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Theories of Public Policy.doc

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Health Studies
Scott Sams

Theories of Public Policy Purpose: To introduce frameworks for understanding decision making in the health policy-making process. How do theories differ in their interpretation of the political influences on health? • What is a theory? o Frameworks for understanding facts & phenomena o Sets of statements or principles  Different principles that underpin different theories of public policy process o Emphasize different features of policy process to explain decision-making o Approach/assumptions rooted in values & general model of society o When applying theories must look at  What’s behind it • Why should I care? o Theories influence development and implementation of health policy o Understanding assumptions important to understanding health policy issues o Need to ensure its valid • Characteristics of theories (I): Levels of analysis o Where its social roots are o Macro  Broad issues- big issues  Contours of political system/how power exercised within it  Two types of health policy: 1. Organization/delivery of health care • Public approach (entitlements of citizenship) • Private approach (commodities to be bought and sold on open market) 2. Development/implementation of health-related policies • Assurance of economic and social security • Market-oriented approaches to delivery of goods and services i. Use the two types of health policy and apply a macro approach, Health care side—public and private provision 3.  Examples: 1. (Health care) Creation of public-private partnerships 2. (Health) Creation of national day-care program o Meso-individual government and ministries and influence they have( stuff within the system)  Focus on middle-level institutions—departments; ministries  Accountable to government  Can recommend changes to both types of health policy  Examples: 1. (Health care) Creating a tele-health line 2. (Health) Changing eligibility requirements for social assistance - health= at this level is the implementation o Micro  Administrative/routine day-to-day  Monitoring government operations  Tinkering with public policy  Examples: 1. (Health care) Increasing funding to community health centres 2. (Health) Increasing housing subsidy amounts for tenants - Monitoring the government policy** - Effective in what we want to do - Macro is the system, Meso is parts, and Micro is monitoring  Next week: relate levels of analysis to types of change (first order, second order, third order/paradigmatic change) in Hall’s policy paradigms model. o Micro, Macro and Meso  Characteristics of theories (II): Roots in social theory o Consensus model  Political/economic system a fair one • Anyone can do anything • Change is possible  Therefore Social change within social system (maintain the social order!)  Normal state of a system is -Absence of conflict as equilibrium state (agreement about norms, values, rules and regulations)  Dissent as deviance! o Conflict model  Differences in power and ideology  Critique broad socio-political system  Focus on power differentials and dominant ideologies  Social structures created through conflict between people of different resources and interests.  Theories: What are the characteristics and limitations of the three prominent theories of public policy o Pluralism (meso-focus; consensus)  Groups of people with interest with a NEUTRAL government •  Most influential?  Interest groups vie for power to realize goals/objectives •  Democratic society organized in interests of members  State a neutral arbiter; government receptive to all interests with interests mediated by institutions of government  Critique: /Limitations • Ignores political power relations—ignores the idea there is a power dominance( • Absence of structural and societal factors o How structure constrains factors • Doesn’t tell you about their relative power—assumes the state will decide and what makes sense..—doesn’t say one power bigger than the other*  Example: • Advocate that government change health care policy (rather than considering other
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