People centered Science and Globalization: Putting the Public Back into Public Health Policy

Abstract

Developing countries have no. significant policies for occupational health. This analysis identifies four broad mechanisms through which state- and enterprise-level decision makers in developing countries diffuse attemps to instigate improvements in occupational health: inaction or stifling of such efforts during policy implementation; exercise of power; appeal to the existing bias (norms, rules, procedures) of the system; and prevailing dominant ideology. Addressing these limiting factors requires initiating a process of raising the occupational health policy profile that recognizes the importance of empowering workers' organizations, and enabling professionals to play an active role in the generation of occupational health knowledge required to improve occupational health in the developing countries.     

Understanding Evidence-Based Public Health Policy

Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts).We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy.Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.IT HAS LONG BEEN KNOWN that public health policy, in the form of laws, regulations, and guidelines, has a profound effect on health status. For example, in a review of the 10 great public health achievements of the 20th century,¹ each of them was influenced by policy change such as seat belt laws or regulations governing permissible workplace exposures. As with any decision-making process in public health practice, formulation of health policies is complex and depends on a variety of scientific, economic, social, and political forces.²There is a considerable gap between what research shows is effective and the policies that are enacted and enforced. The definition of policy is often broad, including laws, regulations, and judicial decrees as well as agency guidelines and budget priorities.^2–4 In a systematic search of “model” public health laws (i.e., a public health law or private policy that is publicly recommended by at least 1 organization for adoption by government bodies or by specified private entities), Hartsfield et al.⁵ identified 107 model public health laws, covering 16 topics. The most common model laws were for tobacco control, injury prevention, and school health, whereas the least commonly covered topics included hearing, heart disease prevention, public health infrastructure, and rabies control. In only 6.5% of the model laws did the sponsors provide details showing that the law was based on scientific information (e.g., research-based guidelines).Research is most likely to influence policy development through an extended process of communication and interaction.⁶ In part, the research–policy interface is made more complex by the nature of scientific information, which is often vast, uneven in quality, and inaccessible to policymakers. Several models for how research influences policymaking have been described,^7–9 most of which involve moving beyond a simple linear model to more nuanced and indirect routes of influence, as in gradual “enlightenment.”¹⁰ Such nonlinear models of policymaking and decision-making take into consideration that research evidence may hold equal, or even less importance, than other factors that ultimately influence policy, such as policymakers'' values and competing sources of information, including anecdotes and personal experience.¹¹ Although not exhaustive, 12–16

TABLE 1

Barriers to Implementing Effective Public Health Policy

Public Policy Involvement by Health Commissioners

The purpose of this national study was to determine advocacy activities and level of involvement of health commissioners regarding public policy. Benefits, barriers, and perceived outcomes of advocacy efforts were also explored. A previously validated (Holtrop et al., Am J Health Behav 24(2):132–142, 2000) four-page survey was mailed to 700 health commissioners, who were randomly selected from the National Association of County and City Health Officials (NACCHO) database. A three-wave mailing was performed which yielded a 50% response rate. Of these respondents, the majority (70%) were female and (88%) Caucasian. Overall, 31% of health commissioners reported being involved in influencing public policy in the last 4 years. The most common reported activities engaged in by health commissioners included voting (84%), and providing policy information to consumers or other professionals (77%). Perceived barriers to influencing policy were time, (64%), and other priorities (46%). Perceived benefits to influencing policy included improving the health of the public (94%) and making a difference in others’ lives (87%). Only 15% perceived their knowledge regarding the process of changing public policy was excellent. Although health commissioners are often spokespersons for health agencies and communities, their public policy involvement is marginal. Professional preparation programs and continuing education opportunities should focus on advocacy, public policy development, and removing barriers to action.     

后SARS时期的公共卫生政策发展

SARS直接冲击了现有的公共卫生政策，暴露出我国公共卫生服务存在的种种问题。由于现行的公共卫生政策已不能适应市场经济的要求，公共卫生应引入公共管理的理念，重新界定公共卫生要迫切解决的问题，科学地制定适时、有效的公共卫生政策，以促进公共卫生服务的发展。     

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013.The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts.Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.Innovative policy solutions to address public health problems are becoming increasingly important, particularly because chronic diseases constitute a growing share of the disease burden in the United States. Public health policies increasingly aim to shape an environment that encourages healthy behaviors, such as physical activity or healthy eating.1,2Although traditional public health programs often target smaller groups, such as those infected with or at elevated risk of particular infectious diseases, public health policies can influence the behavior or environment of large populations. Such policies, which include laws, regulations, rules, or operational decisions intended to improve population health, can help jurisdictions meet population health goals because they work “upstream” of heath care services and even many traditional health promotion programs.The Public Health Division (PHD) of the Oregon Health Authority (OHA) is working to enhance the competencies of the state and local health agencies in Oregon to develop, implement, and evaluate public health policies; these competencies receive limited attention in existing degree programs or in-service training. The PHD funded Oregon State University (OSU) to develop a Public Health Policy Institute (PHPI) tailored to the state’s institutional and political environment, and designed to train public health professionals to address public health problems with upstream policy solutions. We describe the existing public health policy background and training resources nationwide and in Oregon, and outline the structure and content of the PHPI curriculum. We present the results from the evaluation of the first offering of PHPI and reflections on lessons for other states.     

Public Participation in the Process of Local Public Health Policy,Using Policy Network Analysis

Objectives:

To assess the current public participation in-local health policy and its implications through the analysis of policy networks in health center programs.

Methods:

We examined the decision-making process in sub-health center installations and the implementation process in metabolic syndrome management program cases in two districts (‘gu’s) of Seoul. Participants of the policy network were selected by the snowballing method and completed self-administered questionnaires. Actors, the interactions among actors, and the characteristics of the network were analyzed by Netminer.

Results:

The results showed that the public is not yet actively participating in the local public health policy processes of decision-making and implementation. In the decision-making process, most of the network actors were in the public sector, while the private sector was a minor actor and participated in only a limited number of issues after the major decisions were made. In the implementation process, the program was led by the health center, while other actors participated passively.

Conclusions:

Public participation in Korean public health policy is not yet well activated. Preliminary discussions with various stakeholders, including civil society, are needed before making important local public health policy decisions. In addition, efforts to include local institutions and residents in the implementation process with the public officials are necessary to improve the situation.     

面对"SARS"谈国家公共卫生政策

SARS从 2 0 0 2年 11月中旬开始 ,经过半年的时间横扫中国 2 5个省市。SARS的横行不但是对科学研究和医疗卫生技术的考验 ,而且也是对国家执行公共卫生政策能力的考验。从SARS的发生、发展到目前的状态 ,我们可以看到政府正在逐步建立协调的指挥系统 (从初期的由卫生部门为主 ,其它部门各自为政到 4月中下旬由国务院副总理吴仪挂帅的防非典联合工作小组成立 )和逐步完善社会管理目标 (由前期的对疫情犹抱琵琶半遮面、采取的措施集中在医疗卫生领域到全方位的社会管理 :尊重公众的知情权 ,公开疫情 ;遵守法律法规、依法行政 ;通过各种方…