Theoretical Approaches to Explaining Health Policy Agenda Setting - Coursework Example

Name: Health and social care Date: Mental health policy agenda setting Table of content 1.0 introduction 3 2.0 Approach 4 2.1 Interest-based approach 4 2.2 Institutional-based approach 5 3.0 Agenda setting in mental health 6 3.1 Pharmaceutical companies 7 3.2 Industry organisations 7 3.3 Democratic policy making process 8 4.0 Policy agenda setting for schizophrenia 10 5.0 Conclusion 12 6.0 References 13 Medicines Australia (2013). About us, available at: http://medicinesaustralia.com.au/about-us/ 14 1.0 introduction Analysis of policy is broad and covers various theoretical frameworks as well as empirical approaches. With regard to how policy and politics are defined, the analysis of policy can be either highly rational endeavour which means laying focus on specific policy instances, or highly political as well as being concerned with examination of policy making process. Policy process is shaped and constrained by various factors and its analysis is based on concentration of interests, institutions as well as ideas (Lewis, 2009). The theory of agenda-setting is very common is various academic fields such as politics, communications and studies. The information on mass communications is based on the role of the media with regard to setting public agenda. The political information is based on more concentration in regard to how certain issues reach government policy agenda. However, since the government policy agenda is affected by the public agenda, the focus of the two statements is thus interrelated (Gosden, & Beder, 2001). Among the important approaches in health policy agenda setting is the interest-based approach and institutional approach. Institutional approach is more involved in examination of political institutions which include systems and regimes of government as well as a wide range of factors (Weaver & Rockman, 1993). An interest-based approach is very common in health sectors and involves the influence of powerful groups that are interested especially in terms of economic returns after agenda setting (Gosden, R., & Beder, 2001). In regard to the field of mental health policy, public relations companies have been very powerful through lobbying to get particular policies to the formal agenda in a direct way as well as using media in order to set public agenda. It is important to understand why some issues are identified as the focus of policy action while on the other hand; others get weaker in regard to the periphery of consideration of policy. This article discusses health policy agenda setting using different theoretical approaches. In order to understand health policy agenda setting, it focuses on the process of agenda setting in the field of mental health. In particular, it explains agenda setting policy on schizophrenia. 2.0 Approach 2.1 Interest-based approach In regard to interest-based approach, much of the agenda setting theory is more into the idea of advocating for expansion of interests in a particular policy or issue. This is mostly implemented by policy entrepreneurs who come up with advocate coalitions which are meant for pushing policies onto the agenda. It is worth noting that in the field of mental health policy, public relations are very dominant and play a significant role in creation of relevant advocate coalitions (Kingdon, 1995). According to Steinmo and Watts (1995), such coalitions develop their own consumer groups, a factor that may create a challenge for real consumers to be fully involved. There are front groups in healthcare which enable corporations such as pharmaceutical companies to participate in government hearings as well as in public debates by acting the role of community concern. Such corporations have great interests and could present themselves either personally or rather do it in an effective way through group of experts or citizens. Absence of such groups leads to paying public relations firm in order to represent their interests (Beder, 1997). By doing so, they promote the desired outcomes of the corporations while acting as presenting the interest of the public. Representing the interests of the industry as those of concerned citizens has been a heavily utilised phenomenon. Such interests as identified by Alford in late 1970s have been one of the major barriers to the reforms in healthcare (Alford, 1975). Use of such groups and public relations firm play an important role in agenda setting and their efforts influence the consumers as well as the government. 