Health Policy and Political Analysis

• Health policy and political analysis involves understanding politics for system change and advancing health equity.

Policy - Definition

• Policy is intertwined with politics, especially in public policy analysis.
• Policy can be a deliberately chosen action or inaction reflecting a broad goal or specific intent.
• Policies exist in both public and private spheres, but the focus is on public policy.
• Public and private policies can conflict, especially regarding ethics or legal standards, and are subject to scrutiny.
• Policies may consist of a single decision or a series of related actions.
• Government policies must adhere to the constitution and the law.

Public Policy - Definition

• Public policy refers to actions within the public sector.
• Authoritative decisions made by the legislative, executive, or judicial branches guide behavior.
• Public policy uses legal and constitutional means for change, unlike the private sector’s inability to legislate.
• A course of action is adopted by a government, party, statesman, or organization.
• These decisions and guidelines steer human behavior towards specific goals in either the public or private sector.
• Public policy aims to benefit the majority, prioritizing public interest, unlike the private sector's focus on return on investment and clients.
• Public policy decisions should benefit the public, although defining "public interest" is complex and varies among groups.
• The worldview differs significantly between the public and private sectors regarding global impact.

Other Policy Details

• Perspectives on who benefits depend on the organization.
  • Private: Centers on the bottom line.
  • Public: Centers on benefit to the most people.
• Conflicts and differing goals are integral to public health policies.
• Private sector pushback often occurs, contesting the public sector's role in their domain.
• Integrating public and private interests is crucial in public and health policy.
• Public policies are expressed through laws, regulations, and litigation.
• Litigation can drive policy agendas or be used as a tool.
• Executive orders, proposed rules, and practices/procedures also convey policy.
• Policies may change the status quo and address issues, but implementation and enforcement can vary.
• While policies empower individuals, enforcement is key, especially in sectors like prison healthcare and Medicare.

Public Policy-Making Process

• Demands expressed by actors require policy and political advocates to identify problems Policy and political advocates work to persuade policymakers to make change.
• Includes model legislation or suggested solutions.
• Government involvement includes legislative branches writing laws and holding hearings.
• Legislative branches include agencies and the executive branch is also invovled.
• Agencies and the executive branch both write regulations (generating outputs).
• Policy outputs such as legislation, regulation, or maintaining the status quo occur.
• Policy impacts can result from action or inaction.
• Inaction remains a choice with potential impacts.
• Senators can build support for change through various means like vetoes, appointments, and agency inquiries.
• Hearings, media engagement, and budget influence also drive change.
• Policy change is a lengthy process requiring issue promotion to policymakers and various strategies.

Public Policy - Governmental impact

• Public policy varies based on governmental structure.
• Government structures include monarchies (Oman), dictatorships (North Korea), communist states (China), and democracies (Canada, US).
• Democracies receive primary focus.
• Focus is applicable at state, local, national, and international levels.
• Non-democratic systems have uncompetitive elections and hierarchical power.
• Participation in government relies on ideology and obedience.
• Leader belief dictates the right answer in autocracies.
• Democracies feature free elections, speech, and open participation.
• Democracies allow organizations to participate.
• Democracies have free media without censorship.

Importance of Democracy + Decision Making

• Elections incentivize governments to act right due to accountability.
• Free press enables information flow in government.
• Conflicting values and interests exist in democratic regimes.
• Compromise is possible.
• Inclusive decision-making may be slower but yields comprehensive options and legitimacy.
• Inclusive organizations show better decision-making, unlike autocracies.
• Democratic policy-making is politically charged.
• Policy analysis must address values and their impact on debates.
• Ideas require amenability to various groups.
• Acceptance depends on broad criteria.
• Ideas, interests, and institutions shape policy, with institutions being paramount.
• Policy choices integrate actors and ideas, with exceptional institutions playing a key role (Steinmo & Watts).
• This institutional context explains the failure of U.S. healthcare reform, not flaws in plans or strategies.
• Policy reflects expressed preferences, considering institutional roles in conflict resolution, power distribution, and preference channeling.
• Institutions act as gatekeepers, either allowing or blocking ideas.

