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Policy Making Webster's ... Alternatives are generated and narrowed in the policy stream and by: ... Policy proposals are developed according to their own ... – PowerPoint PPT presentation

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Title: Policy%20

Policy Nutrition
  • Example Obesity
  • Conceptual Frameworks
  • Kingdon Policy Model
  • IOM Obesity Prevention Organizing Framework

What is Policy?
Policy Websters
  • Wise, expedient, or prudent conduct or management
  • A principle, plan, or course of action, as
    pursued by a government, organization,
    individual, etc.

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

Examples of Policies
State County MPO/RDC City
Tax Ordinance
Internal Policy
Design Manual
From Thunderhead Alliance Complete Streets Report
Why do we need policy?
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,
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
Community Wide Campaigns School based intervention Mass media strategies Laws and regulations Reducing costs to patients
Vaccination X X X X
Motor vehicle safety X X X X
Safer work places X X
Control of infectious disease X X X X
Decline in deaths from CHD and stroke X X X
Community Wide Campaigns School based intervention Mass media strategies Laws and regulations Reducing costs to patients
Safer and healthier foods X X X X X
Healthier mothers and babies X X X X
Family Planning X X X
Water Fluoridation X
Recognition of tobacco as a health hazard X X X
Kingdon JW. Agendas, Alternatives, and Public
Policies. 2002
Participants The Streams Agenda
Setting Alternative Specification Coupling the
Streams/ Windows
National Policy Participants
  • President
  • Members of congress
  • Civil servants
  • Lobbyists
  • Journalists
  • Academics
  • Others

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
  • Willing to invest resources in return for future
  • 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

The streams
Policy Proposals
Policy Proposals
Legislation or Change in Policy
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
  • Feedback about existing programs evaluation,
    complaints, etc.

Agenda Setting
Problem Recognition is Key
  • Policy entrepreneurs invest resources
  • Bringing their conception of problems to
    officials attention
  • Convincing officials to see the problem the way
    they want it to be seen

Agenda Setting
Google Hits for Obesity
1/29/05 2/20/07
Obesity 8,650,000 31,100,000
Obesity and New York Times 214,000 932,000
Obesity and Wall Street Journal 49,300 386,000
Obesity and Seattle Times 13,100 91,700
Obesity and CBS 97,100 863,000
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 H The Year of
Obesity Our perennial interest in losing weight
became a national obsession in 2004 By MICHAEL D.
  • Developments in the political arena are powerful
    agenda setters.
  • National mood
  • New administrations
  • New partisan/ideological distributions in
  • Interest groups that press (or fail to press)
    demands on government

Agenda Setting
Political Decisions
  • Consensus is built by bargaining
  • Trading provisions for support
  • Adding elected officials to coalitions by giving
  • Compromising from ideal positions to those that
    will gain wider acceptance
  • National mood and elected officials more
    important than interest groups for political

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

Obesity 'a threat' to U.S. security Surgeon
general urges cultural shift Kim Severson,
Chronicle Staff Writer Tuesday, January 7, 2003
Alternative Specification
  • Narrows the large set of possible alternatives to
    that set from which choices are actually made.

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

Alternative Specification
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)

Alternative Specification
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
  • 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
  • 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

Preventing Childhood Obesity Health in the
IOM, 2005
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
  • 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
  • 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

  • Policy Entrepreneurs push for consideration in
    many ways and in many forums.
  • Most proposed alternatives have long gestational
  • Recombination (coupling of already familiar
    elements) is more effective than mutation (wholly
    new forms).

Alternative Specification
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 is made up of more than 300 organizations.
NANA Priorities
  • 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)
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

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

Policy Proposals
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
  • 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,
  • 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
  • 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
  • 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/
2001 2002 2003
Nutrition bills introduced 88 58 174
Nutrition bills enacted 32 15 35
Physical Activity Bills introduced 167 148 240
Physical activity bills enacted 28 33 55
State Nutrition and Physical Activity Legislative
Database http//apps.nccd.cdc.gov/DNPALeg/
2004 2004 2005 2005 2006 2006
All States WA State All states WA All States WA
Nutrition bills introduced 172 8 280 4 220 1
Nutrition bills enacted 28 2 55 0 38 1
Physical Activity Bills introduced 214 8 340 6 273 6
Physical activity bills enacted 50 1 72 6 47 2
State Nutrition Legislation Enacted 2001-2006
Category Bills
Assistance Programs 12
Cafeteria Meals/Food Service (schools) 49
Nutrition Education 46
Farmers Market 9
Liability 22
Access to Obesity Treatment Services 13
Grocery Store/Food Market 0
Labeling (Ephedrine) 1
Restaurant (all about liability) 5
Worksite (tax credits for certain benefits) 1
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 Haugen

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

  • 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

IOM, Preventing Childhood Obesity, 2005
  • Powerful tool for tobacco, gun violence, lead
  • 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

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
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