Future Research. Conclusion

Public policy agenda setting is a well-developed field of inquiry. Few public health scholars have paid attention to the subject or its constructs, however, and as a result we have accumulated little systematic knowledge on health policy agenda setting.

We do understand a few facets of the process. It is clear that the emergence of health issues onto policy agendas does not conform closely to criteria that many observers would call rational or equitable. The diseases of rich people are more likely to appear on health agendas than those of the poor.

The health problems of wealthy countries attract more research funding than the condi­tions that afflict less-developed nations. In many countries, hospitals and other tertiary care facilities that serve cura­tive functions, often directed toward members of wealthier socioeconomic classes, command larger percentages of national health budgets than do local-level primary health-care facilities that might address the health pro­blems of the poor.

At a general level we understand why such imbal­ances exist: The distribution of power and wealth within and across societies heavily shape which health condi­tions are identified as problems, which health problems receive attention, and which health causes receive public and private resources. The problem lies in understand­ing the specific dynamics of these processes.

What influ­ence does the public framing of a health issue have on its likelihood of appearing on a national agenda? Under what conditions do policy monopolies - networks of actors that hold the power to control and define health issues in ways advantageous to themselves - fall? Why do some health causes such as HIV/AIDS control rise to global prominence while other high-burden diseases such as malaria struggle for attention? How is the global health agenda formed? These constitute some of the central questions for future research on agenda setting in public health policy.

Conclusion. It is useful to consider explicitly how health agendas are formed, both nationally and globally. Doing so reminds us that resources are scarce, not all needs can be met, and factors beyond rational deliberation and careful consider­ation of evidence shape the process. The five models dis­cussed in this chapter - rationality; incrementalism; legitimacy, feasibility, support; streams; punctuated equili­bria - offer alternative understandings of the agenda-setting process. Ideas from each may help in advancing our limited knowledge of how health agendas are formed, and what actors may do to alter health policy priorities.

See also: Health Policy: Overview; The State in Public Health, The Role of.

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