Stephen Jones, Oxford Policy Management; Minah Kang Kim, Ewha Womans University;. Kelley Lee, Simon Fraser University; Robert Marten, Rockefeller ...
http://dx.doi.org/10.4161/23288604.2014.991221
Report from Bellagio: Advancing Political Economy of Global Health to Understand and Influence the Drivers of Universal Health Coverage Participants at the Bellagio Workshop on Political Economy of Global Health* http://dx.doi.org/10.4161/23288604.2014.991221
Abstract Motivated by a common interest in political economy analysis in global health and a belief that this field has been neglected in global health policy debates, we convened at the Rockefeller Foundation’s Bellagio Center for a workshop on the Political Economy of Global Health in May of 2014. Given our shared experiences working as academic researchers and practitioners in global health, we agreed on the importance of promoting research and improving practice in the political economy of global health. During this meeting we tried to articulate how a political economy perspective might strengthen policy analysis in global health and made some recommendations on how to promote more analysis of this nature. The purpose of this article is to report some of the conclusions we drew from our rich discussions. Full text The field of political economy of global health seeks to explain and influence the broader forces that affect the distribution of health and resources for health within and across populations globally. Studying the prioritization, design, adoption, and implementation of health policies through a political economy lens allows us to draw inferences about the motivations, incentives, policies, and dynamics that can lead to improvements in population health. A political economy differs from more traditional perspectives in that it seeks to better understand and emphasize the contestation of interests, and that engages core concepts such as power, incentives, interest groups, ideas, and institutions. Examining issues such as UHC using a political economy approach, offers a fuller understanding of policy processes and outcomes, in particular why some countries are making progress towards UHC while others are not. Learning from the experiences of some countries can be useful in developing strategies in other contexts. Political economy provides concepts and methods for analyzing and influencing extremely difficult challenges to health reform, including collective action problems, corruption, distributional issues, and patronage. It helps explain and manage different forms of power and the networks through which they flow, including the production of knowledge and the creation of legitimacy. Political economy analysis can help with understanding and changing the structure and allocation of power, for instance, through assessments of governance, accountability, participation, and voice. In particular the participants agreed that political economy was particular helpful for many issues current under debate in global health because:
http://dx.doi.org/10.4161/23288604.2014.991221
Efforts to improve health are characterized by major collective action challenges and important social conflicts, which make the determination of health outcomes fundamentally political and economic. • Health system reform, including current efforts to move towards Universal Health Coverage (UHC), usually entails the allocation and redistribution of a society's resources, which creates winners and losers. It is thus a profoundly political and economic process. • Governments face many competing priorities. Elevating health on the national political agendas requires understanding the preferences of governments for health improvements vis-‐à-‐vis other activities and the ability and willingness of governments to respond fairly to the health priorities of their varied constituents. • Weak institutions contribute to profound problems of implementation, and thus improving the performance of institutions is essential to improving health. Political economy can analyze the incentives that affect institutions and identify ways to make them more responsive to the health needs and desires of citizens. • The field of political economy analysis in global health seeks to explain and change the structural inequalities and related processes that characterize certain forms of globalization. The field recognizes the role of social movements engaged with understanding and shaping public health, and builds on past efforts by the classical pioneers of political economy who sought to improve the lives of those marginalized by structural forces in the industrial revolution. To date the application of political economy frameworks in global health has received limited attention from researchers and practitioners. Much of the analysis in global health focuses on the technical aspects of diseases and policies, with far less attention to the political and economic forces that shape what technical interventions and policies are developed and whether they are adopted and implemented. To promote more political economy approaches among researchers and practitioners, the meeting participants made the following recommendations: First, we recommend the application of political economy concepts and methods in the design, adoption, and implementation of health policies. For instance, we recommend more political economy analysis to better understand and support the processes by which countries are making progress toward UHC. Second, we recommend creating a core research agenda for political economy of global health through dialogue with policy makers, public health practitioners, social movements, and researchers. Third, we recommend efforts to build the field of political economy analysis in global health, through investments in capacity in countries to conduct such analyses, and by creating opportunities for dialogue between practitioners in different places and different disciplines. •
http://dx.doi.org/10.4161/23288604.2014.991221
Fourth, we recommend more high quality publication of political economy research in leading global health journals. A scoping review of political economy of global health and a special issue of a journal could help advance global attention and understanding to the political economy of health. Fifth, we call for international health organizations, private foundations, and government and multilateral agencies to give more attention and support to both applied and theoretical political economy analysis of global health, and to build in-‐country capacity to conduct political economy studies. Addressing health challenges and improving population health is a complex issue at the core of the field of global health policy. Viewing this process through political economy analysis provides new perspectives, generates new ideas, and can help in the development of more effective health policies around the world. The dialogue around promoting political economy analysis of global health should occur at major global health where researchers and practitioners come together. At the end of the meeting we organized a new group known as the Society for Political Economy Action and Research in Global Health (SPEAR-‐GH). SPEAR-‐GH will hold periodic meetings and provide a forum for ongoing exchange, sharing resources, and coordinating efforts to advance global health through political economy analysis. To join the conversation or learn more, please contact info@spear-‐gh.org or visit www.spear-‐gh.org.
Participants at the Bellagio Workshop on Political Economy of Global Health: Yarlini Balarajan, UNICEF; Sara Bennett, Johns Hopkins Bloomberg SPH; *Jesse B. Bump, Georgetown University; Mariam Claeson, Bill & Melinda Gates Foundation; Kevin Croke, Harvard School of Public Health; Ashley Fox, Mt Sinai University; Asha George, Johns Hopkins Bloomberg SPH; Octavio Gomez, Instituto Nacional de Salud Pública, Mexico; Karen A. Grépin, New York University; Guy Grossman, University of Pennsylvania; Piya Hanvoravongchai, Chulalongkorn University; Macartan Humphreys, Columbia University; Stephen Jones, Oxford Policy Management; Minah Kang Kim, Ewha Womans University; Kelley Lee, Simon Fraser University; Robert Marten, Rockefeller Foundation; Yasuhiko Matsuda, World Bank; Kelechi Ohiri, Ministry of Health, Nigeria; *Michael R. Reich, Harvard School of Public Health; Jeremy Shiffman, American University; Leni Wild, Overseas Development Institute; Joseph Wong, University of Toronto; Shehla Zaidi, Aga Khan University *Co-‐organizers; Organizations are solely for affiliation purposes.
