Lecture 5 - Politics and Policy Analysis

Question 1

What are the 3 perspectives on health policy?

Answer 1

1. Health as a technical decision: health is a good thing, no one would oppose it, should undertake decisions to improve health outcomes, policy should be “evidence-based”
2. Health as public policy: health decisions have trade offs, society has different values and concerns so we need to decide what matters the most
3. Health as party politics: health is subservient to broader struggles, health can become part of partisan (strong supporter of party) efforts for power regardless of health outcomes

Question 2

What makes health policy a political challenge?

Answer 2

The policy process

Change involves a political struggle, and political struggle involves power

Question 3

What are the 3 policy change processes?

Answer 3

1. Rationalism
2. Incrementalism
3. Dynamic models

Question 4

What is the Rational view of policy change?

Answer 4

Policy change follows a series of clear steps: the problem is identified, values/goals are decided, alternatives adn considered, a choice is made, and the decision is implemented

Question 5

What are the limitations of the rational view of policy change?

Answer 5

Multiple Actors and Interests: The rational view presents a simplified picture where a single, unified decision-maker weighs options. Policymaking involves a complex interplay between diverse stakeholders with varying goals and values, leading to negotiation, compromise, and power dynamics.

Uncertainty and Risk: The rational view assumes perfect foresight of the consequences of policy choices. However, the future is inherently uncertain, and the long-term effects of policies can be difficult to predict.

Value Conflicts and Ethical Dilemmas: Policy decisions often involve trade-offs between competing values. The rational view doesn’t adequately address the ethical considerations and potential unintended consequences of policy choices.

Question 6

What is the incrementalist view of policy change?

Answer 6

Policy change consists of small changes and adjustments to existing policies

Question 7

What are the dynamic models of policy change? What do they have in common?

Answer 7

Policy change occurs over time, resulting from shifting processes

e.g. Kingdon’s multiple streams approach

Question 8

What are the 4 parts of Walt and Gilson’s health policy framework?

Answer 8

Context, content, actors, processes

Question 9

Apply the Walt and Gilson Framework to the case study of France’s mandatory childhood vaccination policy (2018). Include details on Context, content, actors and processes.

Answer 9

Context
* Social: Herd immunity is crucial to protect vulnerable populations who cannot be vaccinated.
* Political: Governments prioritize public health and reducing the burden of vaccine-preventable diseases
* Economic: Vaccinations are cost-effective by preventing outbreaks and associated healthcare costs
* Cultural: Cultural emphasis on public health and social responsibility. Growing public trust in science and medicine but vaccine hesitancy still exists.
Content
* Since 2018, 11 vaccinations are mandatory for children born on or after January 1, 2018 entering school and day care
* Exemptions are made for medical reasons, but not based on religious grounds
* Public health campaigns promote the benefits of childhood vaccination
Actors
* Policymakers: French Ministry of Health sets vaccination policies and oversees immunisation programs
* Healthcare providers: Doctors, nurses and public health officials administer vaccines and track immunisation records
* Parents: Make decisions about their children’s health
* Pharmaceutical companies: develop and supply the vaccines
* Anti-vaccination groups: limited presence in comparison to other countries, but still spread misinformation
Process
* Public health agencies monitor vaccine effiectiveness and safety
* The Ministry of Health, in consultation with medical experts, defines the mandatory vaccination list
* Public education campaigns use scientific evidence to address vaccine hesitancy and promote informed decision-making by parents
* Monitoring and enforcement mechanisms ensure compliance

Analysis:
* Context: The policy prioritizes public health and herd immunity, aligning with the strong social emphasis on collective responsibility. However, addressing pockets of vaccine hesitancy fuelled by misinformation remains a challenge.
* Content: The specific vaccinations are based on scientific evidence and risk assessments. While exemptions exist for medical reasons, not allowing religious exemptions reflects a strong public health focus.
* Actors: Healthcare providers play a vital role in education and vaccination administration. While anti-vaccination movements have a limited presence, their influence requires effective public education campaigns.
* Process: A science-based approach guides the policy, but public education is crucial to address concerns and ensure compliance. Monitoring and enforcement are essential for maintaining high vaccination rates.

Overall, the policy has achieved high vaccination rates and reduced vaccine-preventable diseases.

Question 10

Context can be removed or included when analysing something. What are the 2 views on context in analysis and what do they mean?

Answer 10

Natural world: we investigating something by decontextualising - holding all other things equal to see mechanisms of effect (e.g. experimentation)

Social world: mechanisms of effect are determined by context. We need contextualisation to explain or understand.

Question 11

What type of validity do experiements offer?

Answer 11

Internal validity. Since lacking external validity, it means the results may not be applicable everywhere

Question 12

Explain why context is important using the case study of Malawi.

Answer 12

Parkhurst et al, 2015

• Global policy recommendation for scaling up male circumcision for HIV prevention
• Malawi was slower to take up this policy recommendation due to strong political discourse
  Potential causes of discourse:
• History of colonisation and dominance by “western world”, perception of “donor agenda”, history of donor dependence and external influence on agendas
• History of contestation for power between groups. Electroal appointments favouring certain groups, and Presidents favouring certain regions or ethnicities
• Circumcision is a strong ethnic identifier; Most Chewa (an ethnic group in Malawi) do not circumcise while Yao-speaking groups do. History of contestation for power between Yao and Chewa.
• Past president of Malawi was Muslin so there were fears over Islamification (since Muslims circumcise)