2.2 Institutional-based approach In regard to institutional approach, political institutions are very significant on agenda setting where they may be easily manipulated by interested bodies. According to Gosden and Beder (2001), the front groups usually lobby governments to legislate in regard to the interests of the corporate in order to oppose the regulations that seem undesirable to them as well as introduce policies which will enhance profitability to the corporate. Dearing and Everett (1996) add that such groups are also influential to the public as they campaign to change the opinion of the public to ensure that the markets of the goods of corporate are enhanced rather than being threatened. This is the point where the public relations industry comes in. According to Rabin (1992), public relations view front groups as partners. The organisations join together as adversaries with an aim of influencing the government and public; they establish brand loyalty, enhance the sale of pharmaceutical products as well as maintain the image and reputation of these corporations within the community. Through public relations, there is a creation of artificial grass root coalitions that implement programs meant for immediate manufacturing of the support of the public for a point of view by recruiting activists. Such activists are meant to change the view of the public as well as influence the government to act towards the interests or the views of the corporate (Stauber, & Rampton, 1996). A grass roots specialist has the greatest challenge of creation impression that the millions of public are in support of the views of their client in regard to a particular issue. It is at this point that a politician is very crucial to the public relations industry as the corporate (Public Citizen, 2000). This is achieved by targeting potential politicians as well as supporters that usually have persuading characteristics value (Cooper, 1994). The moment the potential supports are identified and agree to endorse the view of the corporate that is being promoted, the corporate are sure that the setting of agenda will go their way. Such politicians and supporters usually get good benefits in return in terms of monetary (Mintz, 2000). Influencing the views of political institutions as well as the public in general by interested corporations is done in a tactical way. Such corporations hire specialists who use opinion research data with an aim of identify the main themes that are most likely to arouse the main groups and then gearing their telemarketing pitches based on the key themes (Lewis, & Considine, 1999). Demographic information, polling results, election results as well as lifestyle clusters are also taken together in order to identify potential supporters through provision of individual information such as income, age, gender, marital status, the type of car or music one likes as well as ethnic background (Anon, 1994). By use of such techniques, the interested groups are in a better condition to indentify political opinions and attitudes. By doing so, the coalition builders will not waste their time and resources in the populations that is not likely to be persuaded. In addition to this, they will have to use different arguments in persuading different types of people (Grefe & Linsky, 1995). 3.0 Agenda setting in mental health The policies on mental health have been focused in regard to their effectiveness in achievement of desirable outcomes on mental health. However, the political basis in regard to their formulation as well as adoption, that is, the process of agenda setting is also very crucial. (Gosden, & Beder (2001) explain agenda setting process in mental health in a flow chart. 3.1 Pharmaceutical companies At the top are various pharmaceutical companies that have the responsibility of manufacturing drugs for the treatment of mental disorders. Such corporations are very powerful and are usually transnational. The lines f agenda setting flow from such corporations (individual companies with their own interests) to pharmaceutical industry organisations. These organisations are usually set up as well as funded by pharmaceutical industry. It is worth noting that the pharmaceutical industry has specific purpose of lobbying governments as well as setting agendas. In Australia, such main industry representative body is Medicines Australia (Medicines Australia, 2013). 3.2 Industry organisations Down from the industry organisation, there are advertising consultants and public relations on one hand while psychiatric researchers and the profession is on the other hand. The commissioning of the activity of agenda setting can reach these two entities directly from interested corporations or through industry organisations. In regard to interest-based approach, set the agenda by funding psychiatric research in a selective way with an aim of promoting a belief based on their interest such as brain disorders result from brain defects. By providing such theories that are brain-based, they develop a foundation that claim the suitability of drugs as a form of treatment. In another way, individual companies also retain advertising consultants and public relations as well as funding professional bodies on psychiatry through making their advertisements in their journals. These corporations also fund institutes and structures that are related to addressing the issues of their interests. A two-way agenda setting communication between the psychiatric profession or researchers and public relations or advertising is very important. By use of public relations firms, the sources of pharmaceutical company that fund the research are covered but its interests are expressed. In addition the constant advertising of pharmaceutical companies in psychiatric journals also acts as an indirect way of persuading psychiatrists to use a specific drug (Gosden, & Beder, 2001). 