Final Study Guide
Final Study Guide UAPP110
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This 16 page Study Guide was uploaded by Audrey West on Thursday December 10, 2015. The Study Guide belongs to UAPP110 at University of Delaware taught by Erin Knight in Summer 2015. Since its upload, it has received 29 views. For similar materials see Changing the World and Public Policy in Public Health at University of Delaware.
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Date Created: 12/10/15
Final Review (Notes since Midterm) October 14 Guest Speaker Roles of Media – Dr. Yanich First, my conclusions … • News presentation makes citizenship difficult to practice. • Audience is treated only as consumers o Audience becomes the commodity – it is SOLD to advertisers • Constructed reality is reflected in pejorative images ... because it sells • Reality is being delivered by forces public cannot change. • Opportunities to exercise citizenship are few. News is.. • A construction o Every day organizations decide what we will hear, see and read o Their version of reality Explicit promises of equality • “And that’s the way it is.” –Walter Cronkite signing off on CBS evening news “Reality is set up for grabs.” –Captain Hawkeye Pierce News is.. • Zero-sum game o Some things IN, other things OUT o Limited time or space • Extraordinary o Not a MIRROR that reflects everything o A BEAM that searches for extraordinary aspects of human condition § Dog bits man – not a story § Man bites dog – THAT’S a story News as Product News is market driven* … • Profit motive • Credence good News producers construct the newscasts… • Not to INFORM the audience • But to DELIVER that audience to a set of advertisers A prescription for creating reality • Every news story should, without sacrifice of probity or responsibility, display the attributes of fiction, drama • It should have structure and conflict, problem and denouement, rising action and denouncement, rising action and falling action, a beginning, a middle and an end, • Should have a beginning, middle and end o Want to sell to the people, for advertisement • These are not only the essentials of drama; they are the essentials of narrative. • Is this really realistic? Giving people the truth? Award winning stuff – a disconnect? Audience only reacts • We do not question the reality… • Only react to it as if it were on objective fact • We do not function as citizens… o Rather as consumers, that’s how the news people want you Remedies.. Where to intervene? • The organization • The market • The individual viewer Individual viewer change? • Critical pause • Single criterion to every news story.. o What makes the story news? A consumer does not mean citizen • If something is wrong, ACT like it o Don’t apologize for acting like it • We do it regarding consumer goods/services o Exit.. Voice.. Loyalty • DO something.. o About the information you receive as a citizen October 19, 2015 Notes: Policy Analysis and Evaluating Alternatives Policy analysis tends to focus on steps 2 and 5 of policy process (policy formulation and policy evaluation) Policy Analysis • What is it? o A systematic method for studying o Problems – nature and scope o Policy alternatives – possible actions o Policy outcomes – implemented policies • Who does it? o Government agencies (federal and state) o Universities o Think tanks o Interest groups Policy Analysis by Think Tanks • “Policy research institutes” – growing sector (4,000+ world wide) o Small and specialized vs. large and diverse o Mostly non-profit o Often issue-specific • Their work helps policymakers o Understand complex problems o Learn ways to address problems o Understand views of interest groups Steps in the Policy Analysis Process • Define and analyze the problem • Construct policy alternatives • Develop evaluation criteria • Assess the alternatives • Draw conclusions Step 1: How do policymakers (and other stakeholders) analyze a problem? • Define and measure • Collect data • Investigate causes Major Components of Problem Analysis • Understand the CONTEXT surrounding the problem • Define the problem (narrowly) • Measure it • Document the EXTENT or MAGNITUDE of it • Identify CAUSES of the problem • Think about.. What should policy outcomes be? What are your goals in addressing the problem? Determine how to measure it • Be as objective as possible o Sometimes problems are clear; sometimes not o Politics of problem definition o “I think…” is irrelevant o Be very careful of assumptions/myths • Identify or develop operational measures: o Observable evidence (DATA) describing the problem o Cite your sources What’s causing the problem? • What are the root causes of the problems? o