US Institutions + Ideals

• Separation of powers is a key feature of U.S. political institutions.
• Dispersed authority is built to impede radical change.
• Executive vs. Legislative Branch
• Committees in Congress share jurisdiction
• State vs. Federal authority
• There is a lack of disciplined party government (traditionally).
• Parties have become more disciplined recently.
• Federalist 51 prevents institutional power concentration.
• The US is decentralized.
• Decisions can be vetoed at many points due to veto power.
• Exceptional institutions exist alongside beliefs and perspectives.
• American exceptionalism stands for distinctiveness.
• American exceptionalism connotes liberty, egalitarianism, individualism, populism, and laissez-faire.
• Distrust of government and self-help tendencies are cultural features.
• Emphasis is placed on equality of opportunity and individual rights.

National Healthcare

• Public opinion and institutions influence healthcare.
• Institutions affect power dynamics and achievable goals (ACA example).
• Political institutions determine policy outcomes.
• Political institutions play a role, regardless of the strength of an idea.
• Progressive reform fragmented centralized power leading to current conditions (post civil war US).

Public Policy

• Public policy involves action or inaction.
• Agreement on the problem or solution is not always achieved.
• Problem definition and solutions reflect societal values.
• Policies reflect ideas, interests, and institutions with American exceptionalism shaping the policy-making environment (Watts & Steinmo).
• Policymaking often jumps to solutions or assumptions, which may be incorrect.
• Media-reported causes may differ from actual causes.
• Stating the problem well impacts the solutions.
• Healthcare problems are real, but nuanced due to varying debates.

Policy Changes

• Policies address well-documented, significant problems.
• Exceptions do occur when not done because of a problem (politically or agenda driven).
• Changes include problem definition and agenda setting.
• Persuasion is key to prioritizing a problem.
• Movement from problem definition into the public domain also drives change.
• Alternative specifications and authoritative choices among alternatives are involved.
• Policy changes require implementation in public or private sectors.
• Public problems lead to public policy solutions, often debated.
• Only certain issues get recognized explicitly, deeming public action necessary.
• No objective problems exist; it depends on perspective.
• Example: PANDAS advocated for.
• This selectivity is necessary as not all personal troubles should be thought of as public problems.
• Advocates and interest groups influence problem perception.

Actions and Impact

• Government receives input from advocates and shapes its agenda.
• Elected officials push for problem recognition.
• Problems are contested and debated.
• Whether something is a problem relies on debate.
• Social constructs define problems differently across time and regions.
• Examples: homosexuality or thousands dying from COVID
• Differing perceptions require advocates to argue the problem's existence while the government assesses it.
• Consequences arise from misfocusing resulting in the wasting of resources.
• Issues compete, requiring momentum for your stance.

Problems Causes

• Definitions often point to a cause
• The type of cause dictates the seriousness of the problem
  • Intentional v. unintentional
  • Unintentional can be harder for a policy change
  • Creates sympathy though
  • Intended Consequences – oppression, blaming the victim
  • Accidental, Unintended Causes – fate, natural disasters, bad luck
• Inadvertent causes - avoidable ignorance, carelessness
• Mechanical causes - machines that perform as designed but cause harm

Defining a Problem

• Consider a problem as harm
• Identify who is harmed by the current situation
• Some criteria that helps justify a problem
  • Impact and scale – magnitude, scoop, severity, geographical scope
  • Market / Government Failure – Causing harm and the problem won't solve itself → policy gaps causing harm because of unintended consequences of policies
  • Efficiency, Equity, Justice: Costing/wasting resources or maldistribution costs
  • Values: community values and moral standards – eg social media use in children
• Defining and justifying an action depends on numbers – but numbers are political and politicized
• Questions to asking about the problem
  • Who is affected → who is affected? Sub populations?
  • Magnitude → what is the size of the problem?
  • Impact - what kind of impact does it have?
  • When does it occur - time dependent?
  • Location – where does it occur?
  • Causes and Risk Factors – What increases the likelihood that the problem will concur?
  • What are the characteristics of those affected?
• Number of factors included in scale
• Impacts across geographic regions are more recognized.
• Advantage an issue targeting a state gets over the state officials
• Big impacts are more likely to get recognized as policy
• Impact depends on the averages
• The number subjective
• Bigger may not mean more Deborah Stone
• Conscience effort to including and excluding people because they will be stigmatized based on arbitrary measurements.
• Definitions matter
• Numbers are symbols and tall stories
• Number symbolize precison and accuracy
• Numbers are political because it shows growth
• Measuring something will start a change and the people will be aware
• Measures create incentive to manipulate
• Measurers are depend on the measure

