Public health and the policy process

Transcription

1 Public health and the policy process Carole Clavier, Ph.D. Assistant professor, Université du Québec à Montréal Workshop of the Canadian Partnership Against Cancer, Montreal, March

2 Disclosure statement No conflicts to disclose

3 Public policies are ubiquitous in public health practice

4 Yet, public policies are also elusive Public Health Public policy making Public policy

5 WHAT IS PUBLIC POLICY?

6 Public policy is «Anything a government chooses to do or not to do» (Dye, 1972, 2) «A set of interrelated decisions taken by a political actor or group of actors concerning the selection of goals and the means of achieving them» (Jenkins, 1978) The programme of action (or inaction) of a government to achieve specific goals

7 The stages model: appealing but misleading Agendasetting Policy formulation Decisionmaking Implementation Evaluation

8 The policy process: complex and nonlinear Actors Ideas Institutions Set of interrelated decisions and programme of action Clavier & de Leeuw, 2013

9 The multiple sources of policy change Time Policy institutions Policy instruments Policy actors Policy ideas

10 HOW IS A THEORY OF THE POLICY PROCESS USEFUL FOR PUBLIC HEALTH?

11 Theory is practical for understanding public policy Case: Quebec s 1998 Tobacco Act That tobacco kills smokers has been long-established Public health interests collide with economic interests How did the Act happen? The Advocacy Coalition Framework explains policy choices through the confrontation of different coalitions of actors, each united around a particular set of values and ideas about a given policy issue Breton et al., 2008; 2013

12 Advocacy coalitions within the policy process Relatively stable system-wide parameters Tobacco kills; Strong economic interests Anti-tobacco advocacy coalition Pro-tobacco coalitions External events Governmental decisions: 1998 Tobacco Act 1994: cigarette contraband crisis 1994: Election of the Parti québécois 1995 Supreme Court of Canada judgement on federal restrictions on tobacco advertising Adapted and simplified from Breton 2008; 2013 and Sabatier & Jenkins-Smith, 1993

13 Theory is practical for making public policy De Leeuw et al., 2013

14 Conclusion The policy process is complex, iterative and power-driven. It engages and thrives through a set of rules, values and norms in which the ideal of health rarely predominates. Understanding the complexity of the policy process will help public health practitioners critically assess policy processes, make pronouncements on how to act at the policy level, and actively take part in this process.

15 References Bernier, N. F., & Clavier, C. (2011). Public health policy research: Making the case for a political science approach. Health Promotion International, 26(1), Breton, É., Richard, L. Gagnon, F., Jacques, M. & Bergeron P. (Forthcoming) Coalitions advocacy action and research for policy development. In C. Clavier & E. de Leeuw (Eds.), Health Promotion And the Policy Process. Oxford: Oxford University Press. Breton, E., Richard, L., Gagnon, F., Jacques, M., & Bergeron, P. (2008). Health promotion research and practice require sound policy analysis models: The case of Quebec's Tobacco Act. Social Science & Medicine, 67(11), Clavier, C., & de Leeuw, E. (Forthcoming). Framing public policy in health promotion: Ubiquitous yet elusive. In C. Clavier & E. de Leeuw (Eds.), Health Promotion And the Policy Process. Oxford: Oxford University Press. de Leeuw, E., Keizer, M., & Hoeijmakers, M. (Forthcoming). Health policy networks: Connecting the disconnected. In C. Clavier & E. de Leeuw (Eds.), Health Promotion And the Policy Process. Oxford: Oxford University Press. Dye, T. R. (1972). Understanding Public Policy. Englewood Cliffs, NJ. Fafard, P. (2012). Public Health Understandings of Policy and Power: Lessons from INSITE. Journal of Urban Health, 89(6), Jenkins, W. (1978). Policy Analysis: A Political and Organizational Perspective. London. Sabatier, P. A., & Jenkins-Smith, H. C. (1993). Policy change and learning : an advocacy coalition approach. Boulder, Colo.: Westview Press.