Theoretical Approaches to Explaining Health Policy Agenda Setting - Essay Example

Title Author Institution Thеоrеtiсаl Aррrоасhеs tо Eхрlаining Health Policy Agenda Setting Introduction An agenda refers to a number of issues that are given to people in order of significance at a given time. Agenda setting deals with the competition of issues to be addressed by policy elites, media professionals and the public (McCombs 2004). What the media rates as crucial, communicates to listeners, viewers and readers the issues the need to dwell on in their conversations. How important an issue is will determine how often it features in the media. Another agenda setting method focuses on how an issue is ordered relative to other issues. The third policy agenda setting has its focus on the way policy actions surrounding the issue function in response to public agenda and media. Health policy agenda setting is very important because it determines what kinds of issues will feature in the health policies. Health policies may be determined by governments, organizations and other stake holders with the input of the public and the media (Dearing & Rogers, 1996). Political agenda setting development by use of advanced public relations methods is becoming a threat to representative democracy. This has a bearing on policies meant to provide mental health services and the execution of mental health legislations. The main setters of the agenda are pharmaceutical companies that have commercial objectives of promoting public policies that increase their sales. They come up with very efficient advocacy collaborations that include front groups so that they can set the policy agenda for issues of mental health. There are three approaches to explaining the setting of health policy agenda (Dearing & Rogers, 1996). They include the outside initiative model; the placement of issues on the agenda due to government initiative while the third approach is that policy proposals originate with policy communities that can easily access government. This essay will discuss the theoretical approaches being used to explain the setting of health policy agenda in Australia. The issue of mental illness and Schizophrenia in particular will be discussed. Theoretical Approaches There are three theoretical approaches used to explain the process of setting agenda for health policies. The first one is an outside initiative model where groups of citizens get wide support from the public and force some issues into the formal agenda. The other approach is that the issues on the agenda are initiatives by government. For such issues to be implemented successfully they are put on the public agenda (Protess & McCombs, 1991).  The third approach is that policy proposals originate with policy communities that can easily access government. Such communities are backed by specific interest groups but the involvement of the public is very minimal. It is obvious that the campaigns that public health consultants have run to set the agenda of mental health use these three approaches. They conduct coordinated campaigns in which they give funds to consumer advocacy groups to copy outside initiatives. They put certain stories in the media which they design to get the public to accept policies that have been put on the agenda of government. They also utilize the insider access approach when they make use of pharmaceutical lobbying companies to reach the government. This access is possible because pharmaceutical companies donate a lot of money to political parties and politicians (Birkland 1997). The agenda setting theory is popular in mass communication, politics and policy studies. Mass media focuses on what media can do to set public agenda while political literature focuses on how certain issues get to government policy agenda. When it comes to the arena of mental health policy public relations companies do a lot in using media to set public agenda and also lobbying to put certain policies on the formal agenda. Policy setting in Australia is based on Westminster government style. Mental health policies are made at the federal and state levels of government. The mental health policies in Australia are drug based (Dearing, & Rogers,1996). Most agenda setting theories summarize the notion of the need for supporters to increase their interest in a given policy or issue. This is the role of policy entrepreneurs who create advocacy coalitions to put some policies on the agenda. What is not usual in the area of mental health is the huge role that public relations play in forming advocacy coalitions. The advocacy coalitions normally have their basic purpose-built consumer groups which act as front groups in the psychiatric industry. Front groups make it possible for corporations like pharmaceutical companies to participate in public debates under the pretext of community concern (Gosden, and Beder, 2001). Outside initiative model The public agenda is best pushed through the media. The mental health issues especially the schizophrenia problem could not have been taken serious if the public did not have its voice amplified through the media. Media organizations did not just broadcast information in a passive manner repeating the statements of official sources or transmitting the incidents observed they way they happened (Birkland1997). They also did not choose or reject the news of the day based on proportionality of reality. By selecting and showing news stories the editors and reporters have the focus of influencing the perception of the public about the most critical matters of the time. Through this, media is very critical to setting the public agenda in health policy. Media highlighted the issue of mental illness and schizophrenia to the extent that it became an important issue to be put on the agenda. Media works hand in hand with the public to set agendas and its function is known as the agenda setting function. Agenda setting is a critical media theory in these times. The media uses its news to transfer various issues into a public agenda. Journalists treat news in different ways (Gosden, and Beder, 2001).They select the news they will cover and those they do not want to cover. They do an assessment of all the reports available. The news items that go through the media are not treated equally by the audience. Some stories are displayed more prominently than others which are only given very brief attention. In the