Considerations

• Incentive for people to make their problem look bigger – then once they are responsible for it then they want to show progress
• Numbers in Problem Descriptions
  • The example jumps back and forth in years which is confusing
  • Why 1991 – do they have more recent statistics? Did they pick a low year?
  • 2.4 million times a month is large when everything else is a percentage
  • "Higher than the legal limit"
• Market and Government Failure
• Problems may be justified on the groups that the market is failing.
• This means you can leave it to the market to manage it - need intervention
• Markets are not operating how we expect
  • Monopolies - consolidation lead to producers setting higher prices and too much power above consumers
  • Externalities – bear cost of production not profit
  • Information failure - no information of potential harms; not fully informed
  • Public good cannot be easily sold so won't provide it or its exploited
• Sometimes the governments are creating the problem
• When government intervention on a market failure has created incentives that lead to a poor outcome or unintended consequences
• Corn subsidies are thought to be contributing to obesity ⇒ subsidies went WAY up corn subsidies allowed farmers to sell corn at lower prices, lower prices for corn syrup is cheaper, cheaper food leads to higher consumption, created incentive for over sweetened food and obesity
• In some cases government policy is creating a problem
• Government intervention of markets are causing a problem
• Some situations may not be interfering but are more problems with the design.
• Be aware about the definitions as that my not be accurate.
• You can make policies in values but it helps metrics

Key Facts for Problem Analysis

• Define the phenomenon
  • What is it?
  • What are they including and excluding important?
  • What's the cause
• How are current counts or measures of impact assessed
  • What is the denominator – comparing to irrelevant or “out of how many.”
  • What's the baseline or the comparison being made
  • Norm or average mentioned
• What arguments justify
  • How significant
  • Values/community standard
• Assumptions
  • What assumptions are embedded in the information?
  • Who is mentored and not mentioned?
  • What information would be helpful or could be needed if you get involved in this issue?

Issues

• Always include situations
• Where do the policies occur?
• Powerless situations may not have an influence
• Problem should match the person that can influence
• Problem should not include a solution
• Should include a why the problem is important

Components for Problems

• You have to evaluate the statements
• Can also find corrections
• What measurement units are used in the infographic? List as many as you can see.
  • Dollars, cost, percentages, total population count, and age groups

Definitions

• Conditions – things seen as intractable.
• Problems – Conditions seen as solvable
• Solutions are important to see the shifts Conditions that has defined has solved
• There must be a human action

Model for Problem

• Kingdon- Explain to people how their problems gets on the stand.
• Kingdon says that time line will more likely when an indicators change
• Change can push to put the audience to agree.
• Always push the number
• Indicators should bound
• Feedback that need to be address to be serious.
• Indicators of attention

Important Elements

• Focusing events = highlight a unrecognizable issues
• Symbol – to bring the attention of the people.

Problems + Solutions

• At some point they are hard to solve.
• Confusion and disagreements.
• You cant force them but there will be changes for others to not do it.
• Changes from the budget

Summarization

• Numbers is a increase of people to recognize has countable.
• Make sure numbers aren't bias.
• You cannot counts may go unaddressed.
• Be aware of the numbers

Points on Numbers

• Number points to the causes.
• Always point causes to create and mislead
• Global indicators

Parts of Problem Discussion

• Gag rules problems
• Need to be careful about not exaggeration problems
• Encourage status code

General Key Points

• Try and keep it trutful
• Have the right definitions
• Its very important to have a analysis on this

Framing of Analysis

• Framing- is important show that problems are addressed.
• How do the audience sees a case
• You must be able to know what makes this analysis unique by highlighting the facts.
• Look at the things that come out of it and what is not.
• Activate information that the audience already knows
• Look at the target and values

Analysis of Framing

• You must know what the text is.
• See what is at hand\
• Framing is a power for advocacy
• To the smaller group
• Can easily be accused
• Derision towards people who work for the government by calling them bureaucrats

Key Points with Framing

• Expend considerable resources on change the framing of issues to support their position and preferences
• There are long term and short term goals for framing
• Be able to identify the bad things and what the reasons are
• Understand the reason and why it happens

Policy and Memos

• Memos is important for context
• Should say to support or not.
• Policy analysis determines the nature of the problem using data, evidence and considers alternative frame
• May have identification
• STEP – is defined
• There are types of problems
• Must know the situation