NURS 605-Social Policy & Global Health Discussion

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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 empha

Three Forms of Social Democracy in Low & Middle Income Countries

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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