Ingredients for good health policy-making: incorporating power and politics into the mix

Abstract

*Correspondence to: Yusra Shawar, Department of Public Administration and Public Policy, American University, Washington, USA Email: yusra.shawar@american.edu Copyright: © 2014 by Kerman University of Medical Sciences Citaion: Shawar Y. Ingredients for good health policy-making: incorporating power and politics into the mix. Int J Health Policy Manag 2014; 2: 203–204. doi: 10.15171/ ijhpm.2014.45 Received: 18 April 2014, Accepted: 6 May 2014, ePublished: 9 May 2014 Eggs, flour, sugar, butter, baking soda, milk, and vanilla extract—all ingredients necessary to make a delicious cake. Similarly, good health policy-making can only be successfully pursued and understood by accounting for all of its basic ingredients, including the role of politics and power. Otherwise, the result is simply not good. In the second edition of Making Health Policy, respected health policy experts Buse, Mays, and Walt have crafted the ultimate health-policy-making “cookbook”—an essential read for any individual seeking to better understand how a health policy emerges and which factors contribute to its success or failure. However, rather than predominately focusing on examining the content of policy—an approach typical of other health policy books—the authors provide the analytical framework needed to consider and bring politics and power, two essential ingredients, to the forefront of any health policy examination. As illustrated by the authors, the role of politics is overwhelmingly pervasive in the emergence, design, execution, and evaluation of health policy. Their work thoroughly explores the role of politics and power in determining, among many other processes in health governance, which health issues receive attention on national agendas (p. 66), how networks of interest groups and government actors form around a health issue (p. 108), the manner in which front-line health workers perceive and chose to implement proposed policies (p. 133), and which health program evaluation findings are utilized and translated to policy (p.176). In addition, each chapter, with its own collection of related theoretical constructs and examples, provides a critical foundation to begin answering important questions that have historically not received adequate attention by the public health community: Why do some health issues receive priority over others? How can we understand and study power in a health system? Which sorts of interest groups are most influential? Why is evidence-based policy-making so challenging? While the role of politics in policy-making is widely acknowledged among the public health community, little effort has been devoted to exploring and integrating this important area of study in university-level curriculum, scholarly research, and practical policy design. Furthermore, remarkably little guidance has been made available to students and practitioners as to how these political dynamics can be managed. Recognizing this gap, the authors draw on the most up-todate research in order to illustrate precisely how politics shape processes in health governance like agenda setting (chapter 4), policy implementation (chapter 7), as well as research and evaluation (chapter 9). Furthermore, they show how power is distributed among and exercised by key-players in the health policy-making process, including: the private, for-profit sector (chapter 3), different institutions of government (chapter 5), various types of interest groups in the health sector (chapter 6), and those actors working at the global level (chapter 8). Perhaps most importantly, their work provides valuable insight on how the complexities posed by politics, which are inherent and unavoidable, can be navigated while making health policy (chapter 10). Making Health Policy’s underlying framework of organization builds on the idea of the “policy triangle” first proposed by Walt et al. (1). The triangle presents four factors that should be taken into consideration in the process of health policymaking: content, actors, processes, and context (p. 8). Although policy content is recognized as an important component, the book gives special attention to the place of politics in the complex interactions that occur among the other three components: the actors (the individuals, organizations, and nation state that make and implement policy), processes (how policies are initiated, developed, negotiated, communicated, implemented, and evaluated), and context (which includes the political, social, and economic environment in which actors work). While the policy triangle is a useful way to organize and think systematically about the different factors that might affect policy, the authors find that as is, it is too simplistic, only representing “a map that shows the main roads but that has yet to have contours, rivers, forests, paths, and dwellings added to it” Making Health Policy (understanding public health)