Academy Role in Public Policies in Health Care

1. Academy Role in Public Policies in Health Care Paula Lantz University of Michigan

2. Academic Approach to Policy • Policy Typologies and Frameworks • Research or Evidence Base for Policy

3. 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

4. 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.

5. 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 failures • Sociological 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

6. Policy Typology FORMAL POLICY • Laws, regulations, court rulings, administrative rules, Ministry resource allocation decisions, budget rules • Consequences for not following violating • Tend to have impact on large numbers • Examples: • 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

7. 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 Medicines • Cancer screening guidelines • Hospital policy to screen for domestic violence

8. Policy Typology (O’Hare) Non-intervention Do nothing/status quo Moral suasion Provide information [Inform] Exhort [Implore] Incentive Subsidize Tax Procure Grant/Contract [Buy] Produce [Make] Law & Regulation Require [Oblige, Prohibit]

9. 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.

10. Policy Target Groups Convergence of political power and social constructions creates 4 target populations, with different benefits and burdens from policy: Advantaged: Positively constructed and politically powerful Contenders: Negatively constructed yet politically powerful Dependents: Positively constructed yet no political power Deviants: Negatively constructed and no political power

11. Policy Target Groups

12. 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? Policy Action

13. Assessment of Population Health Policy Evaluation Assessment of Potential Interventions Policy Implementation Policy Choices The Policy Cycle

14. Issue Definition Setting Objectives Priority Setting Defining Options Options Appraisal Implementation Evaluation Stages in the Policymaking Process

15. Agenda Setting Government decides that action is (or is not) required on a particular issue Issue Filtration Government decides the means by which options for action will be generated Issue Definition The problems, options and opportunities that the government needs to consider are clarified Forecasting Probable consequences should a given policy be adopted are considered Stages of Government Policy Process

16. Options analysis Government reviews various options that will achieve the desired goal, and selects most appropriate Objective setting Government sets objectives to measure the effectiveness of the policy chosen Monitoring Consequences of the chosen policy are monitored against objectives; unintended consequences monitored Maintenance/Succession/Termination Government decides to maintain policy (M), succeed it with something new (S), or terminate policy (T) Stages of Government Policy Process

17. 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 Role of Advocacy

18. 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 Evidenced-Based Public Health

19. Many other things besides scientific information influence the policy process. WHY? Public health policy is not always based on science

20. Pyramid for Evidence Reaching Policy Makers (WHO, 2006)

21. Pyramid for Policy Makers Influencing Research (WHO, 2006)

22. 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

23. 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

24. 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 concerns Personal stories/anecdotes Legal concerns Ideology/bias/prejudice Ethics/norms Political concerns/pressures Others Barriers to Strong Link Between Science and Policy

25. 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

26. 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 Importance of Integrity in Use of Data and Research Evidence

27. 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. Final Thought