Lecture 7 - Policy Actors and Governance Flashcards
Who are the 3 policy actors as per Walk and GIlson’s framework? How do they interact?
The state
The market
Civil society
- The state might regulate the market by setting quality standards or negotiating drug prices with pharmaceutical companies.
- Civil society might lobby the state for increased public funding for healthcare or specific health programs.
- The market might respond to state regulations by developing new technologies or service delivery models that comply with the regulations.
What are the implications of the private sector being a policy actor?
- They have a global reach
- They have large knowledge bases
- They can directly use their resources to lobby governments
- They are major contirbutors to economies (e.g. through taxes and employment)
Explain how food corporations influence health policy according to Scott et al (2016).
- Product reformulation is the process of altering a food or beverege’s product recipe or composition to improve it’s health profile. Has gained traction in the public health policy arena.
- Reformulation initiatives in the US are mainly voluntary
- Examined the food/beverage industry’s responses to a 2014 US government consultation on reformulation to understand political strategy aspects of voluntary reformulation efforts.
- Industry responses fell into 5 categories:
1) Participating in the policy process to define dietary guidelines; lobbying, drafting government policy, donations
2) Influencing framing of the debate; strategic discourse, front groups to advocate for their own goals, deflect (obesity is caused by lack of physical activity), reformulating despite how hard it is
3) Creating partnerships; partnering with health or public interest groups
4) Influencing evidence; use academic sources to support claims, however citing own data - Consistent narrative that the industry was part of the solution
- Used as a way to avert regulation
Why does the medical profession have power?
- Based on a body of knowledge that is highly values by society and the state
- Have control of knowledge which means they can negotiate to gain certain priviledges
- Have unique access to policymakers
What are the 6 types of power as defined by Dalglish et al (2019), and how do they intersect with medical power?
- Medical power: authority, influence or leverage derived from recognised membership in general medicine or other specialties
- Political power: medical doctors usually occupy high appointed positions in ministries of health, and other important government positions, historical link between biomedicine and authorities in LMICs
- Knowledge claims: Medicine is one of the most highly specialised bodies of knowledge, non-health professionals have limited knowledge claims on clinically oriented policies, medical professionals from HICs often have greater access to medical knowledge
- Bureaucratic power: MoH personnel with broad responsbility for national health policy include many medical doctors, self-regulatory role given to the medical profession leads to regulatory capture
- Financial power: medical sphere linked to economically powerful actors (pharma, insurance, device manufacturers, for-profit hospitals), medical officials at international agencies have the power to allocate funding to support decision-making, policy implementation, research etc.
- Network/corporate power: medical networks are often highly cohesive and compromised of elites, often connected via shared educational experience, elite universities closely involved in developing health policy, medical professionals tend to be influential in health policy
- Social-structural power: medical professionals benefit from high social status, one of the most trusted professions, on average more likely to be male, come from an advantaged family and ethnic background
What 2 points may support that life has become over medicalised?
1) natural processes such as menopause and childbirth are treated medically
2) socially derived health issues such as diet, smoking and unsafe sex are being addressed through medical solutions
What are the 6 points proposed by WIlliams et al (2011) to explain the ways the pharmaceutical industry is shifting social norms to increase the price of drugs?
- Selling sickness: redefining health problems as having a pharmaceutical solution
- Changing forms of governance: increasing role of regulatory agencies in promoting drug innovation by streamlining approval processes, reducing regulatory hurdles
- Mediation: reframing health problems in the media as having a pharmaceutical solution (e.g. creating Female Sexual Dysfunction, Restless Leg Syndrome)
- Creation perception of patient autonomy: patients perceive to be more in control on their own health, advocate in public sphere which can influence policies
- Use of drugs for non-medical purposes to create new markets (e.g. ADHD medications for cognitive enhancement in those without ADHD)
- Set expectation that pharma can solve future health problems to get more investment
What did Le Noury et al (2015) find about research about Paroxetine and Imipramine?
- Used for the treatment of depression in adolescents
- Unable to recreate same findings are the drug companies
- Their research showed that neither treatment demonstrated efficacy in treating major depression, and there was an increase in harm for both drugs; increased suicidal ideation and behaviour
- Found more than double the number of suicidal events when compared to the drug company
Explain some factors that contributed to the opioid crisis.
- Pain is the “5th vital sign” was intended to emphasize the importance of assessing the managing patients pain as a part of routine medical care
- Idea that physicians should regularly assess and treat pain contributed to increased opioid prescription.
- Cultural shift to recognise pain created strong demand for pain medication
- Aggressive marketing and lobbying by pharmaceutical companies
o Purdue Pharma severely misrepresented the risks of OxyContin, training sales representatives to carry the message that the risk of addition was less than 1% - Took advantage of regulatory loopholes
o In the US congress can pass (with the president’s approval) new restrictions on drugs or can move drugs into more stringent regulatory categories, but to do so they have to resist medical professionals and the pharmaceutical industry. Pharmaceutical companies want to maintain profits and doctors want to maintain their autonomy.
What impacts does governance have on actors?
Governance arrangements have implications on what actors are included, what actors are seen as legitimate
What impacts does governance have on content (since governance can change actors)?
- By changing which actors have power, governance can change the priorities of a system
- Changing actors can change what evidence is used and hence the decisions that are being made
What impacts does governance have on processes?
- New decision-making structures can mead the decision-making process changes (2nd dimension of power)
What are the 3 global health governance challenges according to Frenk and Moon?
1) The sovereignty challenge: Global health issues often transcend national borders. Diseases can easily spread across countries, and environmental factors impacting health can have regional or global consequences. However, countries are traditionally hesitant to cede control over their health policies to international bodies.
2) The sectoral challenge: Global health issues are not solely confined to the health sector. Factors like poverty, education, sanitation, and environmental quality significantly impact health outcomes. However, the responsibility for addressing these issues often falls under different government ministries or non-health related agencies.
3) The accountability challenge: Effective global health governance requires clear lines of accountability to ensure resources are used efficiently and programs achieve their intended outcomes. However, accountability can be complex in a multi-stakeholder environment with international organizations, national governments, NGOs, and private sector actors involved.
