Policy & Nutrition

1. Policy & Nutrition Example: Obesity Conceptual Frameworks: Kingdon Policy Model IOM Obesity Prevention Organizing Framework

2. What is Policy?

3. Policy – Webster’s • Wise, expedient, or prudent conduct or management • A principle, plan, or course of action, as pursued by a government, organization, individual, etc.

4. Policy Making – Webster’s • The act or process of setting and directing the course of action to be pursued by a government, business, etc.

5. Examples of Policies From Thunderhead Alliance: Complete Streets Report

6. Why do we need policy?

7. Levels of Influence in the Social-Ecological Model Structures, Policies, Systems Local, state, federal policies and laws to regulate/support healthy actions Institutions Rules, regulations, policies & informal structures Community Social Networks, Norms, Standards Interpersonal Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs

8. Intervention Categories with Strong Evidence of Effectiveness for the 10 greatest Achievements in Pubic Health: From IOM report: Preventing Childhood Obesity, 2005…

11. Kingdon JW. Agendas, Alternatives, and Public Policies. 2002 Participants The Streams Agenda Setting Alternative Specification Coupling the Streams/ Windows

12. Participants

13. President Members of congress Civil servants Lobbyists Journalists Academics Others National Policy Participants Basics

14. Kinds of Participants • Visible: those who receive press and public attention – high level electeds and their appointees, the media, political parties, etc. • Affects the agenda • Hidden: academic specialists, career bureaucrats, congressional staffers • Affects the choice of alternative solutions Basics

15. Policy Entrepreneurs • Willing to invest resources in return for future policies • Can be elected officials, career civil servants, lobbyists, academics, journalists • Entrepreneurs: • Highlight problem indicators to dramatize problem • Push for one kind of problem definition or another – invite electeds to see for themselves • “Soften up” by writing papers, giving testimony, holding hearings, getting press coverage, meeting endlessly…..

16. The “streams”

17. Problems Policy Proposals Politics

18. Problems Policy Proposals Politics Legislation or Change in Policy

19. 3 streams of processes • Problem recognition • Policies: proposal formation • Politics Basics

20. Problems Why do some problems get attention? • Indicators – large magnitude or change • Focusing event – disaster, crisis, personal experience • Feedback about existing programs – evaluation, complaints, etc. Agenda Setting

21. Problem Recognition is Key Policy entrepreneurs invest resources: • Bringing their conception of problems to official’s attention • Convincing officials to see the problem the way they want it to be seen Agenda Setting

22. Google Hits for Obesity –

23. Decisions about Problem Recognition: Made through persuasion • Use indicators to argue that conditions should be defined as problems • Argue that proposals meet tests of feasibility or value acceptability Agenda Setting

24. Y O U R  T I M E / H E A L T HThe Year of ObesityOur perennial interest in losing weight became a national obsession in 2004By MICHAEL D. LEMONICK

25. Politics Developments in the political arena are powerful agenda setters. • National mood • New administrations • New partisan/ideological distributions in congress • Interest groups that press (or fail to press) demands on government Agenda Setting

26. Political Decisions Consensus is built by bargaining • Trading provisions for support • Adding elected officials to coalitions by giving concessions • Compromising from ideal positions to those that will gain wider acceptance National mood and elected officials more important than interest groups for political decisions Agenda Setting

27. Agenda Setting

28. Agenda Setting • Agenda = list of subjects to which officials are paying some serious attention at any given time Basics

29. Obesity 'a threat' to U.S. security Surgeon general urges cultural shift Kim Severson, Chronicle Staff Writer Tuesday, January 7, 2003

30. Alternative Specification • Narrows the large set of possible alternatives to that set from which choices are actually made. Basics

31. Alternative Specification • Alternatives are generated and narrowed in the policy stream and by: • Hidden participants: Loosely knit communities of academics, researchers, consultants, career bureaucrats, congressional staffers, analysts who work for interest groups who: • Float ideas, criticize each other works, hone ideas, recombine ideas Alternative Specification

32. Generation of Policy Alternatives • Generation of policy alternatives analogous to natural selection • Order developed from chaos • Criteria include: • Technical feasibility • Congruence with values • Anticipation of future constraints (budget, public acceptability, politicians’ receptivity) Alternative Specification

33. 2001 The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity

34. Ensure daily, quality physical education for all school grades. Currently, only one state in the country -- Illinois -- requires physical education for grades K-12, while only about one in four teenagers nationwide take part in some form of physical education. • Ensure that more food options that are low in fat and calories, as well as fruits, vegetables, whole grains, and low-fat or non-fat dairy products, are available on school campuses and at school events. A modest step toward achieving this would be to enforce existing U.S. Department of Agriculture regulations that prohibit serving foods of minimal nutritional value during mealtimes in school food service areas, including in vending machines. • Make community facilities available for physical activity for all people, including on the weekends.  • Create more opportunities for physical activity at work sites. • Reduce time spent watching television and in other sedentary behaviors. In 1999, 43 percent of high-school students reported watching two hours of TV or more a day.

