Lecture 1 Sept 10th Flashcards
What is policy?
Why study policy?
- Central instrument for helping to organize and manage modern societies
- Often key in advocacy work
-Not just why and how to act, but also the allocation of resources - Policy can be thought of as ‘intent’, and, also as understanding and process
-Understanding the evidence that guides policy AND the beliefs that guide what we do/do not do - Essential programs that work to change society
What is Public Policy
A course of action or inaction chosen by public authorities
Addresses a given problem
addresses inter-related sets of problems
Anchored in a set of beliefs about the best way to achieve those goals
Health policy is a subset of public policy
> who has power and who does not have it to influence policy and outcomes? Who benefits/does not benefit?
Policy “Rhetoric” vs. Reality
- Policy as two choices: for or against? All or nothing? or more nuanced?
- Policy does not take place in a vacuum
- course of action created by actors in response to public problems
- accounting for different ways problems are approached and understood
- focusing events: episodes/experiences that catapult issues to the force
How did we end up with existing policies? What will they look like in the future?
- Political Environment
- Economic Environment
- Socio-cultural environment
- Administrative Environment
- Actors, Content, Context, Process
- Frameworks, tools, levers, “belief” systems
Ways of Thinking About Public Policy
One way is to sort policy analyses into two large buckets:
consensus and conflict / critical
Both assume policy choices are based on rational consideration of alternatives
Each has own place in explaining development/implementation
Consensus Policy Theory
- Policy - made using rational consideration of alternative courses of action
- choices are based on cost and benefits and evidence
- Focus on small improvements that can be made to improve existing services
- Emphasis on technical issues such as day-to-day organization, financing, delivery – not much about the forces (economical, political social) that shape overall organization
- Often neglects importance of ideology, values and power and misses the ‘big picture’
- AKA: “nuts and bolts” lens
Conflict / Critical Policy Theory
- Consider broader issues in the organization and development of policy
- Policy debates are influenced by social class politics and inequalities in influence and power including gender, race, class, disability, etc.
of policy - Acknowledges power differential
- WHO will be affected – for better or for worse – by policy decisions
- AKA: “socio-cultural-economic” lens
Another is to apply Social Theory to Policy Analysis
Different approaches to health
Medical approach
> individual based or micro
Behavioural/lifestyle approach
- individual based or micro
Socio-environmental approach
-both individual and environmentally based
Structural/critical approach
-socially based, structural, macro
Social theory that endorses the medical approach
Positivism
-objective, rational
Social theory that endorses the Behavioural/lifestyle approach
Structural Functionalism - objective, rational
Social theory that endorses the Socio-environmental approach
Interpretivism -subjective
Social theory that endorses the Structural/critical approach
Critical Theory and Political Economy -both objective and subjective
Positivism
- Only authentic knowledge is scientific
- Strict adherence to the scientific method
- Hypothesis testing and identifying relationships
- Predict and control
- Bottom up (a posteriori) approach
- e.g. biological and physical science, much of health sci
Structural Functionalism
- Apply positivist notions of knowledge and methodology
whose function together creates overall societal - Views society as an organism, a system of parts
- Shared norms and values; cooperation effectiveness
- e.g. herd immunity
Interpretivism
- Critique of positivism
- Hermeneutics – how individuals understand themselves through shared systems of meaning
- All views considered equally valid
- Can lead to removal of important contexts that help explain individual understandings and experiences
- e.g. experience of an individual with health conditions
- Socio-environmental approach as it emphasizes lived experience
Critical Theory
- Structures and processes that are usually hidden and ignored by positivists
- Critique and transformation of society as a whole
- Considers haves and have-nots in society
- Nature and distribution of power
- Who has the ability to bring about social and political change
- e.g. Enviro and Social Determinants
- How political and economic structures shape the health care
Regardless of HOW we look at Policy, we are typically asking the following questions:
- What do we value?
- What do we need?
- How do we know?
- How Do We Decide?
- How Do We Decide Who Knows?
- How Do We Decide Who Gets To Decide?
- How Are People Important? Which people are Important?
Martsolf and Thomas, 2019
“Positions on key public policy issues are driven by largely implicit and unarticulated philosophical presuppositions that guide individuals’ notions of the nature of government, individuals’ moral obligations to each other, how society assesses quality of life, and what it means to be a community.”
Philosophy Cannot be Ignored in Policy
- How knowledge is generated
- Studies in biology, epidemiology, and social science, etc.
- Our understanding of health
- Basis for choosing and undertaking interventions
- reflect policy maker’s values, worldviews and philosophies
-Acceptable policy levers
Epistemology and Ontology
- “Episteme” = “knowledge” or “understanding” ; “logos” = “account” or “argument” or “reason”.
- What is knowledge? How is it created and understood?
- Ontology is the study of existence - what exists, what kinds of things exist, and what it means for something to exist
WHO (1948)
“a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Lalonde Report (1974)
identifies two main objectives: the health care system; and prevention of health problems and promotion of good health. Considers the health field (more broad view of health than in the past - determinants);
- human biology
- environment (physical and social)
- lifestyle
- Health care organization
Public Health
- “the combination of science, practical skills, and values directed to the maintenance and improvement of health of all people” (Last, 1988)
- the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society (WHO, 1988)
Medical Care
- Identify and understand disease
- Biological
- Often Consensus
Health Care
- Health Status
- Socially constructed
- Often Critical
Health has a definition, but…
- Health is also a social construct
- traditional WHO definition leaves out a lot of people (or conversely, says they are not “healthy”)
Social construction of illness
- Some illnesses are embedded with the cultural meaning - not directly related to condition
- Illness and disease, at the experiential level, are socially constructed (there’s a biological and an experiential piece)
- Medical knowledge is created within the social norms and priorities (there is also a social construction of treatment)
Worldviews
Comprehensive - collection of deeply held beliefs about how we interpret and experience the world
Connection to individual experience of normative ethical theory (ergo what is right and wrong)
Who says worldviews are aspirational and acted upon & when?
Boylan 2004, 2012
Schiff 1968
suggested that worldviews were cognitive, affective and behavioural
Identification of your worldview:
Indirectly identifies your greatest weakness
Decision theory
On any given occasion, a person is guided by beliefs and desires/ values
a theory of beliefs, desires and other relevant attitudes AND a theory of choice; what matters is how these various attitudes (call them “preference attitudes”) meld together
What criteria someone’s preference attitudes should satisfy in any generic circumstance
could be suggesting that this amounts to a minimal account of rationality
Ideology
Political scientists - identify packages of positions, often seen as consolidated in a “single, preferred optimal state”
“A set of beliefs or principles, especially one on which a political system, party, or organization is based”
Can be used to denoted the beliefs, attitudes and opinions of those with whom we disagree
Political and social analysts tend to give extremely broad definitions, e.g. beliefs, attitudes and values. This basically runs the gamut of all possible cognitive elements
Moral Decisions Normative Ethics
What is right and what is wrong
What is a good decision and what is a bad decision
Ethical principles
Prescriptive - offer recommendations for moral action
They are NOT values permanent, universal, and unchanging
Health care professions operate on a set of ethical principles that are morally established
Normative Ethics: Fundamental to Policy
What makes a “good” action or decision?
Justice
Ethical choices and actions
Justice
fairness
Intrinsic value = moral standing
Procedural justice
Ethical choices and actions
Deontology
Consequentialism
Virtue ethics
Virtue Ethics - Aristotle