3.3 Democratic policy making process At the base of the chart is the sphere of the process of democratic policy-making. The process involves a flow of information, opinion and power between three entities: the government; the public; and the media. Each of these entities can have the power over the other. The public can have power over the government through the exercise of electoral choices or over the media through exercising consumer choices. The media can have power over government by manipulating public opinion and over public through controlling of the quality and type of information it receives (Wanta, & Salma, 2007). The government also can have power over the public through law enforcement and legislation and exercise power over the media through selective release and regulation of information (Lewis, 2009). In such a democratic policy filed, the core agenda setting is an implication of the right idea at the right point and having it flow in the right direction. There are agenda setting lines that flow to the policy-making sphere from other entities. However, in regard to mental health policy agenda setting, the most crucial input is the one coming from the public relations consultants. The campaigns on public relations based on the interests of corporations can target all the three entities of policy making. This can be achieved through a common strategy of using both the elements of the public and media as entry points but at opposite directions. As a result, there will a creation of urgency within the circles of the government as well as making mental health politicians and bureaucrats vulnerable to both direct and indirect approaches by consultants who offer policy solutions. It is worth noting that these consultants are sponsored by pharmaceutical industry (Gosden, & Beder, 2001). Pharmaceutical companies Flow of pharmaceutical agenda setting Source: Gosden and Beder (2001) 4.0 Policy agenda setting for schizophrenia Policy agenda setting can be explained by use of schizophrenia as a mental disorder. There was an extended campaign in Australia and in United states in regard to setting policy making agenda on schizophrenia. The pharmaceutical companies that were involved in the campaign on agenda setting played a significant role. The companies introduced new drugs for treatment of schizophrenia based on two reasons: cheap generics were on market and patent older generations drugs were also expiring; and the older generation drugs were becoming dangerous and ineffective. According to Gosden and Beder (2001), the companies settled on the best approach to come back into the market by looking for ways of expanding the market size. However, the challenge was restriction on marketing schizophrenia drugs by diagnostic conventions. On the other hand, there was protection of civil liberties. In regard to interest-based approach, the pharmaceutical companies came up with an overall solution which involved the development of public relations campaign in two-fold. The first, process involved connecting support groups that were related to the people who were suffering from schizophrenia. This was meant to be the driving force for an advocacy coalition. The pharmaceutical corporations achieved this by laying their focus on funding these organisations. In order to address their interests, the companies needed to make these organisations dependent on them through sponsorship. The companies would then use the organisations as public relations front groups in order to allow planting their views in the media in regard to the safety and efficacy about the new drugs. Through researchers and professions, the companies would also influence them in proving scientifically that the mental disorder called for urgent drug treatment especially during the earliest signs (Gosden, 2001). For instance, a site: schizophrenia.com provide information said to be representing the consumers and acknowledging that it is a support and educations centre providing non-profit information. However, the schizophrenia website was being promoted by one of the pharmaceutical companies, that is, Janssen Pharmaceuticals (Schizophrenia.com, 2001). It can be argued that by being funded by the company, the organisation was intended impact the government by positioning their new drugs as the selected treatment methods by government services on mental health. It was also intended to impact the government by advocating the expression of public interests. Another part of campaigning was to fund psychiatric researchers that were selected based on the interests of pharmaceutical companies in order to promote the belief that was in doubt. This belief involved the detection and treatment of schizophrenia at pre-psychotic stage in order to avoid deterioration of the brain. With such an argument, it is a potential way of expanding the market for these drugs in a vast way. This impacted the Australian government as it developed a government-sponsored schizophrenia preventative treatment programs which could lead to utilization of drugs (Gosden, & Beder, 2001). The key element in regard to the strategy of the public relations is funding from the pharmaceutical