Developing Policy for Public Health Nutrition

1. Developing Policy for Public Health Nutrition

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. Policy = The Rules

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

7. Why do we need policy?

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

11. How is policy developed?

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

13. Participants

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

15. 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

16. 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…..

17. Food and Nutrition Policy Entrepreneurs Consumer Interest groups & Other NGOs Government – at all levels Health Professional Associations Food & Nutrition Policy Farmers/Commodity groups Scientific Bodies & Researchers Food Industry

18. The “streams”

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

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.

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

22. Framing the Problemhttp://www.frameworksinstitute.org/ • Problems with the Dominant Communications Approach to Childhood Obesity: • It focuses on the individual as the cause of the problem. • Parents are the only responsible actors in the frame. • The problem is overwhelming. • Behavior change by parents and children is the solution to the problem.

23. Examples of Causal Sequences that Include Environments & Policies • "Today's kids are generally getting less exercise as schools decrease the amount of phys ed and recess time offered each week, increasing their risk of becoming sedentary adults.” • "When parents don't have access to healthy food because they live in a neighborhood where access to fresh produce and other healthy foods is limited, this makes it almost impossible to offer healthy diets at home. Initiatives such as community gardens can help make healthy food available to everyone." • "The constant barrage of junk food ads directed at children shapes their food preferences, leading to an increase in consumption of unhealthy snacks, especially while watching television.”

24. Policy Proposals: Alternative Specification • Narrows the large set of possible alternatives to that set from which choices are actually made.

25. 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

26. 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)

27. 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

28. 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

29. “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).

30. 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

31. Problem Recognition Policy Proposals Politics

32. Problem Recognition Politics Policy Proposals Legislation or Change in Policy

33.     C B A C Problem Stream No policy adoption Policy Stream 3 B 1 2 Politics Stream     Scenario 1: No Coupling of Streams or Window Closed > Policy Proposal Not Adopted 2 Problem Stream Policy Adoption Policy Stream 2 Politics Stream  Scenario 2: Coupling of Streams and Window of Opportunity Open > Policy Proposal Adopted Figure 2: Kingdon’s Multiple Streams Model

34. 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.

35. 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

36. Local Policies Related to Restaurant Menu Labeling: Barriers, Facilitating Factors, and the Role of Local Health Departments Donna B. Johnson, RD, PhD, University of Washington Elizabeth C. Payne, MPH, RD, University of Washington Kirsten Frandsen, BS, Tacoma-Pierce County Health Department Deborah Allen, PhD, Thurston County Public Health & Social Services Donna Oberg, MPH, RD, CD, Public Health-Seattle & King County Molly McNees, PhD, Public Health-Seattle & King County

37. Policy Development is a Function of Public Health • Institute of Medicine • 1988: The Future of Public Health • 2011: For the Public’s Health - Revitalizing Law and Policy to Meet New Challenges

38. Nutrition & Obesity Policy Research & Evaluation Network NOPREN is funded by the Centers for Disease Control and Prevention under cooperative agreement number 1-U48-DP-001946.  The findings and conclusions are those of the authors and do not necessarily represent that official position of the Centers for Disease Control and Prevention.

39. Three County Public Health Departments Work to Improve Restaurant Food

40. Approaches

41. Design & Methods Multiple-case, replication design Data: documents and key informant interviews • Interviews: public health practitioners (11), board of health members (9) , restaurant owners and restaurant association representative (10) • Interview questions: explore themes related to policy process and change as described by the Advocacy Coalition Framework

42. Advocacy Coalition Framework Policy Subsystem Relatively Stable Parameters System-wide with enduring/constraining effect Coalition APolicy beliefsResourcesStrategy Coalition BPolicy beliefsResourcesStrategy Constraints & Resources Decisions by Governmental Authorities External Events - Change in socioeconomic conditions, public opinion, leaders- Policy decisions/impacts from other subsystems Policy Outputs & Impacts Adapted from: Breton E, Richard L, Gagnon F, Jacques M, Bergeron P. Health promotion research and practice require sound policy analysis models: The case of Quebec’s Tobacco Act. Social Science & Medicine 2008; 67:1679-1689.

43. Common Agreement on Parameters • Obesity rates are a concern • Meals away from home are important determinants of food intake • Restaurants need to be profitable

44. External Events All: External funding for Policy, Systems & Environmental change; economic recession

45. Policy Sub-System Actors BOH – Board of Health HEAL- Healthy Eating Active Living HD – Health DepartmentWRA – Washington Restaurant Association

46. Boards of Health

47. Policy Beliefs

48. Policy Beliefs

49. Policy Oriented Learning • Ability of actors to learn how to find common ground to work together over time • Strong demonstration in King County – • End result: ability to come together to modify regulations to be in line with what federal regulations were expected to be after passage of ACA

50. Implications for Practice • Policy Development models can be helpful. • Core policy beliefs can be barriers or facilitators of the policy process. • Lessons learned can be applied to future nutrition policy development.