Social Policy & Global Health
Social Policy & Global Health
Social Policy & Global Health
Key Ideas
A nation’s political and economic structures help shape the way social services including health care are delivered
Nations commonly are grouped according to the way they pay for social services
Democracy plays an important role in health but some authoritarian governments also maintain good health among their people
ORDER COMPREHENSIVE SOLUTION PAPERS ON Social Policy & Global Health
Traditional Policy Making Cycle
Problem presented
Solution proposed
Proposal accepted
Policy implemented
Policy monitoring & modification
Policy Development Considerations
Policy environment: cultural, legal, and political context in which policies are made
Solutions sometimes proposed before problem is clearly defined
Even with accurate cost-effectiveness data decisions may not be data-based
Window of opportunity often relevant
More similar to program evaluation
Defining the Problem
First step in policy making
Role of burden of disease analysis
May be challenging to quantify in marginalized or mobile populations (selection bias)
Making private issues public
Domestic violence
Media coverage, public attention
Program/Policy Evaluation
Program should be based on causal evidence
Cost-effectiveness analyses are helpful but usually not stand alone
Politically powerful constituents can influence decisions
Risk and risk perception are important, and prediction is challenging
Balance of objective data and narrative interpretations
Health may be secondary to other goals (e.g., economy) for decision-makers
Measurement Issues
Selection bias: people included in the study do not represent the underlying population of interest
Randomized controlled trials: the exposure of interest is assigned to participants at random
Reduces confounding
Sensitivity analysis: limiting the analysis to a specific group of people or definition of exposure/outcome to see if findings hold
Can be used to calculate upper and lower bounds
Political Economy & Health
Economies reflect the allocation of resources within society
Political economy: how political and economic institutions interact in a given environment
Market socialist countries tend to provide social services directly through government agencies
Corporatist states typically provide social services in collaboration with associations
Local politics and social norms influence how social services are delivered
Political Economy & Health: Low & Middle Income Countries
Typically governments are challenged to provide social protections and services
Low income, low tax revenue
Informal workers may get few or no services
Formal: government jobs
Colonial histories may have contributed to underdeveloped institutions
Services not for locals, civil wars
Clinton & Blair “third way”: markets exist but social programs are emphasized
Three Forms of Social Democracy in Low & Middle Income Countries
| Feature | Radical Social Democratic | Classical Social Democratic | “Third Way” |
| Unit of organization | Class | Entire society | Individual or society |
| Social goals | Equity | Solidarity, growth | Market-based growth |
| Social policies | Universal entitlements, redistributive policies | Universal policies, no eligibility requirements | Means-tested benefits, accessible education, poverty reduction |
| Benefit levels | Traditionally high, now variable | Pretty high universally | Fairly low but with subsidies |
| Example countries | Kerala, West Bengal | Costa Rica, Mauritius | Chile, Uruguay |
Health-Optimizing Social Policies
State understands the needs of the population
Well organized state with multilevel communication, adequate resources, and strong infrastructure
A robust civil society to demand some distribution of new wealth
A history of competition, compromise, accountability, and feedback
A strong political party with health sector allies to coordinate efforts and lead program development
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