| Literature DB >> 35331575 |
Scott L Greer1, Sarah Rozenblum2, Michelle Falkenbach3, Olga Löblová4, Holly Jarman2, Noah Williams2, Matthias Wismar5.
Abstract
COVID-19 led to significant and dynamic shifts in power relations within and between governments, teaching us how governments make health policies and how health crises affect government. We focus on centralization and decentralization within and between governments: within government, meaning the extent to which the head of government controls policy; and between governments, meaning the extent to which the central government pre-empts or controls local and regional government. Political science literature suggests that shifting patterns of centralization and decentralization can be explained by leading politicians' efforts to gain credit for popular actions and outcomes and deflect blame for unpopular ones. We test this hypothesis in two ways: by coding the Health Systems Response Monitor's data on government responses, and through case studies of the governance of COVID-19 in Austria, Czechia and France. We find that credit and blame do substantially explain the timing and direction of changes in centralization and decentralization. In the first wave, spring 2020, heads of government centralized and raised their profile in order to gain credit for decisive action, but they subsequently tried to decentralize in order to avoid blame for repeated restrictions on life or surges of infection. These findings should shape advice on governance for pandemic response.Entities:
Keywords: Coronavirus; Federalism; Governance; Health policy; Public health
Mesh:
Year: 2022 PMID: 35331575 PMCID: PMC8913406 DOI: 10.1016/j.healthpol.2022.03.004
Source DB: PubMed Journal: Health Policy ISSN: 0168-8510 Impact factor: 3.255
The interaction of credit, blame, centralization and decentralization.
| Independent variable | |||
|---|---|---|---|
| Blame-avoidance | Credit-claiming | ||
| Dependent variable | Centralization | AT (autumn), FR (autumn) | AT (spring), FR (spring) CZ (spring) |
| Decentralization | CZ (autumn) | AT (summer) FR (summer) CZ (summer) | |
Source: Authors. Spring runs until roughly mid-May 2020, summer to the start of September; autumn to the end of January 2021.
Austria, Czechia and France in comparative perspective.
| Austria | Czechia | France | |
|---|---|---|---|
| Formal presidentialism | No | No (but president informally powerful) | Yes |
| Formal federalism | Yes | No | No |
| Head of government's party | Christian Democrat | ANO 2011 (centrist / “technocratic populist”) | La République en Marche |
| Coalition government? | Yes (Christian Democratic/Green) | Yes (ANO / Social Democrats) | No |
| Population | 8.8m | 10.6m | 67m |
| GDP per capita (US$, PPP, most recent) | 50,137 | 23,494 | 40,439 |
Source: authors; World Bank for population and GDP.
Centralization and decentralization by country and domain of intervention.
| Domain of intervention | Centralization within government (spring/summer) | Centralization between governments (spring/summer) | Centralization within government (autumn/winter) | Centralization between governments (autumn/winter) | Decentralization (any kind) (autumn/winter) | |
|---|---|---|---|---|---|---|
| Interministerial committee, | AL, AM, AT, BA, BE, BG, CA, CH, CY, CZ, DE, EE, FR, GE, GR, HR, IE, IL, IT, KG, LT, LU, LV, ME, NL, PL, PT, RS, RU, SK, UA, US | BE, DK, FR, KZ, RU | DK, ES | BE, BG, RS | BE, BG, CA, CH, DE | |
| Expert/Vaccine committee | AL, BE, BG, CA, EE, FR, HR, IE, MK, SI, TR, US | CA | FI, FR, IE, LT, LU, NL, RU | |||
| State of emergency/ Emergency Laws | AM, BA, BE, BG, EE, ES, FR, GE, HU, LU, MD, MK, MT, PL, RO, RS, US | CH | FR, PT, ES | |||
| Centralized governance of the healthcare system | AT, DE, IT, LT | LT | ||||
| Health communication | GR, HU, IT, ME, RS | |||||
| Physical distancing | BE, CA, DE | DE, FR, ES | ||||
| Contact tracing | ME | |||||
| Isolation and quarantine | FI | UA | ||||
| Monitoring and surveillance, Contact tracing, Reporting cases and hospital capacity | BE, BG, CY, DK, IL, MK, PL, RO | AT, BG, CA, CH, DE, ES, GB, IT, MK, NO, PL | IE | DE | DK, NO | |
| Testing | GR, IE, IL, ME | LT, ES | DE | IT | ||
| Physical infrastructure | DK, HR, IE | DE | DE | |||
| Workforce | DE | |||||
| Planning services | BE | IT, RO | GR | BG | ||
| Managing cases | LT | |||||
| Maintaining essential services | ||||||
| Health Financing | BE, ME | CA, DK, FI | BG, CA, CH, ES, RU | |||
| Entitlement and Coverage | ||||||
Fig. 1Policy stringency over time, Austria, Czechia and France. Source: Hale et al. 2021.
Fig. 2Excess mortality, all ages (% change over 2015-19). Source: Our world in data.