Why is policy needed? Who makes public policy?

[Pages:3]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

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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

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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

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