# Session Overview # 1. Introduction # 2. What is Global Health? # 3. What is [[global health policy]]? # 4. Global Health Policy Initiatives # 5. Analysing policy: overview of key frameworks and theories The stages heuristic (developed in the 1950s-70s originally by H.D. Lasswell (1956) then refined by others including Anderson (1975)) is considered to be one of the most useful frameworks for explaining the policy process. This framework divides the public policy process into four separate and sequential stages: agenda setting, policy formulation and legitimation, implementation and evaluation. The main criticisms (Sabatier 1991) are: 1. that the stages are presented as linear and mutually exclusive while in reality they are non-linear and iterative; 2. the framework does not offer explanations of how policy moves from one stage to another. Power can be conceptualised in many different ways. One prominent contemporary theorist is John Gaventa (2005) who has built on the work of others including [[Foucault]], [[Bourdieu]] and policy theorists including Kingdon, to develop an analytical framework to analyze how power functions. He conceptualises three interrelated forms of power: 1. The forms power takes: - Visible: e.g. decisions made by official structures and institutions; - Invisible: accepted “norms” and values that are in fact shaped by the dominant groups in society; - Hidden: powerful groups controlling the agenda and participants (e.g. may exclude groups from decision-making processes). 2. The spaces in which power is used and discussions and decisions take place: - Claimed: spaces of social mobilization outside formal decision-making, where citizens come together based on shared interests - Invited: formal channels of citizen participation in decision-making arenas; - Closed: participation by citizens/non-powerful/dominant groups in decision-making is severely constrained by powerful groups. 3. The levels (global, national, local) at which power is enacted: power relations at global or national levels might have an impact on, or ultimately determine, local governance and policy decisions. # 6. Integrating activity # 7. Summary # 8. References ## 8.1 [[Essential readings]] Fried LP, Bentley ME, Buekens P, Burke DS, Frenk JJ, Klag MJ and Spencer HC (2010) Global Health is Public Health. Lancet. 375 (9714): 535-537. Responds to the Koplan Lancet paper and maintains that in fact “Global health and public health are indistinguishable”. Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit JN for the Consortium of Universities for Global Health Executive Board (2009) Towards a common definition of global health. Lancet. 373 (9679): 1993–1995. This paper provides an overview and critique of the definitions of “global health”, “international health” and “public health”. WHO, Government of South Australia (2010). The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. See link here (Accessed 24 September 2023). WHO (2011). Rio Political Declaration on Social Determinants of Health, 21 Oct 2011. https://www.who.int/publications/m/item/rio-political-declaration-on-social-determinants-of-health, (Accessed 24 September 2023) The Rio Political Declaration expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities. This was endorsed by the World Health Assembly in May 2012 thus giving it a global policy mandate (though it is not legally binding). ## 8.2 [[Recommended reading]] Buse K et al (2023). Ch 1 Framework for Health policy analysis in Making health policy 3rd ed. London. Link to book (Accessed 24 September 2023) Walt G and Gilson L (1994) Reforming the health sector in developing countries: the central role of policy analysis. Health Policy and Planning. 9 (4): 353-370. Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognised crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national and sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in four sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyse the policy process, but also to plan. Walt G, Shiffman J, Schneider H, Murray SF, Brugha R and Gilson L (2008) ‘Doing’ health policy analysis: methodological and conceptual reflections and challenges. Health Policy and Planning. 23 (5): 308-317. The case for undertaking policy analysis has been made by a number of scholars and practitioners. However, there has been much less attention given to how to do policy analysis, what research designs, theories or methods best inform policy analysis. This paper begins by looking at the health policy environment, and some of the challenges to researching this highly complex phenomenon. It focuses on research in middle and low income countries, drawing on some of the frameworks and theories, methodologies and designs that can be used in health policy analysis, giving examples from recent studies. The implications of case studies and of temporality in research design are explored. Attention is drawn to the roles of the policy researcher and the importance of reflexivity and researcher positionality in the research process. The final section explores ways of advancing the field of health policy analysis with recommendations on theory, methodology and researcher reflexivity.