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. Examples of Policies From Thunderhead Alliance: Complete Streets Report

6. Why do we need policy?

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

10. How is policy developed?

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

17. The “streams”

18. 3 streams of processes • Problem recognition • Policies: proposal formation • Politics

19. 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.

20. 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

21. 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.

22. 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.”

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

24. 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

25. 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)

26. 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

27. 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

28. “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).

29. 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

30. Problem Recognition Policy Proposals Politics

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

32.     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

33. 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.

34. 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

35. State Nutrition and Physical Activity Legislative Database http://apps.nccd.cdc.gov/DNPALeg/

36. State Nutrition and Physical Activity Legislative Database http://apps.nccd.cdc.gov/DNPALeg/

37. Regulation • “If the tobacco experience is any guide, it is likely that the food companies will act just enough t o avoid government regulation…..to date companies have been much more comfortable with educational campaigns emphasizing personal responsibility and the need for increased physical activity, than proposing major policy or structural change.” IOM, Preventing Childhood Obesity, 2005

38. Regulatory Options • FDA has authority to enforce laws about labeling and false claims, not to deal with nutritional adequacy. IOM, Preventing Childhood Obesity, 2005

39. Litigation • Powerful tool for tobacco, gun violence, lead paint • Initial attempts at fast food litigation have been “less than successful” • Future is unclear • Several states have passed legislation aimed at prohibiting lawsuits against food and beverage manufactures for obesity-related health problems. • Documents obtained through discovery could damage the public's perception of food companies. IOM, Preventing Childhood Obesity, 2005

40. Evaluation of Policy Change • Policy development should include plans for policy evaluation • Process evaluation: Was the policy actually carried out? • Outcome: Did the policy change have the intended outcome?

41. State Nutrition Legislation Enacted 2001-2008

42. SB5436 - 2004 • Requires state school directors convene advisory committee to develop model policy on: access nutritious foods and development, appropriate exercise. Policy to address nutritional content of foods and beverages and the availability and quality of health, nutrition, and physical education curricula. SPONSOR: Kohl-Welles

43. SB6601 - 2004 • No distributor, manufacturer or seller of food and non-alcoholic beverages will be held liable for claims resulting from weight gain, obesity or related health conditions due to long-term consumption of a product. SPONSOR: Brandland, Companion Bill: HB2994

44. HB1254 - 2005 • In regards to a specialized "Share the Road" license plate. Proceeds beyond costs of implementation will be used towards contracting with a qualified nonprofit organization to promote bicycle safety and awareness education in communities throughout Washington. The organization must promote bicycle safety and awareness education in communities throughout Washington. The Washington state traffic safety commission shall establish a program for improving bicycle and pedestrian safety, and shall cooperate with the stakeholders and independent representatives to form an advisory committee to develop programs and create public private partnerships which promote bicycle and pedestrian safety. Sponsor: Wood

45. HB 1413 and SB 5396- 2005 • Relates to expanding the criteria for habitat conservation programs, sets forth funding and guides the interagency committee for outdoor recreation. Defines trail as a means public ways constructed for and open to pedestrians, equestrians, or bicyclists, or any combination thereof, other than a sidewalk constructed as a part of a city street or county road for exclusive use of pedestrians. Not less than twenty percent of appropriations for habitat programs must be used for the renovation, or development of trails. Sponsor: Dunshee Companion bill: SB5396

46. SB 5186 - 2005 • Provides for county and city plans, wherever possible, to include urban planning approaches that promote physical activity. Transportation planning in cities, towns, and counties should incorporate policy and infrastructure changes that promote non-motorized transit. State agencies applying for loans or grants must have incorporated elements in their plans that increase access to walking and biking in their communities. Superintendent of Public Instruction to promote adoption of school-based curricula and policies that provide quality physical education for all students. Sponsor: Franklin

47. SB 6003 - 2005 • Relating to commute trip reduction tax credit. Offered to employers and property owners who are taxable and provide financial incentives to their own or other employees for ride sharing, for using public transportation, for using car sharing, or for using nonmotorized commuting before July 1, 2013, are allowed a credit against taxes payable. Sponsor: Jacobsen

48. SB6197 - 2006 • Creates the Governor's Interagency Council on Health Disparities to create an action plan and statewide policy to include health impact reviews that measure and address other social determinants of health that lead to disparities as well as teh contributing factors of health care that can have broad impacts on improving status, health literacy, physical activity, and nutrition. SPONSOR: Franklin

49. HB 1311 - 2007: Continuing the small farm direct marketing assistance program. • The small farm direct marketing assistance program is created. • The director shall employ a small farm direct marketing 8 assistant. (3) The small farm direct marketing assistance program shall assist duty the program shall: (a) Assist small farms in complying with federal, state, and local rules and regulations as they apply to direct marketing of agricultural products; (b) Assist in developing infrastructure to increase direct marketing opportunities for small farms; (c) Provide information on direct marketing opportunities for small farms; (d) Promote localized food production systems; (e) Increase access to information for farmers wishing to sell farm products directly to consumers; (f) Identify and help reduce market barriers facing small farms in direct marketing; (g) Assist in developing and submitting proposals to grant programs to assist small farm direct marketing efforts; and (h) Perform other functions that will assist small farms in directly marketing their products.

50. SB 5093 - 2007: Concerning access to health care services for children • Declares that it is the goal of Washington state to ensure that: (1) By 2010, all K-12 districts have school health advisory committees that advise school administration and school board members on policies, environmental changes, and programs needed to support healthy food choice and physical activity and childhood fitness; and (2) By 2010, only healthy food and beverages shall be available on school campuses.