.
Power = the ability to achieve a desired outcome. A has B to do something that B would not
have otherwise done.
Steven Lukes: three dimensions of power:
Power as decision making – focuses on acts of individuals and groups which
influence policy decisions. Different groups in society, including weak groups, could
penetrate the political system and exercise power over decision makers in accordance
with their preferences
Power as non-decision making – the practice of limiting the scope of actual decision
making by manipulating the dominant community values, myths and political
institutions and procedures. Power as agenda setting powerful groups control the
agenda to keep threatening issues out of sight.
Influence over others can flow from authority: the legitimate right to get someone
to do what you want
1. Traditional : obedience is based on custom and the established way of doing
things (king or sultan)
2. Charismatic : intense commitment to a leader and their ideology or other
characteristics (religious leaders, statesmen, Nelson Mandela)
3. Rational-legal : based on rules and procedures (office holder)
4. Technical : knowledge and expertise play a role (doctor)
Power as thought control – power can be a function of the ability to influence others
by shaping their initial preferences. Most insidious form: it dissuades people from
having objections by ‘shaping their perceptions, cognitions and preferences in such a
way that they accept their role in the existing order of things, either because they can
see or imagine no alternative to it, or because they see it as natural and unchangeable,
or because they value it as divinely ordained and beneficial’.
These three dimensions of power suggest different views as to wo wields power and how
widely it is shared in public processes. For example the tobacco industry has more influence
over tobacco control policy than the ministry of health and public health when, in that
country, the tobacco industry constitutes a considerable proportion of the gross domestic
product and is a valuable source of government revenue and foreign exchange.
,Theorists have different views on who has power: (1) in their assessment of whether the state
is independent of society or a reflection of the distribution of power in society and (2) in their
view whether the state serves a common good or the interests of a privileged group.
Pluralism = Power is dispersed throughout society. No single group holds absolute power
and the state arbitrates among competing interests in the development of policy. Health policy
emerges as a result of conflict among several groups organized to protect the interests of their
members. Key features:
Open electoral competition among a number of political parties
Ability of individuals to organize themselves into pressure groups and political parties
Ability of pressure groups to air their views freely
Openness to the state to lobbying on behalf of all pressure groups
The state as a neutral referee adjudicating between competing demands
Although society has elite groups, no elite group dominates at all times
Public choice = Agree with pluralists that society is made up of competing groups pursuing
self-interested goals but they dispute the claim of the state’s neutrality.
The state itself is an interest group which wields power over the policy process in
pursuit of the interests of those who run it (elected public officials and civil servants)
The self-interested behaviour of state officials leads to policy that is captured by
narrow interest groups. As a result, policies are likely to be distorted in economically
negative ways and are not in the public’s interest
Critics suggest that public choice theory both overstates the power of bureaucrats in
the policy process and is largely fuelled by the ideological opposition to escalating
public spending and so-called ‘big government’.
Elitism = policy in dominated by a privileged minority. Public policy reflects the values and
interests of the elite (according to pluralists). Elitists question the extent to which modern
political systems live up to the democratic ideals suggested by the liberal pluralists. They
suggest that power may be based on a variety of resources: wealth, family connections,
technical expertise, office or education.
Key features:
Society is comprised of the few with power and the many without. Only the few who
have power make policy
Those who govern are unlike those who do not. In particular, the elite comes from the
higher socio-economic strata
Non-elites may be inducted into the governing circles if they accept the basic
consensus of the existing elite
Public policy reflects the values of the elite. This may not always imply a conflict with
the values of the masses. The elite can manipulate the values of the masses to reflect
their own
Interest groups exist but they are not all equally powerful and do not have equal access
to the policy making process
The values of the elite are conservative and consequently any policy change is like to
be incremental
Most pluralists acknowledge that the policy making playing field is not level. They note the
privileged position of organized business interests and the role that the media and
socialization play in most political systems.
, Common to these 3 theories is the proposition that understanding policy change requires an
understanding of how power is distributed and exercised in society.
Power and political systems
Easton political systems
model
Inputs
Outputs
Links between them
The model explains why
political systems are responsive
to public pressure & also breaks
down the policy making
process into discrete stages
how should the government work?
Input = take form of demands and support from the individuals and groups. They are
fed into policy to produce outputs
Output = decisions and policies of government including legislation, imposition of
taxation and budgets
Black box = government decision making
Drawbacks simplified model:
The model fails to explain why governments may employ regression and coercion, as
many have at some time, to curb demands
It does not account for policy that arises from decision making within private
organisations
The model places too little emphasis on what happens inside the ‘black box’ of policy
making
Inputs are fed into policy making to produce outputs which are the decisions and policies of
government including legislation, imposition of taxation and budgets.
Classifying political systems: participation, benefits and openness
To extent to which people can participate in the political system is partially a function of the
culture and nature of the political system. Systems are usually distinguished in terms of who
rules, who benefits and how open the systems are:
Liberal democratic regimes – governments that operate with relatively stable political
institutions which considerable opportunities for participation through a diverse
number of mechanisms and groups
Egalitarian-authoritarian – closed ruling elite, authoritarian bureaucracies and state-
managed popular participation. In these states, health care was treated as a
fundamental human right
Traditional-inegalitarian – rule by traditional monarchs which provide few
opportunities for participation. Health policy relies heavily on the private sector with
the elite using facilities in other counties as the need arises
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