lecture 3

Policy Landscape and Everyday Realities

  • Observation: daily life dominated by cheap fast food; policy questions arise about affordability, access, and what policies should do when people log meals or meals become part of daily life. Discussion includes influence of celebrities/influencers on behavior, but speaker notes they personally don’t follow them.
  • Influence of consumer trends on policy needs: affordability of hair/beauty trends and other lifestyle choices (e.g., hair dyes) discussed as part of how people invest in themselves, with a caveat about costs and weaknesses but overall seen as a step in the right direction.
  • Basic policy levers mentioned include subsidies and income supports that affect children and families; emphasis on how financial support changes child poverty rates.
  • Concrete policy questions raised:
    • What impact do monthly child benefits have on child poverty if such income streams were removed?
    • How does minimum wage compare to a living wage in terms of real ability to cover essential needs?
  • Examples of specific policies discussed:
    • Childcare subsidies and monthly payments for children reduce poverty and support development.
    • Minimum wage vs living wage debate; living wage often misunderstood as unattainable but framed as earnings just sufficient to maintain a basic standard of living.
    • Agricultural policies and environmental protections as major policy areas.
    • Immunization policies and public health implications; concerns about governments making immunizations optional and the risks to vulnerable students.
    • Tariffs and their impact on food pricing and supply chains; links to food deserts and where people can access affordable nutritious food.
  • Real-world consequences discussed:
    • Immunization and herd immunity versus opt-out policies; risk to immunocompromised students in schools.
    • Measles outbreaks referenced: Alberta reportedly having measles cases comparable to or exceeding those in the US, highlighting public health risk.
  • Education and taxation topics:
    • Free college education as a potential policy to expand workforce in health care (doctors and nurses) and reduce debt burdens for students.
    • Comparison with other wealthy countries where postsecondary education is cheaper or free; discussion of how taxes support such models and the fear of taxes here.
    • Tax base considerations: Alberta vs Nova Scotia; resource wealth and tax capacity influence regional opportunities and living standards.
  • Economy, resources, and regional disparities:
    • Alberta’s oil wealth discussed as a factor in regional prosperity; Nova Scotia described as having fewer valuable resources, affecting the economy and tax base.
    • The economy is described as symbiotic: oil workers and farmers both contribute to the national economy; decreased oil demand affects communities, but farming remains essential.
      -Housing costs and living conditions differ by province; migration between provinces to seek better wages or living conditions is common.
  • Equity vs equality vs justice: core framework for evaluating policies
    • Equality = treating everyone the same (e.g., giving everyone the same exam time).
    • Equity = tailoring supports to individual needs (e.g., more time for someone who needs it due to processing differences).
    • Justice = ensuring equal opportunities regardless of identity or background; addressing the underlying barriers and opportunities in a system.
    • Example: exam accommodations illustrate how equal treatment can fail to produce fair outcomes; equity provides necessary adjustments to enable meaningful opportunity.
    • Intersections of disadvantage (gender, race, age) compound barriers; policy must address overlapping vulnerabilities (intersectionality).
    • The difference between resources (equal distribution) and opportunities (adequate supports and access) is emphasized as essential to achieving justice.
  • Practical applications and rhetoric:
    • Caution against framing equity as a policy ‘favor’; aim for universal opportunities that are not dependent on identities.
    • Justice is achieved when opportunities are alike for everyone, irrespective of social determinants of health.
    • The discussion invites students to consider how policies should be designed to ensure everyone can thrive, including people with genetic conditions or disabilities who may require accommodations (e.g., ramps, wheelchairs).
    • A metaphor used: equal shoes for all may not fit; equity involves providing the right size or supports for each individual.

