Summary PGZ2025
Public Health Policy: General Principles
Table of content
Lecture Introduction.............................................................................................................................................3
Case 1: The boundaries of the (public) health system.....................................................................................6
Lecture Economics of PH: is it worth investing in promotion and prevention?.................................................15
Lecture Public and occupational health policy...................................................................................................21
Case 2: Public health policymaking............................................................................................................... 27
Lecture Different approaches to policy making.................................................................................................33
Case 3: Rational policy making: the Lancet EAT commission.........................................................................39
Case 4: Priority setting in occupational health: rational policy making?.........................................................48
Case 5: The political arena is not a market but a polis...................................................................................56
Lecture Model of health policy making: the political approach.........................................................................66
Case 6: Use of symbols and numbers to convince in the stage of agenda setting’..........................................70
Case 7: Introduction to institutional theory..................................................................................................78
Lecture Institutional theory, path dependency and historical institutionalism.................................................85
Case 8: Dare to compare in mental health: translation issues.......................................................................90
Lecture Cross country comparison of mental health problems and stigmatization..........................................98
Lecture Mental health from a public health perspective.................................................................................101
Case 9: Policy vs. practice: implementation issues......................................................................................107
Lecture Policy vs. practice: policy formulation and implementation...............................................................117
Case 10: Public health policy evaluation options: an overview....................................................................124
Lecture Policy evaluation.................................................................................................................................135
Case 11: Cooperation and negotiation in Public Health...............................................................................140
Lecture Cooperation, negotiation and project management in PH settings...................................................146
Case 12: PH management or leadership?.................................................................................................... 153
Lecture Leadership...........................................................................................................................................162
Lecture Wrap up & responsive.........................................................................................................................166
Lecture Training 1: Mapping health systems/stakeholder analysis of public health system..........................169
Lecture Training 2: Policy analysis according to the rational and political approach.....................................171
1
, Lecture Training 3: Transferability of interventions, dare to compare............................................................175
Lecture Training 4: Practice your negotiation skills.........................................................................................178
Lecture Training 5: Writing a research proposal for a policy evaluation.........................................................180
Lecture English language center: writing a research proposal........................................................................182
2
,Lecture Introduction
Policy = a deliberate course of (in-)action selected from available alternatives to achieve a
certain outcome.
Public health and policy
Definition Oxford textbook: “Public health is the science and art of preventing disease,
prolonging life and promoting health through the organized efforts of society”
Goal: biologic, physical, mental well-being of all members of society
Public Health (clinical) health care
Public health functions
PH identifies, measures, and monitors community health needs through surveillance of
disease and risk factor trends (information)
PH formulates, promotes and enforces sound health policies, e.g.
o Policies requiring reporting of highly transmissible diseases and health threats to the
community
o Control of hazards
o Promote healthy behaviour etc.
Also:
PH should influence politics
Effective planning, management and administration is necessary
10 indicators of Public Health policy performance
1) Tobacco
2) Alcohol
3) Food and nutrition
4) Fertility, pregnancy and childbirth
5) Child health
6) Infectious diseases
7) Hypertension detection and treatment
8) Cancer screening
9) Road safety
10) Air pollution
NL ranks 5th of EU.
Road safety: example
Obligation to wear safety belts in cars implemented in many countries in the past decades
(e.g. NL: in front since 1976, in back since 1992)
25-48% reduction in lethal car accidents
Influence of PH measure on mortality.
The Netherlands vs. Sweden
In the Netherlands
o 55% more lung cancer among men, 30% more breast cancer (due to less tobacco
control)
o 33% more babies die
o 25% more traffic accidents
Background variables Sweden vs NL (macro context)
Self-expression values
Democracy
Left-party government
3
, Less ethnic fractionalization (more cohesion & solidarity)
High national income
More government effectiveness
Contribute to a better PH outcome and more favorable indicators than NL.
Health in All Policies (HiAP)
Health in All Policies is an approach to public policies across sectors which:
Systematically takes into account the health implications of decisions
Seeks synergies
Avoids harmful health impacts, in order to improve population health and health equity
(WHO)
Public Health in local settings
Communities/municipalities: e.g.
o Breast cancer screening
o Alcohol and youth (NIX18)
o Mental health
o Low SES
Organizations (Occupational Health): e.g.
o Prevention, sustainable employability
o Sickness absence and return to work policies in organizations
In local settings: New York
“What’s the message of the New York soda-size ruling? Government can’t control lifestyle
diseases the way it controls infectious epidemics”
In local settings: Maastricht
Healthy neighborhoods
Regarding environment policy on:
o Attractive to walk, cycle etc.
o Health care, sports facilities, places to socialize
o Attention for healthy living in schools
o Healthy internal environment in public buildings
o Good air quality tunnel
Who makes the policies?
Ministries of Health
Regional Public Health services (GGDs)
Public Health Research institutes
Government
o Politicians, policymakers
Director/management of organizations
Stakeholder involvement
o Citizens, consumers, representatives, trade unions etc.
