Health policy

health policy

1. Health System: Policy Planning and Evaluation Abdullah Alshehari

2. The health policy framework

3. Definitions Institutions: The ‘rules of the game’ determining how government and the wider state operate. Policy: Broad statement of goals, objectives and means that create the framework for activity. Policy elite: Specific group of policy makers who hold high positions in a policy system, and often have privileged access to other top members of the same, and other, organizations. Policy makers: Those who make policies  such as central or local government, multinational companies or local businesses, clinics, or hospitals. Policy process: The way in which policies are initiated, formulated, developed, negotiated, communicated, implemented and evaluated. policy area : it may be in health or the environment, in education or in trade. Public policy : refers to government policy or the policies of government agencies Health policy: may cover public and private policies about health.

4. Why is health policy important? It is important because it may help to tackle some of the major health problems of our time – such as rising obesity. Health policy guides choices about which health technologies to develop and use, how to organize and finance health services, or which drugs will be freely available.

5. What is health policy? Health policy may cover public and private policies about health. It includes policy made in the public sector (by government) as well as policies in the private sector. But because health is influenced by many determinants outside the health system, health policy analysts are also interested in the actions and intended actions of organizations external to the health system which have an impact on health (for example, the Ministry of Transport or the food, tobacco or pharmaceutical industries).

6. The ‘health policy triangle’ (framework) it can be applied to high, middle and low income countries.

7. Actors The actors who make or influence policy ( at the center of the health policy framework) E.g. government, ex-President, big companies such as shell Actors may try to 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.

8. Activity Make a list of the different actors who might be involved in making policy on AIDS in your country? government (e.g. ministries of health, education, the interior) International non- governmental organisations ( e.g . Médecins Sans Frontières) National non-governmental organizations (e.g. of people living with HIV, faith based organizations) Pressure/interest groups (e.g. the Treatment Action Campaign) International organizations (e.g. WHO, UNAIDS, the World Bank) Bilateral agencies (e.g. DFID, SIDA) Funding organizations (e.g. the Global Fund, PEPFAR) Private sector companies (e.g. Anglo-American, Heineken, Merck & Co) Researchers (e.g. from universities, think tanks)

9. Context Refers to systemic factors – political, economic and social, local, regional, national and international – which may have an effect on health policy. categorizing factors ( Leichter 1979) : 1- Situational factors (e.g. wars, droughts). earthquake may leads to changes in hospital building regulations 2- Structural factors are the relatively unchanging elements of the society.. For example wages for nurses are low, or where workloads are unrealistically high, countries may suffer migration of these professionals to other societies where there is a shortage or better working conditions. 3- Cultural factors - The position of ethnic minorities or linguistic differences may lead to certain groups being poorly informed about their rights, or receiving services that do not meet their particular needs. 4- International or exogenous factors: For example, the eradication of polio has taken place in many parts of the world through national and regional action, sometimes with the assistance from international organizations such as the WHO.

10. Processes Process refers to the way in which policies are initiated, developed or formulated, negotiated, communicated, implemented and evaluated. The most common approach to understanding policy processes is to use what is called the ‘stages heuristic’ (Sabatier and Jenkins-Smith 1993). This means breaking down the policy process into a series of steps, but acknowledging that this is a model, and does not necessarily represent exactly what happens in the real world. 1- Problem identification and issue recognition : explores how some issues get on to the policy agenda, while others do not even get discussed. In Chapter 4 you will go into this stage in more detail. 2- Policy formulation : explores who is involved in formulating policy, how policies are arrived at, agreed upon, and how they are communicated. The role of policy making in government is covered in Chapter 5 and that of interest groups in Chapter 6. 3- Policy implementation : this is often the most neglected phase of policy making and is sometimes seen as quite divorced from the first two stages. However, this is arguably the most important phase of policy making because if policies are not implemented, or are diverted or changed at implementation, then presumably something is going wrong from the point of view of the policy originator – and the policy outcomes may not be those which were sought. These issues are discussed in Chapter 7. 4- Policy evaluation : identifi es what happens once a policy is put into effect – how it is monitored, whether it achieves its objectives and whether it has unintended consequences.

11. content Substance of a particular policy which details its constituent parts (e.g. its specific objectives and methods of implementation). policy aims and means

12. Analyzing health policy an economist  may say health policy is primarily about the allocation of scarce resources for health; a planner  may see it as a way to influence the determinants of health in order to improve public health; and a doctor  may see it as it all about health services to individuals (Walt 1994).

