Policy influences upon health

1. Policy influences upon health

2. Session aims • To explore what social policy is and how the policy making process works • To show how social policy influences individual health in a variety of ways both positively and negatively • To identify the principles of healthy public policy

3. What is social policy? • Social policy can be described as a field of activity decided upon and implemented by the government, a course of action and indeed a web of decisions rather than a single decision (Hill 1997) • Policy usually is a stance towards a particular topic and involves a cluster of related decisions and actions often dealt with in a consistent fashion (Harrison 2008) • Social policy is often concerned with tackling social problems and bringing about change • The policy making process in which policy paths are determined is also complex and dynamic, itself subject to a range of influences from various groups and stakeholders who have an interest in directing policy

4. What is health policy? • Blakemore and Griggs (2007) define health policy in two ways • as the efforts made by the government to improve health through both services and medical treatment • as any activity undertaken by the government that affects health and illness • They argue that the wider social and environmental influences on what happens to us in the doctor’s surgery or hospital are reflected in government policy.

5. Getting issues onto the policy agenda • Certain issues become important in policy terms and make it onto the policy agenda • The media has often played a role in the UK in framing specific health issues as important, for example, the unavailability of life-prolonging drugs for cancer patients has had a wealth of media attention, as has the refusal of treatment for patients based upon certain criteria such as their refusal to stop smoking, change their lifestyle or because of their obesity • Powerful corporate interests group can often work with politicians and government officials to negotiate and lobby, as a mechanism to serve their private corporate interests particularly within the USA (Crinson 2009)

6. Models of policy making

7. Stages of the policy-making process • The three key stages described by Harrison (2008) are 1. the public policy agenda – how and why do issues come onto the agenda? 2. alternatives and choices – are policy choices rational? 3. implementation- are choices put into action and if so, how so?

8. How does policy act as a determinant of health? • Health policy can be described as efforts by the government to improve health, welfare and medical treatment • Health care policy tends to focus upon the medical services that are delivered within hospitals and across communities • Measures to tackle health related problems such as alcohol consumption, obesity, inactivity are all relevant to health • Health policy is also important in attempting to tackle inequalities by trying to change the circumstances in which people live such as housing conditions, the local environment and the distribution of income in society (Hudson et al 2008)

9. The British Welfare State • Welfare policy is important for health • There are different models of welfare across the world • The UK welfare state was established during 1945-50 to tackle 5 giants (Beveridge 1942) • Want – people did not have sufficient income • Idleness – unemployment because there were not enough jobs • Squalor – poverty and poor housing conditions • Ignorance – gaps in educational provision • Disease – poor health made worse by a lack of affordable and accessible medical care.

10. The UK welfare system • The 5 giants underpin the modern welfare system, based upon five pillars of social security employment, housing, education and health (Hudson et al 2008) • Several acts of parliament established a number of welfare benefits, enabling mass education and health care free at the point of consumption for the UK population • The principles of UK welfare have fundamentally remained the same but debates continue about its future

11. Health is political • Health and therefore health policy are political because population health is related to the actions of the government and the policy environment in which people live • Politics is important in health care within every country with governments intervening in health care provision across the globe in a variety of ways • There are many different clusters of values in policy-making, often associated with different political approaches and parties and we each hold our own ideological viewpoints, which influence our attitudes to health and health care

12. Ideology and health care

13. Ideology and health care • Navarro & Shi (2001) argue that population health is the best in countries that have social democratic governments, after analysing evidence from a range of countries including Sweden, Denmark and Austria. • Health care in the USA is underpinned by neo-liberal ideology, which results in more inequality and poorer health outcomes (Kaiser Family Foundation 2009) • The principles of equality and redistribution of health are seen as fundamentally good for health

14. The UK NHS • Based upon the ideological principles • rights for every citizen • the provision of care as comprehensive • universal care • free to all at the point of consumption

15. How important are health services? • There is an array of evidence to demonstrate that health and illness are determined by many factors other than individual treatment • Only 25% of the health of a developed population is attributable to its healthcare system (Harrison & Macdonald 2008) • Health services favour clinical interventions to treat illness and disease, rather than dealing with environmental and cultural factors that cause ill-health in the first instance

16. Healthy Public Policy • Healthy public policy is policy that has a clear and explicit concern for health • As the determinants of health are so broad, healthy public policy needs to have a broader focus than just health • The 2006 health bill in the UK ensured that smoking was made impossible in many spaces. The primary objective of this healthy public policy was to reduce exposure to second hand smoke for workers and the general public, with the secondary objective of reducing overall smoking rates

17. The broader policy environment and health • Many government activities affect health and illness for example, the taxation of certain products, the regulation of air and water pollution, the safety of food and the working environment (Blakemore & Griggs 2007) • The biggest health outcome gains have resulted from public health measures such as removing impurities from water and improving nutrition (McKeown 1979) • The introduction of compulsory seat belt wearing in the UK in 1983 as a transport policy has had clear health benefits by reducing the number of deaths in car accidents

18. Policy as detrimental for health • The broader policy environment can also be detrimental to health • The policy to generate nuclear power led to the 1986 Chernobyl disaster which caused many long term health effects that are little understood (Crinson 2009) • 2005 changes to the UK licensing laws allowing extensions to the hours in which alcohol can be sold led to what critics called a twenty four hour drinking culture (BBC News 2005). These changes were criticised in relation to potential negative health outcomes associated with additional alcohol consumption in a country where death rates for chronic liver disease and cirrhosis have risen in recent years and are well above the European average (DoH 2007)

19. Fiscal policy • Policy can be used as a mechanism to try to changing people’s social and emotional well-being and improving their health by generally tackling the economic circumstances in which they live • There is a large bank of evidence that shows how income levels are strongly correlated to the health of people • Policy can be designed to try to support those on lower incomes for example to redistribute income by applying progressive taxation rates • Policy concerned with money and general economics used to try to tackle problems such as inequality will also benefit health • Wilkinson & Pickett (2009) argue that income distribution provides policy makers with a way of improving the well-being of whole populations

20. Summary • Social policy as a discipline is crucial in helping us to understand how the social and economic environment in which we live influences our health through the mechanisms of health and welfare systems • Health and welfare policy are important determinants of health, underpinned by complex ideological values and beliefs • Health policy and healthy public policy are important for our health, but the complexity of the social policy field means that many policy sectors are important in determining health outcomes