General aims of this module
Understand the policy process
Improve policy skills
Basic insight in how to develop effective policies and how to affect policy-making in local
settings
Policy cycle/process
4
Public Health Policy: General Principles
Table of content
Lecture Introduction.............................................................................................................................................3
Case 1: The boundaries of the (public) health system.....................................................................................6
Lecture Economics of PH: is it worth investing in promotion and prevention?.................................................15
Lecture Public and occupational health policy...................................................................................................21
Case 2: Public health policymaking............................................................................................................... 27
Lecture Different approaches to policy making.................................................................................................33
Case 3: Rational policy making: the Lancet EAT commission.........................................................................39
Case 4: Priority setting in occupational health: rational policy making?.........................................................48
Case 5: The political arena is not a market but a polis...................................................................................56
Lecture Model of health policy making: the political approach.........................................................................66
Case 6: Use of symbols and numbers to convince in the stage of agenda setting’..........................................70
Case 7: Introduction to institutional theory..................................................................................................78
Lecture Institutional theory, path dependency and historical institutionalism.................................................85
Case 8: Dare to compare in mental health: translation issues.......................................................................90
Lecture Cross country comparison of mental health problems and stigmatization..........................................98
Lecture Mental health from a public health perspective.................................................................................101
Case 9: Policy vs. practice: implementation issues......................................................................................107
Lecture Policy vs. practice: policy formulation and implementation...............................................................117
Case 10: Public health policy evaluation options: an overview....................................................................124
Lecture Policy evaluation.................................................................................................................................135
Case 11: Cooperation and negotiation in Public Health...............................................................................140
Lecture Cooperation, negotiation and project management in PH settings...................................................146
Case 12: PH management or leadership?.................................................................................................... 153
Lecture Leadership...........................................................................................................................................162
Lecture Wrap up & responsive.........................................................................................................................166
Lecture Training 1: Mapping health systems/stakeholder analysis of public health system..........................169
Lecture Training 2: Policy analysis according to the rational and political approach.....................................171
1
, Lecture Training 3: Transferability of interventions, dare to compare............................................................175
Lecture Training 4: Practice your negotiation skills.........................................................................................178
Lecture Training 5: Writing a research proposal for a policy evaluation.........................................................180
Lecture English language center: writing a research proposal........................................................................182
2
,Lecture Introduction
Policy = a deliberate course of (in-)action selected from available alternatives to achieve a
certain outcome.
Public health and policy
Definition Oxford textbook: “Public health is the science and art of preventing disease,
prolonging life and promoting health through the organized efforts of society”
Goal: biologic, physical, mental well-being of all members of society
Public Health (clinical) health care
Public health functions
PH identifies, measures, and monitors community health needs through surveillance of
disease and risk factor trends (information)
PH formulates, promotes and enforces sound health policies, e.g.
o Policies requiring reporting of highly transmissible diseases and health threats to the
community
o Control of hazards
o Promote healthy behaviour etc.
Also:
PH should influence politics
Effective planning, management and administration is necessary
10 indicators of Public Health policy performance
1) Tobacco
2) Alcohol
3) Food and nutrition
4) Fertility, pregnancy and childbirth
5) Child health
6) Infectious diseases
7) Hypertension detection and treatment
8) Cancer screening
9) Road safety
10) Air pollution
NL ranks 5th of EU.
Road safety: example
Obligation to wear safety belts in cars implemented in many countries in the past decades
(e.g. NL: in front since 1976, in back since 1992)
25-48% reduction in lethal car accidents
Influence of PH measure on mortality.
The Netherlands vs. Sweden
In the Netherlands
o 55% more lung cancer among men, 30% more breast cancer (due to less tobacco
control)
o 33% more babies die
o 25% more traffic accidents
Background variables Sweden vs NL (macro context)
Self-expression values
Democracy
Left-party government
3
, Less ethnic fractionalization (more cohesion & solidarity)
High national income
More government effectiveness
Contribute to a better PH outcome and more favorable indicators than NL.
Health in All Policies (HiAP)
Health in All Policies is an approach to public policies across sectors which:
Systematically takes into account the health implications of decisions
Seeks synergies
Avoids harmful health impacts, in order to improve population health and health equity
(WHO)
Public Health in local settings
Communities/municipalities: e.g.
o Breast cancer screening
o Alcohol and youth (NIX18)
o Mental health
o Low SES
Organizations (Occupational Health): e.g.
o Prevention, sustainable employability
o Sickness absence and return to work policies in organizations
In local settings: New York
“What’s the message of the New York soda-size ruling? Government can’t control lifestyle
diseases the way it controls infectious epidemics”
In local settings: Maastricht
Healthy neighborhoods
Regarding environment policy on:
o Attractive to walk, cycle etc.
o Health care, sports facilities, places to socialize
o Attention for healthy living in schools
o Healthy internal environment in public buildings
o Good air quality tunnel
Who makes the policies?
Ministries of Health
Regional Public Health services (GGDs)
Public Health Research institutes
Government
o Politicians, policymakers
Director/management of organizations
Stakeholder involvement
o Citizens, consumers, representatives, trade unions etc.
General aims of this module
Understand the policy process
Improve policy skills
Basic insight in how to develop effective policies and how to affect policy-making in local
settings
Policy cycle/process
4
