Public Health Policy Vocabulary

Flashcards based on lecture notes about Public Health Policy, focusing on key vocabulary and definitions.

Public Health System

The organized efforts of society to promote health, prevent disease, and protect populations from health threats.

Healthcare System

Focuses on individual-level care, diagnosing, treating, and rehabilitating patients.

Health System

Umbrella term encompassing both the public health system and the healthcare system, along with supporting infrastructure, workforce, policies, financing, and governance.

GDP

Gross Domestic Product; a measure of a country's economic output.

Böhm’s Model of Health System Regulation

A model with three dimensions (regulation, financing, provision) and three actors (state, societal, private).

Regulation (in Böhm's model)

The relation between financing agencies, providers, and potential beneficiaries including coverage, financing, remuneration, market access, patient access, and benefit packages.

Financing (in Böhm's model)

How healthcare is funded, including general and earmarked tax revenues, private out-of-pocket payments, societal funds, and social security funds.

Service Provision (in Böhm's model)

The entities that deliver health services, including governments, NGOs, private sectors, communities, and international bodies like the WHO.

Etatist Social Health Insurance

A system that mixes state control and societal financing, like in the Netherlands, where the government sets rules, healthcare is paid for by society through mandatory insurance, and service provision is largely private.

HiAP (Health in All Policies)

A horizontal, complementary policy-related strategy contributing to improved population health by addressing health in other sectors' policies.

Ottawa Charter (1986)

An international health promotion framework defining health promotion as enabling people to increase control over and improve their health; emphasizes building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.

Vienna Declaration (2016)

Emphasizes health promotion in the context of Sustainable Development Goals (SDGs), focusing on equity, governance, and urban health.

Resilience (in a health system)

The health system’s ability to absorb shocks, adapt to changing circumstances, and transform when needed to maintain essential services, enabled by strong leadership, supportive policies, dual-purpose funding, effective communication, open data sharing, and institutional support.

Democracy

A type of government where the people have the power to make decisions through free elections.

Dictatorship

A form of government where power is concentrated in one individual or a small group, suppressing community input.

Rule of Law

The principle that the rules apply equally to everyone, and no one is above the law.

Trias Politica

The separation of powers into legislative (law-making), executive (law-enforcing), and judicial (law-interpreting) branches to prevent any one branch from gaining too much power.

Health Policymaking

The process of designing, enacting, and implementing a policy to improve the health system and overall outcomes for individuals.

Evidence Informed Policymaking

An approach to policy decisions, ensuring that policies are guided by scientific evidence in combination with other factors.

Allin figure, 2004 (WHO)

Outlines how research evidence is integrated into health policymaking, especially considering the influence of political contexts, highlighting facilitators and barriers.

Welfare State

A system where the government provides key welfare services through solidarity, decommodification, and defamilisation.

Rational Policymaking

A systematic, theoretical way of decision-making based on evidence and logic rather than politics or personal opinions, with clear goal setting, analysis, and consideration of alternatives.

Synoptic model

Similar to rational policy making (seen as the “pure” form of rationalism). Step by step process. Limited feasibility. No support from the whole community.

Deliberative model

Focuses more on discussion and participation (consensus). Different views → public experts, etc. Includes fairness and debates and not just focusing on evidence. May lead to better acceptance of policies.

Incremental Model

A sub-approach of rational policymaking that involves small, gradual changes instead of big over halls, recognizing limits in information and consensus.

Advocacy Coalition Framework

Focuses on the coalition of actors with shared beliefs to shape policies over time.

Multiple Streams Model

Change occurs when the problem, policy, and political streams of an issue align.

Punctuated Equilibrium Theory

Prolonged periods of stability intersected by short bursts of significant change.

Nuffield Ladder

Classifies governmental interventions from the least to most intrusive.

Simon’s Bounded Rationality

Policymakers aim to be rational, but due to limited time, cognitive capacity, and information, they choose a solution that is good enough, not perfect.

Choice Approach

When a decision hasn’t been made yet, different levels of intervention can be used: Doing nothing, Market mechanisms, Structured options, Biased options, Regulation.

Defective Democracy

Holds elections and may have some democratic features, but fails to fully uphold core democratic principles such as civil rights, rule of law, or separation of powers.

Defective Autocracy

Authoritarian regime that incorporates some democratic features, but not enough to qualify as a true democracy.

Political approach in policymaking

Sees policymaking as a process driven by conflict, power, negotiation, and values.

Society as a market model

Individuals act only to maximise their own self interest (welfare, well-being of loved ones) → results in a rise in economic well-being and society as a whole (follows the political approach).

Society as a polis model

People are actively engaged in giving meaning (follows the rational political approach). More cooperation. Motivation is public interest, altruism, solidarity, and moral obligation

Garbage can model

A political model of decision making where decisions are made when problems, solutions, participants and opportunities converge, not through linear analysis.

Interest groups

Organized entities that seek to influence policy decisions to align with their specific goals or values through lobbying, public campaigns, or direct negotiations.

Insider vs outsider interest groups

Insider: not officially part of the machinery of government but are regarded as legitimate by government policymakers. Outsider: organizations that reject a close involvement in government processes on strategic grounds or have been unable to gain a reputation as legitimate participants in the policy process.

Great Food Transformation

Global shift towards predominantly plant-based diets, sustainable agriculture, reduced food waste and overconsumption with the aim to improve global health, protect the environment, and ensure food security for future generations.

Global shift towards predominantly plant-based diets

Reduce consumption of red meat and highly processed foods & increase the intake of fruits, vegetables, legumes, nuts…

What is the problem represented to be?

