Health Policy, Governance, and Evidence Review Flashcards

Flashcards testing concepts of policy processes, governance structures, implementation models, evidence integration, and global health policy based on the lecture material.

What four types of contextual factors affect policy making according to the lecture notes?

1) Situational factors, 2) Structural factors, 3) Cultural factors, and 4) International (exogenous) factors.

How are situational factors defined in policy making, and what is an example?

They are 'focusing events' that trigger policy attention, such as elections, wars, or earthquakes.

What are examples of structural factors that affect policy making?

Political system, type of economy (planned vs. "free"), technology, infrastructure, GDP, demography, and migration.

What is meant by the 'duality of structure' in policy analysis?

The reciprocal relationship where individual behavior influences the community, market, and system, while the system simultaneously shapes individual behavior.

What is the distinction between agency and power?

Agency is the ability of individuals to act independently and make their own decisions, whereas power is the ability to control resources and influence people to do things they otherwise would not do.

How does authority differ from force or coercion?

Authority is the legitimate right for domination, which is accepted by people, whereas force or coercion lacks legitimate acceptance.

What are the three types of authority described in Table 2.1 and their sources?

1) Traditional authority (derived from customs and social structures, e.g., the Pope), 2) Charismatic authority (derived from individual leader characteristics, e.g., MLK), and 3) Rational-legal authority (derived from formal rules and laws of the state).

What is Steven Lukes' first dimension of power?

Decision making, where A has power over B to do something B would otherwise not do. It is used in parliaments or courts and involves visible conflicts with clear winners and losers.

What is Steven Lukes' second dimension of power?

Agenda setting, where A determines the agenda for decision making, constraining B's choices in a less visible form (such as lobbying).

What is Steven Lukes' third dimension of power?

Power as thought control, where A shapes B's perceptions and interests without B's awareness in a manner contrary to B's actual interests.

How does Pluralism view the distribution of power in society?

Power is relatively well distributed among societies, no individual group has absolute power, elections are open and fair, and citizens have the ability to organize politically.

According to Pluralism, what role does the state play among competing interest groups?

The state acts as a neutral referee between the demands of different lobbies.

How does the Theory of Public Choice view the state and elected officials?

The state is not neutral; elected officials consciously seek to reward particular groups to remain in power, and public servants seek to maximize their own budgets, power, and prestige.

What is the primary critique of the Theory of Public Choice?

It overstates the influence of bureaucracy.

How does Elitism describe society and policy change?

Policy is determined by and reflects the values/interests of a privileged minority; society consists of the few with power and many without, and policy change is merely incremental.

What is a main critique of Elitism theory?

It overstates the capacity of the elite to wield power and overlooks that health policy is often a low priority.

Who constitutes the elite according to Marxism?

The owners of capital.

What is a Unitary government system, and what country is provided as an example?

A system where lower levels of government are constitutionally subordinate to the national government; an example is the Netherlands.

What is a Federal government system, and what are two examples?

A system where sub-national levels are not subordinate to the national government and have substantive powers of their own (though not in all policy domains like the military); examples are Germany and the US.

How do Presidential and Parliamentary systems differ regarding the executive branch?

In parliamentary states, the executive branch IS the parliament (prime minister is chosen through the legislature usually via parliamentary support), whereas in presidential states, the executive branch is not the parliament and citizens choose their president.

What is the difference between Majoritarian and Proportional electoral systems?

In majoritarian systems, the candidate/party with the majority of votes wins (e.g., districts), whereas in proportional systems, seats in parliament are divided based on proportional vote shares.

What two characteristics of states directly affect their ability to make 'good' policy?

1) Autonomy (the extent to which government operates independently, objectively, and without wrong outside influence) and 2) Capacity (the resources, knowledge, and staff required to implement policies effectively).

What are the three bodies of the state ('Tras Politicas') and their core functions?

1) Legislature (enacts laws and oversees executive), 2) Executive (leadership/cabinet supported by bureaucracy that executes policy), and 3) Judiciary (judges/courts ensuring executive acts according to laws).