13. You can use the health policy triangle to help analyse or understand a particular policy or you can apply it to plan a particular policy. Analysis of policy is generally retrospective and explanatory – it looks back to explore the determination of policy (how policies got on to the agenda, were initiated and formulated) and what the policy consisted of (content). It also includes evaluating and monitoring the policy – did it achieve its goals? Was it seen as successful? Analysis for policy is usually prospective – it looks forward and tries to anticipate what will happen if a particular policy is introduced. It feeds into strategic thinking about how to modify policy and may lead to policy advocacy or lobbying. For

14. upstream factors Creating a healthier nation requires  address “ upstream factors ”  the broad range of issues, other than health care, that can undermine or promote health (also known as “social determinants of health” or “core determinants of health”) (World Health Organization [WHO], n.d. ). Upstream factors promoting health include  safe environments, adequate housing, and economically thriving communities with employment opportunities, access to affordable and healthful foods, and models for addressing conflict through dialogue rather than violence. Upstream factors have a large influence on the development and progression of illnesses (Williams et al., 2008).

15. the core determinants of health developed by the Canadian Forces Health Services Group.

16. REFORMING HEALTH CARE THE TRIPLE AIM In 2008, Don Berwick, MD, and his colleagues at the Institute for Healthcare Improvement (IHI) first described the Triple Aim of a value-based health care system (Berwick, Nolan, & Whittington, 2008): (1) improving population health, (2) improving the patient experience of care, and (3) reducing per capita costs. The Triple Aim represents a balanced approach: by examining a health care delivery problem from all three dimensions, health care organizations and society can identify system problems and direct resources to activities that can have the greatest impact. The Institute for Healthcare Improvement (IHI) identified these components of any approach seeking to achieve the Triple Aim: A focus on individuals and families A redesign of primary care services Population health management A cost-control platform System integration and execution

17. Form of policy Policies are constructed as a set of regulations (public policy), Practice standards (workplace), Governance mandates (organizations), Ethical behavior (research), Ordinances (communities) Forms directs individuals, groups, organizations, and systems toward the desired behaviors and goals. Thus, Policy is authoritative decision making related to choices about goals and priorities of the policymaking body. ( Stimpson & Hanley, 1991)

18. The Policy Process Problem identification. ( Interest groups & Values) Agenda setting. (Policy analysis and analyst) Alternatives.(Advocacy & Activism, Presidential power, Politics) Policy choice implementation. (Science & Research) Evaluation.

19. Politics A process by which one influences the decision of others & exerts control over the situation and events.

20. Classification of Politics 1. Formal Politics refers to the operation of a constitutional system of government and publicly defined institutions and procedures. 2. Semi-formal Politics is Politics in government associations such as neighborhood associations, or student governments where student government political party politics is often important. 3. Informal Politics is understood as forming alliances, exercising power and protecting and advancing particular ideas or goals. Generally, this includes anything affecting one's daily life, such as the way an office or household is managed, or how one person or group exercises influence over another.

21. Why nurses need to be politically active? Politics can change the work we do. We can represent the interest of the Nursing profession. We can Advocate our patients.

22. Who acts to influence health and policy? (Nurse) Where in what environment or area of influence the nurses act to influence policy? (The workplace,) What are examples of strategies nurses use to influence policy? (Knowledgeable about issues, Contact policy makers, media coverage, run for office, identify policy problems, and analyze solutions, assess beneficiaries) When do nurses act to influence policy? (when health problems needs remedy) Why do nurses act to influence policy? (to improve human health, Access, safety, quality of care and to reduce cost of care.)

23. Using the Power of Media to Influence Health Policy and Politics Media advocacy is the strategic use of media to apply pressure to advance a social or public policy initiative It is a tool for policy change by mobilizing constituencies and stakeholders to support or oppose specific policy changes. ( Dorfman & Krasnow 2014; Wallack & Dorfman , 1996).

24. Affordable Care Act (ACA) and The legislation (four main cornerstones for Health Reforms)

25. FORCES THAT SHAPE HEALTH POLICY

26. THE FRAMEWORK FOR ACTION

27. Nurse advocacy Example: Florence Nightingale was the Perfect political nurse. Why Understood how to influence the British parliament to allocate funds to reform British military hospital & fairly improve health and sanitary condition of the troops.

