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Healthcare Assignment: Understanding Policy Making Process


Task: The purpose of this healthcare assignment is to give you an understanding of the policy making process and its role in the health system. By now you’ve heard us mention the term ‘policy’ more than a few times, and no doubt you’ve also heard it discussed frequently by our politicians and the media. Buse, Mays and Walt (2012, 5) define policy as a:

“Broad statement of goals, objectives and means that create the framework for activity. Often takes the form of explicit written documents, but may also be implicit and unwritten”.

In short, policy includes many quite different types of statements, intentions and actions and can be developed across a range of different organizations, both government and non-government. Policy is not clean and neat, it rarely involves transparent processes and it often involves struggles between competing interests (our Stakeholders or Policy Actors as Buse et al (2012) say). Some of these struggles are highly visible, while others are conducted quietly on the sidelines or behind closed doors.

Required Readings and Audios
Buse, K., Mays, N., and Walt, G. (2012) Making Health Policy. Open University Press: Maidenhead. (Chapter 1).This is an ebook, but if there are any problems with access please contact Allyson immediately.

Foreign Correspondent (2019) Opioid America – March 19,2020 – 30 minutes long The Washington Post – Opioid Files

Since 2016, The Washington Post has been investigating the opioid epidemic that has ravaged communities and claimed the lives of more than 400,000 people nationwide. Within this link there are two important, short video clips to watch: (1) Inside the Opioid Industry’s Marketing Machine; (2) ‘There’s no peace’: The toll of Opioids Brown R & Morgan A 2019. The opioid epidemic in North America: Implications for Australia. Trends & issues in crime and criminal justice no. 578. Canberra: Australian Institute of Criminology.

Question 1: Drawing on Buse, Mays and Walt (2012), but in your own words, outline the difference between a policy, public policy and health policy?

Question 2: There is a large body of literature that attempts to understand the policy making process. Walt and Gilson (1994, cited in Buse, Mays & Walt, 2012) provide a simplified model of an extremely complex set of relationships. Identify and describe the four critical components of the Walt and Gilson Model as outlined in Buse et al (2012). Including:

  • a description of the three contextual factors (please ignore international/exogenous factors)
  • the key components of the policy making process
  • 3 examples of health policy actors in Australia.

Question 3: The three short videos provided (videos 4.2 and 4.3) and the reading by Brown and Morgan (2019) describe the Opioid Epidemic in the United States. Drawing on the Walt and Gilson Model (cited in Buse et al., 2012), discuss:

  • What is the context in which the Opioid Epidemic has developed in the USA?
  • Who are the key actors linked to the epidemic USA? Describe the roles they played.

Question 4: Australia is also experiencing a rising death rate from Opioids –

  • How is the context surrounding opioid use in Australia different from the USA?
  • Who are the key actors we should engage in a discussion to address excessive opioid use/death in Australia. Identify at least 3 actors and explain why they should be involved.


Healthcare Assignment Answer-1:
Policy: The policy may be used in several ways to cover a wide range of different kinds of statements, intentions, and actions. 'Policy' may refer to a comprehensive declaration of goals and intentions; this meaning is shown by political leaders' policy speeches, which are often lengthy and detailed (Health, 2018). It is a collection of standing norms meant to serve as a guide for taking action or remaining silent in a certain situation. When dealing with policies for which governments are mainly accountable, the term "public policies" is used. Public policies are implemented in the name of the general public, using public resources and impacting the general public's interests.

Health policy: Health policies mean, on the other hand, decisions, methods and actions to achieve certain health care goals in a given society. Health policy includes a range of action courses that affect the collection of institutions, organizations, services and funding systems, commonly referred to as the health system (Palmer & Shorts, 2011). The policy is a wider world than health policy since it influences a variety of other policies in addition to health. On the other hand, health policy is concerned with issues that are directly linked to health, such as hospital facilities, health spending, and the provision of safe births.

Comparison: Policies are aimed towards a collection of procedures that are used to put policies into effect. Policies define an organization's long-term goal or strategy, while procedures detail the precise activities taken to achieve that goal in the short term. An organization must provide its members with policies that have been appropriately created to achieve its goals. To operate effectively, any firm, regardless of industry, need the development of clear rules and processes. Organizational leaders should establish norms and procedures as soon as possible, if at all possible. They not only protect a business and its employees from noncompliance, but they also help to define and develop corporate culture. Depending on the industry, failure to comply may result in fines, legal actions, a loss of reputation, or even the jeopardization of the employees' safety (Health, 2018). These and other unknown hazards often happen suddenly and unexpectedly; thus, taking proactive and preventative action is the best course of action before anything occurs.

Policies and procedures should be updated regularly to keep a business as safe as possible. One must not only grow with the company, but must also keep up with continuously changing federal, state, and local regulations.

