3 H policy.pdf

Chapter 2: Power and the Policy Process Introduction Think of policy making as a struggle between groups with competing interests, some in favour of change and others opposed to it, depending on their interests or ideas. For example, health economists often wish to limit the professional autonomy...

Chapter 2: Power and the Policy Process Introduction Think of policy making as a struggle between groups with competing interests, some in favour of change and others opposed to it, depending on their interests or ideas. For example, health economists often wish to limit the professional autonomy of the medical profession so as to control spending patterns. Yet such reforms are often opposed by doctors – some of whom are concerned that this will sieze their professional authority and others because it may affect their income. Understanding of policy making requires the nature of power. • Policy making is, often characterized by conflicts that arise when change is proposed or pursued which threatens the status quo. • The outcome of any conflict depends on the balance of power between the individuals and groups involved and the processes or rules established to resolve those conflicts. What is power? • The ability to achieve a desired outcome – to ‘do’ something. • In policy making, the concept of power is typically thought of in a relational sense as in having ‘power over’ others. • Steven lukes (1974) characterized three dimensions of power as- Power as decision making Power as non-decision making Power as thought control Power as decision making • ‘Power as decision making’ focuses on acts of individuals and groups which influence policy decisions. Robert Dahl’s classic study, Who Governs? • Examined Known preferences of interest groups and compared these with policy outcomes. • found that the resources which conferred power on citizens and interest groups varied (resources were distributed unequally social standing, access to cash, credit and wealth, legal trappings associated with holding official office, jobs, and control over information as particularly important in this policy arena. Power as decision making • Different groups in society, including weak groups, could ‘penetrate’ the political system and exercise power over decision makers in accordance with their preferences. • Few people had direct influence over key decisions, defined as successfully initiating or vetoing policy proposals, • Most had indirect influence by the power of the vote. Power as non-decision making Bachrach and baratz (1962) argued that • ‘Power is also exercised when A devotes his energies to creating or reinforcing social and political values and institutional practices that limit the scope of the political process to public consideration of only those issues which are comparatively innocuous to A’. • Consequently, power as agenda-setting highlights the way in which powerful groups control the agenda to keep threatening issues out of sight. Power as non-decision making Power as ‘non-decision making’ involves • ‘The practice of limiting the scope of actual decision making to safe issues by manipulating the dominant community values, myths and political institutions and procedures’ (Bachrach and Baratz 1963). • In this dimension of power, some issues remain latent and fail to enter the policy arena. Example-In 1999 independent committee of expert reviewed tobacco industry document to assess the influence of the industry on WHO ? Power as non-decision making Activity 2.2 What differentiates authority from coercion and persuasion? Why might this distinction be important in relation to one person getting another to support a policy that s/he wouldn’t have otherwise done? Power as non-decision making Authority is defined as the right to rule or govern. It exists when subordinates accept the dictates of their rulers without question. When authority exists, personal judgement is surrendered to an authority on the basis of trust and/or acceptance. Relationship between Power and Authority Max Weber (1948) identified three sources of authority. 1. 2. 3. Traditional Authority, Charismatic Authority, Rational-legal Authority. Weber’s Three Types of Authority Traditional Charismatic Legal-Rational Source of Power Legitimized by long-standing custom Based on a leader’s personal qualities Authority resides in the office, not the person Leadership Style Historic personality Dynamic personality Bureaucratic officials Example Patriarchy (traditional positions of authority) Napoleon, Jesus Christ, Mother Teresa, Martin Luther King, Jr. U.S. presidency and Congress Modern British Parliament Source of Power Legitimized by long-standing custom Based on a leader’s personal qualities Authority resides in the office, not the person Power as thought control Power is a function of the ability to influence others by shaping their preferences. In this dimension, ‘a exercises power over b when a affects b in a manner contrary to b’s interests. For example, poor people voted for president bush in 2004 in spite of his domestic policies which were not in their interests. Power as thought control • A gains B’s compliance through subtle