# Learning outcomes: - identify the objective of political analysis and differentiate this from other forms of analysis (e.g. economic and analysis and policy evaluation); - compare and contrast the concepts of government and governance; policy (the approach adopted to addressing a specific governance issue) and politics (the process through which this approach is adopted, challenged, and maintained) and structure and agency; - understand the importance of further concepts, derived from social and political sciences (to be introduced later in the module), for the study of global public health policy; - understand how subsequent sessions relate to the overall theme of the module. # 1. What is politics The Oxford English Dictionary defines politics as: ‘==the activities associated with the governance of a country or area==’. The Cambridge English Dictionary, meanwhile, defines politics as ‘the activities of the government, members of law-making organizations or people who try to ==influence the way a country is governed==’. Harold Lasswell (1958) summarised politics as being about '==who gets what, when and how==.' Politics is about ==making collective decisions about the rights and responsibilities== we have, and ==the way in which resources are redistributed from and to different individuals and groups== (e.g through taxation and the welfare and social security systems) [[Adrian Leftwich]] (2004) argues that ==politics is to do with questions of power, control, decision-making, conflict, and resource allocation==. ## 1.1 Government and Governance [[The differences between Oxford Dictionary and Cambridge dictionary on politics emphasized on politics as either process (governance) or an arena (government)]] [[Adrian Leftwich]] sees this different by which he summarized politics as being about who gets what, when, and how. If we use Cambridge's definition, then we confine politics to the social arena of formal government of a state. If, however, we use Oxford's definition, then we define politics as a process (governance), which could take place in any social sphere where rules exist. Two implications from our understanding of politics: 1) the business of government now takes place in multiplicity of settings and involving a range of different actors beyond those we typically associate with 'the government', e.g. National Institute for Health and Care Excellence in the UK, with varying degrees of autonomy from the government and involving a range of different actors including academics, scientists, experts and representatives from NGOs and civil society bodies. In global health, we have Global Fund, GAVI Alliance, and other forum such as G20. 2) Recognition that politics exists in all aspects of social life where rules, obligations and power relations exist. In this module, we will use definition of politics as process since the activities that shaped global health policy are not limited to the direct arena of states, but also influenced by other actors, e.g. BMGF, MSF, pharma industry, etc. # 2. What is policy? [[Policy]], according to Oxford English Dictionary, defined as 'a course or principle of action adopted or proposed by an organization or individual.' while Cambridge Diciontary defined policy as 'a set of ideas or a plan of what to do in particular situations that has been agreed officially by a group of people, a business org, a government, or a political party.' Buse, Mays, and Walt (2005) define policy as a 'broad statement of goals, objectives and means that create the framework for activity'. Anderson (1975) defines policy as 'a purposive course of action followed by an actor or set of actors in dealing with a problem or matter of concern'. To sum it up, first policy as a course of principle of action; the second one as a plan on what to do; the third one as a statement of goals that create the framework for activity; and the fourth one as a purposive course of action. While in certain languages they do not differ politics and policy (French, politique; Spanish and Italian, politica; German, politik) but for the purpose of this module we will distinct policy and politics. There are analysis which look at the policy without looking at the policymaking process, such as economist. They only analyse the efficiency with which it allocates a given set of resources. Or, from the perspective of policy evaluation, we can analyse a specific policy in terms of whether it achieves an agreed set of a priori goals. **In neither of these approaches we would examine the ways and the context in which competing actors, interests and political priorities shaped the decision-making process, or the distributional effects of the policy in different groups and sub-populations**. Moreover, the analytical approaches outlined above would probably not look at the processes that led to this particular policy being implemented and other policy options being discarded and the power relations between policy actors that lead to these outcomes. Buse, Mays and Walt (2005) state, [[there can be no policy without politics]]. In other words, it is through political processes that policies are made, implemented, sustained, challenged, and potentially amended or repealed by a range of different policy actors. And it is these political processes that shape global health policy, which we examine in this module. # 3. Analysing the politics of global health policy [[Question]] Does the policymaking principally the result of structural factors or of agency? Agency: the state, civil society, trans-national corporations, trans-national expert networks