1. Power and the policy process
Dr. Israa Al-Rawashdeh MD, MPH ,PhD
Faculty of Medicine
Mutah University
2017

2. Remember?
Process in policy making: refers to the way policies are initiated, developed or formulated, negotiated, communicated, implemented and evaluated.

3. theories of the relationship between power and health policy making.
theories on the distribution of power.

4. What is POWER? Ability to achieve a desired outcome. In policy making?
HOW?
Activity 1

5. Intimidation and coercion (Stick)
Productive exchange/ mutual gains (Carrot)
Creation of obligations, loyalty, commitment (Hug)

6. Steven Lukes (1974) 3 “faces”/ “dimensions”: Power as decision making
Power as non-decision making
Power as thought control

7. 1. Power as decision making
A exercise power over B and makes him do, even B doesn’t want to do. In other words, it is a direct and observable power.
it is an open system (referring to pluralism), where anyone can easily and freely make their voice heard, or participate in. (political resources?)
Social standing, access to cash, credit, wealth, information access..etc

8. 2. Power as non-decision making
A exercises power over B, and gets him/her do even B doesn’t want to do. But, there is an indirect use of power.
Agenda setting.
Limiting the policy agenda, manipulating dominant community values. Issues fail to enter the policy arena.
E.g. Powerful industries (smoking, pharmaceutical).

9. 3. Power as thought control
A not only exercise power over B to make him/her do what B doesn’t want to do, but also determines and shapes his/her very wants as well. Shaping preferences. Conditioning. Positive thinking. Insidious. Invisible. Changing minds.
WAYS TO DO THAT?
Media,
Language used
Control of information
Schooling
Religion
Processes of socialisation

10. Range of approaches of power
“hard” (carrot and stick)/ “soft” (hug) power.
Power vs authority
Getting others to want what you want
Having the legitimate right to get someone do what you want

11. POWER / Authority Control vs influence 3 types of authority:
-Traditional
Charismatic
Rational-legal
Authority is legitimate = Presence of trust and acceptance

12. Activity 2: For the following cases:
Which dimension/face of power described?
Developing countries lack significant occupational health policies
Fast food chains are popular regardless of the increased awareness about risk of obesity
The pre-marital screening for Thalassemia is mandatory in Jordan

13. Who has power??
No correct answer to this question. The distribution of influence will depend on the specific policy content and context.
E.g. Tobacco producing countries (power over tobacco control policies , less power over cancer screening policies)

14. However, different views:
Power is dispersed evenly.
State is neutral
Health policy=conflict/competition of different actors
Pluralism
State is an interest group
Public choice
Policy is dominated by privileged minority. (high socio-economic)
Conservative, resistant.
Elitism

15. Case study: Gendered policy implementation In India.
Discuss how the power interacted with health policy in India.
Who had the power?
Which theories were applied?

16. Easton’s political systems model (1965)
Inputs
Demands
Resources
Support
Black Box
Policy making within government
Outputs
Public policies for services
Environment
Environment
Environment
Environment

17. Decision making (Black box) Theories:
Rationalism: logical sequence, steps. (e.g. Breast cancer screening). Too idealistic!
Bounded rationalism: acknowledging complexities. Real world constrains.
Incrementalism
Mixed scanning
CHAPTER 2

18. HOT TOPICS OF PAST FEW MONTHS?
Agenda setting
The list of subjects or problems to which government officials and people outside of government closely associated with those officials, are paying some serious attention at any given time.
HOT TOPICS OF PAST FEW MONTHS?

19. Agenda setting in politics-as-usual circumstances
How do issues get on to the policy agenda?
What is the public problem? Importance? Priority? How it is framed?

20. The Hall et al model (1975) Agenda setting Legitimacy Feasibility
Support

21. Remember: kingdon's policy stream model (2010)
Problem
Policy (Solutions)
No Change
No Change
Politics (Political
will)
ACTION

22. Activity: Classify these events according to Kingdon’s model:
• media attention to a problem and to possible solutions
• a crisis such as a serious failure in the quality or safety of a service or other unpredictable event
• the dissemination of a major piece of research
• changes of government after elections or other regular, formal landmarks in the political process (e.g., budgets)

23. Agenda setting and policy change under crisis
Crisis: opens policy window.
Under crisis: different policy making.
Threatening issue, more pressure, more radical solutions.

24. Agenda setting by Hogwood and Gunn (1984) an issue will be on the agenda if..
It has reached crisis proportions
It has achieved particularity – that is, it exemplifies a larger issue
It has and emotive aspect
It is likely to have wide impact
It raises questions about power and legitimacy in society
It is currently ”fashionable”