LECTURES POLICY, MANAGEMENT AND ORGANISATION IN IPH
Introduction (Ch.1)
Public health as a global challenge. Politics is a about who gets what when and
how (definition). On a global scale no paramount body for making binding
decisions -> differentiated policy. Governing is a multi-level multi-actor game:
- Variety of parties (actors)
- Public/private/non-governmental not-for-profit, etc
- Operating on a local regional national and supra-national level
- Negotiating arrangements in various ways
There is a global dynamic, with nation-states:
- Within a certain geographical territory
- In which inhabitants share a (minimum of) cultural identity
- The state is the paramount organization for conflict management and and
coordination
- With (de-) centralized governmantal arrangements
- Capable of making binding decisions
- And maintaining a monopoly on the legitemate use of force
Global health and international public health are intrinsically intertwined.
International public health: interactions between multiple nation-states to set
and implement an international foreign policy agenda with a focus on trade and
diplomacy to adress the global burden of disease. International health becomes
global health when the causes or consequences of a health issue circumvent,
undermine, or are oblibious to the territorial boundaires of states and thus,
beyond the capacity of states to address effectively through state institutions
alone.
Governance refers to sustaining co-ordination and coherence among a wide
variety of actors with different purposes and objectives, such as policical actors
(and state instituions), corporate interests, civil society and transnational
organizations.
(Nation-state based) political institutions no longer exercise a monopoly on the
orchestrations of governance. No sovereign actor is (solely) able to steer or
regulate. BUT there are very much still there, they do have interests.
Governance in public health is about the formal and informal rules that distribute
roles and responsibilities among governments, providers, and beneficiaries that
shape the interactions among them.
Three ways (mechanisms) to create social order and resolve problems. How to
formulate and address shared problems?
- Self-organisation of societal actors
- Market dynamics
- ‘Hierarchy’: state organisation
Market logic, key assumption: in a free market, self-interest will inevitabiliy result
in a beneficial situation for all without central planning.
‘Hierarchy’: government logic. Key assumptions:
- Citizens are born as free people with inalienable rights
- They hive off some of their rights to a state organisation
- That limits them to a certain extent in their freedom
, - In exchange for safety and stability
- (Hence: the state’s monopoly on the legitimate use of force)
Why would a governement be allowed to act? Why do we trust the government.
Having a government in place, as a society we give our support and trusy for
safety and services. The government gives accountability so we give our vote
and trust to hold up that government. (Democracy setting). There is a social
contract between society and the government.
WHO does not have a social contract, but there are other reasons why we trust
them. However, there are limits to what they can do.
Whose problem is being addressed, how is the problem framed/articulated. A
problem is never given, who gets to decide how we frame a problem.
Problem: a discrepancy between a situation as experiences (what is) and a
desired situation (what ought to be). “What is” is not a given.
Policy: constructive action that moves the community from a flawed present
toward an improved future.
A flawed present: problems
An improved future: solutions.
- A (plan for a) course of action, adopted, or proposed by an organization or
individual
- Usually written down in documents but may be implicit/not written down
- Broad statement of goals, objectives and means that create framework for
activity
- Public policy: in view of the benefit
Analyzing public policy > policy triangle
, Puzzling and powering - the policy process (Ch.2)
An issue:
- A matter of concern (for some or many, possibly you yourself), here or
elsewhere, related to public health
- That has your attention
How to go about it: how to make sense of it? = analysis
And how to do so from a perpsective
To make sense of an issue the concepts of theory are important.
Models of policy decision making
Rationalism: the ideal model of decision making (theory to make sense of policy
making).
Policy makers reason logically, following these steps:
1. Policy makers are faced with a particular problem
2. Goals, values and objective are clarified and ranked
3. Various alternative solutions are considered
4. Costs and benefits of each alternative are investigated: cost-benefit
analysis
5. Each alternative choose the alternative that has the highest net benefits
6. Policy makers choose the alternative that has highest net benefits (for
when the other policy does not work)
Critisim on the rational model:
Does not describe how policies are made in practice:
- The problems policy makers face are complex
- Policy makers lack the time and information to make predictions about all
costs and benefits of all alternatives
- Policy makers are not value-free and prefer certain types of solutions
- No one can know all options: bounded rationality
- Past policy determines present policy
- There are all sorts of external pressures on policy makers
Rational model prescribes how policy ought to be made – normative/prescriptive
model.
Incrementalist perspective: alterntive theory to make sense of policy making.