The World Health Organization defines public health as the entire state of a community's physical well-being. Specific public health policies include efforts to prevent, control, or improve the health of persons who are suffering from transmissible illnesses and health problems caused by their living conditions, habits, or exposures to health hazards such as pollution that everyone shares in the community.

On the other hand, public policy is how authority impacts the communities in which it has the authority to exercise its authority. Official institutions, such as governments, are generally regarded as authoritative (Buse, Mays & Walt, 2012). However, other groups, such as non-governmental organizations (NGOs) or international non-governmental organizations (INGOs), may develop and implement public policies based on public consensuses, such as the United Nations.

On the other hand, global health policies are actions taken by authorities that have an impact on people's health outside of or at the global level, as opposed to at the local level. Global health policy is now mainly an attempt by non-governmental organizations and a few countries to address health problems worldwide due to a lack of a generally recognized authority with a legitimate claim to government authority to compel an individual or organizational behavior. These programs depend on volunteer cooperation in the absence of a genuine global governance structure. Public health is concerned with epidemiology and the reduction of hazards to public health, such as viruses, certain types of pollutants, dietary recommendations, etc (Palmer & Shorts, 2011). The public health community works to minimize the threats to physiological stability while also promoting behaviors that enhance physiological stability. Market imperfections — moral risk, negativity, asymmetric information, and monopolies – are addressed via public policy. Policy analysts gather information to analyze it, validate it, and propose possible solutions to political organizations. The effectiveness of these programs may be evaluated via the use of cost-benefit analysis or other analytical techniques.

Policy making: A complex set of legal, ethical, and social issues arises from contemporary health policy. Healthy people and the community are the ultimate aim of health policy to preserve and promote their well-being. Government officials may achieve this goal in respectful methods of human rights, such as the right to self-determination, the right to privacy, and the right to be treated equally.

Because of Australia's diverse variety of policymaking agencies and groups trying to exert influence on policy, it is difficult to provide a systematic and complete study of health policy development in Australia.

Situational factors: Situation factors are more or less temporary or distinctive situations that may influence policy and policy (or instances epidemic, wars, droughts). This may be a unique occurrence, such as an explosion that leads to modifications in the standards of hospital building or may stem from a broad public knowledge of an issue over a longer timeframe.(Buse, Mays & Walt, 2012). For example, due to the connection between HIV and tuberculosis (TB), the emergence of the HIV pandemic resulted in the gradual adoption of new tuberculosis treatment and control strategies.

Structural factors: Structural factors are the social components that are usually stable throughout time. Political institutions, including their degree of openness or closure, and civil society's opportunities to participate in policy discussions and choices are examples of structural variables. Examples of structural factors include the kind of economy and employment base. For example, in countries with low wages or excessively heavy workloads, these experts may have to move to other cultures where there is little or better workplace, leading to a loss of income for that country (Buse, Mays & Walt, 2012).

Cultural influences: Cultural influences may also have an impact on public health policy. In cultures where formal hierarchies are essential, it may be not easy to call senior officials or elder politicians to account for or challenge their decisions (Palmer & Short, 2014). Because of their status as ethnic minorities or language difficulties, some groups may be underinformed about their rights or get services that do not suit their specific requirements.

Opioid use

Recently, more emphasis has focused on the prevalence and danger of opioid use in the United States, which is a cause for worry. In general, this has been a commendable effort on many stakeholders to enlist public involvement in efforts to solve the opium consumption issue. San Francisco is a city in California in the United States of America, and it is the capital of the city (Haight et al., 2018). The use of opiate medicines regularly in California was first documented in San Francisco in the early nineteenth century. However, since the effects were not consistent and were not particularly harmful to the users, little attention was paid to them during this time period (Palmer & Shorts, 2014). However, the first investigations into the usage of opiate medications were conducted in 1997 and 1898, which were landmark years. Over 1,000 people took part in the study, which focused on opiate medications in the San Francisco metropolitan area.

But from the other hand, health policy refers to decisions, methods and actions to achieve specific health goals in a certain society. Health policy includes a number of action courses that affect the collection of institutions, organizations, services and financial arrangements which one generally calls the healthcare system (Palmer & Shorts, 2011).

Since 2015, SHADAC researchers have observed and documented variations and trends in the opioid epidemic at the state level (Buse, Mays and Walt, 2012). Ultimately, one may want to make data accessible to the public and state politicians to comprehend better the effects of the opioid crisis in their states and create customized solutions to meet their specific circumstances.

In most cases, legal opioids are given by a health care practitioner to treat pain associated with illnesses such as injuries, surgery and dental treatments, as well as long-term chronic pain (Parker, 2012).

