Week 2

Learning Outcomes

  • Focus on understanding power in the policy-making process and health policy context.

  • Define key terms, including power, pluralism, elitism, health policy.

  • Explore Eastman's systems model of policy-making.

  • Examine the Canadian health policy process, focusing on Ontario.

Key Concepts and Definitions

Health Policy Triangle

  • Representation of complex relationships in policy-making including:

    • Who: Actors engaged in policy-making.

    • What: Content and substance of policies.

    • How: Mechanisms and processes of policy formulation.

Definitions

  1. Policy:

    • General Definition: Decisions made by those with responsibilities in a setting.

    • Health Policy: Decisions impacting institutions, organizations, services, funding in health care. Can be made by public and private sectors.

  2. Politics:

    • Defined as the allocation of resources; who gets what, when, and how.

    • Crucial for understanding health policy decisions as they reflect values, goals, and resource scarcity.

  3. Power:

    • Ability to achieve desired outcomes and shape decisions.

    • Distributed unevenly across groups, affecting conflicts and policy outcomes.

The Role of Power in Policy Making

  • Policymaking is essentially conflict resolution.

  • Conflicts may arise from:

    • Competing interests of individuals or groups.

    • Scarcity of resources requiring decisions on their distribution.

  • Outcomes depend on the balance of power between conflicting sides.

Understanding Power

Major Accounts of Power

  1. Power as Decision Making:

    • Robert Dahl's research emphasizes individual/group actions to influence laws through various resources (money, social standing, information).

    • Resources are distributed unequally; availability affects political influence.

  2. Power as Non-Decision Making:

    • Some groups influence which issues are even considered by setting political agendas, limiting discourse to less threatening topics.

    • This eliminates many issues critical to the public from policy consideration.

  3. Power as Thought Control:

    • This form of power influences how preferences are formed or altered, often contrary to individuals’ actual interests.

    • Examples include political actions that manipulate public perception around certain issues.

Case Study: AIDS Epidemic in the U.S. (1970s-1990s)

  • Initial Recognition:

    • Emergence of HIV/AIDS noted around 1981, with clusters of specific illnesses affecting primarily gay men.

    • Stigmatization and media portrayal linked the disease unfairly to homosexuality, impacting policy responses and societal attitudes.

    • Reagan's public silence on AIDS until 1985 contributed to stigma and inaction.

  • Stigmatization Effects:

    • Stigmatization affected policy responses, leading to inadequate research funding and treatment access.

Theoretical Framework for Power in Policy

Pluralism

  • Suggests power is distributed among many groups with no one group dominating.

    • Assumptions include:

    • Individuals can organize into pressure groups.

    • Groups can voice concerns freely.

    • Government is open to lobbying by any group.

    • The state acts as a neutral arbitrator.

Elitism

  • Argues power policies are dominated by privileged minorities.

    • Features include:

      • Society has few with power and many lacking it.

      • Public policies reflect elite interests rather than public interests.

      • Elite groups can manipulate public values to support their own interests.

Eastman's Systems Model of Policy Making

  • Input Phase:

    • Initial demands from public or organizations regarding policy issues.

    • Example: ACT UP demands for HIV/AIDS recognition, funding, and treatment access.

  • Black Box Phase:

    • The decision-making process where inputs are considered, and outputs are generated (can result in action or inaction).

  • Output Phase:

    • Actual results of governmental responses to inputs, including policy implementations or failures to enact policy.

    • Outputs can reflect successful policies or inaction that ignores issues.

  • Impact Phase:

    • The effects of policy outputs on society, which can lead to new inputs if dissatisfaction arises.

Canadian Policy-Making Structure

Levels of Government:

  1. Federal:

    • Responsible for issues affecting the entire country (e.g., defense, immigration).

    • Comprised of legislative (Parliament), executive (Prime Minister and Cabinet), and judicial branches (Supreme Court).

  2. Provincial:

    • Responsible for regional issues including health care, education, environment.

    • Governed by a legislature (e.g., Ontario's Legislative Assembly).

  3. Municipal:

    • Local governments with power granted by provinces to address community-specific issues.

Legislative Processes in Canada

  • Federal Level:

    • Bills can be introduced in either the House of Commons or the Senate, followed by readings and committee stages before receiving Royal Assent to become law.

    • Differentiation between public and private bills.

  • Provincial Level:

    • Similar steps as federal, however, no Senate exists; decisions made solely within the legislative assembly.

    • Royal Assent given by the Lieutenant Governor.

Policy Priorities and Actions

  • Determined through mandate letters from prime ministers/premiers outlining priorities for cabinet ministers.

  • Political party platforms influence which policies are prioritized after elections, allowing public engagement with these platforms as a negotiation tool for advocacy.