What is the key structural difference between government and state?

The government can change via elections, whereas the state does not get elected and contains the government.

What is meant by the 'Stewardship' role of the Ministry of Health?

Directing and overseeing the health system, for which the government holds ultimate responsibility (e.g., in the Netherlands).

Why are nationwide health policy changes difficult to realize in federal systems?

Because federal states are already decentralized, health policy decentralization is seen as unfavorable, and executive power often fails to secure parliamentary support.

How is Agenda Setting defined in health policy?

The process by which certain issues come onto the policy agenda from the much larger number of issues potentially worthy of attention by policymakers.

What three factors must a government evaluate according to Hall et al.'s theory before taking policy action?

1) Legitimacy (right or duty to act), 2) Feasibility (potential support and resources to implement), and 3) Support (societal support for the measure).

What are the three streams in Kingdon's Multiple Streams Theory?

Stream 1: Problems (public matters requiring government attention), Stream 2: Policies/Solutions (ideas floating around needing a problem), and Stream 3: Political Will (national mood and parties in government).

When does a 'window of opportunity' open according to Kingdon's theory?

Only when all three streams (Problems, Policies, and Political Will) meet.

According to Shiffman, what four factors explain why different governments take different actions on similar health issues?

1) Ideas, 2) Networks and actor power, 3) Issue characteristics, and 4) Political context.

Is the statement 'The legitimacy of a policy is crucially influenced by financial limitations' True or False?

False (financial limitations crucially influence feasibility, not legitimacy).

What is an 'implementation gap'?

The difference between what the policy architect intended and the actual end result of a policy.

What are the key criticisms of top-down policy implementation approaches?

It is hard to achieve all conditions, real life is far more complex, it overestimates the impact of central government action, and focuses excessively on central decision makers.

Who introduced the concept of 'Street-level bureaucrats' in 1980, and what role do they play?

Michael Lipsky; officials like social workers, nurses, teachers, and civil servants who interpret policies and have discretion to implement them in different ways.

What are the advantages and main challenge of a bottom-up implementation approach?

Advantages: better tailored to local needs and utilizes front-line knowledge. Challenge: blurs the clear distinction between policy formulation and implementation.

What core problem does Principal-Agent Theory highlight in policy implementation?

Decision makers (principals) delegate responsibility down a chain of agents who have discretion, professional views, and resources, making monitoring difficult as hierarchy levels increase.

What does the WHO MPOWER acronym stand for in tobacco control?

M – Monitor tobacco use, P – Protect people from smoke, O – Offer help to quit, W – Warn about dangers, E – Enforce advertising bans, R – Raise taxes.

How does New Public Management (NPM) redefine the role of government?

Government should move from 'rowing' (directly delivering every service) to 'steering' (setting direction and monitoring performance).

What are the five policy instruments utilized under New Public Management (NPM)?

1) Information and persuasion, 2) Regulation, 3) Public provision, 4) Market & market-like incentives, and 5) Performance-based funding / Payment by results.

What are two major criticisms of New Public Management (NPM)?

Increased administrative costs and a disproportionate focus on easily measurable targets at the expense of harder-to-quantify values like the humanity of care.

What is the core focus of 'Digital Era Governance' compared to NPM?

Digital Era Governance focuses on collaboration over competition and using digital tools to empower service users.

What are the four constructs of Normalization Process Theory (NPT) in Implementation Science?

1) Sensemaking (understanding the intervention), 2) Cognitive Participation (commitment to it), 3) Collective Action (teams carrying it out together), and 4) Reflexive Monitoring (evaluating and adjusting as they go).

What is the difference between downstream and upstream behavioral policy interventions?

Downstream interventions target individual-level behavior change (e.g., nudges), whereas upstream interventions target structural or system-level causes.

What two dimensions form Matland's Conflict-Ambiguity Matrix?

1) Conflict (agreement on policy goals/means) and 2) Ambiguity (clarity of motivations and outcomes).