print media the importance of an item is always evident from the page placement given to it, the length and the headline. In Agenda setting by the public, people get the order of importance of issues from the news media. They then include into their agenda such priority sets. Agenda setting elaborates the transfer of these saliencies as one of the critical mass communication aspects. The news media gives people information about the world and also influences the prominence of the same elements in the pictures (Kay 2006). In the development of public agenda and its setting, the media is always a major player. The mental issue of schizophrenia in Australia received sufficient media attention for it to become a critical issue. The media was instrumental in setting the agenda because the public only got to understand and to talk a lot about the issue because it was all over in the media. The fact that the media gave it prominence made it an important public issue for discussion by all concerned people. The public gave the issue a lot of importance by talking much about it to the level that it gained government attention (Gosden, and Beder, 2001). Government approach for agenda setting The government may also set its agenda which may include the list of issues being dealt by government officials. The issues may be there for debate and decision making. Therefore when the government decides to set its agenda it should make a decision which are he critical issues that should be dealt with (Kozel et al. 2006). The government then makes a decision on whether to act or just consider the issues. However, a government cannot go all the way to determine which issues should be on the agenda because the process of setting the agenda is external and it has external considerations and inputs. The Kingdon’s model of agenda setting will be used in this section to analyze the health issue under discussion. This same health issue was on the agenda of the government of Australia at a particular time. Kingdon has three important components in his framework. These components are important in deciding if an issue will become part of the agenda of government (Gosden, and Beder, 2001). For a particular issue to be on the government’s agenda the opportunity to deal with the issue in different ways must be there. A better understanding of Kingdon’s streams can be achieved by getting to know what they are defined by. The problem stream can be defined by change in indicators, focusing events and the results of the operation of existing programs. A focusing event is a crisis such as a mental health issue which shocks people (Gosden, and Beder, 2001). An event like this gets a lot of coverage in the media. Indicator change may be seen through statistics. For example the number of people with schizophrenia may be used to evaluate the changes in the magnitude of a particular issue. Feedback of a formal or informal nature from ongoing initiatives and programs may be use din the identification of the problems on government agenda. The politics stream influences government agenda by swinging the mood of the nation, change in the stability of organized forces and the events taking place within government. For it to be seen as of vital influence the popularity of the national mood should be high enough and it should have adequate conviction to trigger political action. Organized forces are the interest groups that promote campaigns to push governments to put a particular issue on its agenda. Events taking place inside government may be lections, jurisdictional disputes and turnover in parliament (Buse, Mays, & Walt, 2012). These are important agenda setters in government. The policies stream provides solutions on how to handle issues and it comprises of the dispersal of ideas into a particular policy area, results from the handling of existing policies and persuasion. Feedback in this stream may be about the evaluation of how best existing policies work with issues. Communication and persuasion in such a case is characterized by a respected figure giving his proposals on policy so that he can push them on the agenda of government. The last thing to consider when evaluating the agenda of government is that a government has two categories of agendas namely specialized and generalized (Gosden, and Beder, 2001). The two classes are also divided into the government agendas mentioned earlier on which are decision and governmental. The general agenda is composed of the issues that the senior most government officials in Australia care about. The issues existing on specialized agenda are handled by other officials of government such as ministers of government in Australia. Schizophrenia was once among the top healthcare issues in the country and the agenda of government. Government events may not have been of vital influence in putting the issue onto the agenda of government (Gray 2013). Proposals from policy communities with access to government Policy communities had a very strong impact on agenda development because of their ability to easily access government. The vital push of agenda setting in mental health policy causes mental disorders to be interpreted biologically. Together with are the treatment methods based on drugs. These are preferable over policies and theories based on talking therapy such as family therapy and psychotherapy. This drastic change in policy results from the activity of public relations which is funded by the pharmaceuticals industry. It makes policy entrepreneurs and advocacy coalitions to support drug treatment for imbalances in brain chemistry. At the peak of the flow chart are pharmaceutical companies involved in producing drugs used in the treatment of mental disorders (Dattani, 2010). These are very influential transnational companies. Industry organizations established by the pharmaceutical industry get their funds from this industry to lobby governments and set agendas. Australia has the Australian Pharmaceutical Manufacturers Association. Lower than the industry organizations comes the public relations and advertising consultants against the psychiatric profession and the psychiatric researchers on the opposite side. The launching of agenda setting activity can be known to these two sides via industry organizations or through individual companies. Individual companies maintain public relations and advertising consultants besides giving money to