Structural: economy, culture, or political system, e.g., GDP of a country, the distribution of wealth, and the level of industrialization. Culture: role of women in society, religious beliefs. Political structure: the form of govt, be it democracy or an authoritarian regime, parliamentary or presidential system. Key policy developments are the results of a complex interplay of structural factors and political agency. [[Insights]] #trade-and-investment The emergence of a global [intellectual property (IP)]([[Intellectual Property Rights (IPR)]]) regime, and particularly the emergence of the World Trade Organization’s (WTO) Agreement on Trade Related Aspects of Intellectual Property (TRIPS), have examined how the US government played a key role in pushing for stronger global standards and enforcement of IP rights for pharmaceutical products. They have pointed out that research-oriented pharmaceutical companies are an important export industry in the US economy and structural factors associated with globalization led the US government to purse a global IP regime to protect the interests of this sector. Within the context of a global economy, pharmaceutical manufacturers are unable to effectively protect their intellectual property (IP), i.e. the patents on the drugs they developed as the result of expensive research and development processes. This places a structural constraint on their business model which can be undermined by the production and availability of generic medicines using the formulas they had developed. From the industry perspective, this ‘free riding’ on the IP development of big pharma would undermine the economic rationale for companies to develop further drugs. On the other hand, there was also a political agency by the US government on behalf of the pharmaceutical industry. CEOs of a dozen US companies lobbied the govt of US, several EU countries, and Japan to set global IP standards and place them on the international political agenda. [[Structural factors then, determine the specific approach adopted by industry actors]] to address the issue of IP. In the absence of a world govt able to regulate IP issues, the industry actors identified the ongoing Uruguay round of trade negotiations, which would lead to the establishment of the [[World Trade Organization (WTO)]]. # 4. Why study the politics of global health policy To understand past/existing policy and plan for the future. To understand the conflicting interests and ideas that were or will be affecting the process of policymaking and implementation and the power-relations between different groups and organisations involved. Due to the nature of the subject – which deals with issues of human rights, equity, justice both within states and between them – the analysis of global health policy is often examined from what are referred to as [[critical perspectives]]. Critical perspective also highlights the power relations, not just the process and practice of global health policy. Power relations might charactise and lead to the oppression or marginalisation of specific group of people (colonial). They also consider socio-economic spectrum # 5. Integrating activity [[Question]] Pick a global health issue. How can we understand this as a policy issue? What are the key issues at stake? Who is affected by this issue? Who are the key decision-makers deciding policy responses? What forums are these decisions taken in at the national and global levels? Who are the other key actors involved in shaping and influencing the policy (e.g. NGOs, corporations, funding bodies)? What outcomes do they promote? Climate is primarily seen not as a health-led issue. The Lancet recently launched a paper highlighting the imperative for a health-centered response for climate change issue. This example highlighted the interplay between structural factor (the way climate is handled with environment, energy, or economy at the center) and the loud voice of agency from health sector (The Lancet, and the group of scientists and experts who signed the paper). # 6. Summary # 7. References ## 7.1 [[Essential readings]] [[Thinking politically (on the politics of politics)]] [[@rushtonFramesParadigmsPower]] Rushton S, and Williams OD (2012). Frames, paradigms and power: global health policy-making under neoliberalism. Global Society 26, 2: 147-167. [[How does neoliberalism shape global health policy?]] Stone D (2020), Making Global Policy. Cambridge: Cambridge University Press. Chapter 1 [[Making Global Policy]] ## 7.2 [[Recommended reading]] Buse K, Mays N, Walt G (2005). Making Health Policy. Maidenhead: Open University Press, Chapter 1 [[@greerPolicyPoliticsPublic]] Greer SL, Bekke, M, De Leeuw E, Wismar M, Helderman JK, Ribeiro S, Stuckler D (2017). Policy, politics, and public health. European Journal of Public Health, 27(suppl_4), 40-43. [[@stoneMakingGlobalPolicy2019]] Stone D (2020), Making Global Policy. Cambridge: Cambridge University Press. Chapter 2-5. ## 7.3 Other cited references and sources Anderson J (1975). Public Policy Making. London: Nelson. Farnsworth K, Holden C (2006). The business-social policy nexus: corporate power and corporate inputs into social policy. Journal of social policy, 35(3), 473-494. Giddens A (1984). The Constitution of Society. Berkeley: University of California Press. Hay C. (2002) Political Analysis: A Critical Introduction. Basingstoke: MacMillan. Lasswell HD (1958). Politics: Who Gets What, When, How. New York: Cleveland. Sell S (2003). Private Power, Public Law: The Globalization of Intellectual Property Rights. Cambridge: Cambridge University Press.