Why is policy needed? Who makes public policy?
Global Health and Public Policy
Per Pinstrup-Andersen, PhD
Division of Nutritional Sciences Cornell University April 1, 2008
What is Public Policy?
? A plan of collective action ? Regulations, incentives, knowledge ? Policy design and implementation ? Policy vs. program vs. project
Why is policy needed?
? Public goods ? Market failure ? Externalities ? Social vs. private costs ? Market power
Who makes public policy?
? National governments ? Local governments ? International institutions ? Civil society organizations
? NGOs ? Foundations ? Other groups
How is health policy made?
? Government goals
? Whose goals and who has the power?
? Ministry of Health? ? Ministry of Finance? ? Others?
? Stakeholder influence ? Are policy-makers rational?
Government goals
? Gov't maximizing social welfare
? Seeking efficiency gains (more health/$) ? Correcting market failures ? Making social benefits dominate private ones
? Political economy goals
? Seeking gov't legitimacy ? Rent-seeking by public or private groups ? Create market distortions
? Prioritizing: competing demands
1
Stakeholder Groups
? Various parts of government ? Pharmaceutical industry ? Citizens groups (civil society) ? Advocacy groups ? International agencies ? Intended beneficiaries ? Others
Policy feasibility
? Expected response
? Intended beneficiaries
? Compatibility, conflict, compliance
? Other potential beneficiaries ? The various stakeholder groups
? Costs and cost-effectiveness ? Ethical issues ? Health policy as an investment ? Consider both design and implementation
Ethical issues in health policy
? What ethical standards?
? Utilitarianism ? Deontological or virtue ethics ? Human rights ethics
? Trade-offs
? Which health problems? ? Preventive or curative? ? Poor vs. non-poor? ? Poorest or less poor ? Rural or urban?
Interactions Between the Food System and Human Health
Contamination ?Microbial ?Chemical ?Toxic Metals
Water-borne Diseases
Global Food System
Zoonotic Pathogens
Drugs
Health Status
Occupational Hazards
Medicinal Plants
Toxins and Allergens
Energy & Nutrient Balance
Setting Policy Priorities
? Solution-free specification of problem ? Preventive or curative approach? ? Changing environment or behavior?
? Access to clean water, good sanitation ? Access to health clinics ? Attendance at health clinics ? Breast feeding, child care ? Changing diets
? Regulations, incentives, knowledge
Issues in health policy analysis
? Aim to inform policy process ? Stakeholder analysis ? Narrow or comprehensive? ? Positive or normative? ? Which ethical foundation? ? Is utility maximization value-free? ? Are other goals or ethics relevant? ? Single discipline or interdisciplinary? ? Choice of analytical approach
2
Stakeholder Analysis
? Identify and describe stakeholder groups
? Description ? Position on policy issue ? Strength of interest ? Capacity to influence policy debate and
outcome ? Possibilities for coalitions and consensus ? Government position and strength
3
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