Comparing Top Health Concerns in Canada and the US Using the Kingdon Model - Article Example

Comparing top health concerns in Canada and the US using the Kingdon Model A top health concern in Canada is the nations heart health strategy. The News, a Canadian daily newspaper, reported that with the new heart health strategy, billions of Canadian dollars could be saved.1 In the United States, however, President Barack Obama expressed that the countrys main concern at the moment is to reduce health cost but at the same time extending coverage to the uninsured and people with medical condition.2 We compare the two priorities of the two countries by deriving insights from the Kingdon model. John Kingdons model on agenda, alternatives, and public policies3 posits that government agendas are influenced by both visible and hidden participants and participant involvement are in three streams, components, or processes: problems, policies, and politics. The problems catapulted into national or locality attention usually results from the efforts of visible participants. However, problems can also be brought into national or locality attention with the emergence of a focusing event or a change in statistics or indicator. It must be emphasized, however, that each of the streams (or components or processes) can serve as an impetus that can lead to the consideration of an agenda. Likewise, each of the three streams (or components/processes) can also serve as a constraint that can lead to the non-consideration of an agenda. Government action responds to or remedies the problems brought into national or local attention. In addressing problems, policies are formulated. The political stream can influence both the agenda setting and policy. Agenda refers to the list of subjects to which government and those around are focused on. Events and problems create a policy window in which policy proposals or felt-problems can be elevated as a government agenda. In the window, both visible and invisible participants invest resources to put problems or proposed policies into national or local prominence so they can be adopted as government agendas. Understanding the process of agenda-setting is important because health reforms can only be facilitated if one has a clear understanding of the processes involved in the emergence and implementation of a policy. Government time and resources are limited and not all agenda can be considered or adequately considered. If a health concern is not even considered as an agenda, a concern cannot even be considered as a possible concern area for formulating policies. In the language of the Kingdon model, the particular concern is still a decision agenda or an agenda up for “active decision.” Worst, a particular concern may not even be a government agenda nor a decision agenda at all. Meaning, it is not up for active decision or recognition as a matter worth the focus of government. Some subjects or concerns do even elevate to the level of a government agenda nor even as a decision agenda. Attention to a problem can be a result of an event, change in indicator, a change in the value of an indicator, or feedback. Visible participants or those directly engaged in the problem (government officials, opposition leaders, interest groups, and journalists) can also take a concern and highlight the importance of the concern as a problem.4 Policies themselves can influence agendas. Emergence of ideas from a policy area, feedbacks, and communications can result into policy proposals and construct an agenda or agendas. Likewise politics through changes in national moods, configuration of political forces or lobby groups, and events within government can also influence agendas. Thus, agenda items that are consistent or congruent with the national mood, enjoy support from powerful support groups, and have a good fit with events are most likely to be adopted as part of the government agenda or recognized as decision agendas.5 The Canadian heart health strategy has been on the government agenda for the past several months if not years. The Canadian government has recognized that heart health is a pressing problem and for this reason has already incorporated heart health into its agenda in the form of a national health strategy. The cost of the strategy has been anticipated and there is a belief among policy makers that the program can save billions of Canadian dollars. That heart health has been identified as a concern both in February 2009 and February 2010 does not come as a surprise because during the month of February is Valentines Day. Both invisible and visible actors are taking advantage of an event or mood---Valentines Day---as an occasion to focus on heart health and draw attention to the governments heart health strategy. Invisible and visible actors are most likely trying to draw both national attention and support to the program. That news coverage on the program emphasizes on the "billions of savings" that can generated from the program does not come as an accident. Events during the past several months have identified a global economic crisis that first affected the United States and then all countries all over the world. Further, economists have expressed concern on the need for a balance budget for the last several years and pinpointed sound or balanced government budgeting as a one important factor that can enhance a countrys resilience in facing economic crises. The Canadian “Heart Health Strategy and Action Plan” was presented last year sometime February by Dr. Eldon R. Smith, Chairman of the Steering Committee of the Heart Health Strategy and Action Plan. It will take Canadian $ 700 million to implement the plan over the seven years or from 2010 to 2017 but proponents and government believe that the heart health care plan can lead to $ 22 billion savings in costs. The plan advocates six key recommendations: 1) creating “heart-healthy” environment through education, regulation, and legislation; 2) helping Canadian lead healthier