Policy influences upon health
Session aims
• To explore what social policy is and how the
policy making process works
• To show how social policy influences
individual health in a variety of ways both
positively and negatively
• To identify the principles of healthy public
policy
What is social policy?
• Social policy can be described as a field of activity decided upon and
implemented by the government, a course of action and indeed a
web of decisions rather than a single decision (Hill 1997)
• Policy usually is a stance towards a particular topic and involves a
cluster of related decisions and actions often dealt with in a
consistent fashion (Harrison 2008)
• Social policy is often concerned with tackling social problems and
bringing about change
• The policy making process in which policy paths are determined is
also complex and dynamic, itself subject to a range of influences
from various groups and stakeholders who have an interest in
directing policy
What is health policy?
• Blakemore and Griggs (2007) define health policy
in two ways
– as the efforts made by the government to improve
health through both services and medical treatment
– as any activity undertaken by the government that
affects health and illness
• They argue that the wider social and
environmental influences on what happens to us
in the doctor’s surgery or hospital are reflected in
government policy.
Getting issues onto the policy agenda
• Certain issues become important in policy terms and make
it onto the policy agenda
• The media has often played a role in the UK in framing
specific health issues as important, for example, the
unavailability of life-prolonging drugs for cancer patients
has had a wealth of media attention, as has the refusal of
treatment for patients based upon certain criteria such as
their refusal to stop smoking, change their lifestyle or
because of their obesity
• Powerful corporate interests group can often work with
politicians and government officials to negotiate and lobby,
as a mechanism to serve their private corporate interests
particularly within the USA (Crinson 2009)
Models of policy making
Model of policy making
Description
Rationalist
Policy makers have a good understanding
of the problems and make clear, rational
decisions
Incrementalist
Policy makers do not start with a blank
sheet, they respond to issues and make
small and incremental changes
Pluralist
Policy is understood to emerge from the
interaction of different parties at all
stages of development and
implementation
Institutionalism
Policy is created by government
institutions and implemented by them
Policy communities
Policy is made within specific
communities via networks such as those
that exist between public and private
actors
Stages of the policy-making process
• The three key stages described by Harrison
(2008) are
1.
2.
3.
the public policy agenda – how and
why do issues come onto the agenda?
alternatives and choices – are policy
choices rational?
implementation- are choices put into
action and if so, how so?
How does policy act as a determinant
of health?
• Health policy can be described as efforts by the
government to improve health, welfare and medical
treatment
• Health care policy tends to focus upon the medical services
that are delivered within hospitals and across communities
• Measures to tackle health related problems such as alcohol
consumption, obesity, inactivity are all relevant to health
• Health policy is also important in attempting to tackle
inequalities by trying to change the circumstances in which
people live such as housing conditions, the local
environment and the distribution of income in society
(Hudson et al 2008)
The British Welfare State
• Welfare policy is important for health
• There are different models of welfare across the world
• The UK welfare state was established during 1945-50 to
tackle 5 giants (Beveridge 1942)
– Want – people did not have sufficient income
– Idleness – unemployment because there were not enough
jobs
– Squalor – poverty and poor housing conditions
– Ignorance – gaps in educational provision
– Disease – poor health made worse by a lack of affordable
and accessible medical care.
The UK welfare system
• The 5 giants underpin the modern welfare system,
based upon five pillars of social security
employment, housing, education and health (Hudson
et al 2008)
• Several acts of parliament established a number of
welfare benefits, enabling mass education and health
care free at the point of consumption for the UK
population
• The principles of UK welfare have fundamentally
remained the same but debates continue about its
future
Health is political
• Health and therefore health policy are political because
population health is related to the actions of the
government and the policy environment in which
people live
• Politics is important in health care within every country
with governments intervening in health care provision
across the globe in a variety of ways
• There are many different clusters of values in policymaking, often associated with different political
approaches and parties and we each hold our own
ideological viewpoints, which influence our attitudes to
health and health care
Ideology and health care
Ideology
What it means for health
Conservatism
• Reductions in public expenditure
• Expansion of the private sector
• Increased inequalities
Neo-liberalism
• Emphasises both privatisation and
individual responsibility for health
• Increased inequalities
Socialism
• Expansion of services
• Equality of provision
Nationalism
• Context dependent
Feminism
• Changes in service provision and
treatment to promote female equality
Environmentalism
• Sustainable development for health
• Reduced inequalities
Ideology and health care
• Navarro & Shi (2001) argue that population
health is the best in countries that have social
democratic governments, after analysing
evidence from a range of countries including
Sweden, Denmark and Austria.
• Health care in the USA is underpinned by neoliberal ideology, which results in more inequality
and poorer health outcomes (Kaiser Family
Foundation 2009)
• The principles of equality and redistribution of
health are seen as fundamentally good for health
The UK NHS
• Based upon the ideological principles
– rights for every citizen
– the provision of care as comprehensive
– universal care
– free to all at the point of consumption
How important are health services?
• There is an array of evidence to demonstrate that
health and illness are determined by many
factors other than individual treatment
• Only 25% of the health of a developed population
is attributable to its healthcare system (Harrison
& Macdonald 2008)
• Health services favour clinical interventions to
treat illness and disease, rather than dealing with
environmental and cultural factors that cause illhealth in the first instance
Healthy Public Policy
• Healthy public policy is policy that has a clear and
explicit concern for health
• As the determinants of health are so broad, healthy
public policy needs to have a broader focus than just
health
• The 2006 health bill in the UK ensured that smoking
was made impossible in many spaces. The primary
objective of this healthy public policy was to reduce
exposure to second hand smoke for workers and the
general public, with the secondary objective of
reducing overall smoking rates
The broader policy environment and
health
• Many government activities affect health and illness
for example, the taxation of certain products, the
regulation of air and water pollution, the safety of food
and the working environment (Blakemore & Griggs
2007)
• The biggest health outcome gains have resulted from
public health measures such as removing impurities
from water and improving nutrition (McKeown 1979)
• The introduction of compulsory seat belt wearing in
the UK in 1983 as a transport policy has had clear
health benefits by reducing the number of deaths in
car accidents
Policy as detrimental for health
• The broader policy environment can also be detrimental to
health
• The policy to generate nuclear power led to the 1986
Chernobyl disaster which caused many long term health
effects that are little understood (Crinson 2009)
• 2005 changes to the UK licensing laws allowing extensions
to the hours in which alcohol can be sold led to what critics
called a twenty four hour drinking culture (BBC News
2005). These changes were criticised in relation to
potential negative health outcomes associated with
additional alcohol consumption in a country where death
rates for chronic liver disease and cirrhosis have risen in
recent years and are well above the European average
(DoH 2007)
Fiscal policy
• Policy can be used as a mechanism to try to changing people’s
social and emotional well-being and improving their health by
generally tackling the economic circumstances in which they live
• There is a large bank of evidence that shows how income levels are
strongly correlated to the health of people
• Policy can be designed to try to support those on lower incomes for
example to redistribute income by applying progressive taxation
rates
• Policy concerned with money and general economics used to try to
tackle problems such as inequality will also benefit health
• Wilkinson & Pickett (2009) argue that income distribution provides
policy makers with a way of improving the well-being of whole
populations
Summary
• Social policy as a discipline is crucial in helping us to
understand how the social and economic environment in
which we live influences our health through the
mechanisms of health and welfare systems
• Health and welfare policy are important determinants of
health, underpinned by complex ideological values and
beliefs
• Health policy and healthy public policy are important for
our health, but the complexity of the social policy field
means that many policy sectors are important in
determining health outcomes