People in connection with the use of Opioid
Illegal opioids are any opioids that are produced, distributed, or sold in violation of the law. The following are examples of illegal opioids:

  • Narcotics obtained from a drug dealer on the street
  • Opioids prescribed by a person who is not the healthcare professional.
  • Opioids that have not been prescribed but have been obtained from another source

Comparison of Australia and America

There is a lot of difference with respect to the pattern and the use of drugs and Opiods between the two countries of Australia and America. The pattern, context, issues and the backdrop of substance use in two different countries can never be the same. At the end of 2016, approximately one in ten (11 percent) Australians aged 14 and older at some time in their life had at least one type of opioid for illegal or non-medical reasons; current usages of opioids (in the previous 12 months) were 3.7 percent considerably lower (Scholl, et al., 2019). In contrast to illicit opioids, the majority utilized medicines opioids, 9.7% used pain relievers, analgesics and pharmaceutical opioids, and in the past 1,3% used heroin at all times.

People reporting non-medical use of pain relievers/analgesics and pharmaceutical opioids are 75% more likely to have used over-the-counter codine, 40% more likely to use prescription codeine and 17% more likely to use oxycodone (Brown & Morgan, 2019).

Both Australia and the United States have government-financed pharmaceutical firms. Generally, the total average dosage of opioids DDD per 1,000 people per day fell in both countries during a five year period from 2010–11 to 2016–17. The types of opioids administered have nevertheless changed somewhat, with the DDD rate for hydromorphone substantially greater in America and the DDD rate for tramadole and buprenorphine much higher in Australia. For fentanyl, the DDD rates were similar in both countries (Brown & Morgan, 2019).

In the USA, illegal fentanyl is more common than in Australia, while in Australia, heroin is more prevalent than in the United States (Wilson et al., 2020). People, who take these different medicines, while they are all opioids, may have varying Trajectories but because of that variation, the acute care system comes into touch. Fentanyl is stronger than heroin and has a higher fatal potential, which means that many addicts die before to immediate treatment.

People whose intervention is needed
The increase in the use of the substance use and the impact of the same in the society can be removed if some influential people and organisation comes into play some instrumental roles. The following are the three actors and the procedure that they may take to avoid Opioid abuse:


  • Adoption of strict rules and regulations to combat the dangers of opioids and raise public awareness about their use.
  • Consistent usage of prescription drug surveillance programs (PDMPs) must be taken by the local authority
  • Implementation of overdose education and distribution initiatives that directly provide naloxone to opiate users and prospective suppliers
  • Aggressive enforcement measures to target shopping for doctors and pills is necessary by the local authorities
  • Diverting people with drug use problems to drug courts can be done by the people in power

Academicians, adults and parents

  • Adults should exercise strong and tight control over youngsters to avoid the Opioid epidemic.
  • Education projects in schools and communities (primary prevention) can help to prevent the issue as creating awareness among the children is the first step that should be taken into consideration.

Famous personalities

  • Using a well-known celebrity to raise awareness among the general population via the use of various social media platforms

Brown R & Morgan A (2019). The opioid epidemic in North America: Implications for Australia. Trends & issues in crime and criminal justice no. 578. Canberra: Australian Institute of Criminology.

Buse, K., Mays, N., and Walt, G. (2012) Making Health Policy. Open University Press: Maidenhead.

Haight, S. C., Ko, J. Y., Tong, V. T., Bohm, M. K., & Callaghan, W. M. (2018). Opioid use disorder documented at delivery hospitalization—United States, 1999–2014. Morbidity and Mortality Weekly Report, 67(31), 845. (2018).Department of Health | National mental health strategy.[online] Available at:

Howard, R., Fry, B., Gunaseelan, V., Lee, J., Waljee, J., Brummett, C., ...& Vu, J. (2019). Association of opioid prescribing with opioid consumption after surgery in Michigan. Healthcare assignment JAMA surgery, 154(1), e184234-e184234.

Palmer, G & Short, S. (2014) Health Care and Public Policy: An Australian Analysis. Palgrave Macmillan: South Yarra, Victoria (Chapter 2). Palmer,G. &Short, S.
(2011).HealthCareandPublicPolicy:AnAustralianAnalysis.AustralianandNewZealand Journal ofPublic Health,35(5),pp.497-498.

Parker, E. (2012) 'Contemporary public health policy, in Fleming, M., and Parker, E (eds) Introduction to Public Health, Churchill Livingston Elsevier: Chatswood, NSW.

Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2019).Drug and opioid-involved overdose deaths—United States, 2013–2017. Morbidity and Mortality Weekly Report, 67(51-52), 1419.

Wilson, N., Kariisa, M., Seth, P., Smith IV, H., & Davis, N. L. (2020).Drug and opioid-involved overdose deaths—United States, 2017–2018. Morbidity and Mortality Weekly Report, 69(11), 290.


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