More than one years ago, I commenced teaching a path on health coverage and practice at UCL’s new global enterprise faculty for health. A number of the key questions I was trying to address in the MBA class were about what health policy is and the elements that contribute to coverage exchange over time, even while also considering my target audience (a truly worldwide blend of healthcare specialists, digital fitness specialists, and other early-career specialists from around the arena).
I went back to conceptual frameworks and educational readings, and dug deep into my own experience. The World Health Organization (WHO) defines health policy as ‘choices, plans, and actions that are undertaken to attain specific healthcare goals within a society’ (WHO, 2011).
What this definition fails to deliver is the breadth of what health policy covers. It’s far about many things, unexpectedly:
- Shielding populations from risks to their health (e.g. introducing anti-tobacco guidelines, hospital hygiene practices)
- Strengthening health systems (e.g. investing in the health workforce or digital health policies)
- Enhancing the prevention and care pathways for particular conditions (e.g. growing cardiovascular disease or cancer plans)
- Ensuring care is equitable, responsive, accessible and of high quality (e.g. setting quality standards or duty mechanisms for healthcare organisations)
Why Does Health Policy Matter?
Health policy is more than a composite of individual policies targeting health. It is a set of principles, ideas, rules and boundaries that provide the foundation on which person policies are structured. Health policy has a strong cultural component – for example, around whether individuals should accept more responsibility for their health, or whether private sector involvement is a good or bad thing.
History has shown us that investing in health is a prerequisite for economic and social prosperity. This is reflected in the United Nations’ Sustainable Development Goals, of which many include components related to health. Importantly, Goal 3 is dedicated entirely to health and wellbeing. In 2001, economist Jeffrey Sachs coined the phrase ‘health is wealth’, showing a linear relationship between national GDP and life expectancy. The WHO Pan-European Commission on Health and Sustainable Development went on to say that ‘we cannot accept a situation in which we fail to place enough value on health’ for moral, economic and security reasons.
When governments fail to invest in the health of their people, this can undermine trust in political institutions, potentially threatening democracy at its core. And this loss of trust can be felt most acutely in underserved communities, exacerbating existing inequalities.
The Need for an Intersectoral Approach in Health Policy
Improving population health is the main goal of health policies, and yet health is influenced by more than just health rules. It follows that a ‘health in all policies’ approach is needed. This means that different sectors, such as environmental or housing, consider the health implications of their policies and work together to improve population health.
At the individual level, it means recognising that a person’s health is influenced by multiple factors – the social determinants of health – and solutions need to target these root causes, and the interaction between them, to have a real impact.
What Drives Policy Change?
Clear answer? It depends. Multiple models exist, but perhaps the most compelling conceptual framework is the Kingdon Streams model, which identifies three reasons for policy change: problem, policy and politics.
- Problem can mean that a new issue comes to the political agenda, for example due to pressure from advocacy groups or a shift in epidemiology (e.g. a pandemic)
- Policy is about a shift in approach, for example a reshuffling of government departments
- Politics is about political will and convergence of interests within government toward the need for change
The confluence of these three streams creates a window of opportunity for policy change. And the key element is time – these changes may happen simultaneously, or at different times, but somehow a tipping point occurs and a change in policy is proposed.
The Kingdon Streams model assumes a relatively rational process, though there are many who suggest that the only stream that really matters is the politics stream, and that policy change is more chaos than method.
I take a less cynical view: I strongly believe in the power of evidence to drive policy change, and the power of advocacy to change ideas governing policy. Always, the most powerful driver of policy change is people – not only people with the power to change policy, but also people who can influence it by challenging the governing values and interests and communicating a compelling, evidence-based case for change.
Who Can Influence Change in Policy?
Civic society has a strong role to play in shaping policy – think back to the role of ACT UP in shaping HIV/AIDS policy in the 1980s and 1990s. But policy change can also be strongly influenced by healthcare professionals, the general public and the private sector.
The ideal situation is that all ‘advocates’ come together to join forces, creating a case for change that takes account of all perspectives and unmet needs. A powerful example of this is the WHO Framework Convention on Tobacco Control, which set in motion a global movement of anti-tobacco policies that have had significant impact in many countries around the world. Similarly, global policies on antimicrobial resistance (AMR) recognise that change at the ground level will require collaboration between the WHO, public health, the scientific community, healthcare professionals, pharmacovigilance and the life sciences industry.