lives; 3) Ending the disease within aboriginal communities; 4) a reform on health care with improved service delivery; 5) improvement of surveillance; and 6) development of a “right number” of service providers with “right” education and skills. The plan has specific numeral targets on eating vegetables, physically active Canadians, percentage of obese children, death rate, mortality rate and the like but it remains to be seen whether the plan will indeed achieve its targets. The targets of the plan are clear but it is not clear whether the activities outlined in the plan will indeed bring about the targets, considering that a number of the activities required for the plan are dependent on the legislations that are still being advocated. Within the Kingdon framework, the Canadian Heart Health Strategy and Action Plan is a government agenda where specific policies that are required to produce the targets of the plan are decision agendas.6 Canadian health priorities cover not only heart health but also HIV-aids, food-borne ailments, infectious diseases, health risks related to the environment, ailments coming from consumer products, safety in the workplaces, substance use and abuse, and many others.7 Yet, at the same time, the World Health Organization (WHO) confirms that heart disease is the leading cause of mortality in Canada. In 2002, while heart diseases took 222,000 lives the 9 of the top 10 causes of mortality took around 123,000 lives. Thus, heart ailments are not only the top killer ailment but it is also a single cause of mortality that kills almost twice the number of Canadians killed by 9 of the top 10 killer diseases.8 Indeed for heart disease to be in the government agenda has good basis. Both visible and hidden participants in the agenda setting are taking advantage of national mood, or February as the heart month or Valentines today, to drumbeat the decision agendas required to implement the heart health strategy of Canada. Meanwhile, the current situation puts the United States in a different position for two reasons. Firstly, the United States is in the middle of fixing up a crisis that has been described in the past as a situation that can compete with the Great Depression of the 1930s. There is an extreme pressure on the country to reduce its government spending. Reducing government spending is important because conventional economists today see that a reduced government budget is a way out of typical economic crises. At the same time, the US government has also been concerned with bailing out a number of companies from bankruptcy. There is a serious concern therefore for saving resources that can be used instead for bailing out companies directly affected by the crisis or that can be used instead for strengthening the United States economy. Secondly, a popular government program that provides increased spending for social, health, and educational services is a primary concern among citizens of the United States. A reduction in government spending for health services can trigger a tremendous backlash in public opinion and can trigger a political situation similar to earlier decades when street protests can have tremendous energy. On the other hand, government budget deficits are not desirable in a crisis or when there is a larger crisis threatening to swallow the nation. If the United States economic crisis exacerbates, not only the United States but also the rest of the world will be affected. Worst, the crisis can trigger cuts in social and health spending the can worsen the situation of the health uninsured and can put a greater number people dislodged from health coverage as they join the ranks of the unemployed. The United States decision agenda really is to how to address the concerns of the uninsured and those without health coverage. Most likely, the United States government wants to address the problem without spending too much. A different type of a problem exists in the United States being in the center of source of the economic crisis. Moreover, while heart ailments are also the top killer in the United States, mortality due to cancer comes as a close second. In 2006, some 631,636 people died from heart diseases in the United States but cancer has death toll of almost the same size at 559,88 deaths. Thus, from one perspective, the problem of heart diseases can be said to be worse in Canada compared to the United States. In summary, we can say that the Kingdon model and the articulation of the model by Dr. Lavis provides a good perspective for understanding policy and planning the reform of health policy. References 1. Ward J. Conference Board says new heart health strategy could save billions of dollars. The News. February 8, 2010. Available at http://www.ngnews.ca/index.cfm?pid=575&cpcat=national&stry=84327627. Accessed February 9, 2010. 2. Bohan C. Obama invites Republicans to healthcare session. News Daily. February 8, 2010. Available at http://www.newsdaily.com/stories/tre6111wj-us-obama/. Accessed February 9, 2010. 3. Kingdon JW. Agendas, Alternatives, and Public Policies (Longman Classic Edition) 2nd Edition. New York: Addison-Wesley Educational Publishers Inc.: 2003. 4. Lavis J. How do governments make decisions about health care? Part 1: Agenda-setting. PowerPoint Slide Presentation. McMaster University, January 2010. 5. Lavis J. How do governments make decisions about health care? Part 1: Agenda-setting (2b). PowerPoint Slide Presentation. McMaster University, January 2010. 6. National heart health strategy. Health Habits. 24 February 2009. Available at http://www.healthhabits.ca/2009/02/24/national-heart-health-strategy/. Accessed February 9, 2010. 7. Canadian Ministry of Health. Health Canada 2008-2009 Report on Plans and Priorities. Canadian Ministry of Health, 2009. 8. World Health Organization. Mortality Count Facthsheet 2006 for Canada. Geneva: World Health Organization. Available at http://www.who.int/whosis/mort/profiles/mort_amro_can_canada.pdf. Accessed February 9, 2010. Read More