Policy process – agenda setting
The agenda setting of this policy is based on Kingdon’s agenda setting model. In this model problem stream, policy stream and politic stream are three independent streams. When the three streams run together, the policies are taken seriously. A number of actors can influence the making of the agenda and influence the ideas considered for the policy. The problem combined with the features of politicians, the circumstances and the policy solutions can create an opportunity for opening or closing a policy window (bogen).
Problem stream
This refers to the problems in public that require attention from the government. The officials learn about the problems and socio-economic conditions through indicators, feedback or focusing events, such as crisis. This will help the problem reach the agenda when running together with the two, other streams (bogen).
In the 21st century, non-communicable diseases are a huge health and development challenge. Indicators show that in 2012, 38 million deaths were due to NCDs and more than 40% were premature deaths, affecting people under 70 years. The NCDs affect people’s health and inflict with the socioeconomic status particularly in the low – and middle-income countries. The negative human consequences of the socio- and economic status affects all societies but they are particularly damaging the poor and vulnerable populations. Taking the lack of evidence based action into account and the fact that the NCDs will continue to grow it might overwhelm the countries with little capacity to handle them. Therefor governments cannot avoid the rising burden of the NCDs and it is now an opportunity to change the crucial point that the world has reached and address the NCD problem (WHO).
In 2016 WHO organized a meeting where 137 countries came together to share experiences and identify priority actions for NCDs. The meeting consisted of interactive sessions with live feedback using a custom-made app and the participants engaged in an interactive and lively dialogue. Almost all respondents found the meeting useful and 97% expressed their interest on another meeting towards experiences on dealing with NCD risks. (http://www.who.int/ncds/media/ncd-focal-points-report/en/).
Policy stream
This surrounds the possible ideas and solutions to the problem and the ongoing debate about the problem and the possible responses. To reach the agenda the ideas need to be feasible, match with social values and be capable to handle feasible limitations in the future as well as respond to the public and the politicians (bogen).
In the health sector, the implementation is more effective if all stakeholders are engaged in the development and negotiation of the national policy and strategies. This includes all actors to interact in dialogues and broad consultations about the current situation and the goals that will help directing the health policy. To make it feasible WHO engages and supports all members of the state both political, technically and social to help guide the dialogue towards the health policy strategies and plans (WHO).
In the 21st century, it is time to unleash the world’s potential to beat NCDs as indicated in the problem stream. WHO is, taking action against the NCDs. They have made nine targets for the countries to achieve against NCD risks such as smoking, alcohol abuse, unhealthy diets and physical inactivity. They will help countries meet the global targets to reduce premature deaths from cancers, heart and lung diseases, and diabetes by 25% by 2025. (WHO).
Politics stream
This refers to change in the national mood, change of government and campaigns by interest groups. It involves visible participants such as organizations with a specific interest in the problem who might highlight the problem and a possible solution through campaigns.
WHO is a visible participant and they are the organization with the main interest. They have made a campaign, which aims to demonstrate the potential that exists for countries, and the world, to achieve the nine global voluntary NCD targets. The campaign provides policymakers and the public with help from WHO who have made guidelines and technical information on the prevention and control of NCDs and their risk factors. The campaign builds upon WHOs ongoing work and encouraged by their agreed policies. It will contain recommendations that are reliable, currently, available and actionable. The campaign will discuss and reflect upon different themes and content across WHOs programmatic areas, initiatives and campaigns.
They will provide products for use by the politicians and for the public to support the implementation. There made country implementation profiles that contain the countries progress to obtain the nine targets and the campaign needs support and implementation at regional, national, and local levels. There also made a portal that engage the people directly to face the risks of the NCDs.
Policy entrepreneurs
The policy entrepreneurs are both active in the problem stream and in the policy stream. These people can be politicians and interest groups and they have a special interest in the policy to reach the agenda. They increase the chance for the policy to reach the agenda by promoting their ideas in many different ways (http://heapro.oxfordjournals.org/content/24/4/434.full).
WHO has made a work group for the alignment of international cooperation and national plans on NCDs. The working group consist of representatives of two of the member states, one from a developing country and one from a developed country. The meaning is to encourage member states and non-state actors to align international cooperation on NCDs with national plans aiming to strengthen the prevention and control of the NCDs. WHO wants to strengthen international cooperation and promote healthy lifestyles. They want to promote an environment that facilitates the healthy lifestyle choices at the national, regional and international levels in collaboration with the countries government and public people (http://www.who.int/global-coordination-mechanism/ncd-themes/international-cooperation/en/).
Policy window
The policy window is open in a short time and opens when the three streams run together. The policy entrepreneurs must act fast and promote a specific solution before the opportunity passes (http://heapro.oxfordjournals.org/content/24/4/434.full).
