ST

Lecture 1

Core Concepts: Policy and Health Policy

  • What is policy?

    • Broad statement of goals, objectives, and means that create a framework for activity

    • Can be explicit (written) or implicit/unwritten (as per Buse et al., 2012)

  • The Policy Process

    • Initiation, formulation, development, negotiation, communication, implementation, and evaluation

  • Public policy

    • Government policy or policies of government agencies

  • Relevance to health

    • Health is affected by decisions made by policy makers; link between policy choices and health outcomes is critical

Policy Goals, Tensions, and Interpretations

  • Policy decisions balance competing values:

    • Individualism: personal independence, autonomy, liberty

    • Collectivism: group norms, common good, social justice, social support, ethics

  • Policy goals often include:

    • Security

    • Liberty

    • Equity

    • Efficiency

  • These goals can conflict and be interpreted differently across contexts and actors

Politics, Ideology, and Health Policy

  • Policy is inseparable from politics: ideology and worldviews influence policy preferences and outcomes

  • Politics and ideology matter even if you do not share them; understanding your own political compass helps contextualize policy views

  • Example provided: Political Compass results (from transcript)

    • Economic Left/Right: -7.5

    • Social Libertarian/Authoritarian: -6.97

    • Source: https://www.politicalcompass.org/test/en?page=1

  • Practical takeaway: policy choices reflect value judgments about economy and society; ethical lens matters in policy debates

Equity in Health and Access to Care

  • The least well-off have greater barriers to healthcare access

  • OECD (2023) findings:

    • The least well-off are three times more likely to delay or not seek care compared with the highest earners

    • Waiting times are a primary reason for unmet healthcare needs in many countries, with cost as another barrier

  • Implications for policy: equity in access, affordability, wait-time reductions, and targeted interventions for vulnerable groups

Canadian Health Care Spending: Structure and Implications

  • CHART 1: Canadian health care spending by sector (2018)

  • Key figures available from transcript:

    • Public spending share: 68.9 ext{ exttt{ extpercent}} of total spending

    • Private spending share: 31.1 ext{ exttt{ extpercent}} of total spending

  • Spending categories (approximate backbone of the chart):

    • Hospitals

    • Physicians

    • Other health professionals

    • Pharmaceuticals

    • Other institutions

    • All other health spending

  • Note on the transcript: the exact public/private split by each subcategory (Hospitals, Physicians, etc.) is not clearly legible in the provided text; the two primary figures above are clearly stated

  • Significance: demonstrates how funding streams and sector contributions shape policy debates on access, efficiency, and equity in Canada

Health Financing and Insurance Contexts (Examples in Transcript)

  • ACA Silver Plan premiums (monthly, 2021) by state:

    • General range across states shown: from 307-394 to 597-791 per month (illustrative bands on the transcript’s map)

    • Specific bands mentioned include:

    • 307-394

    • 405-493

    • 495-590

    • 597-791

  • Relevance: illustrates how financing and insurance design affect affordability and policy choices in health systems; cross-jurisdiction comparisons highlight policy trade-offs

Tobacco, Vaping Trends and Public Health Policy Context

  • Tobacco use declines; vaping increases in many OECD countries

  • OECD (2023) data indicate vaping increased in around two-thirds of countries with available data

  • Youth vaping findings (2021 data in transcript):

    • 6.1 ext{ exttt{ extpercent}} of youth reported regular vaping

    • 3.2 ext{ exttt{ extpercent}} of overall population reported regular vaping

  • Practical implications for policy: regulation of vaping products, age restrictions, marketing controls, and public health messaging

Student Engagement, Communication, and Course Tools

  • Questions and discussions

    • All questions should be posted on OWL forums

    • Forums are the first line for questions on course content, mid-term, assignments, and final exams

    • Expected response time: within 48 hours on weekdays; weekends may vary

    • Forums include dedicated spaces for: (1) course content, (2) mid-term exam, (3) project/assignments, (4) final exam

    • Instructors and TAs respond; students may also contribute to discussions

    • Netiquette: be respectful to teaching team and peers; posts deemed inappropriate may be deleted

Textbook and Readings

  • Required textbook: Case Studies in Canadian Health Policy and Management by Raisa Deber and Catherine Mah (University of Toronto Press, 2014)

  • Access: copy obtained via course syllabus; OWL provides assigned readings

  • Textbook structure: described in course materials (no detailed breakdown in transcript)

  • Relationship to course: foundational cases anchor weekly learning and policy concepts

Course Syllabus, Evaluation, and OWL

  • Syllabus and evaluation items are available in the course materials (OWL)

  • OWL as central hub for:

    • Reading schedules and course schedule

    • Discussion boards and forums

    • Assignment submission and feedback

    • Links to external resources (e.g., Health Care Ethics dictionary – Internet Encyclopedia of Philosophy)

  • Week-by-week planning:

    • Week 2: Introduction to Policy, Theory, and a bit of Epistemology

    • Rationale for discussing why policy decisions are made in health care, beyond textbook content

    • Thursday session: first introduction to policy tools

Epistemology, Theory, and Early Preview of Policy Tools

  • Early week topics to set foundation:

    • Why decisions are made in health care policy and delivery

    • Connection between theory, epistemology, and policy practice

    • Not all content is in the textbook; online resources provided in OWL (Health Care Ethics dictionary)

    • First exposure to policy tools planned for Thursday lectures

References and Suggested Readings Mentioned in Transcript

  • Camus and Sartre on freedom and justice (Dresser, 2017):

    • Quote highlights balancing freedom with justice; re-balancing politics to reflect our humanity; “To live and let live” as a guiding principle in complex policy choices

    • Source: Dresser, S. (2017). How Camus and Sartre Split up Over the Question of How to Be Free. Psyche; URL: https://aeon.co/ideas/how-camus-and-sartre-split-up-over-the-question-of-how-to-be-free. Accessed August 11, 2020

  • Buse et al. (2012): definition of policy

  • OECD and national health expenditure data referenced for cross-country and Canadian spending context (data cited in charts and discussion)

Quick Study Reminders

  • Always relate policy concepts to real-world health outcomes and equity considerations

  • Use OWL discussion boards to clarify course content and stay aligned with weekly case discussions

  • Prepare for Week 2 by reviewing the epistemology themes and early policy tools

  • Expect that some charts and data sections in the transcript may be hard to read; rely on the stated key figures (e.g., Public vs Private spending shares, and the range of ACA premiums) and understand their policy implications

Summary of Key Points by Theme

  • Policy and policy process: framework and lifecycle from initiation to evaluation

  • Health policy impact: decisions affect access, equity, and health outcomes

  • Equity and access: address disparities for the least well-off; waiting times and cost barriers matter

  • Financing and expenditure: public vs private shares; major spending categories; cross-country comparisons

  • Political dimension: ideology, values, and personal compass shape policy choices

  • Educational structure: case-based learning, weekly rhythm, and OWL-driven engagement