What type of implementation occurs under High Ambiguity and High Conflict in Matland's Matrix?

Symbolic implementation, where the key factor is coalition strength.

What type of implementation occurs under Low Ambiguity and Low Conflict in Matland's Matrix?

Administrative implementation, where the key factor is resources.

What type of implementation occurs under Low Ambiguity and High Conflict in Matland's Matrix?

Political implementation, where the key factor is power.

What type of implementation occurs under High Ambiguity and Low Conflict in Matland's Matrix?

Experimental implementation, where the key factor is contextual conditions.

How is 'evidence' defined in health policy?

Any form of data, information, or knowledge, including, but not confined to, research, that may be used to inform decisions.

Why has the field shifted language from 'evidence-based' to 'evidence-informed' policy?

To recognize that evidence is only one input into a decision alongside values and politics, avoiding an overly technocratic framing.

What is the difference between Formative and Summative policy evaluation?

Formative evaluation occurs in early stages to assess implementation and refine policies in real time, whereas Summative evaluation produces an overall verdict on final costs and benefits.

How do Positivist and Interpretivist perspectives differ in policy research?

Positivism is quantitative and assumes an objective truth exists, whereas Interpretivism is qualitative and treats knowledge and society as actively constructed.

What are the three forms of coloniality in global health research?

1) Power (control over resources in Global North), 2) Knowledge (interpretive injustice; Global South experiences marginalized), and 3) Being (testimonial injustice; Global South limited to data collection while Global North gets credit and authorship).

What are the characteristics and weakness of the 1st Generation 'Engineer Model' of evidence use?

It sees the relationship between research and policy as rational and linear; its weakness is that it is too simple for real-life policy complexity.

How does the 2nd Generation 'Enlightenment Model' describe research impact on policy?

It sees the relationship as indirect and non-linear, bringing communities together to shape broader conceptual understanding rather than directly dictating single decisions.

What is the primary focus of the 3rd Generation / Systemic Model of evidence use?

It focuses on how systems through which policy and research interact constrain or improve evidence use across multi-level coordinated approaches.

What is the 'Strategic Model' of evidence use?

A model (combining 2nd and 3rd Gen elements) where evidence is used politically to support a predetermined position.

Why did UK tobacco control take over $50+$ years to align with scientific evidence?

Due to political and ideological factors—specifically lobbying and tax revenue interests—rather than changes in scientific evidence itself.

What is the difference between genuine uncertainty and manufactured uncertainty?

Genuine uncertainty occurs when facts are truly unknown, while manufactured uncertainty is intentionally promoted to delegitimize expertise itself.

What three knowledge roles does the Netherlands Environmental Assessment Agency (PBL) fulfill?

1) Estimator (producing objective facts/figures), 2) Designer (generating and comparing policy options), and 3) Facilitator (organizing dialogue between science and society).

What are the three knowledge functions through which experts influence policy?

1) Instrumental use (facts directly affecting decisions), 2) Substantiating use (evidence justifying an existing position), and 3) Legitimizing use (knowledge building authority for policy).

What is the 'Double-sided trap' faced by scientific advisory bodies like PBL?

Navigating between Depoliticization by science (hiding political/value trade-offs behind numbers) and Hyperpoliticization of facts (facts being contested along partisan lines).

What are Wicked Problems, and where do they sit in Matland's Matrix?

Problems with no definitive formulation or stopping rule where solutions are better/worse rather than right/wrong; they sit at High Ambiguity + High Conflict (Symbolic Implementation).

What is 'Third Loop learning' in policy systems?

Learning that questions the system's own goals, values, and assumptions rather than merely evaluating if a specific intervention worked.

At what four levels do challenges arise when learning to change policy systems?

1) Political level (short-term focus), 2) Cultural level (output-oriented logic), 3) Structural level (sector-oriented structures), and 4) Agency level (reflexes and routines).

What four defining characteristics describe an interest group?

1) Voluntary membership, 2) Aim to achieve desired goals, 3) Located outside formal government, and 4) Can represent private or public interests.