Foundations of Sustainable Development and Global Health Policy

  • Historical context of global health governance:
    • Post-World War II era: UN foundation to prevent conflict and foster development; a shift away from colonization toward decolonization and coordinated global development.
    • Early health systems were often charity-driven and church-based; modern health systems emerged with structures supported by philanthropy and international organizations (e.g., Rockefeller, Heritage) to build sustainable health infrastructures.
  • Emergence of global health frameworks:
    • The United Nations (UN) and global health declarations/guidelines emerged to coordinate health, economics, and security in a post-war, decolonizing world.
    • Initial global health focus prioritized communicable diseases (e.g., cholera, diarrhea, tropical diseases) due to widespread outbreaks.
  • Millennium Development Goals (MDGs) and shift to Sustainable Development Goals (SDGs):
    • MDGs emerged in the early 2000s with a set of targeted goals to address extreme poverty and health inequities; there were eight major goals guiding global action.
    • In 2000–2015, progress included substantial reductions in extreme poverty and undernutrition, with campaigns to expand school enrollment and health interventions.
    • Specific metrics discussed:
    • Extreme poverty aimed to be reduced by half from the starting baseline over 15 years, using a poverty measure historically defined as earning below a certain per-day income (recent discussions reference $1 per day, later $3 per day as thresholds in historical contexts). In LaTeX form: 1\ ext{USD per day} and 3\ ext{USD per day}.
    • Undernutrition among children under five (wasting, stunting, underweight) decreased as part of nutrition improvements.
    • Maternal mortality, child mortality, school enrollment, and access to vaccines improved due to global campaigns (breastfeeding promotion, nutrition education, food security programs).
  • Millennium Development Goals outcomes (approximate narrative):
    • Maternal mortality, child mortality, and nutrition improved; HIV, malaria, and TB control achieved through health education and destigmatization, enabling better testing and treatment uptake.
    • HIV stigma reduced, leading to better testing and treatment adherence; malaria and TB interventions contributed to mortality reductions.
  • Transition to the Sustainable Development Goals (SDGs):
    • Adopted in 2015 as the successor to the MDGs, with 17 goals and a broader, more integrated approach for 2030.
    • 17 SDGs call for inclusive, sustainable development with a focus on equity and environmental protection, requiring cross-sector collaboration among civil society, public sector, and private sector.
  • SDGs and their targets:
    • End poverty and hunger; ensure universal access to water, sanitation, and sustainable energy.
    • Promote inclusive education and decent work; build resilient infrastructure and sustainable cities.
    • Reduce inequalities (with emphasis on gender equality); protect the environment and combat climate change.
    • Promote peaceful and inclusive societies; foster global partnerships.
    • These goals collectively aim to improve life quality and provide agency for individuals to earn a livable wage and lead dignified lives.
  • Progress and challenges since the SDGs:
    • COVID-19 caused significant setback, with backsliding in health and nutrition indicators across many regions.
    • Ongoing geopolitical tensions and funding volatility affect global health initiatives; debates around involvement with UN agencies like WHO and potential withdrawals impact progress.
    • Trade disruptions and funding shocks threaten nutrition programs, vaccination campaigns, and cancer research trials, potentially erasing years of progress if funding remains unstable.
    • The SDGs’ reliance on sustained nutrition investments is underscored; nutrition is described as central to achieving many SDG targets (undernutrition, overnutrition, and overall food security).
  • The role of nutrition in SDGs:
    • Nutrition is foundational to achieving SDGs; addressing both undernutrition and overnutrition is essential to meet health and development targets.
    • Nutrition programs influence maternal and child health, education outcomes, and economic productivity.
    • The need to integrate nutrition into broader policy discussions across health, education, agriculture, trade, and social protection is emphasized.

Equity, Justice, and Social Determinants of Health in Policy

  • Key terms and distinctions:
    • Equality: giving everyone the same resources or opportunities.
    • Equity: providing tailored supports to meet individuals’ specific needs and barriers.
    • Justice: ensuring equal opportunities and outcomes by addressing systemic barriers and enabling participation for all.
  • Illustrative examples:
    • Exam accommodations on campus: giving everyone the same time (equality) may disadvantage some students; providing extra time for those who need it (equity) improves outcomes.
    • People with disabilities may require ramps or other accessibility supports; without these, equity is compromised and opportunities are limited.
    • Intersectionality: overlapping identities (gender, race, age, disability) create compounded disadvantages requiring targeted interventions.
  • Practical implications for policy design:
    • Policies must address not only resource distribution but also opportunities and structural barriers.
    • Upstream interventions (education access, health equity, accessible infrastructure) are essential to achieving justice.
    • Avoid framing equity policies as favors; instead, promote universal opportunities that accommodate diverse needs.
  • Regional and resource disparities as equity concerns:
    • Alberta’s resource wealth (oil) versus Nova Scotia’s limited resources illustrates how uneven resource distribution affects economies, tax