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Summary HPI4009 - Case 3: Health policy making: a matter of evidence or power struggle?
Case 3 of the HPI4009 module
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Case 3: Health policy making: a matter of evidence or power struggle?Learning goals
- What is health policy and how can it be described in terms of content, process, actors and
context?
- Why do some issues get on the policy agenda, while other do not? How do different
theoretical frameworks explain this phenomenon (i.e., agenda setting)?
- What are the common elements of the main agenda setting frameworks include in the
literature and how do these elements explain differences in issues prioritization?
- Once on the agenda, how are health policy decisions made according to different theoretical
perspectives? Pay particular attention to the roles of evidence and power.
Literature
- Buse K, Mays N, Walt N. Making Health Policy (2nd edition). Berkshire: Open University Press, 2012.
- Parkhurst JO, Vulimiri M. Cervical cancer and the global health agenda: insights from
multiple policy-analysis frameworks. Global Public Health, 2013;8(10):1093-1108.
- Shiffman J, Smith S. Generation of political priority for global health initiatives: a
framework and case study of maternal mortality. The Lancet, 2007;370:1370-79.
1. What is health policy and how can it be described in terms of content, process, actors and
context?
Health systems governance versus health policy (making)
- Health systems governance: how things are done.
- Health policy (making): what should be done.
Health policy (making)
Policy is not a precise of self-evident term. The definition of health policy we use in this course is:
“Health policy is assumed to embrace course of action (and inaction) that affect the set of
institutions, organizations, services and funding arrangement of the health and healthcare system”
(Buse et al., 2012).
- Another definition states: “A collective and more or less deliberate effort to achieve health
goals (or policy objectives) by means of policy instruments.
à These definitions are really on: “what should be done”?
,Health policy
- Health
There is a new paradigm for health:
o We witness a shift from a pure biomedical model to a biopsychosocial model: “it is
more important to know what sort of patient has a disease than what sort of a
disease a patient has” (William Osler).
o We pay more attention to how to keep people healthy.
- Policy
A decision that is taken by those with responsibility for a given policy area.
o Public policy: government policy or the policies of government agencies (whatever
the government choose to do or not to do).
o Private policy: policy for companies. However, private sector corporations have to
ensure that their policies are made within the confines of public law that is made by
the government.
à The only important difference between public and private policies is that public
policies can often take longer to implement, especially in liberal democratic political
systems because of the larger number of actors necessary to agree to putting the
policy into effect.
à So, health policy encompasses:
- Health care policy
- Public health policy
Health policy triangle (Walt & Gilson, 1994)
, - Actors:
o Actors are influenced by the context within they live and work.
o Actors can be:
§ Individuals (Nelson Mandela)
§ Organizations (World Bank)
§ Multinational companies (Shell)
§ State/ government
o Actors can influence the policy process at the local, national, regional or
international level. Often, they become parts of networks to consult and decide on
policy at all of these levels.
o The extent to which actors will be able to influence policy depends on their
perceived or actual power. Power is characterized by a mixture of individuals wealth,
personality, level of access to knowledge or authority, but is also strongly tied up
with the organizations and structures (including networks) within which the
individual actor works and lives as well as the position or office that the individual
holds.
- Context
o The context is affected by systematic factors which may have an effect on health
policy. Different kind of factors include:
§ Situational factors: are more or less transient or idiosyncratic conditions
which may influence policy. In other words; focusing events (e.g., an
earthquake or the HIV epidemic).
§ Structural factors: relatively unchanging elements in the society (e.g., type of
economy, the opportunity to participate in policy discussions and type of
employment).
§ Cultural factors: (e.g., formal hierarchies or religious factors).
§ International or exogenous factors: factors leading to greater cooperation
between states, and influencing sovereignty and international cooperation in
health may also affect health policy. Although many health problems are
dealt with by national governments, some demand cooperation between
national, regional or multilateral organizations (e.g., polio and climate
change).
à All the contextual factors are complex and unique in time and setting.
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