What is the distinction between Civil Society Organizations (CSOs) and NGOs?

CSOs exist outside government and market structures (e.g., sports clubs, churches), while NGOs are non-governmental, non-market, but structured with paid staff (e.g., Doctors Without Borders).

What is the difference between Insider and Outsider interest groups?

Insider groups are recognized and legitimized by governments for consultation, whereas Outsider groups are rejected or excluded by government.

Which three groups compose the classic 'Iron Triangle' policy model?

1) Executive agencies of government, 2) Legislative committees, and 3) Private market interest groups.

What is an Advocacy Coalition?

A grouping of actors within a policy subsystem (politicians, civil servants, journalists, academics) distinguished by a shared set of norms, beliefs, and resources.

How does John Rawls propose establishing a fair health system?

Through the 'veil of ignorance,' where principles of justice are decided without individuals knowing their own social standing or place in society.

How is a Conflict of Interest defined in health governance?

A set of circumstances creating a risk that professional judgment is or could be impaired by a secondary interest (usually financial).

How does globalization affect LMIC health policy compared to HIC policy?

LMIC health policies are far more subject to external forces, such as rich donor nations or conditionality attached to international loans and grants.

What is the difference between Internationalization and Liberalization?

Internationalization refers to the increasing volume of cross-border flows of goods, people, and ideas, whereas Liberalization is the explicit removal of trade barriers enabling those movements.

What is Jan Scholte's concept of 'supraterritoriality'?

The emergence of transworld geography where technology compresses time and space, allowing social connections to transcend physical territorial boundaries.

What is Multilateralism?

The practice of cooperation and coordination among three or more states to pursue common interests through formal institutions.

What are two major structural criticisms of the World Health Organization (WHO)?

1) It is constrained by sovereign member states, and 2) It relies on a relatively small budget dominated by voluntary earmarks from specific governments and foundations.

How does voting power in the World Bank differ from standard UN agencies?

Standard UN agencies operate on a one-country-one-vote rule, whereas World Bank voting rights are weighted based on financial capital contributions.

What is TRIPS and what health policy domain does it impact?

The Agreement on Trade-Related Aspects of Intellectual Property Rights; it regulates patent protection and severely impacts generic drug production, costs, and availability.

What principle was affirmed by the DOHA Declaration regarding TRIPS?

It affirmed that TRIPS should not prevent member states from taking public health measures, guaranteeing flexibilities like compulsory licensing and parallel importing.

What five actor groups comprise Cerny's 'Golden Pentangle' model?

1) Elected officials, 2) Bureaucrats, 3) Interest groups, 4) International organizations, and 5) Global civil society.

What is Coloniality?

The lasting legacy of colonial power structures and ways of thinking that shape institutions long after formal colonialism ends.

What are Investor-State Dispute Settlement (ISDS) mechanisms?

Provisions in trade deals allowing corporations to directly sue host governments if domestic policy changes threaten corporate earnings.

What three reasons explain why policy transfers between settings often fail?

1) Uninformed policy transfer, 2) Incomplete policy transfer, and 3) Inappropriate policy transfer (ignoring context).

What are four recognized forms of policy transfer?

1) Copying, 2) Emulation, 3) Hybridization & Synthesis, and 4) Inspiration.

How did Doctors Without Borders (MSF) reduce Ebola death rates from $7000/10000$ ($70\text{\%}$) to $3000/10000$ ($30\text{\%}$) in Sierra Leone?

By adopting safe rehydration protocols after consulting a local Ugandan doctor.

What does the Buurtzorg model represent in health policy?

A Dutch nurse-led, decentralized home-care model representing the shift toward local governance.

What is a 'dark nudge'?

A behavioral technique used by commercial industries (e.g., Big Alcohol) to exploit cognitive biases and encourage unhealthy behaviors.

What is the tension between 'outside-in' and 'inside-out' policy approaches?

'Outside-in' relies on societal logic and reflexivity, whereas 'inside-out' relies on plan-driven government routines seeking central control.