Annual Meeting of the CARMEN Observatory on Chronic NonCommunicable Disease Policy: Mobilizing for A

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Annual Meeting of the CARMEN Observatory on
Chronic Non-Communicable Disease Policy
Mobilizing for Action May 12-13, 2008Hilton
Montreal Bonaventure Hotel
MAKING THE CASE The Power of Policy Arguments
Cristina Puentes-Markides Public Policy,
Regulation and Health Financing Area of
Strengthening Health Systems and Services PAHO/WHO
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Policy Decisions .

• Policy requires decisions
• Decisions require at least
• Facts and anticipated consequences
• About values, what matters, priorities and
  preferences.
• A process to integrate facts and values in
  analysis and constructive deliberation. (NRC,
  1996)
• Yet,
• Policy problems are wicked / ill-defined
• Scientific evidence/data are insufficient to
  generate action.
• Beliefs, ideology, interests often drive public
  policymaking.
• Often too much data, too little wisdom.

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Argumentation in Public Policy

• For individual positions
• In public deliberation
• In practical politics.
• Can be useful at various stages of the policy
  process
• When positions are being taken or developed
• When positions are declared and agendas set
• When a decision is being made.

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Argumentation in Public Policy

• Not equivalent to a quarrel
• Not equivalent to proof
• Prominent role of communication, deliberation and
  dialogue
• Policy argument
• Not to prove or disprove
• Not only to argue for or against
• To support a claim of what needs to be done
• An effective policy argument must assume, assert
  the facts, definition, interpretations,
  assumptions, value, consequences

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Knowledge Approaches Needed in Policymaking

• Episteme what is objectively true
• Universals, objective, repeatable rules,
  codified, corresponds to modern scientific ideal,
  achieved with the aid of analytical rationality.
  
• Techne what works in place.
• Concrete, pragmatic, variable and context
  dependent, arts/craft, capability, tacit
  knowledge.
• Phronesis where are we going? is it
  desirable? what must be done? what should we do
  
• Pragmatic, variable, context dependent, requires
  consideration, judgment, choice, experience,
  emotional intelligence.
• Metis savvy, cunning, street smart. Great
  politicians and leaders have it.

Tim Tenbensel . The role of evidence in policy
how the mix matters. School of Population Health
University of Auckland Panel Track 4) Evidence
Based Policy
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Perceptions and Framing
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Perceptions about chronic diseases
Gerard F. Anderson. Physician, Public, and
Policymaker Perspectives on Chronic Conditions.
Arch Intern Med. 2003163(4)437-442.
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Obesity Example
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Framing How to analyze who is blamed and
burdened in public debate
Individualizing Frames
Systemic Frames
Causes limited to particular individuals Limits
governmental responsibility for addressing it.
Responsibility falls on government., business,
larger forces. Invite governmental action
Public Discourse
Involuntary, universal, environmental, knowingly
created risk
Biological Behavioral factors
Burden to powerful groups
Interpreted from Lawrence, Regina G. Framing
Obesity The Evolution of News Discourse on a
Public Health Issue. The International Journal of
Press/Politics 2004 9 56
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Agenda and Agenda-Setting
Agenda The list of subjects or problems to which
government officials, and people outside of
government closely associated with those
officials, are paying some serious attention at
any given time the agenda setting process
narrows a set of conceivable subjects to the
set that actually becomes the focus of
attention. Kingdons 19843

• Political, conflictive, competitive among issue
  proponents
• Contingent on ability to influence, power and
  position of groups, preferences of
  decision-makers.
• Almost unlimited number of issues, some dont
  make it.

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POLICY STREAM Alternatives, solutions, policy
communities, feasibilities. Hidden cluster of
participants dominate.
POLITICAL STREAM National mood, public opinion,
electoral politics, consensus building, Visible
cluster of participants dominate.

• PROBLEM STREAM
• Indicators, events, definitions, values,
  collective action. Policy entrepreneurs aware of
  the problem.

Streams are coupled
Kingdons Agenda Setting Model
Window of Opportunity (predictable, unpredictable)
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Policy Entrepreneur

• Analogy of a surfer, waiting on the board to
  catch the wave

They bring several key resources into the fray
their claims to a hearing, their political
connection and negotiating skills, and their
sheer persistence. Items chances of moving up on
an agenda are enhanced considerably by the
presence of a skilful entrepreneur. (Kingdon,
1995)
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Policy entrepreneurs
Storytellers
Networkers
Practitioners, bureaucrats and policy-makers
often articulate and make sense of complex
realities through simple stories. Sometimes
misleading, yet their narratives are very
powerful.
Policy-making usually takes place within
communities of people who know each other and
interact. If you want to influence policymakers,
you need to join their networks.
Engineers
Fixers
Often, a huge gap between what politicians and
policy-makers say they are doing and what
actually happens. Researchers/ analysts need to
work not just with the senior level
policy-makers, but also with the 'street-level
bureaucrats'.
Policy making is essentially a political process.
You dont need to be a Machiavelli, but
successful policy entrepreneurs need to know how
to operate in a political environment - when to
make your pitch, to whom and how.
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A successful argument depends partly on

• Recognizing how the policy/political climate
  shapes effectiveness.
• Recognizing frames, perceptions.
• Awareness of complexity and potential tensions
• Recognizing and taking advantage of policy
  windows.
• A policy entrepreneur, someone willing to invest
  time and energy for policy change
• Ability to integrate different types of knowledge
  (episteme, logos, techne) for policy relevance.
• Power, position
• Reputation, prestige, political clout,
  credibility (ethos), ability to appeal to the
  emotions of the audience (pathos) and ability to
  present good reasons/logic (logos).

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• Currently, are chronic diseases (as a package or
  specific diseases/conditions) issues in the
  policy agenda of your government?
• Can you identify the policy frames used?
• What was the policy window (the coupling of the
  problem, the solutions, the political climate)
  that made it possible?
• If they are not in the policy agenda, in your
  view what can you do as a policy entrepreneur to
  help it happen?