Saturday, March 19, 2011

Comparative Public Policy

Cross national comparison of public policy is a worthwhile endeavor that gives us the opportunity to understand how similar nations can approach issues in a multitude of ways and use a variety of policy tools to resolve their particular societal concerns. There exist a number of challenges to conducting comparative policy studies, one of area of concern surrounds the difficulty in developing adequate measures for output and outcome; Adolino and Blake (274) point to this when they describe the inadequacy of measures associated with healthcare outcomes, lifespan and infant mortality. Identifying causal linkages between public policy and outcomes is not an easy task, as outcomes are typically influenced by a variety of variables that may not be easily identifiable. This issue extends beyond the health sector, consider a common comparative measures such as Gross Domestic Product (or per capita GDP), measures of a countries total economic output and the most prevalent measure of economic development et cetera, dissatisfaction with these measures have led to the development of alternative conceptions, that aim to look at the broader socio-economic conditions of a country. One example of such an alternative is the Gross National Happiness.

Another area of concern would be the difficulty in accounting for all the potential socio-political frameworks that may influence policy in the countries compared. Consider the comparison of health care policy in Canada, U.S., U.K and Sweden conducted by Raphael and Bryant, they identify a number of plausible contextual factors accounting for the variability in policy outputs; ideological predisposition and cultural/historical emphasis on welfare. However, they do not include the fact that Canada and U.S. are federal systems (Adolino and Blake, 242) which would partly explain the diffuse nature of health policy and the absence of unified national policies, as opposed to the unitary states of Sweden and the U.K. Context, as Freed (though focused only on vaccine policy) sees it is crucial and understanding context should chasten the analysts from trying to advocate like policies in varying socio-political contexts: “Those who seek to substitute portions of one vaccine system with those of another must appreciate the context within which each functions.” (Freed, 755)

The Freed and the Raphael & Bryant articles also point to an additional complicating aspect of comparative policy, whereas Raphael & Bryant seem to be focused on advocating one particular approach to health policy (broad-based approach inclusive of socio-economic determinants of health) and approach their task from a more normative perspective, Freed has a more descriptive and positivist approach, eschewing the need for making value judgments on which system is better: “The two systems are likely good ‘fits’ for their respective constituencies within their countries’ social and political frameworks…Nevertheless, what works in one society will not necessarily work in another.” (Freed, 757) Having a dispassionate approach to analysis is obviously difficult, as would eschewing ones on value judgments (based on ones one socio-political context) when analyzing other countries’ policies.


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