Policy & Nutrition Example: Obesity
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 • The act or process of setting and directing the course of action to be pursued by a government, business, etc.
Examples of Policies From Thunderhead Alliance: Complete Streets Report
Intervention Categories with Strong Evidence of Effectiveness for the 10 greatest Achievements in Pubic Health: From IOM report: Preventing Childhood Obesity, 2005…
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?
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
Framework from 2003 meeting: • Robert Wood Johnson Foundation • Kaiser Permanente • Centers for Disease Control and Prevention • American Association of Health Plans • Washington Business Group on Health • 47 public and private sector professionals.
What does it take to make changes that lead to better health for the population?
A persuasive science base documenting a socially and scientifically credible threat to the public health with important economic implications. A supportive partnership with the media Strategic leadership and a prominent champion A diverse constituency of highly effective advocates Enabling and reinforcing laws, regulations and policies Core Factors Associated with Health Related Change Efforts (IOM, Preventing Childhood Obesity, 2005)
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
Information Environment Opportunities • Health ed campaigns and other persuasive communication • Require product labeling • Restrict harmful or misleading advertising
Access and Opportunity • Community environment • Restrict access like we have for tobacco? • School environment
Economic Factors • 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 • 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/
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
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
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
HB 1413 and SB 5396- 2005 • 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 • 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 • 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 • Relating to funding and appropriations for transportation. Sponsor
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
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
Regulatory Options • FDA has authority to enforce laws about labeling and false claims, not to deal with nutritional adequacy. IOM, Preventing Childhood Obesity, 2005
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
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
How is policy really made? Basics of Kingdon’s model Agenda Setting Alternative Specification Coupling and Windows Policy Entrepreneurs Kingdon JW. Agendas, Alternatives, and Public Policies. 2002
Agenda Setting • Agenda = list of subjects to which officials are paying some serious attention at any given time Basics
Alternative Specification • Narrows the large set of possible alternatives to that set from which choices are actually made. Basics
3 streams of processes • Problem recognition • Policies: proposal formation • Politics Basics
President Members of congress Civil servants Lobbyists Journalists Academics Others Policy Participants Basics
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
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
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
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
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