Policy and diffusion in public health transitions: Indonesia in global perspective

Two of the central questions in the field of public health policy concern whether developing world states can overcome barriers imposed by weak socioeconomic settings to accelerate public health transitions through policy interventions, and by what mechanisms such policies appear in developing countries. In this study I employ structure and agency theory to investigate both issues, examining on a global basis the impact and origin of three public health initiatives: family planning, safe motherhood and polio immunization. To add qualitative detail to the analysis, I also investigate Indonesia's experience in each of the programs.;I find strong support for the contention that public health policies do matter, and that the governments of less developed countries need not wait for socioeconomic modernization to make significant improvements in the health conditions of their populations. In a chapter on family planning I conduct a cross-national regression analysis of fertility levels in countries with predominantly Islamic populations and find that programs have significant influence on birthrates. I find a similar result for the Indonesian family planning program in particular and analyze the sources of effectiveness in that program. In a chapter on maternal mortality I undertake a cross national regression analysis on maternal death rates and find that targeted medical interventions can have strong impact on mortality levels even in poor countries. I show this power in practice by illustrating how the Indonesian government mobilized to shape safe motherhood outcomes in the country in the course of just eight years. In a chapter on polio I demonstrate that a World Health Organization-led disease eradication initiative was a major factor behind a dramatic decline in disease incidence globally through the 1980s and 1990s. This initiative and intervention on the part of the Indonesian government also led to a large decline in that country over the same time period. Aside from demonstrating policy impact, in each chapter I also indicate the power of international diffusion as a force shaping the appearance of public health policy in developing countries, pointing to the inadequacy of theories of policy origin that consider domestic factors alone.