35. Educate all expectant parents about the benefits of breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older. • Change the perception of obesity so that health becomes the chief concern, not personal appearance. • Increase research on the behavioral and biological causes of overweight and obesity. Direct research toward prevention and treatment, and toward ethnic/racial health disparities. • Educate health care providers and health profession students on the prevention and treatment of overweight and obesity across the lifespan.

36. Preventing Childhood Obesity: Health in the Balance IOM, 2005

37. Federal Government • Establish an interdepartmental task force and coordinate federal actions • Develop nutrition standards for foods and beverages sold in schools • Fund state-based nutrition and physical-activity grants with strong evaluation components • Develop guidelines regarding advertising and marketing to children and youth by convening a national conference • Expand funding for prevention intervention research, experimental behavioral research, and community-based population research; strengthen support for surveillance, monitoring, and evaluation efforts

38. State and Local Governments • Expand and promote opportunities for physical activity in the community through changes to ordinances, capital improvement programs, and other planning practices • Work with communities to support partnerships and networks that expandthe availability of and access to healthful foods

39. State and Local Education Authorities and Schools • Improve the nutritional quality of foods and beverages served and sold in schools and as part of school-related activities • Increase opportunities for frequent, more intensive, and engaging physical activity during and after school • Implement school-based interventions to reduce children's screen time • Develop, implement, and evaluate innovative pilot programs for both staffing and teaching about wellness, healthful eating, and physical activity

40. “Softening-up” • Policy Entrepreneurs push for consideration in many ways and in many forums. • Most proposed alternatives have long gestational period • Recombination (coupling of already familiar elements) is more effective than mutation (wholly new forms). Alternative Specification

41. National Alliance for Nutrition and Activity NANA promotes within the legislative and executive branches of government a better understanding of the importance of healthy eating, physical activity, and obesity control to the nation's health and health-care costs. One of the primary goals of NANA is to cultivate champions for nutrition, physical activity, and obesity prevention in Congress and federal agencies. Efforts include supporting effective education programs, advocating adequate funding for programs, and promoting environmental changes that help Americans eat better and be more active. http://cspinet.org/nutritionpolicy/nana.html NANA is made up of more than 300 organizations.

42. NANA Priorities • Model local school wellness policies • Strengthen national school lunch and other child nutrition programs • Strengthen national and state nutrition, physical activity and obesity programs

43. POLICY OPTIONS to promote nutrition and activity Nutrition Labeling on Menus/Menu Boards at Chain Restaurants Decrease Marketing of Low-Nutrition Foods to Children Improve School Foods Increase Physical Activity in Schools Support Physical Activity through Transportation Policy Promote Fruit and Vegetable Intake Increase Resources for Nutrition and Physical Activity Programs (including Soft Drink Taxes)

44. Lives of the “Streams” • The three streams have lives of their own. • Problems are recognized and defined • Policy proposals are developed according to their own incentives and selection criteria and are often waiting for a problem or political event they can be attached to • Political events flow along on their own schedule

45. Coupling the Streams • The probability of rising on the agenda is increased if all 3 streams are joined • Partial couplings between 2 streams are less likely to result in policy changes

46. Problems Policy Proposals Politics

47. Problems Policy Proposals Politics Legislation or Change in Policy

48. Window • Window of opportunity open when policy advocates can push their solutions • Advocates can wait for problems to “float” by that they can attach their solutions to or wait for the political stream to be advantageous. • Windows do not stay open long.

49. Entrepreneurs Take Advantage of Open Windows • Can make the critical couplings when policy windows open. • Bring resources to the fray • Bring claims to a hearing • Political connections and negotiating skills add to ability to move policy forward • Sheer persistence is essential

50. Organizing Framework for Public Health Interventions(IOM, Preventing Childhood Obesity, 2005) • The information environment • Access and opportunity • Economic factors • The legal and regulatory environment • Prevention and treatment programs • The social environment