Increases the complexity of the problem o Policies that can impact root causes will be more effective o These policies may be harder to sell • Research backward.. Get to the “root” o What contributes to the problem? o Where does it start? • What are the proximate causes? (Low hanging fruit?) Getting at the root: ask “why” 5 times Why is Jason in the hospital with an infection? Because he has a cut on his leg. Why does he have a cut in his leg? Because he was playing in an abandoned lot near his apartment and got cut on an old car. Why was he playing in an abandoned lot? Because his neighborhood is rundown and a lot of kids paly there and there’s no one there to watch them. Why does he live in that neighborhood? Because his parents can’t afford a nicer place to live. Why can’t his parents afford a nicer place to live? Enough though they both work, they have a hard time paying the bills… Step 2: Constructing Policy Alternatives Developing potential solutions to policy problems. What policy outcomes need to be attained? Set goals. Be clear about your specific goals • Reduce illegal immigration or reduce immigration • Improve highway safety or reduce highway traffic • Reduce binge drinking or reduce underage drinking • Reduce accidents caused by distracted driving or reduce accidents caused by cell phone use • Create living wage jobs or reduce poverty • Reduce the prevalence of obesity or increase physical activity Instruments of Public Policy (things we might consider) • Regulate • Subsidize • Improve taxes or give tax deductions • Etc. Methods to formulate policy alternatives • Importance of CREATIVE THINKING • NO ACTION ANALYSIS: what happens if we do nothing? • Quick surveys o Talk with EXPERTS to see tools they recommend • Literature review o What policy alternatives are out there? o Think tanks, interest groups Construct alternatives • Real-world situations o What’s worked in similar situations? o Has it been tried by a state? • Parallel situations/analogies o Used in other sectors? o For other problems? • Brainstorm Step 3: How is the right course of action chosen? Access policy alternatives using SPECIFIC evaluative criteria Selected criteria for evaluating public policy proposals • Effectiveness • Efficiency • Equity • Liberty/freedom • Political feasibility • Social acceptability • Administrative feasibility • Technical feasibility Why are criteria used? • Policy decisions are complicated. o Focus on what’s (most) important o Organize your thinking o Make your perspective explicit • Can be used to choose on option over another • Can be used to judge merit or impact or current policy • Helps to identify winners and losers Evaluative Criteria • Effectiveness o Does the policy alterative reach outcome goals? § Operational measure that define “effective” § An estimate of its likelihood of working • Efficiency o One step beyond effectiveness § Effectiveness RELATIVE TO COSTS § Costs relative to benefits § An “efficient policy” is one that works well at low cost… • Feasibility o Political/social § Extent to which policy makers accept/support an alterative § Extent to which public will accept/support an alterative o Administrative/technical § Likelihood that a department or agency can implement the alternative well (example: resources, expertise, organizational structure) § Availability/reliability of technology needed for implementation of the alternative • Equity o Fairness in the distribution of the costs, benefits and risks across the population o NOT necessarily the same as equality o Different ways to think about equity (example: process vs. outcome equity) Using Evaluation Criteria • Different decisions rely on different criteria o The criteria should relate well to the decision o The situation/context also influences criteria • Criteria should use operational measures or indicators – be objective and measurable whenever possible • Not necessary to consider every criterion; and may need to balance one against another Approaches to policy analysis • Economic analyses o Cost benefit/risk assessment o Cost-effectiveness • Forecasting and impact assessment • Political and institutional analysis • ETHICAL ANALYSIS October 21, 2015 Notes: Drone Policy Evaluation Criteria • Effectiveness • Efficiency • Equity • Political feasibility Understanding Drones What do drones do? • Used to monitor what is happening on the ground • And possibly shoot missiles Advantages of drones: • Don’t put lives at risk • Less expensive than traditional warfare • Easy to support politically Disadvantages of drones: • Not a long term solution • Secret CIA operation • US bears sole responsibility for attacks What are the controversies about the use of drones? • Laws