company by channelling through organisations such as World Psychiatric Association (Rosen et al. 2000) and National Alliance on Mental Illness (Oaks, 2000). Such a strategy is aimed at mounting an anti-stigma campaign. By use of such an anti-stigma campaign, the drug company is able to indirectly represent its interests through advocating for elimination of those diagnosed with schizophrenia, so long as they are on drugs. According to Gosden and Beder (2001), such an approach is effective in regard to its intention to send agenda setting in a direction of their interest by impacting on the government as an urgent law and order as well as warning the public. This leads to the policy intention which is weakening the protections of civil liberties in laws on mental health as well as increasing the number of those eligible for involuntary treatment. For pharmaceutical companies, involuntary treatment is crucial in regard to the market for schizophrenia drugs. Without this treatment, the market would not be present virtually since those diagnosed with this mental disorder had to be force-treated with nueroleptic drugs. Thus, the core of focusing campaigns on law and order is to introduce the commitment of outpatients (that is, court order in order to treat people in their own homes by force), or community treatment orders. By doing so, there would be an expansion of the market for the new drugs for treating schizophrenia. 5.0 Conclusion The agenda setting is based on: outside initiative where groups usually gain the support of public then get an issue onto the formal agenda; issues are also initiatives that results from the government and may requires to be replaced on public agenda for the purpose of successful implementation; and insider access where policy proposals also originate from policy communities which can easily access the government and more important with the support of interested groups, but minimal involvement of public. From this article, it is clear that the campaigns which public relations have run in agenda setting in mental health involve: outside initiatives where there have been campaigns for funding consumer advocacy groups; influencing the media in order to gain public policies acceptance already on the government agenda; and use of insider access where organisations gain easy access to the government where the access is facilitated by pharmaceutical companies worth of millions of dollars and associations which donate to political parties and politicians. 6.0 References Anon (1994). Public Interest Pretenders. Consumer Reports, 59(5), 316-320. Alford R.R. (1975). Health care politics. Ideological and interest group barriers to reform. Chicago: University of Chicago Press Beder, S. (1997). Global Spin: The Corporate Assault on Environmentalism, Vermont: Chelsea Green Publishing. Dearing, J.W., &Everett M. R. (1996). Agenda-Setting. Thousand Oaks, CA: SAG Gosden, R. (2001). Punishing the Patient: How Psychiatrists Misunderstand and Mistreat Schizophrenia, Melbourne: Scribe. Gosden, R., & Beder, S. (2001). Pharmaceutical Industry Agenda Setting in Mental Health Policies, Ethical Human Sciences and Services, 3(3), 147-159 Grefe, E. A. & Linsky, M. (1995). The New Corporate Activism: Harnessing the Power of Grassroots Tactics for Your Organization, New York: McGraw-Hill. Kingdon J. (1995). Agendas, alternatives and public policies (2nd ed.). New York: Harper Collins. Lewis J.M., & Considine, M. (1999). Medicine, economics and agenda-setting. Social Science & Medicine, 48(3), 393-405 Lewis, J. (2009). Understanding policy influence and the public health agenda, NSW Public Health Bulletin, 20(7), 125-129 Medicines Australia (2013). About us, available at: http://medicinesaustralia.com.au/about-us/ Mintz, J. (2000). Drug Firms, Unions Funnel Millions to Parties, Washington Post, 26 October, p. A26. Oaks, D. (2000). NAMI: The story behind the story. Dendron, 43, pp. 14-15. Public Citizen, (2000). Addicting Congress: Drug Companies' Campaign Cash & Lobbying Expenses, Available at: http://www.citizen.org/congress/reform/addicting2.htm Rabin, S. (1992). Pooling resources builds public/private partnerships. Public Relations Journal, 48(10), pp.32-33. Rosen, A., Walter, G., Casey, D. & Hocking, B. (2000). Combating psychiatric stigma: An overview of contemporary initiatives, Australasian Psychiatry, 8(1), pp. 19-26. Schizophrenia.com. (2001b). A Not-for-Profit Information, Support and Education Center. Available at: http://www.schizophrenia.com/ Stauber, J. & Rampton, S. (1996). Deforming Consent: The public relations industry’s secret war on activists. Covert Action Quarterly, 55, 18-25. Steinmo S, & Watts J. (1995). It’s the institutions, stupid! Why comprehensive national health insurance always fails in America.  Journal of Health Political Policy Law, 20(2), 329–72 Wanta, W., & Salma G. (2007). Effects of agenda-setting. In Mass media effects research: Advances through meta-analysis. Edited by Raymond W. P., Barbara M. G., Nancy B., Mike A., and Jennings B., 37–51. Mahwah, NJ: Erlbaum. Weaver K, & Rockman B. (1993). Do institutions matter? Governmentcapabilities in the United States and abroad. Washington DC:Brookings Institute. Read More