The Governance of Standard-Setting to Improve Health - Preventing Chronic Disease: November 2010: 10_0027

http://www.cdc.gov/pcd/issues/2010/nov/images/cover_nov10.jpg
November 2010
Volume 7: Issue 6
ISSN: 1545-1151
SPECIAL TOPIC
The Governance of Standard-Setting to Improve Health
Daniel M. Fox, PhD

Suggested citation for this article: Fox DM. The governance of standard-setting to improve health. Prev Chronic Dis 2010;7(6). http://www.cdc.gov/pcd/issues/2010/nov/10_0027.htm. Accessed [date].

PEER REVIEWED
Abstract

This article describes recent events in the governance of standard-setting for 2 areas of US health policy — states’ decisions about which prescription drugs to cover under Medicaid and other public programs and making health an aspect of foreign policy — and whether these events offer lessons for policy making. In prescription drug coverage, methodologic advances in research that evaluates health services and the politics of restraining the rate of growth in health expenditures enabled policy makers in most states to establish new public processes for assessing and applying evidence about the effectiveness of competing drugs. Their counterparts in foreign policy, in contrast, made few changes in existing processes for choosing which interventions to support. The history of governance in each area of policy making for health explains the selection of standards to evaluate evidence about interventions and whether and how to use this evidence to guide policy.


Introduction

Government leaders at every level choose among alternative policies mainly as a result of governance. Researchers in the policy sciences (eg, history, politics, economics, law) describe governance as encompassing the complex relationships among people and organizations that influence the making and implementing of policy. Understanding governance requires analysis of the authority and accountability embodied in constitutions, laws, and regulations; the politics of professional, commercial, and advocacy groups; and the shaping of public opinion. Moreover, ideas and beliefs — some contested, others consensual — influence the governance of each area of policy. In sum, governance is the source of the “power to make, the willingness to obey, and the decisions to contest rules and commands” (1).

This article describes, compares, and seeks lessons from the effects on standard-setting of recent changes in the governance of health care policy in the states and of health as an aspect of American foreign policy. During the past decade, almost all of the states established public processes to set standards for evaluating research findings on the effectiveness of pharmaceutical drugs, for adjudicating competing claims about the strength of the evidence for these findings, and for advising about or, in some jurisdictions, recommending policy. In contrast, the events that raised the priority accorded to health as an aspect of foreign policy did not establish new processes that set standards for how the best available evidence would inform policy. As a result, the conventional governance of foreign policy set standards for which determinants of health to address and with what interventions.

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Preventing Chronic Disease: November 2010: 10_0027