put into place do not cover technology today (conflict and technology) October 26, 2015 Notes: Health Policy Part 1: Health Care Policy Recent history of US health insurance • 1930s – health insurance • 1950s – employer sponsored health insurance grows • 1965 – public health insurance: Medicare & Medicaid established • 1990s2: reform attempts (Clinton era), state children’s health insurance program 1997 • 2010 – affordable care act (Obama care) How is the government involved in health care? • Safety net providers • Public health programs for special populations/conditions • Quality In the US, we have publicly funded health insurance and privately funded health insurance (hybrid). Before the Affordable Care Act, most people had insurance through their employer. Health care around the world • Health care systems in other countries o Health care is a “right”/”merit good” • Other developed countries have o Universal coverage o National health insurance or single payer o More price controls (regulation) o Fewer for-profit stakeholders What are the major problems in the US health care system? • Cost (high) • Poor access • Poor quality Sometimes assume: If we increase access, it is going to cost more. If we reduce cost, we might lose quality. If we increase quality, it will cost more. 1. Cost • Growing burden on government (public spending) • Growing burden on employers o Large businesses offer health insurance, but don’t have to o Small businesses increasingly cannot provide • Growing burden on individuals o Bankruptcies due to health costs o Cost sharing Over half of bankruptcies in the US are caused by health care costs (can’t afford) Why are the costs so high? The Health Care Market • Compared to other individualized countries, the US has: o LESS QUANTITY THAN OTHER COUNTRIES o Fewer physician office visits per capita o Fewer hospital impatient admissions per capita o Lower average length of stay (ALOS) per admission o Fewer hospital impatient days per capita o Etc. • Total expenditures – price * quantity • Third party payer system (insurance system) & market failures (a lot of build in inefficiencies) 2. Access to care (pre-ACA) • Uninsured • Underinsured o Preexisting conditions exclusions o Portability concertinas • Other barriers o Language 3. Quality • We have some of the best health care treatments in the world • We lead the world in medical innovation o For certain diseases, US has better results • In many HEALTH measures, we lag other countries o Infant mortality rate 5.9 per 1000 live births (44 ) th rd o Life expectancy ~ 79 years (33 ) • Our outcomes are not the best in the world Medical errors Every year in the US there are: • 12000 deaths from unnecessary surgeries; • 7,000 deaths from medication errors in hospitals; • 20,000 deaths from other errors in hospitals; • 80,000 deaths from infections acquired in hospitals; • 106,000 deaths from FDA-approved correctly prescribed medications Total annual medically-caused deaths in the US ~ 225,000 The medical system is the third leading cause of death in the US, behind heart disease and cancer. One alternative/solution Patient protection & affordable care act of ?? Key elements of the PPACA (staged roll out) • Expands Medicaid and CHIP • Mandates that individuals not covered through their employers or by public programs purchase a minimum level of insurance (or pay a penalty) • Subsidies for those that cannot afford insurance • Mandates/penalties for large employers that don’t provide insurance; incentives for small employers to do so • Coverage regulations (e.g. no exclusions for pre-existing conditions, eliminate certain limits on coverage, require insurance companies to cover children up to age 26 on parents’ plan) October 28, 2015 Notes: Health Policy Part 2 HEALTH is “a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity” • NOT JUST THE ABSENSE OF A DISEASE Shifting the frame: different policy goals Treating illness VS promoting health (different problems, different goals, different policies) Root cause of poor health: unhealthy communities Re-defining the problem as poor health and focusing on ROOT causes • General socio-economic, cultural and environmental conditions o Living and working conditions § Unemployment § Water and sanitation § Health care services 10-15% § Housing § Agriculture and food production § Education § Work environment • Social and community networks • Individual lifestyle factors Background: Race and Health • Really about racism and racial discrimination • No biological basis for differences in health • Racial discrimination contributes to uneven quality and distributing of the social determinants of health • Racial discrimination creates