Discuss about the Health Policy Analysis and Critique.
All public policies need to be analyzed before they can be considered for implementation (Northway, Davies, Mansell, and Jenkins, 2007). Public policy analysis intimates stakeholders on the relevance of a policy besides estimating its capabilities, effects, and impacts on targeted populations. In the healthcare sector, health policy analysis plays a significant role in informing healthcare stakeholders such as healthcare practitioners, medical superintendents, the ministry of health officials, politicians, patients and the general public, the real value that can be derived from the implementation of a proposed policy. With a policy analysis, health policymakers are in a position to weigh their options on a range of policy alternatives with the view of arriving at the most optimal health care policy option. Facets informing decision making for a particular health care policy include financial implications; political atmosphere; legal concerns, impacts on targeted communities; social implications; patient’s care implications, and family/caregiver viewpoints (Weimer and Vining, 2017). As such, policy analysis enables policymakers to establish a need for establishing the effectiveness and efficiency of a health policy before its actual implementation. In this paper, the primary focus will be on formulating and analyzing a healthcare policy meant to combat alcohol abuse amongst the older population in Australia.
In line with the National Alcohol Strategy 2018-2026, there has been a need to not only prevent but also decrease alcohol-associated harms across the entire country’s populations. This fight has been anchored on the need to identify federal priority areas of concern as well as opportunities for action. Moreover, it is premised on the need to establish consented efforts to promote and facilitate advocacy efforts and forging of partnerships and/or collaborations with relevant stakeholders including the private sector, government as well as non- government sectors. In these efforts, the national alcohol strategy is aiming to minimize harmful alcohol abuse by at least 10% (Kypri, Thorn, and Crozier, 2018).
A primary health care policy such as alcohol abuse prevention and minimization of its harmful effects amongst the elderly in Australia is an important one when the devastating effects of alcohol are taken into consideration. Abusive alcohol consumption has presented itself as a very complex issue across Australian communities. Alcohol is the most abused drug in the whole of Australia with the National Drug Strategy Household Survey (AIHW 2008) showing that approximately 90% of adults have ever experienced alcohol at some point their lifetime and many continue to do so most of their lifetime. The statistics also indicate that of these around 80 % are bound to consume alcohol within any particular year. Though most Australian’s drink alcohol moderately, a quarter of the alcohol drinking population puts itself at risk of alcohol-related harm of injuries from a single drinking occasion.
Those vulnerable to diseases or lifetime injuries account for about 17% of the entire drinkers' number. In a 2004 study, Windle found out that even if the elderly aged 65 and above are bound to drink less alcohol on a single occasion than their youthful counterparts, they tend to consume it on a daily basis (19.5% of males; 8.7% of females). When older persons drink at these levels, they become more vulnerable to age-related illnesses besides significantly increasing social-economic costs such as seeking health care, justice and policing. Moreover, alcoholism plays a significant role in elevating family violence, road clashes, sexual violence and child abuse further contributing to ethical dilemmas in policy development.
The World Health Organization (WHO) has lately singled out alcoholism as one of the priority areas for primary health care consideration following its widespread implications on communities. In a 1998 study, Deehan, Marshall, and Strang ran into the conclusion that primary health care can be of help in laying health policies that can assist in promoting, preventing, advocating for the minimization of alcoholism as well as the treatment of alcoholics with mental illness. Australia's National Survey of Mental Health and Wellbeing (NSMHWB) indicated that approximately 90% of older persons are likely to report mental disorders in their lifetime which can majorly be attributed to alcohol abuse (Reavley, Cvetkovski and Jorm, 2011). In addition to these shocking statistics, alcoholism is the second contributor to tobacco to the Australian disease burden. Alcohol has been associated with close to 200 chronic diseases as their major risk factor. To this end, the formulation of an alcohol prevention and minimization of harm health policy among the older persons is very crucial.