means. • the ability to shape meanings and perceptions of reality which might be done through the control of information, the mass media and or through controlling the processes of socialization. McDonald’s, the fastfood company, spends billions of dollars on advertising annually. Its symbolic Golden Arches are reported to be more widely recognized than the Christian cross. In China, children have been indoctrinated to accept that the company’s mascot, Ronald McDonald, is ‘kind, funny, gentle and understands children’s hearts’ thereby subtly conditioning this emerging market of young consumers to think positively about McDonald’s and its products. McDonald’s targets decision makers as well as consumers. Prior to a parliamentary debate on obesity in the UK, the company sponsored 20 parliamentarians to attend the European Football Championships in Portugal in 2004. Who has Power ? • If power concerns the ability to influence others, it raises the question ‘who has the power to impose and resist policies?’ 1. Distribution of power depends on specific policy content & Context For example, in a country where tobacco constitutes a considerable proportion of the gross domestic product and is valuable source of government revenue, is the tobacco industry or the Ministry of Health and public health and consumer interest groups likely to have more influence over a tobacco control policy? Yet, in the same country, industry may have less influence over policy to screen for cancer than, for example, the Ministry of Health, the medical profession, and patient groups. Who has Power ? 2. Theories which turn on the nature of society and the State • State is independent of society or a reflection of the distribution of power in society (state- and society-oriented respectively). • The state serving a common good or the interests of a privileged group. Power Holders • “Stakeholders”: those with an interest, or “stake” in an issue: • Examples of stakeholders: • • • • • • • • • • Individuals The Public Healthcare professionals Federal and state governments Managed care and traditional insurance companies Employers The pharmaceutical industry The research community Interests groups Others • Power is held by some and shared by others, varies according to issue Distribution of Power Theories There are three major theories of power distribution: 1.The pluralist model. 2.The elitist model. 3.The Marxist model. Pluralism  The Marxist model • Dominant in liberal democracies • Power dispersed throughout society • Groups self-interest • State arbitrates  Public Choice  Same as Pluralism Do not see state as neutral State is an interest group Policies not in public interest Bureaucrat's power Big government       Elitism Policy dominated by privileged minority  Does not reflect interests of people  Power based on wealth, connections, networks, expertise, education  Power and Political Systems • Easton (1965) • Systems Model of Policy Making • System is a complex whole, has inter-dependent parts, parts change and interact • Constant transformation but balance should be maintained for system survival • Laswell (1936) • Politics (Who gets what when and how) • Political system decides which goods, services, freedoms, rights and privileges to grant and deny, and to whom • In both theories, social context and environment affects and provides opportunities, obstacles, resources and constraints • Supply and Demand Concepts Easton’s political systems model Types of Policies • Legislation, Statutes, Laws, Regulations, Rules (others?) • Government Decision-Making “Black Box” • Some visible, some invisible • Non-decisions keep items off policy agendas Participation • Policy impact: how the policy affects the public • Policy cycle, subject to ebb and flow and pressure from groups • Citizens can participate in various ways (direct, indirect) • Extent depends on type of political system Rational Model of Decision Making • Base policy decisions on reason and science, rather than the vagaries of politics and real life • Analyst does not consider politics and values and recommends the “rational, logical, and technically desirable policy” • Decision maker infuses analysis with politics and values once the analyst’s work is complete- idealistic, too simple? Lindblom (1959) Muddling Through • Incremental • Search and undertake small steps not far from status quo • Tests political waters, not go too far at once • Test of good policy= secure agreement of stakeholders • Marginal adjustment by all stakeholders until agreeable to all involved • More practical, real, less dramatic Change Resistance or Radical Change? • Governments can stagnate, suffer from inertia, become habituated (that’s how its done), resist change, can not see alternatives • In other cases, radical and immediate shift in policy can happen overnight, without precedent (examples?) Other Models • “Punctuated equilibrium”: long time no change, sudden fundamental reform • Baumgartner and jones (1991) • Etzioni (1967) “mixed scanning” combines elements of all theories to reach middle ground. Wide view of problem, detailed analysis of certain key components • Global health policy uses “mixed scanning”