psychiatric professional bodies by putting adverts in the journals owned by these bodies. Pharmaceutical companies are also involved in agenda setting by financing psychiatric research intended to advance the idea that brain defects are the causes of mental problems (Kozel, et al. 2006). The advancement of brain based theories sets the basis for the argument that drugs can be used for treatment. A classic example of this in Australia was when six pharmaceutical companies funded the Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD). All the companies deal in the production of new drugs for treating schizophrenia. The companies are Janssen Cilag, AstraZeneca Eli Lilly, Pfizer, Novartis and Lundbeck (Gosden, and Beder, 2001). Pharmaceutical companies taking part in the agenda setting had introduced new neuroleptic drugs for the treatment of schizophrenia in the market in the past 10 years. The development of the drugs was done for two major reasons. The old drugs had expired the market was getting the cheap generics. Secondly the old drugs had become dangerous and ineffective. In the introduction of the new drugs the companies were met with some problems related to public health. First the new drugs cost more than old drugs. Secondly people thought that the new drugs were not as effective as the old drugs. The pharmaceutical companies were interested in maximizing their profits in what seemed to be an important environment and a very tight market. They therefore saw it wise to widen their market. Before that, the market for drugs meant for schizophrenia had been reduced by diagnostic conventions and civil liberties protections (Gosden, and Beder, 2001). For along time diagnostic conventions reduced knowledge about schizophrenia and hence the use of neuroleptic drug remedy to symptoms indicative of psychosis (Gosden, and Beder, 2001). The setters of the agenda decided to widen their market by breaking this assumption and supporting an extra pre-psychotic phase of schizophrenia which needed preventive treatment using their new drugs. In order to expand the market more, they decided to launch campaigns to destroy civil liberties protections and hence increase the number of people that could receive treatment voluntarily. The solution was to create a public relations campaign with two groups. The first part involved the creating support groups for people related to those suffering from Schizophrenia as the power behind the advocacy coalitions. This has come to pass by way of giving funds to these organizations (Kay, 2006). Once they start depending on the support of the drug companies they could then serve as public relations front groups to help with putting stories in the media concerning the safety of the new drugs and about information that schizophrenia has been shown scientifically to be a disease of the brain that needs urgent treatment with drugs early enough. The campaign succeeds through funding particular psychiatric researchers to support the untrue belief that schizophrenia should be discovered and treated while still at the pre-psychotic stage in order to avoid damage to the brain. This thinking greatly expands the market for schizophrenia drugs and has gone ahead to the creation of government sponsored preventive treatment programs for schizophrenia in Australia that make use of the new drugs. An important element of the PR strategy includes funding of companies involved in drug manufacture (Gosden, and Beder, 2001). Policy communities took their time to develop proposals about schizophrenia which they presented to government for inclusion in health policy development processes. Their main impetus in doing this was their easy access to government because of their important position in the country as investors and stake holders. This was made possible by the existence of the association of pharmaceutical organizations which could easily get a hearing from government (Palmer & Short 2000). Conclusion In conclusion, this paper has discussed the various theoretical approaches to explaining health policy agenda setting. The paper has elaborated three important approaches that have been used to explain the setting of policy agenda in the health sector. There are three theoretical approaches used to explain the process of setting agenda for health policies. The first one is an outside initiative model where groups of citizens get wide support from the public and force some issues into the formal agenda. The other approach is that the issues on the agenda are initiatives by government. For such issues to be implemented successfully they are put on the public agenda. The third approach is that policy proposals originate with policy communities that can easily access government. Such communities are backed by specific interest groups but the involvement of the public is very minimal. The outside initial model has a lot to do with specific groups of people with the intention of helping set the agenda and they receive the backing of the public. The public therefore plays a role in the setting of the agenda. The government also has a role of setting the agenda. Government, through different ways ensures that its policies have become part of the agenda. Government also gets the support of the media to get its policy issues on the agenda. Policy can also be made to get to the agenda through policy communities that have a way of getting to government. Through some way the policy communities manage to push their issues on the government’s table so that those issues are made part of the agenda. The mental health issues of schizophrenia in Australia have been discussed. The disease has been used as the issue on which the various approaches were used to set the agenda for health policy. Agenda setting in health policy in Australia takes various forms. However, the discussed approaches form the most common methods of agenda setting in the country as witnessed in the mental health issues. References Birkland, A. T. (1997). After Disaster: Agenda Setting, Public Policy and Focusing Events. Georgetown University Press. Buse, K., Mays, N., & Walt, G. (2012). Making Health Policy. McGraw Hill International. Dattani, N. D., (2010). "Setting the Healthcare Agenda”. Political Science Publications. Paper 1. Dearing, J.W. & Rogers, E, M. (1996). Agenda-Setting. SAGE Publications. Gosden, R. and Beder, S. (2001). 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