Policy responses to COVID-19 present a window of opportunity for a paradigm shift in global health policy: An application of the Multiple Streams Framework as a heuristic

ABSTRACT

Drawing on Kingdon’s Multiple Streams Framework as a heuristic, this article reviews the three streams – problems, policies, and politics – as applied to the adoption of economic policies in response to the socioeconomic impacts of COVID-19. In doing so, we argue that we are currently presented with a window of opportunity to better address the social determinants of health. First, through assessing the problem stream, an understanding of inequity as a problem gained wider recognition through the disproportionate impacts of COVID-19. Second, in the policy stream, we demonstrate that appropriate and unprecedented policies can be enacted even in the face of changing evidence or evidentiary uncertainty, which are needed to address upstream factors that influence health. Lastly, in the politics stream, we demonstrate that addressing a public health ‘problem’ can be well-received by the public, making it politically viable. However, it is important to ensure the ‘problem’ is clearly relayed to the public and that this information is not perceived to change, as this can undermine trust. The social, political, and behavioural lessons presented by the COVID-19 pandemic should be drawn on in this pivotal moment for global public health.

KEYWORDS:

• Public policy
• healthy public policy
• public health
• Multiple Streams Framework
• COVID-19

Acknowledgments

The authors would like to sincerely thank the reviewers for their invaluable, thoughtful, and constructive comments. We would also like to thank our colleague, Sharath Voleti, for generously reviewing and providing feedback for our work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In the context of health, inequity is understood as a political concept with a moral commitment to social justice, while inequality entails systematic measured differences (Kawachi, Subramanian, & Almeida-Filho, 2002). In other words, while inequalities are believed to be unnecessary and avoidable, inequities are understood as also being unfair and unjust (M. M. Amri et al., 2021; Whitehead, 1990).

2 The SDHs are defined as the economic and social conditions which affect an individual’s health status and include: peace, shelter, education, food, income, a stable eco-system, sustainable resources, and social justice and equity, as recognised by the Ottawa Charter for Health Promotion (World Health Organization, Health and Welfare Canada, & Canadian Public Health Association, 1986).