Week 5: Health Inequities case study + Policy Analysis Flashcards
Health inequities are a health and societal concern because:
-They are inconsistent with canadian values
-They are unfair
-They cause preventable suffering
-They threaten the cohesiveness of community and society
-They challenge the sustainability of the health system
-They have an impact on the economy
What are health inequities
-Disparities we see between diff populations when it comes to health
-Differences between people, more specifically groups
-Differences [in health] which are unnecessary and avoidable but, in addition, are considered unfair and unjust
An example of a health inequity
Access to clean water ? Indigenous people vs Canadians
Free standing approach to defining health inequities
any and all health inequalities are unjust (not very popular view but some people do hold it)
Derivative approach to defining health inequities
health inequalities are unjust if and only if they are caused by unjust socially controllable causes
True or False: According to WHO, the more unjust our social conditions are the more unnecessary avoidable deaths we see
true
When are there inequities in the social determinants of health
unjust if social determinants are affecting health negatively
True or False: Whether a difference is unjust has many different opinions
True
What is the TB incidence rates for indigenous identity and what is it a result of
-0.7 per 100 000 non Canadian’s, and much higher for all different indigenous identities and extremely high for inuit in the north
-result of several other social injustices in society
What are inequities in health influenced by
inequities in the social determinants of health
True or False: the social determinants of health are addressed via policies in non-health sectors
true
What is the reduction of health inequities dependent on
interventions in non-health sectors
Almost all respondents __% felt that everyone in Ontario should have the same opportunity for a long and healthy life. Less than half __% felt that everyone does have the same opportunity to live a long and healthy life. Yet, only __ %felt that Ontario society needs major changes to make things more equitable.”
98%, 47%, 58%
Brian Sinclair
Died after waiting 34 hours for treatment in Winnipeg emergency room
-Entered for bladder infection, might have sat there dead for 7 hours
-Aboriginal man, double amputee, whether racism placed a role
-Worker assumed man was “intoxicated” and was “sleeping it off”
-Security guard who found him dead told staff and they thought he was joking
-Underlying assumptions are racist.
-Changes have been made in ER, family lawyer says more disturbing info will be revealed.
-Not uncommon in canadian healthcare system
True or false if we think its unjust we think its unnecessary
TRUE
Mortality rate among those aged 20-24
0.6 per 1,000 (1,588 in 2021 in Canada)
Mortality rate among those aged 90+
186 per 1,000 (64, 451 in 2021 in Canada)
Universalism
a policy approach where eligibility and access to intended benefits are based simply on being part of a defined population without any further qualifiers such as income, education, class, race, place of origin, or employment status.
-2020-2021 vaccine roll out had diff priority groups created barriers
Canada Health Act and healthcare is an example of..
Universalism
Target Approach
a policy approach where eligibility and access to intended benefits are determined by selection criteria, such as income, health status, employment status, or neighbourhood.
-example mobile health clinic that goes to the citys most vulnerable areads
Proportionate universalism approach
a policy approach that “encompasses both targeted and universal approaches to ensure the population as a whole is proportionately allocated benefits and services.”
-Make sure it’s available to everyone but proportionally rolled out to certain groups
Ontarios healthy baby healthy children policy (example of proportionate universalism approach)
no cost home visits to new mothers or new family. From pregnancy till school entry, get infant related needs. No one is negligible, baseline everyone gets something and low income and other metrics can be eligible for extra support, and will be funded. Universalism that’s also proportionate to needs.
Policy Analysis
“… a process of multidisciplinary inquiry aiming at the creation, critical assessment, and communication of policy-relevant information.”
Require evidence or information from many different backgrounds and perspectives (health activists, economists, etc)
Can aim to create policy, but also to assess policy, also we might want to analyze that policy further to make it more effective or to reach other population.
“… a technique used in public administration to enable civil servants, activists, and others to examine and evaluate the available options to implement the goals of laws and elected officials.”
Retrospective policy analysis
Analysis of policy (whether it exists or not)
Look backwards (that’s what retrospect means), see if it exists
Descriptive; explanatory; often conducted by researchers
What was the nature of the policy?
Why did a policy make its way onto the agenda?
Did a policy successfully achieve its objectives
Which policy instruments were used?
Who were the major actors who influenced the development of the policy and the policy process
A policy has to be written down
false
Prospective Policy Analysis
Analysis for policy
Ahead into the future, what we SHOULD do
Prescriptive; typically requested by decision-makers considering whether to develop and introduce a policy; often conducted by government policy analysts
What are the policy options available to address the issue under consideration?
How should a given policy be formulated?
How should a given policy be implemented
How might a given policy fare if introduced now?
True or false: Policy brief consists of retrospective policy analysis
False: consists of prospective
Why conduct a policy analysis?
-To systematically examine and evaluate the options available to pursue/implement the goals of laws to decision-makers
-To better ensure informed decision-making
-To better minimize bias
-To understand what has worked, what hasn’t worked and why
-To better understand the process of policy making
Policy analysis triangle
Content, Context, Process, Actors
Content
What makes up the policy itself
What is the policy statement
What is/are the policy objective(s)
What are the means through which policy objectives will be pursued (i.e., policy instruments)
What is the relationship between the response to the above questions
What reasons/ evidence are supplied (explicit or implicit) to justify responses to the above questions
Actors
Individuals
communities/ populations
Interest groups
organizations/ corporations
Government bodies
** see stakeholder analysis
Context
Situational factors: E.g., focusing events: wars, droughts, outbreaks
Structural factors: e.g., the political system (democracy vs dictatorship, etc), demographics, economy
Cultural factors: e.g., linguistic differences, ethnic minorities religious commitments
Exogenous factors: e.g., international treaties/ partnerships
Process
Agenda setting, policy formation, decision-making, policy implementation, policy evaluation
Stages
stages of the policy process
Heuristic
an approach to analysis
Stage Hueristic
an approach to policy analysis that breaks down the policy process info stages and analyzes each stage
-focuses on the process by which policies are initiated, formulated, implemented, evaluated
Problem Identification and issue recognition
Why did the policy get on the agenda?
Policy formulation
Who was involved in formulating the policy?
How was the policy arrived at and agreed upon?
Policy implementation
How were the policy’s objectives pursued?
How was the policy put into action/ practice?
Policy evaluation
Did the policy achieve its objectives?
What were the unintended consequences of the policy?
Stakeholder (Actor)
“an individual or group with a substantive interest in an issue, including those with some role in making a decision or its execution.”
Stakeholder analysis
“process through which those making policy or affected by it are identified and their likely position and levels of interest and influence are assessed.”
-identify the policy actors, asses actors political resources (power, influence), asses actors’ political resources (power, influence)
Policy actors
rs
Consumer organizations (e.g., patient groups)
Producer groups (e.g., nurses, doctors, pharmaceutical companies)
Economic groups (e.g., workers who may be affected, industries, companies with health insurance schemes) (tobacco workers, farmers, corner store or variety stores have revenue from selling tobacco)
Ideological groups (e.g., single issue campaign organizations, political parties, researchers) (abortion great example)
Assess actors political resources
Assess the power of each actor to influence the policy decision, through e.g.,:
Voting
Material resources (e.g., money)
Organizing people
Etc.
Understand Policy actors positions and interests
stand policy actors’ positions and interests
Interests: e.g., expected economic effect on their interests; what do they have to gain or lose?
Position: e.g., supportive, neutral, opposed
Level of commitment: e.g., how much of their resources/ influence are they willing to devote to pursuing their interests in the policy (i.e., to support or oppose it)?
