The Handbook of Global Health Policy

Garrett W. Brown, Gavin Yamey, Sarah Wamala

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118509609
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Public Policy
• Index: Politics & International Relations

The Handbook of Global Health Policy provides a definitive source of the key areas in the field. It examines the ethical and practical dimensions of new and current policy models and their effect on the future development of global health and policy.

• Maps out key debates and policy structures involved in all areas of global health policy
• Isolates and examines new policy initiatives in global health policy
• Provides an examination of these initiatives that captures both the ethical/critical as well as practical/empirical dimensions involved with global health policy, global health policy formation and its implications
• Confronts the theoretical and practical questions of 'who gets what and why' and 'how, when and where?'
• Captures the views of a wide array of scholars and practitioners, including from low- and middle-income countries, to ensure an inclusive view of current policy debates

Part I
Global Health Policy and Global Health Governance

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• 1 Understanding Global Health Policy
  Ruairí Brugha, Carlos Bruen, and Viroj Tangcharoensathien
• 2 Critical Reflections on Global Health Policy Formation: From Renaissance to Crisis
  Sophie Harman
• 3 Contemporary Global Health Governance: Origins, Functions, and Challenges
  Rajaie Batniji and Francisco Songane
• 4 Global Health Justice and the Right to Health
  Garrett W. Brown and Lauren Paremoer

Chapter 1
Understanding Global Health Policy

Ruairí Brugha, Carlos Bruen, and Viroj Tangcharoensathien

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Abstract

Global health policy comprises the goals, rules, and actions that address or have an impact on the health challenges and priorities that transcend individual countries and regions. This introductory chapter outlines some of the major events, contexts, processes, and actors (the people and organizations) that have contributed to what is a fluid and fast changing global health policy environment. The chapter charts the transformation of global health policy over the twientieth century, including the changing role of the state and traditional multilateral institutions, along with the rise and increasing power of new global health actors. Drawing on the examples of the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the authors discuss how non-state actors and new forms of global partnerships have become increasingly important players alongside states and traditional multilateral agencies in global health policy processes.

Case studies are used to outline key concepts and foundational theories for understanding policy-making and policy implementation. The case study on nutrition and obesity illustrates a failure to tackle vested food industry interests, preventing a coherent and coordinated global health policy response. New global partnerships involving non-state actors, global efforts to strengthen health systems, and global agreement on an international code of practice on health worker recruitment illustrate diverse policy processes, solutions, and instruments. Common to most global health policy issues is the political nature of policy-making, where recognition of actors' interests, power, and ability to mobilize resources are central. The chapter concludes with pointers for policy practitioners, researchers, and students when conducting health policy analyses. Analysts may be actors in policy processes and need to consider how their own institutional positions, resources, and values may influence their analyses.

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Key Points

• Global health policy refers to the statement of goals, objectives, and means that create the framework for global health activities.
• Actors – individuals, organizations and their networks – are central to how priorities are established and how health policies are made and implemented.
• Understanding global health policy requires an understanding of the political nature of policy-making, the role of actors' interests, and the centrality of power.
• Policy theory, developed to analyze national health policies, can be applied to understanding global health policy processes and the influence of old and new actors.
• New global health partnerships, incorporating non-state actors who can mobilize large levels of resources, have become powerful players in setting global health priorities, policy-making, and implementation.

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Key Policy Implications

• Global health policy is an inherently political and complex arena, where the positions, interests, and objectives of nations, organizations, and networks of individuals often determine what policies are formulated and implemented.
• While there is often consensus on the need for evidence-based policy-making, its achievement can be undermined by a failure to understand and analyze how power and the interests of different groups often shape and can determine global health policies.
• The application of theories of policy processes can deepen the understanding of the global health policy terrain, highlighting the political obstacles and opportunities for getting population health issues on to the policy agenda.

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Introduction

Global health refers to issues that directly or indirectly impact on the health of populations and that can transcend national boundaries (Koplan et al. 2009). Solutions to global health issues often require global cooperation and policy actions that are beyond the capacity of individual countries. Building on Kent Buse and colleagues' definition of health policy (Buse et al. 2005), we define global health policy as the statement of goals, objectives, and means that create the framework for global health activities. Global health policy incorporates both policy content, the substance of policy comprising rules and guidelines, and policy processes, the purposeful, deliberate actions, methods, and strategies that influence the shape and impact of policy development and implementation (Jenkins 1978).

