WEEK 2: INTRO TO HEALTH POLICY Flashcards
What is the consensus model of policy?
- assumptions from natural and physical sciences
- rational consideration of alternatives
- cost/benefit analysis
- focus on technical issues
- little focus on economic, political, social forces
What is the conflict model of policy?
- recognition of role of ideologies and values
- groups have differential access to power
- economic, political, social focus affect policy
- focus on inequalities
What is the market model?
Ideology = neoliberal
Motivations = self-interest
Chief conflict = self-interest vs self-interest
Nature of collective activity = competition
Building blocks of social action = individuals
Sources of change = material exchange, quest to maximize
What is the polis model?
Ideology = social democracy
Motivations = public interest and self-interest
Chief conflict = self interest and public interest
Nature of collective activity = cooperation and competition
Building blocks of social action = groups and organizations
Sources of change = ideas, persuasion, alliances, pursuit of power, pursuit of public interest
What are the 4 ways of thinking about health?
- medical
- behavioural/lifestyle
- socio-environmental
- structural/critical
Health as medically determined
- most dominant in Canada and elsewhere
- biomedical
- cause and effect
- physiological risk factors and diseases
- rooted in health individualism
- medical intervention
- health policy: medical care delivery
Health as behaviour/lifestyle determined
- focus on behavioural risk factors such as diet or smoking
- goal is to change behaviours
- interventions = health promotion/education and social marketing
- individuals responsible for their health
Health as socio-environmentally determined
- AKA materialism
- focus on community and social such as poverty or living/working conditions
- interventions = community development, political action, advocacy
- no direct focus on effects of larger economic, political, social forces
- still some individualism
Health as structurally determined
- AKA neomaterialism
- rejects individualization
- focused on ideologies and organization of society
- goal is to address inequalities
- intervention = policy change
What are the 3 concepts related to knowledge and evidence?
- knowledge paradigms
- ontology = what is the nature of reality
- epistemology = what is knowledge
- methodology = what tools do we use to generate knowledge
What are the 3 social theories?
- positivism
- interpretivism
- critical theory
What is positivism?
- beliefs - a natural world exists outside of human interpretation, we can acquire objective knowledge about the world
- positive affirmation of theories through scientific method
- universal laws of natural phenomena and human behaviour
- objectivity
- physical, biological, health sciences
- collection and analysis of quantitative data
- post-positivism
What is interpretivism?
- focus = how people understand the world, shared meanings we create to make sense of things
- all views are equal
- lived experiences
- qualitative research
- useful in health sciences, seen as subordinate to positivism
- criticisms are failure to investigate structural systems, doesn’t question what health and health problems are in the first place
What is critical theory?
- goals are to critique and transform society, describe structures and processes of power and hierarchy not considered by positivists and interpretivists
- focus on social, political, economic context
- investigates distribution of resources and lived experiences
- analysis is independent of citizens perceptions
Match approaches to health and research paradigms
medical = positivism
behavioural/lifestyle = positivism, post-positivism
socio-environmental = interpretivism
structural/critical = critical theory
Definitions of policy and public policy
- policy = plans/procedures developed and implemented by govt, agencies, organizations, associations to achieve desired goals
- public policy = course of action or inaction chosen by public authorities to address a given problem or interrelated set of problems that is anchored in a set of beliefs about the best way to achieve those goals
The scope of health policy
- health care and other health related public policies
- the state determines organization of health care and resources allocations for delivery of health care services
- health care financing and delivery
- improving and maintaining the health of the population
- concerned with a range of issues that affect well-being and concern with health care organization/provision
Who was Tommy Douglas?
- father of medicare
- introduced universal, publicly funded medical care
- socialism
- social welfare, old age pension, women’s assistance
Roles of federal and provincial govt in health care
Federal
- fed and provincial govt share responsibility for health care
- fed govt pays some of the costs, sets some of the rules, and provides health care services to some groups
- Dominion Department of Health
- federal influence upon health care occurs through control of revenue transfers to provinces
Provincial
- provincial govt responsible for administration and delivery of health care
- provincial boards of health
- provincial health care plans must comply with 5 principles of medicare
Health care reform
- medicare can be improved
- predominant reports are Mazankowski, Kirby, Romanow
- one outcome of all activities/commissions has been all levels of govt agreeing to focus efforts on reducing wait times for various medical procedures and devising a health care guarantee