The problem stream made the policy window open. After the indicators and the feedback meeting shown in the problem stream there became an opportunity to combine the three streams. In the policy stream the guidance by WHO and recommendations to the countries made it beneficial for the policy to survive. The policy entrepreneurs in form of WHO made it more likely to reach the countries agenda by engaging actors and collaborate with all actors. The three streams connected when the policy window was open because of the circumstances in the three streams and the entrepreneur work.
Policy formulation
This is focusing on which contextual factors that influenced the policy stream. It refers to the systematic factors that may have an effect on the health policy, such as economic, political, social, local, regional, national or international factors (bogen).
Situational factors
They are transient, impermanent conditions that have can have an impact on the policy (bogen).
A lot of the developing countries suffer from civil wars and the violence in developing countries is one of the primary causes that makes people poor. The poverty is becoming concentrated in countries riven by civil war, ethnic conflict and organized crime. As a result, people in these countries are more likely to have an unhealthy life style, not have an education and infants are more likely to die. It is difficult for the public people in these countries to escape the violence as they are struggling with bad governments that produce weak health systems
(http://www.economist.com/node/18558041).
Structural factors
This refers to relatively unchanging elements of the society. It focuses on the political system, type of economy and demographic features (bogen).
Every year over 16 million people dies from NCDS and 82 percent of the deaths are in developing countries. About two-third of the people that experience premature death dies of exposure from known risks factors. Almost half of the people dies due to weak health systems that does not meet the peoples need both effectively and equitably (http://www.who.int/nmh/events/ncd-coordination-mechanism-essential-medicines/en/).
The governments in developing countries face a large burden of health impacts but these countries often suffer from a dysfunctional government. The government struggle with economic costs of lost productivity, the burden of the health sector, a burden of bad resources and long term social consequences. They do not keep up with the expanding needs for policies, legislation, services and infrastructure to prevent NCDs. Large amounts of human and financial resources are invested in the developing countries to generate governments that are more democratic and equipped to cope with the weak health systems. Even though, the majority of the countries do not achieve the expected improvements in their living standards (http://www.who.int/nmh/publications/ncd_report_chapter2.pdf). The developing countries development decisions do not consider the health and environmental problems enough compared to investments and infrastructure. Therefor the environmental and health problems need to be higher on the policy agendas.
The social determinants, particularly education and income levels are associated with NCDs. People who begin their life poor or become poor have an increased vulnerability to NCDs and are more likely to die prematurely. People are often pushed in to poverty because they have to pay directly for the health services in the developing countries and the patients do not have equitable access to affordable medicine and technologies. (http://www.who.int/nmh/publications/ncd_report_chapter2.pdf). Investing in effective management, such as detection, treatment and palliative care, is the most important thing to cope with NCDs (http://www.who.int/ncds/management/en/). Unfortunately, the developing countries spending on medicines and other health technologies puts a pressure on the health budgets because it accounts for more than half of the health expenditures in some countries (http://www.who.int/nmh/events/ncd-coordination-mechanism-essential-medicines/en/). One of the enemies in developing countries is also corruption. It can have consequences through impacts on government provisions of goods and services. It can increase the cost of goods and services and raise the price of these goods and services (http://www.nber.org/papers/w17398.pdf).
Cultural factors
These refers to the cultural factors that might affect health policy (bogen).
A perspective to public health interventions is the difficulty in sustaining a behavior in change because there is not enough attention to the influence of culture. ‘To change negative health behaviors, one must first identify and promote positive health behaviors within the cultural logic of its contexts’ (https://sph.umd.edu/sites/default/files/files/Why%20Culture%20Matters%20HEB.pdf).
The poor governance in developing countries do not include equal access to public services for the poor and other disadvantaged people of the society, such as women, children and minorities. In developing countries there is wide gap between rich and poor within the country. People who are poor have less access to health care services than people who are wealthy. The gender inequities in health services are common and it is mostly for poor women and in these countries the health care services are not available or acceptable for women as they are for men. The health care choice can also be influenced by people’s religion and sometimes patients have different expectations from different providers that affects the people’s health care chose. (http://onlinelibrary.wiley.com/doi/10.1196/annals.1425.011/pdf). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267750/).
International
This can lead to greater interdependence between states and influencing sovereignty and international cooperation in health (bogen).
To strengthen national efforts to address the burden of NCDs, WHO made the Global Action Plan for the prevention and control of NCDs from 2013-2020. The global action plan is to provide the countries with a road map for strengthening monitoring, implementation and policy options for the member states. WHO implemented the action plan collectively with other UN organizations, intergovernmental organizations, NGOs and the private sectors.
The UN secretary-general, placed under WHOs leadership, established in 2013 a task force on the prevention and control of the NCDs, The United Task Force (UNIATF). They are supporting governments to meet high-level commitments to respond to NCD epidemics worldwide (http://www.who.int/nmh/events/ncd_action_plan/en/).