Global health policy, and its implementation, is shaped by a complex and dynamic set of individuals, groups, and organizations that form global, interrelated networks of actors. These networks have an impact upon the health of populations. Understanding such policy processes is a prerequisite for achieving global population health goals, such as universal health coverage (Kruk 2013), and for tackling the social and economic determinants of health, where causes and actions go beyond country borders. This opening chapter introduces the field of global health policy and provides a brief history of the main actors and processes in global health policy-making over the last 25 years. It also identifies further readings on policy theories, which can help to provide an understanding of how global health policies are shaped.

Actors are considered central to the analysis of how policies are made and implemented. Global and country policy actors include individuals and institutions, such as civil society organizations, research institutions, private sector and philanthropic organizations, governments and program managers, health workers, and community-based organizations. Policy analysis in global health can help explain how power and the interests and values of different global actors play an important role in shaping policies. Power and politics, which are implicit in all fields of knowledge and activity, are made explicit and thereby more transparent through policy analysis (Walt and Gilson 1994). There is a compelling case to be made for grounding global health policies in evidence (see Chapter 7), and an analysis of actors' power and interests may explain whether or not evidence gets used during policy formulation (Buse et al. 2007; Hutchinson et al. 2011).

Health policy analysis is a growing field, occupied by policy practitioners, including policy-makers and technical analysts, and by academic researchers and students (Gilson 2012). Practitioners are primarily interested in using policy analysis prospectively to help shape future policies (analysis for policy), and in bringing evidence from the clinical sciences, epidemiology, and economics to inform the content of health policies. In contrast, health policy researchers mostly conduct retrospective analyses of past policy processes (analysis of policy), recognizing that factors other than scientific evidence – policy context, processes, and actors – play an important role in determining policy content and outcomes (see Chapter 8).

Several papers in a 2008 special issue of the journal Health Policy and Planning help to outline the field of health policy, drawing particularly on lessons and evidence from low- and middle-income countries (Buse 2008; Gilson and Raphaely 2008; Walt et al. 2008). The ethics of whether or not health policy researchers should be actively involved in shaping policy has been debated (Buse 2008; Surjadjaja and Mayhew 2011). The risks of doing so, argue Surjadjaja and Mayhew, include jeopardizing the role of academics as “impartial” and credible researchers. Buse, however, argues that policy researchers should help to shape policy through prospective policy analysis if this helps to achieve international goals, such as the Millennium Development Goals or universal health coverage. Buse's view points to the importance of the relationship between researchers and policy-makers and the respective responsibilities of policy-makers and researchers to ensure evidence-based policies (see Chapter 7).

Walt and Gilson's (1994) health policy triangle provides a useful framework to identify key issues in health policy and how they impact on the health systems, policies, and health of populations (Figure 1.1). The framework can be used to move beyond a study of the content of policies to understand how political, historical, and cultural contexts influence the direction and feasibility of policy-making. The triangle emphasizes the importance of identifying the actors or stakeholders and the processes that lead to (or obstruct) health policy development and implementation. It is a flexible framework that can complement different policy theories to help explain which issues get on the policy agenda, and how these are formulated and implemented. There is now a large body of research on global health policy that has been conducted using this framework (e.g., see Schneider et al. 2006; Hanefeld 2010; Surjadjaja and Mayhew 2011). A particular value is that it can accommodate theories on rational and explanatory theories on how and why policies get made (as discussed later, in the section called “Contribution of Theory to Understanding Global Health Policy”). The health policy triangle can be used to illustrate some important contextual factors, actors, and processes influencing the content of global health policy, which are discussed in this chapter.

Figure 1.1 Health policy triangle (Walt and Gilson 1994).

This chapter is aimed at readers who are interested in what actually happens in global health policy-making, and not just in what should happen, thereby assisting them to make strategic decisions about future policies and steer their implementation. We begin by outlining some of the major transformations in global health policy over the last few decades, linking these to global policy contexts, actors, and processes. We then identify important new global actors and policy instruments, and review how policy theories can be used to explain how global health policies are shaped. Throughout the chapter, we illustrate these concepts by providing “real world” case studies of policy responses (and non-responses) to recent major global health priorities. The chapter ends with a set of key conclusions on what ...

Table of contents

• Cover
• Series
• Titlepage
• Copyright
• Notes on Contributors
• Foreword: Global Health Policy-Making in Transition
• Acknowledgments
• Introduction
• Part I Global Health Policy and Global Health Governance
• Part II Narrowing the Gap Between Knowledge and Action
• Part III The Politics of Risk, Disease, and Neglect
• Part IV Diplomacy, Security, and Humanitarianism
• Part V Financing and the Political Economy of Global Health
• Part VI Health Rights and Partnerships
• Part VII Beyond Globalization
• Index
• End User License Agreement