Suggests that, if you look at a specific policy, you can see that it understands the “problem” to be a particular sort of “problem” .

Agenda setting

Types of agenda setting: Formal agenda, Public agenda, Media agenda. Types of agenda power: The ability to set the political agenda, The ability to keep issues off the political agenda (non-decision-making), The ability to win the frame contest

Hall et al. model

A framework used to explain how certain issues make it onto the government’s policy agenda. Key features: Legitimacy, Feasibility, Support.

Stream Model

Explains how policies get on the government agenda by focusing on timing, opportunity, and strategic action by policy entrepreneurs. A policy is only seriously considered when 3 separate “streams” come together at the same time: Problem Stream, Policy stream, Politics stream.

Shiffman’s Framework

Explains why some global health issues gain political attention and funding, and others don’t. It identifies four categories that influence whether an issue gains global political priority: Actor power, Ideas, Political contexts, Issue Characteristics.

Stone’s theory

Key features:Categorization means drawing boundaries. Numbers are like metaphors. Numbers are political.

Framing

The process of constructing meaning around an issue through emphasis of certain aspects and the overlooking of others. A dynamic and political act to shape the perception and influences surrounding policy making.

Institutions

The structures, such as laws, norms, routines, and belief systems, that shape social interaction and guide how individuals and organizations operate.

New Institutional Theory

A theory that focuses on developing a sociological view of institutions → the way they interact and the way they affect society.

Scott’s pillars

Classification of new institutional theories: Regulative pillar Normative pillar Cultural-cognitive pillar.

Levels of Institutions

Must Rules”, “Must Not Rules”, “May Rules”.

Public mental health

actions aimed at developing the mental health of populations and producing healthy societies. Is not only about the occurrence and prevention of mental disorders in a population but also the promotion of mental health and well-being.

Mental health stigmatization

An attribute that discredits an individual, makes the person different from others, and essentially reduces the person's status from a “whole and usual person to a tainted, discounted one” → cultural-cognitive pillar

Public mental health policy

Promoting - Preventing - Treating. Objectives include increased parity (equality) between mental and physical disorders, reduction of stigma, respect for human rights, a shift from hospital-based to community-based service provision, and strengthening of mental healthcare capacity in primary care.

Cross-country comparison model for work disability prevention (CCC model fpr WDP)

The CCC Model facilitates a comprehensive understanding of how different countries support or hinder the labor participation of people with chronic conditions. It also aids in assessing the transferability of policies and interventions from one national context to another. It’s based on the institutional theory (includes norms and values).

LOLA

Legislation - Organisations - Labour market characteristics - Amazement to translate a policy from one country to another.

Path-dependency

New policies are always dependent upon existing configurations (new path depends on existing path).

Critical juncture

An unexpected incident can change institutions radically. A decisive turning point, usually triggered by a major crisis (e.g., COVID-19), that opens a window for rapid and substantial policy change; radical change.

Policy Implementation

it’s the process of putting decisions into actions to produce the intended outcomes.

Implementation gap

The difference between what the policy architect intended and the outcome of that policy.

Macro Level implementation

National & System-Level Implementation. It’s the highest level, involving central government bodies, ministries, and national agencies.

Meso Level implementation

Regional & Organizational & Institutional Implementation. This level deals with how national policies are put into practice locally, by regional governments, public health institutions, schools, clinics, or NGOs.

Top-down theorists

Top-down theorists developed a list of 6 necessary conditions for effective policy implementation (if all these conditions are met, the policy should be implemented as originally intended).

Policy implementation Theories

Friedman’s Conceptual Framework. Mazmanian & Sabatier model. Elmore’s Backward Mapping Model. Matland’s ambiguity-conflict model.

Elmore’s Backward Mapping Model

Bottom-up approach to policy implementation.

Matland’s ambiguity-conflict model

Categorises policy implementation into 4 types based upon ambiguity and conflict level.

ADEPT Model

Goals are used instead of wants. Obligations are used instead of duties: both policymakers’ professional duties and institutional arrangements of the policy system and the community affected by the system. Resources instead of abilities: policymakers’ individual abilities and the (personnel, finances) capacities of their organisation.

Policy Evaluation

It’s the systematic assessment of the design, implementation and outcome of a PH policy which helps policymakers understand what works, what doesn’t and how this can be used to inform policymakers.

Centers for Disease Control & Prevention’s 6 step framework

1. Engage stakeholders. 2. Describe the Program or Policy. 3. Focus the evaluation design. 4. Gather credible evidence. 5. Justify conclusions. 6. Ensure use and share lessons learned.

What is policy?

It’s a law, regulation, procedure, administrative action, incentive or voluntary practice of governments and other institutions.

Policy evaluation

Assesses policy design, goals, and assumptions in alignment with the desired outcomes to assess the quality and appropriateness of a policy's design prior to its implementation.

Responsive evaluation

Stakeholder-driven, constructivist, negotiation-based evaluation.

Priority Setting

It’s the systematic process of determining which health interventions or services should receive funding or attention based on their relative importance.

Economic evaluations

Ised to set priorities because

Negotiation

Strategic dialogue between 2+ parties with aims of reaching a mutually beneficial agreement

leadership

It’s the art of motivating a group of people to act towards achieving a common goal.

Collaborative leadership

Trying to involve everyone in the organisation in leadership

Managerial leadership

Concerned primarily with running the organisation.

Interdependence

Parties must coordinate with and depend on each other to achieve their own objectives, or they choose to work together because the possible outcome is better than they can achieve on their own.

RDIC Model

It’s based on empirical research and a joint understanding of various theories → organisational behaviour theory, resource dependence theory, and the new institutional theory.