public health policy

public health policy

The Importance of Public Health Policy

1. Overview of Public Health Policy

The WHO has identified core functions of public health. These are (1) assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities, (2) formulation of public policies designed to solve identified local and national health problems and priorities, (3) to assure that all populations have access to appropriate and cost-effective care, including health promotion, and (4) to evaluate the effectiveness of this care and the analysis of health systems in order to continuously improve the health of the population. These core functions basically relate to the definition of public health policy given above and establish roots as to how to set about improving public health.

Public health policy can be defined as “decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society”. Its main aim is to improve the health status of society. Public health policy takes into consideration the health of the society as a whole, by looking at health issues that affect a wide range of the population as opposed to issues that affect a specific person or a small group. This is the main difference from healthcare policy, which concentrates on people receiving healthcare. The public health policy also aims to put strong emphasis on the prevention of diseases and health promotion. This is done by conducting research, compiling comprehensive health data, developing and implementing health programs, evaluating the results, and implementing regulatory health laws. Public health policy touches a wide range of complex issues, therefore it is quite often interdisciplinary, involving many other sectors and corresponding policy areas. The aim is to create a united and systematic health policy able to improve the health of the population.

Public health acts as a leading power to improve the overall health status of the national and international population. However, public health and public health policy are intertwined. Public health is a discipline. It is the organized and systematic effort of society to prevent health issues and treat diseases. It also aims to prolong and promote health throughout people’s lives. Public health has a set of standards by which it can be evaluated.

2. Key Components of Public Health Policy

2.2 Relatively clear beginnings and ends A policy should have a clear point of initiation so that it is easy to determine the pre-policy state and an end-point. With a defined start and end point, it is possible to measure changes in the population.

2.1 A defined goal and specific targets A policy is designed to achieve solutions to a defined problem within a specific time period. Clear goals will make it easier to determine what the policy intends to change and whether it was a success or a failure. Accordingly, there should be specific targets so that it is easy to measure the effect of the policy.

The policy process is integral to the effective maintenance, surveillance, and improvement of health in a community. There are several very important defining features of health policy. Understanding and being able to analyze a policy is a key skill in public health, for example policy analysis is a required competency in the CPH and informatics certificate. Being able to understand policies will contribute to effective policy practice which can improve the public’s health.

3. The Impact of Public Health Policy on Society

Downstream strategies, by contrast, involve the identification and treatment of those who have diseases or conditions and are targeted at specific diseases or conditions. It’s often implicitly assumed that these are the methods by which doctors help their patients and are inappropriate for public health professionals. I’ll revisit this assumption and argue that a concern with health maximization favors upstream strategies. Finally, I shall consider a tool used by economists in health-related disciplines, which is the QALY and edict which strategies for obtaining the optimal QALY gain for a given amount of resources.

In their influential book, Enthoven and Kronick distinguish two broad policy approaches to improving the health of the population. Upstream strategies are defined as interventions directed at the social, economic, and environmental determinants of disease, which involve action outside the health sector.

I argue for a pragmatic utilitarian conception of ‘health’ and contend that a fundamental requirement of any public health policy is the maximization of health gain. I consider the implications of this view for the activities of public health professionals. In both the clinical and non-clinical settings, public health professionals are often faced with situations in which their actions have an impact upon the health of the community, and tough decisions are required which involve trading off the interests of some against the interests of others. Decision making of this kind lies at the heart of priority setting, and I shall argue that a concern with health maximization can provide guidance in this difficult task.

4. Challenges and Opportunities in Public Health Policy

The development of health policy, like other policy developments, is the result of a complex set of interactions between political actors – both within and outside the government – agenda setting, the use of analytical tools, and the influence of key stakeholders. The specific policy analysis framework dictates that the interaction of these four areas in a ‘policy subsystem’ sets the policy and an implementation strategy into a series of ‘stages’ resulting in resolution of the problem at hand. This is a simple version of what is actually a deeply complex process. These features of the policy process combine to throw up certain challenges and opportunities for public health policy. In the modern era, it is believed that more is spent on planning and attempting to shape policy than on the policies themselves. The inevitable outcome is that during times of economic stringency, funding and human resources to many areas of health policy, particularly public health, are reduced. This means that having carried out extensive research, the policy problem at the time ends up being further from resolution than when it was set out. The resources reduction still affects modern policy, and indeed it was mentioned during our interview that one challenge is to sell the importance of investment in public health relative to healthcare on the prevention of disease, with fiscal conservatism dominating the political atmosphere. This suggests that in times of economic hardship, it is often relatively easier to protect policies on individual treatments, than to protect those on prevention to improve overall public health. An opportunity arising from the malleability of policy is the greater potential of some policies compared to others to simply bypass stated government policy and get things done. This phenomenon has been termed ‘policy entrepreneurship’ – the Brownian motion that describes how policy advocates from government, industry, and various special interest groups push, pull, and nudge policy in new directions, building coalitions and expanding networks to effect changes for their cause. This phenomenon is often tied to issues or ‘focusing events’ that raise concerns about a particular public health problem to the level of national. An example would be what happened in the US with the sudden escalation of concern about bioterrorism after the September 11th, 2001 terrorist attacks. This created a vast opportunity and increase of funding for the Center of Disease Control and Prevention to advocate policy changes improving overall US public health infrastructures relevant for both bioterrorism response and other emergencies. This had more to do with CDC policy elites crafting a response to convince the Bush administration to change a previously isolationist stance than it did with the actual threat of bioterrorism for US public health. Such changes may have unintended consequences, however, and one of the most difficult challenges in policy is to predict their effects down the line. Big Decimal and his colleagues described such long-term derivation as second and third order effects of initial policy decisions. This is particularly difficult because evidence and issues that originally led to a problem being set on the policy agenda can change. The world changes, and many risks to public health are dynamic, in that they are affected by other societal or environmental changes. This presents a conundrum as to whether policy change must be repeatedly re-justified or whether it left undisturbed the initial policy is still relevant to the problem.

5. The Role of Advocacy in Shaping Public Health Policy

There are many examples from both within and outside the field of public health of successful advocacy efforts leading to substantial policy change. However, the process of advocacy is not always straightforward, nor does it always result in desirable policy change. Success often depends on alliances with key decision-makers, effective use of the media, the political climate surrounding an issue, and persistence over time. The collaboration between public health advocates and sympathetic legislators is often essential for bringing about sustainable policy change. With this in mind, there is a growing recognition of the need for public health professionals to be trained in the techniques of policy advocacy. This includes an understanding of the policy-making process, the ability to form coalitions and mobilize public support, and the skills to promote policy initiatives within government, the private sector, and the public. Such training holds promise for increasing the effectiveness of advocacy efforts and ultimately improving the health impact of public policy.

To achieve the right mix of policies making up a healthy public health policy, one requires the right ingredients. One of the essential ingredients is the role played by advocacy. Advocacy is about speaking for a cause or an individual or a group to ensure their voices are heard. Advocacy efforts have led to a variety of public health policy victories. For example, the systematic advocacy of MADD and other groups led to an increase in the minimum legal drinking age and saved the lives of countless teenagers. The AAP’s tireless advocacy was instrumental in improvements made in recent years to the U.S. Child Immunization Program. Public health policy change is often the result of long and arduous advocacy efforts wherein public health practitioners are striving to alter or improve a particular policy. IMC uses the example of a health educator hired by the local coalition, whose principal duty was to encourage the passage of successful indoor clean air legislation. Over the course of two years, the health educator mobilized local support and ultimately convinced the town council to enact a clean indoor air policy that was more stringent than originally planned.