chronic stress and contributed to poor health independent of other social factors Background: unhealthy places • Where a person lives – which is largely driven by their position in the social hierarchy – determines whether she or he is surrounded by things that make it easy or difficult to maintain healthy behaviors; maintain good health • Place matters above and beyond the characteristics of the individuals living in that place An alternative to healthcare policy: HEALTHY public policy • Minimum wage November 2, 2015 Notes Energy Policy: The Political Economy of Energy Systems Where do we get our energy from and how do we use it? • Solar, nuclear, hydro, all different kinds of energy • Some energy used for: electricity, residential & commercial transportation • Rejected energy: thermal energy, energy getting ejected as heat, not even being used Issues with conventional energy.. • Volatile and unsure supplies • Climate What’s wrong with the sustainable energy system? • Storage of renewable energy • NIMBY – not in my backyard • Rare earth metal scarcity and geographic concentration • Not everyone wants to change energy systems Energy change in policy could affect: (the inter-connectedness of energy policy to other policy areas) • Economics (fiscal) o Fiscal policy – taxing and spending • Transport • Industrial • Health • Foreign • Rural/urban development (housing) • Environment • Agriculture • Education – moving towards more and more technology Ivan Illich – “radical monopoly” • “I speak about radical monopoly when one industrial production process exercise an exclusive control over the satisfaction of a pressing need..” Radical monopoly over development, agriculture, social media, “The Cloud” Energy policies • Subsidies (tax credits, military presence, loan guarantees, paying for negative externalities, etc.) • Taxes (consumption tax, carbon tax, pollution fees, etc.) • Regulations (CAFÉ standards, emission standards, etc.) • Electricity feed-in-tariffs (FIT) – European model • Electricity renewable portfolio standards (RPS) – American model (Delaware’s electricity RPS is 10% by 2020 and 25% by 2050) • Investments in energy technology R&D November 4, 2015 Notes: The Future of Social Security Supposed to give money (usually older people) Insurance program – social insurance o Insurance that serves a social purpose o Serves 3 social purposes (insurance assistance, assistance to the families of older Americans if the person is deceased, insurance for people with disabilities) National, federal program put in place by the federal government • Put in place in 1935 In 1875, most Americans lived in rural areas – 75% lived in rural areas, 25% lived in cities In 1925, 25% live in rural areas and 75% live in cities. FICA – federal insurance contributions act – 12.4% of wages you earn (cap is $117,000) • Take certain percent of everyone’s wages • Pay as long as you’re working and earning WAGES • Pay something in with the idea that you’ll ultimately enjoy the benefits • Something has to go in to come out • Benefits = money, an actual check • Goes to a trust fund between this time 1960s: 5 people putting in 2013: 2.8 people putting in 2035: 1.9 When social security first started, in 1935, you had to be 65 years old to qualify. The average life expectancy was 65 years old. In 2015, the earliest you can get social security is 66 years old. The average life expectancy is 78 years old. Benefits are a little less than $14,000 a year. November 11, 2015: The Student Debt Crisis • $1.3 trillion • Around 2/3 is staying there – it is not being paid off • College costs more • People can’t pay so they push the costs into debt • UD = national funding • Universities are now charging • State per capita support per state average declined by 28% between 2007 and 2013 o During the Great Recession o In Hawaii, it declined 50% o In that same period, public university tuition and fees increased 27% • As they put more burden on students, they were making public good private good • One could say that higher education was America’s most successful industry of any kind in the second century • China pledges $250 billion funding to expand the higher education sector o Treating higher education as a public good November 16, 2015: Public Health Advocacy Speaker Years ago, 50% of people would have been smoking during class time How to cut the smoking rate even further: • Tobacco prices have increased, raise them even more – the most evidence based, clearly effective (PRICE, EXCESS TAX) • Access: raise the age (if you’re in college not as convenient to get – don’t have a car on campus) • Increase the punishment In Delaware, they run enforcement checks of tobacco at 100% of retailers • Compliance checks • Other states don’t do it to this level November 18, 2015 Notes: Ideology vs. Reality: The Political Economy of Climate Change Policy Non-Decisions Is there a scientific consensus on climate change? • Cook et al. (2013, page 1) looked at the abstracts of peer reviewed scientific literature and found that, “among abstracts expressing a position on anthropogenic global warming, 97.1% endorsed the consensus position that humans are causing global warming” • Proven that it is extremely likely that human activity is causing climate change Fossil Fuel Industry and Commercial Interests • Exxon • Did they defraud the investors because they knew the risks of climate change but did not disclose theses risks like they were supposed to? Conservative Think Tanks • Scientists who work for these think tanks cast doubt on reality o Make it appear as though there are two, equal sides to the event o All of this is to delay action Front Groups/Astroturfers • Go and whip up this debate • Have satellite stations all over Conservative blogs What happened to Bob Iglis? • He admitted that the climate change was real & was human cause • Got booted out • 2010 Conservative Swerve – The Tea Party Ways to restrict your CO2 freedoms • Impose taxes (carbon tax) • Standardize pollution limits • “Cap and Trade” How “Cap and Trade” Works • Marketplace • Incentives people to clean up (innovate) • Intended to drive innovation • As the cap shrinks, you have to get cleaner and cleaner “American Clean Energy and Security Act” – AKA the Waxman-Markey Cap and Trade Bill • It passed 219-212 in the House with 8 Republicans supporting the bill and 44 Democrats opposing it • The senate version is never sent to the floor due to lack of supporting votes o Criticism from the fossil fuel sector that it would unnecessarily burden industry and raise costs to consumers o Criticism from environmental groups that it did not go far enough to limit climate change City/urban scale • Cities are doing things Local community scale • Communities are doing things • People are getting together at the community level acknowledging climate change and how they should go about it o Start community gardens, item swaps Individual scale • Things we can do as individuals • Ride a bike instead of drive a car Embrace change! December 9 Notes: Wrap Up & Looking Forward • Lobbyist – not always necessarily a bad thing, engage in some type of change (for private or public interest) o Advocacy – proposing a certain course of action, trying to INFLUENCE policymakers in a certain way, want some sort of CHANGE • Bias in the news – a lot of it is profit driven, painting the picture you want to see, power of what they report o Question what you read or see • Climate change – it is a problem, what can be done about it • Social security – we are dealing with it now (money being taken out of paycheck) • 6 stages of the ideal policy process ** o Even the IDEAL process is complicated and long • There may be more than two sides – we always present things as being opposing but there may be multiple ways to look at the same thing Public policy is problem solving. It is what government does about PUBLIC PROBLEMS. • Public problems are conditions the public widely perceives as unacceptable; requiring intervention • What is unacceptable depends on values, magnitude/evidence and context • Reasons for government intervention often economic; ethical/moral • Context matters • Scale matters – some problems are local, some are national, some are global o Scale of government Various actors play a role in the policy process. Formal actors: • The way our government is structured directly influences the policy process: BY DESIGN • Often hard to determine which level of government has responsibility (or should have responsibility) to solve a problem • Incremental policymaking is par for the course Informal actors • Citizens/communities • Interest groups • Media • Think tanks • Political parties Careful of myths in the news and holding onto those myths because you want them to be true POLICY ANALYSIS: includes study of problems and solutions; causes and consequences • It relies primarily on evidence to improve public policy o Use of evidence is somewhat subjective (example: how did you define your problems? What should be done about them?) • It uses specific criteria to judge the merit of a policy or compare options o Rarely possible to maximum all criteria (trade-offs are standard in the policy process) Values and common ground • Wicked problems are inherently complex • Identities, assumptions and conflict • Shared values as the starting point for compromise
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