Describes how policy is actually make:
- Selection of goals/objectives is reasoning away from the problem rather
than towards the solution
- Policy makers look at a small number of alternatives that differ marginally
from existing policies
- Of each alternative, only most obvious costs and benefits are considered
- Best decision is the option for which there is agreement among policy
makers
Reinforces status quo
Theories on decision making: policy making = puzzling
Problem/issue = point of departure
Public policy is:
- Answering the question ‘what to do next?’ in view of some problem
- On behalf of society
- In order to mitigate or resolve it
- In a collaborative process, co-determines by a broad set of factors and
actors
Introduction (Ch.1)
Public health as a global challenge. Politics is a about who gets what when and
how (definition). On a global scale no paramount body for making binding
decisions -> differentiated policy. Governing is a multi-level multi-actor game:
- Variety of parties (actors)
- Public/private/non-governmental not-for-profit, etc
- Operating on a local regional national and supra-national level
- Negotiating arrangements in various ways
There is a global dynamic, with nation-states:
- Within a certain geographical territory
- In which inhabitants share a (minimum of) cultural identity
- The state is the paramount organization for conflict management and and
coordination
- With (de-) centralized governmantal arrangements
- Capable of making binding decisions
- And maintaining a monopoly on the legitemate use of force
Global health and international public health are intrinsically intertwined.
International public health: interactions between multiple nation-states to set
and implement an international foreign policy agenda with a focus on trade and
diplomacy to adress the global burden of disease. International health becomes
global health when the causes or consequences of a health issue circumvent,
undermine, or are oblibious to the territorial boundaires of states and thus,
beyond the capacity of states to address effectively through state institutions
alone.
Governance refers to sustaining co-ordination and coherence among a wide
variety of actors with different purposes and objectives, such as policical actors
(and state instituions), corporate interests, civil society and transnational
organizations.
(Nation-state based) political institutions no longer exercise a monopoly on the
orchestrations of governance. No sovereign actor is (solely) able to steer or
regulate. BUT there are very much still there, they do have interests.
Governance in public health is about the formal and informal rules that distribute
roles and responsibilities among governments, providers, and beneficiaries that
shape the interactions among them.
Three ways (mechanisms) to create social order and resolve problems. How to
formulate and address shared problems?
- Self-organisation of societal actors
- Market dynamics
- ‘Hierarchy’: state organisation
Market logic, key assumption: in a free market, self-interest will inevitabiliy result
in a beneficial situation for all without central planning.
‘Hierarchy’: government logic. Key assumptions:
- Citizens are born as free people with inalienable rights
- They hive off some of their rights to a state organisation
- That limits them to a certain extent in their freedom
, - In exchange for safety and stability
- (Hence: the state’s monopoly on the legitimate use of force)
Why would a governement be allowed to act? Why do we trust the government.
Having a government in place, as a society we give our support and trusy for
safety and services. The government gives accountability so we give our vote
and trust to hold up that government. (Democracy setting). There is a social
contract between society and the government.
WHO does not have a social contract, but there are other reasons why we trust
them. However, there are limits to what they can do.
Whose problem is being addressed, how is the problem framed/articulated. A
problem is never given, who gets to decide how we frame a problem.
Problem: a discrepancy between a situation as experiences (what is) and a
desired situation (what ought to be). “What is” is not a given.
Policy: constructive action that moves the community from a flawed present
toward an improved future.
A flawed present: problems
An improved future: solutions.
- A (plan for a) course of action, adopted, or proposed by an organization or
individual
- Usually written down in documents but may be implicit/not written down
- Broad statement of goals, objectives and means that create framework for
activity
- Public policy: in view of the benefit
Analyzing public policy > policy triangle
, Puzzling and powering - the policy process (Ch.2)
An issue:
- A matter of concern (for some or many, possibly you yourself), here or
elsewhere, related to public health
- That has your attention
How to go about it: how to make sense of it? = analysis
And how to do so from a perpsective
To make sense of an issue the concepts of theory are important.
Models of policy decision making
Rationalism: the ideal model of decision making (theory to make sense of policy
making).
Policy makers reason logically, following these steps:
1. Policy makers are faced with a particular problem
2. Goals, values and objective are clarified and ranked
3. Various alternative solutions are considered
4. Costs and benefits of each alternative are investigated: cost-benefit
analysis
5. Each alternative choose the alternative that has the highest net benefits
6. Policy makers choose the alternative that has highest net benefits (for
when the other policy does not work)
Critisim on the rational model:
Does not describe how policies are made in practice:
- The problems policy makers face are complex
- Policy makers lack the time and information to make predictions about all
costs and benefits of all alternatives
- Policy makers are not value-free and prefer certain types of solutions
- No one can know all options: bounded rationality
- Past policy determines present policy
- There are all sorts of external pressures on policy makers
Rational model prescribes how policy ought to be made – normative/prescriptive
model.
Incrementalist perspective: alterntive theory to make sense of policy making.
Describes how policy is actually make:
- Selection of goals/objectives is reasoning away from the problem rather
than towards the solution
- Policy makers look at a small number of alternatives that differ marginally
from existing policies
- Of each alternative, only most obvious costs and benefits are considered
- Best decision is the option for which there is agreement among policy
makers
Reinforces status quo
Theories on decision making: policy making = puzzling
Problem/issue = point of departure
Public policy is:
- Answering the question ‘what to do next?’ in view of some problem
- On behalf of society
- In order to mitigate or resolve it
- In a collaborative process, co-determines by a broad set of factors and
actors
