Summary HS MISC-Social, Political & Environmental Issues in International Healthcare.

1.0 Understand the development of international healthcare policy  Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society. According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people. There are many categories of health policies, including global health policy, public health policy, mental health policy, health care services policy, insurance policy, personal healthcare policy, pharmaceutical policy, and policies related to public health such as vaccination policy, tobacco control policy or breastfeeding promotion policy. They may cover topics of financing and delivery of healthcare, access to care, quality of care, and health equity.  Health-related policy and its implementation is complex. Conceptual models can help show the flow from health-related policy development to health-related policy and program implementation and to health systems and health outcomes. Policy should be understood as more than a national law or health policy that supports a program or intervention. Operational policies are the rules, regulations, guidelines, and administrative norms that governments use to translate national laws and policies into programs and services. The policy process encompasses decisions made at a national or decentralized level (including funding decisions) that affect whether and how services are delivered. Thus, attention must be paid to policies at multiple levels of the health system and over time to ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of health intervention.  The modern concept of healthcare involves access to medical professionals from various fields as well as medical technology, such as medications and surgical equipment. It also involves access to the latest information and evidence from research, including medical research and health services research.  In many countries it is left to the individual to gain access to healthcare goods and services by paying for them directly as out-of-pocket expenses, and to private sector players in the medical and pharmaceutical industries to develop research. Planning and production of health human resources is distributed among labor market participants.  Other countries have an explicit policy to ensure and support access for all of its citizens, to fund health research, and to plan for adequate numbers, distribution and quality of health workers to meet healthcare goals. Many governments around the world have established universal health care, which takes the burden of healthcare expenses off of private businesses or individuals through pooling of financial risk. There are a variety of arguments for and against universal healthcare and related health policies. Healthcare is an important part of health systems and therefore it often accounts for one of the largest areas of spending for both governments and individuals all over the world. 1.1 Explore approaches to healthcare policy formation in an international context  Health policies are formed through the complex inter-relationship of context, process and actors. Walt and Gibson (2010 in Buse et al, 2015) have proposed the health policy triangle as a way of systematically thinking about all the different factors that may affect policy (Figure 1). Figure 1: The Health Policy Triangle Source Walt and Gilson, 1994 (in Buse et al, 2005) Actors refer to individuals, organizations or the state, and their actions that affect health policy. All actors have their own interests and agendas. Examples of actors include individuals, international NGOs, national NGOs, pressure/interest groups, international organizations, bilateral agencies, funding organizations, private sector companies, and the media. Context means systematic factors - political, economic, social or cultural, both national and international - which may have an effect of health policy. These include:  Situational factors- transient, impermanent conditions which can have an impact on policy (e.g. wars, droughts)  Structural factors- relatively unchanging elements of society (e.g. the political system, type of economy, demographic features)  Cultural factors- religion, ethnicity, gender International or exogenous factors- some policies require cooperation between national, regional or multilateral organizations Content is the substance of a particular policy which details the subjects and topics covered. Process is the way in which policies are initiated, developed or formulated, negotiated, communicated, implemented and evaluated. Policy formation falls into the process corner of the framework above and is influenced by actors, content, and context. Sometimes the process is rational - systematically weighing the pros and cons of various alternatives; and sometimes the process is incremental - an iterative decision making process (Buse et al., 2014) Whilst it can be helpful to assess policy formation as a rational, staged process (problem identification, followed by policy formulation, implementation and evaluation), in practice these stages rarely follow in a linear fashion. (Katikirredi et al, 2014; Buse et al, 2005)