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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


Rules, regulations, policies & informal structures


Social Networks, Norms, Standards


Family, peers, social networks, associations


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


The Streams

Agenda Setting

Alternative Specification

Coupling the Streams/ Windows

national policy participants

Members of congress

Civil servants





National Policy Participants


kinds of participants
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


policy entrepreneurs
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…..

Problem Recognition

Policy Proposals



Problem Recognition


Policy Proposals

Legislation or Change in Policy

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

Why do some problems get attention?

  • Indicators – large magnitude or change
  • Focusing event – disaster, crisis, personal experience
  • Feedback about existing programs – evaluation, complaints, etc.
problem recognition is key
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
decisions about problem recognition
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

framing the problem http www frameworksinstitute org
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.
examples of causal sequences that include environments policies
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.”
policy proposals alternative specification
Policy Proposals: Alternative Specification
  • Narrows the large set of possible alternatives to that set from which choices are actually made.
alternative specification
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
generation of policy alternatives
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)

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
political decisions
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



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.
federal government
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
state and local governments
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
state and local education authorities and schools
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
national alliance for nutrition and activity
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.


nana priorities
NANA Priorities
  • Farm Bill Reauthorization
  • 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

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)

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).

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
political decisions44
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

lives of the streams
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
coupling the streams
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

Problem Recognition

Policy Proposals



Problem Recognition


Policy Proposals

Legislation or Change in Policy

  • 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
  • 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(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
  • Health ed campaigns and other persuasive communication
  • Require product labeling
  • Restrict harmful or misleading advertising
access and opportunity
Access and Opportunity
  • Community environment
    • Restrict access like we have for tobacco?
  • School environment
economic factors
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
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
sb5436 2004
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
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
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
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
sb 5186 2005
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
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
sb6197 2006
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
hb 1311 2007 continuing the small farm direct marketing assistance program
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


(b) Assist in developing infrastructure to increase direct

marketing opportunities for small farms;

(c) Provide information on direct marketing opportunities for small


(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.

sb 5093 2007 concerning access to health care services for children
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.
  • “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
  • FDA has authority to enforce laws about labeling and false claims, not to deal with nutritional adequacy.

IOM, Preventing Childhood Obesity, 2005

  • 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
evaluation of policy change
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?

Working Model: Developing Community Policies for Nutrition and Physical Activity





Bring issues to agenda of policy makers

Short Term

Problems recognized; solutions considered


Policy adopted & implemented

Long Term

Policy modifies environment


Nutrition & PA Plan


Technical assistance & training

Awareness: presentations, reports, events, media

Generate policy proposals

Policy proposals included in planning documents

Policy adopted & implemented

Support adoption of policy


Policy Entrepreneurs

Policy makers

Ongoing reporting & communication

Monitor and evaluate outcomes