Following the widespread negative impacts of excessive alcohol consumption as highlighted above and Australia's commitment to the World Health Organization
Global Action Plan for the Prevention of and Control of Non-Communicable Diseases 2013–2020 that also requires world’s nations to minimize alcohol abuse by 10% by 2025, there is need to have a ratified health policy targeting the older population for the same [World Health Organization, 2018]. This is because the alcohol abuse among the elderly presents more peculiar effects than is the case for other population types. Older persons, unlike their younger counterparts, are affected by age-related complications which may compound their health complications as well as healthcare provision concerns.
The proposed health policy is destined to build on the current efforts and responses for the prevention and minimization of alcohol-related harms through existing Commonwealth, state and territory government's laws, guidelines and strategies. One such strategy is the harm minimization policy contained in the National Drug Strategy 2017–2026. This strategy is premised on demand, supply and harm reduction of alcohol abuse. Moreover, it draws insights from the Australian guidelines to reduce health risks from alcohol consumption. The policy will also ride on the World Health Organization’s (2014) objectives of decreasing harmful alcohol abuse. The policy will recognize productive partnership and coordination besides working in tandem with different jurisdictions and community portfolios. Productive interventions call for a comprehensive multiagency approach including law enforcement, social services, justice systems, political pressures, education, healthcare and the local government. Furthermore, interventions under the policy will be informed by evidence and general practice.
Matters concerning older persons’ vulnerability to alcohol-related, age-related illnesses and mental deterioration will be of priority in the policy. Moreover old age lifestyle challenges such as loneliness, bereavement, depression, retirement, social connection, income for the elderly, education and decent housing will come in handy in the formulation of adequate strategies to alleviate them from such situations. To underpin the primary health care objectives as envisaged by the WHO, then a people-centered approach will inform the formulation of old-age specific strategies for alcohol prevention and harm minimization. Major priority areas under the policy will include the strict management of alcohol availability; improving older people safety and amenity; promoting older person’s health and support mechanisms. Finally, the policy will institute opportunities for action in each of these priority areas
The WHO has for a long time vehemently advanced strategies, guidelines, programs and policies aimed at combating alcohol and substance abuse across the globe. This is after its later recognition of excessive alcohol consumption as a primary health care concern under the Alma-Ata Declaration of 1978 and the year 2000 ‘Health-for All’ programme (Davies, et al., 2008; WHO 1978). These declarations are as a result of the worldwide outcries of the devastating effects of alcohol abuse. Australia is also committed to the World Health Organization Global Action Plan for the Prevention of and Control of Non-Communicable Diseases 2013–2020 that also requires world’s nations to minimize alcohol abuse by 10% by 2025 [World Health Organization, 2018].
Through the ratification and implementation of the guidelines, policies, and programs informing these declarations into the Australian society, tremendous outcomes have been achieved. Amongst the strategies Australia has put in place in the recent past to prevent and minimize alcohol abuse is the National Alcohol Strategy 2018–2026 aimed at minimizing the demand, supply and harm of alcohol abuse (Kypri, Thorn, and Crozier, 2018). The 2009 Australian guidelines are meant to minimize alcohol-related health risks besides projecting recommendations for alcohol consumption for different scenarios. Pregnant women and the underage groups have been curtailed from alcohol consumption while adults have been recommended healthy daily and single occasion consumption rates (Chrome, et al. 2012).
The need to politicize and institute legal frameworks over which to advocate for alcohol abuse prevention and minimization of harm amongst the elderly is of ardent priority (Weimer and Vining 2017). This can be affected by legislating policy instruments that take care of the needs of the elderly such as decent housing, bereavement, retirement, income for the elderly and social inclusivity. While some concerns may not require legislation, they may need the proper institution of socio-economic frameworks to cover up gaps in healthcare provision to this group. There is, therefore, the need for in-depth consultations and coordination of facts informing the policy amongst policymakers, politicians, health practitioners, financiers and the alcoholism victims themselves. This is in a bid to find out whether ideas presented in the policy have the capacity to carry the intended aims to a successful realization.