28. Why should registered nurses take action? Nurses have a very high level of credibility with the public. Nurses bring a unique perspective and knowledge to health policy issues. Nurses are successful advocates! See the “Success Stories” of this kit for details.

29. What issues should I become involved with? One that is important to your colleagues, neighbours , family, or community. One that is important to your patients. One that is important to YOU.

30. POLITICAL PHILOSOPHY Political philosophy examines, analyzes, and searches for answers to fundamental questions about the state and its moral and ethical responsibilities. Political philosophy is a normative discipline, meaning that it tries to establish how people ought to be, as expressed through rules or laws. It involves making judgments about the world, rather than simply describing or observing people and society. Political philosophers attempt to explain what is right, just, or morally correct.

31. For nurses political philosophy offers ways of analyzing and handling situations that arise in practice, policy, organizational, and community settings. For example, it helps determine how far government authorities may go in regulating nursing practice. It offers ways of understanding complex ethical situations—such as end-of-life care, the use of technology in clinical settings, and reproductive health—when there is no clear answer regarding what constitutes the rights of individuals, clinicians, government officials, or society at large.

32. THE STATE & Nation State  is a “particular kind of social group” Today’s modern state is a highly organized government entity that influences many aspects of everyday lives (Shively, 2005). It typically refers to the “governing apparatus that makes and enforces rules” (Shively, 2005, p. 56). Therefore the terms state and government may be interchangeable. Nation  is “a large group of people who are bound together, and recognize a similarity among themselves, because of a common culture”

33. Theories and themes Thomas Hobbes (1588-1679)  describe the relationship between individuals and the state. Hobbes’s theory was important in establishing governance and authority, without which people would live in a natural state of chaos. John Locke (1632-1704)  emphasizing the importance of individual rights in relationship to the state. His defense of individual rights was fundamental to liberalism (discussed later) and the development of democracies around the world. Jeremy Bentham (1748-1832). Bentham, heralded as the father of classic utilitarianism, rejected the natural law tradition. His utilitarianism theory basically asserted that individuals and governments strive to attain pleasure over pain. When applying this “happiness principle” John Stuart Mill (1806-1873). Mill, a British political philosopher, is considered a major force behind contemporary liberalism. His essay “On Liberty” (1859) is foundational to modern liberal thinking. Mill was committed to individual rights and freedom of thought and expression, but not unconditionally.

34. POLITICAL IDEOLOGIES A political ideology is a “set of ideas about politics, all of which are related to one another and that modify and support each other” (Shively, 2005, p. 19). Political ideologies are characterized by distinctive views on the organization and functioning of the state. Ideologies give people a way of analyzing and making decisions about complex issues on the political agenda.

35. Liberalism This 18th-century liberalism meshed well with political, economic, scientific, and cultural trends of the time, all of which sought to free people from confining and parochial values. Liberalism relies on the notion that members of a society should be able to “develop their individual capacities to the fullest extent” (Shively, 2005, p. 24).

36. CONSERVATISM In response to liberals’ calls for changing the existing social and political order, conservatives countered with a preference for stability and structure. They preferred patterns of domination and power that had the benefit of being predictable and gave people familiar political terrain. Under conservative thought, those in power had the “awesome responsibility” to “help the weak.”

37. SOCIALISM Socialism grew out of dissatisfaction with liberalism from many in the working class. Unable to prosper under liberalism, which relied on individual capacities, socialists looked to the state for policies to protect workers from sickness, unemployment, unsafe working conditions, and other situations.

38. CONTEMPORARY CONSERVATISM AND LIBERALISM Contemporary political conservatism, which grew in popularity in the late 20th century, is similar to classic conservatism (described previously) but differs from it in several ways. In particular, conservatives oppose a strong government role in assisting the disadvantaged. Now, liberals are the ones who generally favor a strong government role in social policies, such as health, welfare, education, and labor, whereas conservatives prefer minimal government intervention and reliance on privatization and individual choice. Contemporary conservatives oppose rapid and fundamental change, as did proponents of earlier models of conservatism. They call for devolution of federal responsibility for health and other social issues to state governments, a diminished presence of government in all aspects of policy, a reduced tax burden, and the importance of traditional social values.