global health

Social Policy & Global Health Chapter 6 Key Ideas ○ A nation’s political and economic structures help shape the way social services including health care are delivered ○ Nations commonly are grouped according to the way they pay for social services ○ Democracy plays an important role in health but some authoritarian governments also maintain good health among their people Traditional Policy Making Cycle Problem presented Solution proposed Proposal accepted Policy implemented Policy monitoring & modification Policy Development Considerations ○ Policy environment: cultural, legal, and political context in which policies are made ○ Solutions sometimes proposed before problem is clearly defined ○ Even with accurate cost-effectiveness data decisions may not be data-based ○ Window of opportunity often relevant ○ More similar to program evaluation Defining the Problem ○ First step in policy making ○ Role of burden of disease analysis ○ May be challenging to quantify in marginalized or mobile populations (selection bias) ○ Making private issues public ○ Domestic violence ○ Media coverage, public attention Program/Policy Evaluation ○ Program should be based on causal evidence ○ Cost-effectiveness analyses are helpful but usually not stand alone ○ Politically powerful constituents can influence decisions ○ Risk and risk perception are important, and prediction is challenging ○ Balance of objective data and narrative interpretations ○ Health may be secondary to other goals (e.g., economy) for decision-makers Measurement Issues ○ Selection bias: people included in the study do not represent the underlying population of interest ○ Randomized controlled trials: the exposure of interest is assigned to participants at random ○ Reduces confounding ○ Sensitivity analysis: limiting the analysis to a specific group of people or definition of exposure/outcome to see if findings hold ○ Can be used to calculate upper and lower bounds Political Economy & Health ○ Economies reflect the allocation of resources within society ○ Political economy: how political and economic institutions interact in a given environment ○ Market socialist countries tend to provide social services directly through government agencies ○ Corporatist states typically provide social services in collaboration with associations ○ Local politics and social norms influence how social services are delivered Political Economy & Health: Low & Middle Income Countries ○ Typically governments are challenged to provide social protections and services ○ Low income, low tax revenue ○ Informal workers may get few or no services ○ Formal: government jobs ○ Colonial histories may have contributed to underdeveloped institutions ○ Services not for locals, civil wars ○ Clinton & Blair “third way”: markets exist but social programs are emphasized Three Forms of Social Democracy in Low & Middle Income Countries Feature Radical Social Democratic Classical Social Democratic “Third Way” Unit of organization Class Entire society Individual or society Social goals Equity Solidarity, growth Market-based growth Social policies Universal entitlements, redistributive policies Universal policies, no eligibility requirements Means-tested benefits, accessible education, poverty reduction Benefit levels Traditionally high, now variable Pretty high universally Fairly low but with subsidies Example countries Kerala, West Bengal Costa Rica, Mauritius Chile, Uruguay Health-Optimizing Social Policies ○ State understands the needs of the population ○ Well organized state with multilevel communication, adequate resources, and strong infrastructure ○ A robust civil society to demand some distribution of new wealth ○ A history of competition, compromise, accountability, and feedback ○ A strong political party with health sector allies to coordinate efforts and lead program development