This lecture covers health policy, defining it as outputs from the political system affecting community health. It discusses efficiency and equity in health policy, as well as the availability, accessibility, affordability, and quality of health services. Additionally, it explores the policy process involving key players, policy formulation, implementation, evaluation, and resistance to new health policies, illustrated with examples like mask mandates and vaccination resistance during the COVID-19 pandemic.

1. Foundations of
Public Health
Lecture 6 - Political Science as
Applied to Public Health
(Public Health Policy)
Phua Kai Lit, PhD (Johns Hopkins)
Retired public health professor
(Monash University Malaysia School
of Medicine and Health Sciences)

2. Lecture Objectives
 What is “Health Policy”?
 Efficiency and equity
 Availability, accessibility, affordability, quality
 The policy process and main players
 Policy formulation
 Policy implementation
 Policy evaluation - unintended/negative effects too
 Resistance to introduction of new health policy e.g.
compulsory mask-wearing during COVID-19
pandemic, anti-vaxxer movement, resistance to health
care reform e.g. Obamacare, anti-abortion movement

3. What is “Health Policy”?
• Health Policy can be defined as outputs (laws,
regulations, policies, programmes) from the political
system of a jurisdiction (country or state or
municipality) that is related directly to the health of
its residents.
• Examples include the establishment of the National
Health Service (NHS) in Britain in the late 1940s,
the policy of privatisation of the government health
sector during the rule of Prime Minister Mahathir
Mohamed in Malaysia, mandatory masking and
mandatory vaccination policies in various countries
during the COVID-19 pandemic.

4. Efficiency and Equity
 Health policy should not only be effective i.e.
achieve noticeable results (such as mass
immunisation and eradication of smallpox), it
should also be efficient and concerned with
equity at the same time.
 Efficiency is a concept from economics that
emphasises the importance of “more bang
for the buck” i.e. maximum output achieved
with minimum input of resources (human,
financial, physical resources)
 Equity means some social groups should not
be left out or be underserved.

5. Efficiency and Equity
 Horizontal Equity: this means that social groups
that are alike in terms of health needs should be
treated alike in terms of resources allocated to
them.
 Vertical Equity: some ethicists argue that those who
need more health services should be provided with
more e.g. people from the lower classes tend to be
sicker, have higher rates of disability and die earlier
than those from the upper classes. Therefore, the
government should spend more on curative and
preventive services for the lower classes.

6. Availability, Accessibility,
Affordability, Quality
 Availability (e.g. of long term care) means the
resource or servce (such as nursing homes)
actually exists in the community.
 Accessibility can mean physical accessibility
(patient does not need to travel far or for a long
time to reach the resource), cultural accessibility
(the service e.g. psychiatric services, is acceptable
in the local cultural context), information
accessibility (e.g. people are aware of services
provided by NGOs in their region)
 Affordability means use of services does not
impoverish/bankrupt the individual and family.
 Health policy must be made with these issues in
mind, while ensuring that service quality is of a
reasonable standard.

7. 7
Main Players in the Policy
Process
Main players include politicians (who propose
new health legislation), relevant agencies in the
civil service (such as Ministry of Health officials
and experts who provide advice to the
politicians), interest groups (who lobby for or
against a proposed new policy) - including the
local medical association, public interest citizen
groups, industries likely to be affected by the
proposed new policy, religious groups (especially
if the new policy affects family relations, sexual
behaviour) etc.

8. Formulation: how a public health issue gets on the
political agenda, how a policy decision to address the
issue is made by the authorities in the form of new
laws or public health programmes e.g. the decision to
ban smoking in restaurants in Malaysia.
Implementation: how the civil service carries out the
new programme or makes sure the new law is
followed by citizens e.g. the health authorities decide
what to do when the law is broken by smokers.
Evaluation: analysis to find out impact of new policy
The Policy Process: How a New
Policy is Formulated,
Implemented and Evaluated

9. 9
Policy Process
Evaluation includes an analysis of unintended
effects, negative effects etc. too.
For example, if a decision is made to increase
the government tax on cigarettes (to raise the
price of cigarettes and decrease smoking), this
may result in increased smuggling of cigarettes
into the country from neigbouring countries with
lower cigarette prices.
During Prohibition (when alcohol was banned in
USA), criminals got involved in illegal
production/sale of alcohol all over the country.

10. Emerging and re-emerging diseases, including
outbreaks of new infectious diseases.
Climate change resulting in more public health
emergencies such as “natural disasters”.
Refugees and their health needs. There may be more
and more “climate change refugees” too with rising
sea levels, droughts, floods and so on.
Obesity and chronic diseases. Changing diets may
result in more and more cases of diabetes, CVDs etc
Newer challenges include phenomena such as the
anti-vaxxer pressure groups, movements to outlaw
abortion and restrict contraception in the USA etc.
Challenges

11. 11
Resistance to Health Policies
Resistance to new health policies can occur.
COVID-19 pandemic: there was widespread
resistance to compulsory mask-wearing in the
USA. The anti-vaxxer movement also mobilised
against vaccination, with some claiming that the
vaccine actually harmed people who got
vaccinated.
Obamacare: after the ACA or Affordable Care Act
(called “Obamacare” by critics) was passed in
the USA, opponents continued to mobiise
politically and attempted to get parts of the act
declared illegal by US courts.

12. Thank You