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Policy & Nutrition. Example: Obesity Conceptual Frameworks: Kingdon Policy Model IOM Obesity Prevention Organizing Framework. What is Policy?. Policy – Webster’s. Wise, expedient, or prudent conduct or management

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Policy nutrition

Policy & Nutrition

Example: Obesity

Conceptual Frameworks:

Kingdon Policy Model

IOM Obesity Prevention Organizing Framework



Policy webster s
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.


Policy making webster s
Policy Making – Webster’s

  • The act or process of setting and directing the course of action to be pursued by a government, business, etc.


Examples of policies
Examples of Policies

From Thunderhead Alliance: Complete Streets Report



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


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


Kingdon jw agendas alternatives and public policies 2002
Kingdon JW. Agendas, Alternatives, and Public Policies. 2002

Participants

The Streams

Agenda Setting

Alternative Specification

Coupling the Streams/ Windows



National policy participants

President 2002

Members of congress

Civil servants

Lobbyists

Journalists

Academics

Others

National Policy Participants

Basics


Kinds of participants
Kinds of Participants 2002

  • 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


Policy entrepreneurs
Policy Entrepreneurs 2002

  • 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…..



Problems 2002

Policy Proposals

Politics


Problems 2002

Policy Proposals

Politics

Legislation or Change in Policy


3 streams of processes
3 streams of processes 2002

  • Problem recognition

  • Policies: proposal formation

  • Politics

Basics


Problems
Problems 2002

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


Problem recognition is key
Problem Recognition is Key 2002

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



Decisions about problem recognition
Decisions about Problem Recognition: 2002

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


Y O U R  T I M E / H E A L T H 2002The Year of ObesityOur perennial interest in losing weight became a national obsession in 2004By MICHAEL D. LEMONICK


Politics
Politics 2002

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


Political decisions
Political Decisions 2002

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



Agenda setting1
Agenda Setting 2002

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

Basics


Obesity 'a threat' to U.S. security 2002Surgeon general urges cultural shift

Kim Severson, Chronicle Staff Writer

Tuesday, January 7, 2003


Alternative specification
Alternative Specification 2002

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

Basics


Alternative specification1
Alternative Specification 2002

  • 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


Generation of policy alternatives
Generation of Policy Alternatives 2002

  • 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


2001 2002

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


  • 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.


  • 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.


Preventing childhood obesity health in the balance
Preventing Childhood Obesity: Health in the Balance breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

IOM, 2005


Federal government
Federal Government breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


State and local governments
State and Local Governments breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


State and local education authorities and schools
State and Local Education Authorities and Schools breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Softening up
“Softening-up” breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


National alliance for nutrition and activity
National Alliance for Nutrition and Activity breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

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.


Nana priorities
NANA Priorities breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Model local school wellness policies

  • Strengthen national school lunch and other child nutrition programs

  • Strengthen national and state nutrition, physical activity and obesity programs


POLICY OPTIONS to promote nutrition and activity breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

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)


Lives of the streams
Lives of the “Streams” breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Coupling the streams
Coupling the Streams breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Problems breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

Policy Proposals

Politics


Problems breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

Policy Proposals

Politics

Legislation or Change in Policy


Window
Window breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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.


Entrepreneurs take advantage of open windows
Entrepreneurs Take Advantage of Open Windows breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Organizing framework for public health interventions iom preventing childhood obesity 2005
Organizing Framework for Public Health Interventions breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.(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


Information environment opportunities
Information Environment Opportunities breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Health ed campaigns and other persuasive communication

  • Require product labeling

  • Restrict harmful or misleading advertising


Access and opportunity
Access and Opportunity breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Community environment

    • Restrict access like we have for tobacco?

  • School environment


Economic factors
Economic Factors breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Government has power to tax and spend

    • Taxes on calorie dense, low nutritional quality foods?

    • Incentives or subsidies for fruits and vegetables?


Legal and regulatory environment
Legal and Regulatory Environment breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Pubic health law is one of 8 emerging themes identified by IOM as important to the future of pubic health training. Three components:

    • Laws

    • Regulation

    • Litigation


State nutrition and physical activity legislative database http apps nccd cdc gov dnpaleg
State Nutrition and Physical Activity Legislative Database breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older. http://apps.nccd.cdc.gov/DNPALeg/


State nutrition and physical activity legislative database http apps nccd cdc gov dnpaleg1
State Nutrition and Physical Activity Legislative Database breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older. http://apps.nccd.cdc.gov/DNPALeg/


State nutrition legislation enacted 2001 2006
State Nutrition Legislation Enacted 2001-2006 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.


Sb5436 2004
SB5436 - 2004 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Sb6601 2004
SB6601 - 2004 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Hb1254 2005
HB1254 - 2005 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Hb 1413 and sb 5396 2005
HB 1413 and SB 5396- 2005 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Relates to expanding the criteria for habitat conservation programs, sets forth funding and guides the 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


Sb 5186 2005
SB 5186 - 2005 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Sb 6003 2005
SB 6003 - 2005 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Sb6091 2005
SB6091- 2005 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • Relating to funding and appropriations for transportation. Sponsor: Haugen


Sb6197 2006
SB6197 - 2006 breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


Regulation
Regulation breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • “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


Regulatory options
Regulatory Options breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • FDA has authority to enforce laws about labeling and false claims, not to deal with nutritional adequacy.

IOM, Preventing Childhood Obesity, 2005


Litigation
Litigation breast-feeding. Studies indicate breast-fed infants may be less likely to become overweight as they grow older.

  • 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


The social environment policy and norms for health promotion
The Social Environment: Policy and Norms for Health Promotion

  • Norms are:

    • standards or models

    • Voluntary or expected way of behaving

  • Norms drive policy

  • Policy can also drive norms


Steps that previous efforts have taken before norms on the role of Government changed(Kersh and Marone, 2002)

  • Social disapproval

  • Medical science

  • Self-help

  • Demonize the user

  • Demonize an industry

  • Mass movement

  • Interest group action


Evaluation of policy change
Evaluation of Policy Change role of Government changed

  • 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?


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