Approach Getting started Health promotion Stake-holders analysis Advocacy and Implementation Evaluation Chapter 6: Healthy Public Policy Policy making Do Kim Ngan tructure of RationalIncremental state: direct Overview: vs Conflict indirect and participation consensus modelstake-holderscoalitions Advocacy strategiesthe mediapolicy adoption Health impact Assessment Agenda settingproblem framingpriority settingoption settingcriteria selectionpolicy selectionmeans choicesuccess indicatorschanging goals or means Healthy Public Policy Policy making, Definition implementing Process Health Impact Assessment Education Advocacy Power 1. Healthy public policy 1.1.What is policy? (Hogwood and Gunn, 1984) - A label for a field of activity - A statement of aspiration or purpose - Specific proposals - Decisions (government) - Formal authorization - A program - Output(s) - Outcome(s) - A theory or model - A process 1.2.Key elements of policy (Colebatch, 1998) - Authority: official endorsement - Expertise: what should be done at a problem area - Order: consistent and structured decisions 1.3.What is public policy? (WHO, 1988) Public policy the guide to government action sets the range of possibilities for choices made by public and private organizations, commercial and voluntary enterprises, and individuals. In virtually every facet of living, the creation and use of goods, services, information and environments are affected by government policies fiscal, regulator, service provision, research and education, and procedural
1.4.What is healthy public policy? (Hancok, 1982) Healthy public policy is concerned with the role of government and the public sector in creating the conditions that support health => healthy public policy: creating supportive environment 2. Health education and health promotion Figure 6.2, page 261 3. Healthy public policy making, implementing process (a) Goal: To make government activity across the board contribute as much as possible to health development, while recognizing the tradeoffs that are an inevitable and necessary part to the policy process (b) Characteristics - Commitment to social equity ( 사사사사 ) - Influence of economic, social and physical environments on health - Public participation - Cooperation of health and other sectors (c) Policy can support health - Fiscal/monetary: incomes and incentives - Regulation: economic and environmental - Provision of goods and services - Supporting participation - Research, development, information, education To what extent should government intervene in people s live? (Jochelson, 2005), individual freedom vs government intervention 1.Rational: clear goal, objective appraisal, all alternative identification, selection of most appropriate alternative 2.Incremental: unclear goal, subjective (policy makers agreement), restricted number of alternatives, achieve small changes 3.1.Getting started - Direct participation: involvement in the policy making process or lobbying and advocacy
- Indirect participation: electoral process - High vs low politics: consideration of major issues may be dominated by small elites vs participation in more run-of-the-mill (common, everyday life issue) issues of policy - Key points of getting started: o Know your potential allies and adversaries o Know the structures with which you are working o Know the context within which you are working 3.2. Approach - Rational approach: o Clear explication of goals o Identification of all the alternatives for addressing the issue o Objective appraisal o Selection of most appropriate alternative - Incremental approach: o Unclear goal and objectives o Restricted number of alternatives o Subjective appraisal: policy makers agreement o Small changes to existing policy 3.3.Stake holder analysis (1) Conflict and consensus models - Conflict models see groups as having their own interests and competing to ensure that they achieve their own goals. Eg. Tobacco control program - Power strategies: physical power, resource power, position power, expert power, personal power, negative power (2) Stake-holders: are all those who stand to be affected, in whatever way, by the introduction of a policy and who may be, but are not necessarily, involved in policy making - Policy keeper is the agent that holds a policy and moves the policy forwards during any phase of policy making - Interest group, pressure group are used for groups that exist outside government. Interest groups who protect the interests of their members such as Trade Unions, Disability Rights group and those coming together around a specific issue: abortion, pollution - Insider group : recognized legitimacy so participate in policy making easier - Outsider group : have greater difficulties in gaining access to the policy process Move from outsider to insider status - Policy network : the collection of actors and organizations which influences decision making in a policy sector (3) Coalitions - Coalition is an organization of individuals representing diverse organizations, factions or constituencies who agree to work together to achieve a common goal - The importance of coalition (page 271: Butterfoss et al., 1993) 3.4. Policy making - Agenda setting: whether or not a given public issue is an appropriate problem for public policy - Problem framing: determining the definition and scope of the problem - Priority setting - Option setting: finding possible optional solutions, including goals and strategies
- Criteria selection: by what criteria options should be chosen - Policy selection: who bears the responsibility to decide - Means choice: how and by whom, the policy should be implemented - Success indicators: determining the criteria and sources of evaluation - Changing goals or means: how the policy should be reformulated 3.5. Advocacy - Advocacy for health: A combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or program (WHO, 1998) - Advocacy vs. commercial lobbyist: public interest vs. group interest though similar tactics can be used. - Effective advocacy: logically persuasive, morally authoritative, and capable of evoking passion - Public health policy initiatives are open to a range of interpretations => carefully framing of arguments, proactive and reactive, creative, dramatic and news-grabbing tactics - The media: public attention and influencing opinion - The A frame for Advocacy developed by the Johns Hopkins Center for Communication Programs o Analysis: problem, policy change need, stake-holders, policy-making structures, processes and means of influencing decision makers o Strategy: based on clear objectives suited to the context o Mobilization: partners, coalition, resources, power o Action: visibility for messages, private channels, the media o Evaluation o Continuity: longer term planning 3.6.Adoption and implementation - How the policy is conceived? - How is it introduced? - How are the local resources available to assist the introduction? - How is the range of social economic factors? 3.7.Health impact assessment - A combination of procedures, methods and tools by which a policy, program, product, or service may be judged concerning its effects on the health of the population (Smith, 2006) - Purpose: improve knowledge about the potential impact of a policy or a program, inform decision makers and affected people, and facilitate adjustment of the proposed policy in order to mitigate the negative and maximize the positive effects => avoid potential harms - Benefits: o Promote equity o Improve quality of decision making o Emphasize social and environment justice o Encourage public participation o Equal status to both qualitative and quantitative assessment methods o Make values and politics explicit, and open issues to public scrutiny o Demonstrate that health-relevant policy is far broader than health-care issues - Key questions concerning HIA: page 288 - Three types of assessments:
o Prospective: predicts the effects o Retrospective: consequences of implemented policy o Concurrent: consequences of implementing policy - Main stages of HIA: o Screening: whether a particular policy, program or project is relevant to health o Scoping: identify the relevant health issue and public concerns that need to be addressed during appraisal o Appraisal o Reporting: communicating with stake-holders o Monitoring of compliance with recommendations and expected health impacts following the implementation of the policy or program. - Key principles of HIA: page 290