Understanding Health Policy

Health Policy

• Policy involves decisions by those responsible for a specific area such as health, environment, education, or trade
• It can be made at multiple levels, including government, businesses, hospitals, and schools in both public and private sectors
• Public policy is government policy, defined as what the government chooses to do or not do; inaction on an issue also constitutes policy according to Dye (2001)
• Health policy encompasses public and private policies concerning health that affect institutions, organizations, services, and funding within the public health and healthcare system

Analyzing Health Policy

• Health policy is intertwined with politics, showing variations between countries and variations drivers of policy
• An Economic lens allocates scarce resources for health
• A Public health lens influences determinants of health to improve population health
• A Health care lens addresses health services for individuals
• Policy content defines the goals of a specific health policy while the policy context (who and how) involves conditions for policy change/implementation plus the relevant political landscape

Why Policies are Important

• Health depends on more than just healthcare treatments
• Departments of Health (DOH) are significantly influenced by policy
• Policy impacts determinants of health such as poverty, environment, and education
• Policy can be economic, using taxes on items like alcohol and tobacco to influence behavior
• Policies protect from health hazards through measures like food safety regulations
• They determine service access and availability as well as who is responsible for payment

Health Policy Triangle

• The health policy triangle involves context, actors, content, and processes

Actors: Influencers of Policy

• Actors, at the center of the framework, can be individuals, groups, or organizations
• Entities outside the government, such as lobbyists, corporations, non-governmental organizations, and topic experts, can influence health policy
• Actor influence on policy is related to power, which is often defined by the relationship between agency and structure

Context: Systemic Factors Affecting Policy

• Context includes political, economic, social, local, regional, national, and international factors affecting health policy
• Context includes situational factors like wars, natural disasters, outbreaks, and structural factors, the unchanging elements of society such as the political system and demographic features
• Context includes cultural factors like gender imbalances, ethnic division, inequality as well as exogenous factors, outside pressures, such as international relationships
• Time influences context

The Process of Policy Making

• The Policy Process can be defined as the way in which policies are developed, negotiated, communicated, implemented, and evaluated
• The Policy Process includes problem identification, policy formation, policy implementation, and policy evaluation

Using the Health Policy Triangle

• The health policy triangle can proactively plan a policy (analysis for policy) or retroactively analyze a policy (analysis of policy)
• Can be used in combination
• Policies, like analysis of policy, can be an effective way to develop new policy
• Understanding the four parts of this triangle are important steps to undertake when planning or developing policy

Setting the Health Policy Agenda

• Problem identification is the first step in making or changing health policy
• Issues become important due to changes in context, disease patterns, or actors

The Policy Agenda Defined

• Policy issues are those that the government/influential officials closely monitor
• Current issues include Covid-19 with related mask mandates, distancing, limits, business restrictions, funding for the health system/Covid policies/National Pharmaceutical Care plans

What Issues Matter for Policy

• Some issues, like Covid-19, are obvious forcing policy changes
• Others are related to routine adjustments based on government priorities/pressures
• Health issues can emerge all the time as new information arises
• Bisphenol A in plastics (esp. infant bottles) banned in Canada in 2010
• Other issues can be seen on the horizon such as aging populations needing more health support

The Importance of Power

• Defining something as an issue needing government response requires calling it 'normal'
• Ideologies, assumptions, and public perception influence how a government defines an issue
• How the framing an issue influences how it will be perceived and addressed
• When actors clash over framing, how a issue is framed significantly impacts how it's addressed (and shows power)

Agenda Setters

• Governments primarily set the health policy agenda, with some impacting policy internationally such as the US EPA’s global influence on environmental policy
• Under President George W. Bush, PEPFAR (President's Emergency Plan for AIDS Relief) started in 2003 to combat the global HIV epidemic
• Main messaging was ABC (abstinence, be faithful, condom use)
• The program influenced AIDS policy in Central and Southern Africa but faced criticism for prioritizing abstinence and fidelity
• Governments must prioritize due to facing more issues than they have the capacity to address

Media's Role in Setting the Agenda

• Media can guide public attention to various issues
• Media influence public opinion and thus indirectly influence government
• Social media helps governments set the agenda and evaluate public perception of potential issues
• Social media informs influence policy agendas
• Mass media is typically part of large corporations that guide agendas through media outlets

Policy Scenarios

• A hypothetical policy scenario can be based on consideration of true environmental and public health circumstances
• An example of a real policy scenario is the regulation of Bisphenol A (BPA)
• BPA is a chemical used in polycarbonate plastics and epoxy resins found in food/water bottles and protective linings
• Exposure 100% dietary
• Can migrate from food packaging into food when heated and from repeat use containers
• Quickly absorbed after consumption, metabolized in the liver (BPA-G), excreted in urine (6 hr half-life)
• This endocrine disruptor and estrogenic mimic has potential toxic effects in utero and on newborns
• StatsCan data from 2007 to 2009 Canadian Health Measures Survey showed BPA in urine of 5476 Canadians (6–79 yrs)
• BPA detected in urine of 91% of people
• Urinary BPA-G level of 1.16 μg/L (95%CI 1.08–1.24) for populations and 1.30 μg/L (95%CI 1.17–1.45) for children (6-11 yrs)
• Urinary BPA (<3 μg/L) = dietary intake (<0.1 µg/kg body wt/day)
• This is 40–500 times under the safe exposure level according to Health Canada/European Food Safety Authority (0.05 mg/kg/day) and EPA
• BPA was declared toxic by Canada, setting stage for more bans

Explore the levels and scopes of health policy, from government decisions to impacts on healthcare systems. Consider economic, public health, and healthcare perspectives. Learn how policy content defines goals and influences the determinants of health.