Besides, there being numerous efforts geared towards the promotion, prevention, and treatment of alcohol-related harm, these efforts have majorly been universal with little efforts advanced to institute age-specific concerns. Alcohol-related health policies particularly aimed at alleviating harm amongst the elderly has received little attention amongst policymakers. Against this evidence, there is, therefore, the need to have a ratified health policy for alcohol abuse prevention and minimization of harm targeting the older population. Like has been highlighted, older persons are not only vulnerable to alcohol-related harm but also age-related complications which by and large compound challenges facing their health and healthcare provision (Lip et al. 2011). To this end, consented efforts for the advocacy of the same ought to be fronted by relevant stakeholders if any results are to be achieved.
The goal of the alcohol abuse prevention and minimization of harm health policy amongst the older person will read;
A goal of the National Health and Medical Research Council’s (NHMRC) health policy on the freedom from alcoholism is to prevent and minimize alcohol-related harms among older persons by at least 10% by 2025.
This goal is in line with both the National Alcohol Strategy 2018–2026 and the World Health Organization Global Action Plan for the Prevention of and Control of Non-Communicable Diseases 2013–2020 that also requires world’s nations to minimize alcohol abuse by 10% by 2025 (Gilson, and World Health Organization, 2013). This goal would be achieved through the identification of priority areas of focus targeting the older persons as well as opportunities for possible action plans. Moreover, the achievement of this goal will be elevated by the active promotion and facilitation of productive partnerships and commitment from both government and non-government sectors
Against these goals and objectives, action strategies can be instituted and possible opportunities for action advanced. Action strategies under the promotion of older person’s safety and amenity may include those that advance less injury and violence, provision of safe alcohol drinking setting and humanly treatment of offenders. Under the minimisation of alcohol availability objective; strengthening of controls, reduction of alcohol promotions and pricing are efficient. Action strategies such as the usage of evidence to inform decision making, effective treatment systems and support services can go a long way in impacting needed support and information. Lastly action plans for improving the awareness and understanding of the harmful effects of alcohol can be effected through proper communication and the institution of guidelines of modest alcohol usage.
Following the breadth and the depth of the policy, resources needed in implementing it ought to be obtained from a multiplicity of sources. This ensures inclusivity of all relevant stakeholders in achieving desired outcomes besides counteracting financial constraints associated with many healthcare policies (Cairney, 2015). Being a primary healthcare concern as envisaged by the 1978 Alma-Ata Declaration and the fact that Australia recognizes primary healthcare at the point of contact with the health care system, the achievement of this policy will draw resources from the most primary sources. Government budget allocations, healthcare staff, medications, premises, and equipment through the ministry of health are key to this end. Moreover, non-governmental organizations and interested parties can contribute towards the same through donations.
Following the government’s overall National Alcohol Strategy 2018–2026, this policy will also ride on this timeframe. This timeframe is also in congruence with the WHO targets in the prevention and minimization of harm from alcohol-related risks. This will allow for the efficient integration of the policy’s outcome to the overall national outcome on the same besides creating an opportunity for check and balances. However, outcomes will be evaluated every two years to determine milestones and by extension inform the re-evaluation of goals, objectives, and priority areas for fresh consideration. Like has been highlighted, under this timespan, priority areas will include the strict management of alcohol availability; improving older people safety and amenity; promoting older person’s health and provision of support mechanisms.
Health Policy Alternatives
Backing up this policy is the National Alcohol Strategy 2018–2026 which advocates for alcohol demand, supply, and harm reduction through more or less similar strategic approaches and opportunities for action. The National Health and Medical Research Council (NHMRC) have also instituted guidelines that help decrease alcohol-related health risks amongst different age groups and scenarios. The WHO, on the other hand, has the pointed year 2025 and a 10% reduction of alcohol abuse as principal reference points for evaluating the effectiveness and efficiency of any alcohol-related harm minimization interventions. Moreover, according to World Health Organization (2014) alcohol is the most abused drug among the older persons and its under-detection by stakeholders is bound to cause national alarm at some point. To this end, lobby groups such as health groups, the police, politicians, health practitioners, community-based organizations, and researchers ought to combine efforts in the formulation, consultation, coordination, implementation and evaluation of health policies pertaining alcohol-related minimization efforts.
