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All cases Health policies at EU Level and Global HealthEurope (EPH3022)
Case 1- Policy analysis: different types, perspectives, disciplines
The difference between law and public policy
Law is formal; policy is real!
Policy is the informal side of government, the real statement of what government does.
Policy is the servant of the formal rule of law.
In a democracy, "law" sounded too official, unilateral, hierarchical, authoritative, and
bordered on authoritarian. Policy appeared softer, more human, and not as divine.
Public policy as an expression of public opinion in the nineteenth century seems to
have had a renaissance in the democratizing twentieth century.
Law
Law equals legislation rules of just conduct.
"Law" to political scientists means "public law," which concentrated upon "constitutional
law".
Laws are set standards, principles, and procedures that must be followed in society.
Laws are mainly made for implementing justice in society. Laws are administered through the
courts, and laws are enforceable in which the policies comply.
A law is more formal as it is a system of rules and guidelines that are derived for the welfare
and equity in society.
Policy
Policies, defined as "expressions of state will”, as a description of "what legislators do”.
Policies outline what a government is going to do and what it can achieve for society.
Policies also mean what a government does not intend to do.
Policies are only documents and not law, but these policies can lead to new laws.
A policy is framed for achieving certain goals.
A policy is just informal as it is just a statement or a document of what is intended to be done
in the future.
Broad statement of goals, objectives and means that create the framework for activity. Often
takes the form of explicit written documents but may also be implicit or unwritten.
Policy is often thought of as decisions taken by those with responsibility for a given policy
area. Policy may be made at many levels.
- Central or local
- Public or private
,The different contextual factors that can influence policy making
Context
Systemic factors, political, economic, social, or cultural, both national and international,
which may influence health policy.
o Situational factors
Transient or idiosyncratic conditions which may influence policy. Focusing events.
Example: war, earthquake, drought, HIV epidemic, new president/minister.
o Structural factors
Relatively unchanging elements of society. The political system, the type of economy
and the employment base. Demographic features, technological advance, and
countries national wealth.
Example: If there are low wages for nurses and high workloads, then migration to
places with shortages/better working conditions. Long-term care costs rise in
countries with aging populations. Evidence of growing disease mortality made public.
o Cultural factors
Political and general culture. Formal hierarchies, position of ethnic minorities,
linguistic differences, stigma, religious factors.
Example: In some countries women cannot easily access health services because they
need to be accompanied by husband. In the US president Bush promoted sexual
abstinence instead of the delivery of condoms for the control of STI’s.
o International/exogenous factors
Events, structures, and values that exist outside the political system.
Leads to inter-dependence between states, influencing sovereignty and international
cooperation in health. Some health problems demand cooperation between national,
regional, and multilateral organizations.
Example: eradication of poli in most countries through national and regional action.
Contextual factors example smoking cessation:
Situational factors - sudden economic crisis
Structural factors - demographics, knowledge about smoking education, governmental
structuring, taxation of tobacco, interest in tobacco policy
Cultural - attitudes towards smoking, personal habits, generation to generation (farmer
family)
Exogenous - globalization and WHO world trade organization, EU legislation
,Why policymakers should take the context into account
Context influences the effectiveness and appropriateness of policy decisions, ensuring they
are relevant and tailored to specific circumstances.
To understand how health policies change, or do not, implies an ability to analyse the context
in which they are made, and an attempt to assess how far any, or some, of these sorts of
factors may influence policy outcomes.
Politics cannot be divorced from health policy. Nothing is unaffected by the influence of
politics. Most activities that impact on health are subject to the ebb and flow of politics.
Implementing a programme that was implemented and worked somewhere else might not
work in another country. This is context related.
How centralization and decentralization affect policy making
Decentralization
The handing-over of the central government’s power to a lower level of the government.
Transfer of the powers and activities to the sub-national level and actors.
Governments use decentralization to empower the local population for political, economic,
social, management, administration, and technology.
Local people can participate in the planning and management of development process and
decision-making. It creates a good environment for providing better services.
o De-concentration o Devolution
o Delegation o Privatisation
Political decentralization
Citizens or their elected representatives are given more powers to make public decisions.
Requirements are constitutional reforms, development of pluralist political parties,
strengthening of legislatures, creations of local political units and encouraging active public
interest groups.
- Devolution of power: creation and strengthening of sub-national units of the
government, activities of which are substantial outside the direct control of the
central government. full authority shift (policy, managerial, and fiscal)
Administrative decentralization
The provision of administrative responsibilities and services to various public institutions.
Transfer of power, resources, and responsibilities to levels of government institutions.
The transfer of responsibility for the planning, financing, and management of certain public
functions.
- De-concentration: administrative responsibilities are redistributed to
sub-national/local institutions. limited managerial shift
, - Delegation: transfers managerial/leadership responsibility for specifically defined
functions to organizations outside the regular bureaucratic structure (except for
financial decision making). partial shift (not financial)
Fiscal decentralization
Allocation of resources/fiscal power to the sub-national levels of the central government.
- Allocation of expenditure responsibilities
- Assignment of taxes
- Design of intergovernmental allowances system
- Formulation and monitoring of fiscal flows budgeting
Market decentralization
Formal permission of the private sector for the functions of the government.
Privatisation of government institutions is done for this purpose.
- Privatisation: sale of public assets to private investors.
Asymmetrical decentralization
Based on political or geographic factors gives power to the regional/sub-national level.
Helps safeguard multiculturalism is the states.
- Political asymmetry: impact of cultural, economic, social, and political conditions that
affect different regional units.
- Constitutional asymmetry
Consequences of decentralization
- More attention is given to the needs of specific populations.
- To strengthen democratic practices in countries.
- Slower coordination.
- Inequality in the same country.
- Financial problems.
Context and stakeholder
Actors are influenced by the context within which they live and work.
Context is affected by actors, their position in power structures, their own values, and
expectations.
Actors often become parts of networks to consult and decide on policy at different levels.
The extent to which they will be able to influence policy depends on different things (agency
and structure).
Pressure groups: do not seek formal political power for themselves, but they do want to
influence those with formal power.
People’s movements: different groups may get together to demonstrate strong feelings
about particular issues.
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