Academy Role in Public Policies in Health Care

Paula Lantz

University of Michigan

Academic Approach to Policy

• Policy Typologies and Frameworks

• Research or Evidence Base for Policy

Definitions of Policy• “Policy” is a highly flexible concept

• A defined course or method of action or inaction selected from among alternatives by a government, institution, group or individual

• A specific decision or set of decisions designed to carry out a course of action

• A projected program consisting of desired objectives and the means to achieve them

Definition of Public Policy

Statements, procedures, resource allocation decisions or prevailing practices imposed by those with governmental authority to guide or control institutional, community and individual behavior.

Purpose of Policy

General purpose of policy is to solve, lessen or remedy some sort or problem:Economic perspective: Policies address

equity failures or market failuresSociological perspective: Policies attempt to

solve problems that have been defined through social and political processes

• Policy = Planned Intervention

• Many different typologies of policy or types of intervention exist

Policy Typology

FORMAL POLICY Laws, regulations, court rulings,

administrative rules, Ministry resource allocation decisions, budget rules

Consequences for not following violatingTend to have impact on large numbersExamples:

Taxes on cigarettes and alcohol New gun laws in Brazil (October, 2003)Agencia Nacional de Saude (ANS) regulations

regarding premium prices and procedures/ treatments that must be covered

Policy Typology

INFORMAL POLICY Guidelines issued by professional

associations, recommendations of expert panels, rules within institutions, local programs, local planning documents

Smaller scope, less formal, no consequences for not following

Examples:WHO Model List of Essential MedicinesCancer screening guidelinesHospital policy to screen for domestic violence

Policy Typology (O’Hare)Non-intervention Do nothing/status quo

Moral suasion Provide information [Inform]Exhort [Implore]

Incentive SubsidizeTax

Procure Grant/Contract [Buy]Produce [Make]

Law & Regulation Require [Oblige, Prohibit]

Material vs. Symbolic Policy

Material policies either provide tangible resources or substantive power to their beneficiaries, or impose real disadvantages on those who are adversely affected.

Symbolic policies have little real material impact on people; they allocate no tangible advantages or disadvantages; may set the stage for material policy.

Policy Target Groups Convergence of political power and social

constructions creates 4 target populations, with different benefits and burdens from policy:

Advantaged: Positively constructed andpolitically powerful

Contenders: Negatively constructed yet politically powerful

Dependents: Positively constructed yet no political power

Deviants: Negatively constructed and no political power

Policy Target Groups

Target Population Description

What They Get From Policy

Advantaged Politically PowerfulPositively Constructed

Policy benefits highPolicy burdens low

Contenders Politically PowerfulNegatively Constructed

Benefits concealedBurdens symbolic/overt

Dependents Politically WeakPositively Constructed

Policy benefits lowPolicy burdens low

Deviants Politically WeakNegatively Constructed

Policy benefits lowPolicy burdens high

Policy Action

• Set of conditions seen as a problem

• Definition of problem has emerged and received attention in important public arenas

• People are calling for action, intervention, or resource allocation

• How does policy happen?

The Policy CycleAssessment of

Population Health

Policy EvaluationAssessment of

Potential Interventions

Policy Implementation

Policy Choices

Stages in the Policymaking Process

Issue Definition

Setting Objectives

Priority Setting

Defining Options

Options Appraisal

Implementation

Evaluation

Stages of Government Policy Process

• Agenda SettingGovernment decides that action is (or is not) required on a particular issue

• Issue FiltrationGovernment decides the means by which options for action will be generated

• Issue DefinitionThe problems, options and opportunities that the government needs to consider are clarified

• ForecastingProbable consequences should a given policy be adopted are considered

Stages of Government Policy Process

• Options analysisGovernment reviews various options that will achieve the desired goal, and selects most appropriate

• Objective settingGovernment sets objectives to measure the effectiveness of the policy chosen

• MonitoringConsequences of the chosen policy are monitored against objectives; unintended consequences monitored

• Maintenance/Succession/TerminationGovernment decides to maintain policy (M), succeed it with something new (S), or terminate policy (T)

Role of Advocacy

• Advocates can influence the policy process at all stages

• Data and research evidence can and should be used by advocates at all stages

Problem definition/issue framing Assessment of potential interventions Policy choices Policy implementation Policy evaluation

Evidenced-Based Public Health

The development, implementation and evaluation of effective programs and policies in public health through application of principles of scientific reasoning

Evidence = the available body of facts or information indicating whether a belief or proposition is true or valid

Public health policy is not always based on science

Many other things besides scientific information influence the policy process.

WHY?

Pyramid for Evidence Reaching Policy Makers (WHO, 2006)

Pyramid for Policy Makers Influencing Research (WHO, 2006)

Barriers to Strong Link Between Science and Policy

• Science does not always provide clear problem definitions or policy answers– Study design limitations– Human subjects limitations (ethical

issues)– Data limitations

Barriers to Strong Link Between Science and Policy

• Scientific study results are hard to assess, synthesize, communicate (e.g., media misinterpretation)

• Timing: Scientific information not always available when decisions need to be made

• Study results are often contradictory• Interpretation of same results can

vary

Barriers to Strong Link Between Science and Policy

• It is not difficult to produce “evidence” or “scientific data” to support a position

• Even with sound evidence, policy response is often not clear cut

• The policy process values and is shaped by many other things:Drama/urgency Economic concernsPersonal stories/anecdotes Legal concernsIdeology/bias/prejudice Ethics/normsPolitical concerns/pressures Others

Importance of Integrity in Use of Data and Research Evidence

• Advocates can influence policy process at all stages

• Goal should be evidence-based problem definitions and policies

• Advocates should use data and research objectively

Importance of Integrity in Use of Data and Research Evidence

• Benefits– You will be perceived as providing objective and valid

information– People will believe what you say– You will become a trusted resource – You increase chances of being effective

• Risks if You Do Not Use Research Objectively:– You will lose credibility– No one believe or use your information– You will lose opportunities for partnering and for

influencing– You will be less effective

Final Thought

There is a big difference between being neutral and being objective.

You do not have to be neutral about an issue or a policy. You can have a strong opinion.

You should strive to be objective.