Lobby groups provide the vigor that is needed to push a particular health policy towards its actual implementation despite eminent huddles (Walt, et al. 2008). Like has been mentioned, healthcare policies are often underpinned by financial constraints and economic conditions. Again the healthcare sector is overly perceived as a "resource spending" as opposed to "resource generating" presenting financial considerations at a disadvantaging position with regard to the criterion for choosing optimal health care policy alternatives. But even as such, Marmor and Wendt (2012) observe that lobby groups can be instrumental in advocating why particular health policies ought to be considered for implementation despite their financial implications. Healthcare practitioners, for instance, are in a good position to advance policymakers and politicians the cost/benefits analysis of supporting and engaging a particular health policy rather than shunning it (Cheung, Mirzaei, and Leeder 2010).
This allows politicians to further mobilize it by advancing its policy instruments for consideration of legislation in parliament and in the Senate. Another viewpoint lobby groups can use to push the implementation of a health policy is to showcase the significance of the healthcare policy in terms of the outreach and the scope of the population it is bound to impact which by extension substantiates its socio-economic benefits. Such a move shuns the ethical dilemmas and legal constraints that may be fronted to jeopardize efforts. Lobby groups can also utilize timeframes and policy visibility to champion the implementation of policies in which case proper integration of short-term and long-term objectives appear more appealing than long-term rigid objectives.
The policy life cycle presented by Adams, Colebatch, and Walker (2015) presents policymakers with a significant yardstick for considering and implementing various healthcare policies. Upon the successful formulation of a healthcare policy like one presented in this paper, its analysis for possible consideration among alternatives is inevitable. The gathering of both qualitative and quantitative data with regard to social-economic impacts, financial implications, population scope is very crucial in informing the effectiveness and efficiency of a particular health policy. When a particular health policy catches the public attention and lobby groups gather momentum in having it legislated for possible guidelines and strategies Adams, Colebatch, and Walker (2015) observe that it takes the consented agreement of policymakers especially the politicians for it to reach such a stage. Collins, (2005) contend that healthcare policies are bound to face more challenges than other public policies since the policies are not only "resource spenders" but also demand the consent of patients, families, and caregivers in effecting them. However, Buse (2008) observe that with adequate problem formulation, deciphering facets informing the move and the enactment of work goals and objectives, any healthcare policy can receive widespread support.
In this paper, the health policy described presents stakeholders with a new viewpoint in deciphering approaches for combating alcohol abuse among the older persons. The policy aims at presenting a people-centered approach in the fight against alcoholism as opposed to having universal approaches towards the same. To this end, the policy is tailored to cater to the needs of the elderly both in preventing and minimizing the harm from alcohol abuse. Like was established, alcohol abuse prevention and harm minimization among this group are of dire consideration on its own following the older person characteristics and their healthcare needs (Briggs et al. 2011). These virtues are sufficient yardsticks warranting the action from lobby groups in seeking political, legal and socio-economic support from the government and other non-governmental organizations. The problem statement, goals and objectives deduced align to those of the mainstream national and international alcohol strategies with regard to timeframes and major action plans. This makes it possible for the federal government to implement it with some special consideration.
Since alcohol abuse is recognized by the WHO a primary healthcare concern, a favorable health care approach towards the achievement of prevention and minimization of harm from alcohol-related injuries and diseases amongst the elderly would be to adopt a people-cantered approach. In such a policy, the priority concerns informing the formulation of old-age specific strategies can be adopted to successfully achieve the desired goals and objectives. Overly, Bridgman and Davis (2003) observe that the policy cycle advances a structured approach that can assist ease many policy concerns such the case described here.
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