Building healthy public policy

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to: Improve literacy outcomes (for example, support for a pan-Canadian literacy strategy, early childhood education and family literacy programs, and efforts to reduce high school drop out). Improve health literacy (for example, support integrated policy and program development across sectors, integrated research and knowledge translation initiatives, and efforts to build links between literacy and health networks). Reduce disparities by strengthening levels of literacy and health literacy among vulnerable groups.     

Social inequality and healthy public policy.

For decades, health education programmes have been based on the assumption that individual behaviours (for example smoking, drug use, eating patterns) are the major risk-factors in contemporary illness. This assumption often led to interventions that subtly "blamed the victim" for his or her ill-health. In recent years the broader social conceptualization of health and illness has directed many health educators' attention towards socio-economic and environmental factors which condition and constrain lifestyle choices, and which may be directly associated with increased disease risks. While it is becoming common for government health departments and agencies to acknowledge poverty, unemployment and other forms of social inequality as potent health hazards, programmes to ameliorate such conditions are rare. Since 1983, the Toronto health department has developed programmes based upon a socio-environmental model of disease which specifically targets social systems rather than individual behaviour for change. Elements of this approach include extensive media reports on the health implications of such issues as welfare benefits, poverty, unemployment and housing; health education programmes to stimulate a critical understanding of the causes and structure of social inequality; health advocacy initiatives to influence political and legislative reforms; and a community development orientation which involves the department in broad-based coalitions working towards healthy social change. Most recently, the department has become a resource to groups attempting to create employment and service community needs through cooperative forms of economic development. Several examples of the department's programmes in each of these areas are provided. To meet the challenge of the World Health Organization's Alma Ata Declaration, health educators must examine their own potential to act as social-change agents, and must become more sophisticated in the political analysis of their practice.     

Science, advocacy and health policy: lessons from the New Zealand tobacco wars

The New Zealand Smoke-Free Environments Act was passed in August 1990 and is a central component of a comprehensive tobacco control policy. The passage of the Act was preceded by a long campaign. The essential components of this campaign were: international scientific evidence and the estimates of tobacco-caused mortality in New Zealand; activists groups supported by established health charities and the health professions; a sympathetic Health Department bureaucracy; a committed and powerful Minister of Health; and a relatively weak industry. The legislation passed despite adverse timing, the absence of bipartisan political support, and the pressure of industry-supported sports lobby groups. The campaign provides a model for other health issues in New Zealand and lessons for the tobacco wars elsewhere.     

Pesticides and healthy public policy

Despite concern over long-term human and environmental health risks, Canadian and international pesticide use continues to increase. Enormous gaps in pesticide toxicity data persist and, though equivocal, there is mounting evidence that certain pesticide families are carcinogenic. Farmworkers are at greatest risk of pesticide poisoning and long-term health effects, and unions representing farmworkers have initiated a boycott of California grapes to draw attention to the need to reduce pesticide use and improve health and safety conditions. The boycott is a model of "healthy public policy" in action, and can be one element in a public health strategy to reduce significantly pesticide use and promote less toxic alternatives and less chemically dependent forms of agriculture and silviculture.     

Failure to defend a successful state tobacco control program: policy lessons from Florida

OBJECTIVES: This investigation sought to define policy and political factors related to the undermining of Florida's successful Tobacco Pilot Program in 1999. METHODS: Data were gathered from interviews with public health lobbyists, tobacco control advocates, and state officials; news reports; and public documents. RESULTS: As a result of a recent legal settlement with Florida, the tobacco industry agreed to fund a youth anti-smoking pilot program. The program combined community-based interventions and advertisements. In less than 1 year, the teen smoking prevalence rate dropped from 23.3% to 20.9%. The program also enjoyed high public visibility and strong public support. Nevertheless, in 1999, the state legislature cut the program's funding from $70.5 million to $38.7 million, and the Bush administration dismantled the program's administrative structure. Voluntary health agencies failed to publicly hold specific legislators and the governor responsible for the cuts. CONCLUSIONS: The legislature and administration succeeded in dismantling this highly visible and successful tobacco control program because pro-health forces limited their activities to behind-the-scenes lobbying and were unwilling to confront the politicians who made these decisions in a public forum.     

A dose of realism for healthy urban policy: lessons from area-based initiatives in the UK

Many urban policies aim to improve areas and address socioeconomic deprivation. The resulting investment is often delivered through area-based programmes which incorporate initiatives to improve the physical, social and economic environment. Hypotheses that these investments can contribute to wider public health strategies are based on epidemiological data and used to support the concept of healthy urban policy. However, there is little evidence on their ability to generate positive impacts on socioeconomic or health outcomes. The lack of validating evidence on actual impacts raises two important questions: (1) Is area-based investment an effective strategy to tackle socioeconomic deprivation? (2) What is the prospect for new and improved evaluations to provide stronger evidence? Both the programmes of area investment and their accompanying evaluations have been criticised for being overly ambitious in what can be achieved by the investment and what can be measured by an evaluation. Area-based approaches to tackling deprivation have their advantages but a mix of area and individual-level targeting is likely to be needed. While there is scope to improve the utility of evaluation data there are also inevitable constraints on assessing and attributing impacts from urban investment. The inherent limitations to an area-based approach and the ongoing constraints on impact evaluation will inevitably temper expectations of what healthy urban policy can achieve. However, lack of evidence is not grounds to abandon the concept of healthy urban policy; adoption of more realistic expectations together with improved evaluation data may help to increase its credibility.     

Targeting school tobacco policy: lessons from the Acadiana Coalition of Teens Against Tobacco (ACTT)

This case study examines the comparative effect of no-use school tobacco policies and restricted-use tobacco policies on teacher and student smoking behaviors and attitudes. Data from teachers (n = 1,041) and ninth-grade students (n = 4,763) at 20 schools in five districts in southern Louisiana were available. No significant difference was observed between teacher smoking (11% vs. 13%, p = .42) or student smoking (24.6% vs. 25.2%, p = .75) at no-use versus restricted-use policy schools. The proportion of teachers smoking on campus at no-use or restricted-use schools was not significantly different. Teachers at restricted-use schools were however less concerned about students seeing teachers smoke and less supportive of a no-use policy than teachers at no-use schools. Tobacco use policies are often not promoted, and enforcement of policies impacting teachers is complex. Changing social norms for smoking at high schools through policy promotion and enforcement is understudied.     

Social inequality and healthy public policy

For decades, health education programmes have been based onthe assumption that individual behaviours (for example smoking,drug use, eating patterns) are the major risk-factors in contemporaryillness. This assumption often led to interventions that subtly"blamed the victim" for his or her ill-health. In recent yearsthe broader social conceptualization of health and illness hasdirected many health educators' attention towards socio-economicand environmental factors which condition and constrain lifestylechoices, and which may be directly associated with increaseddisease risks. While it is becoming common for government healthdepartments and agencies to acknowledge poverty, unemploymentand other forms of social inequality as potent health hazards,programmes to ameliorate such conditions are rare. Since 1983, the Toronto health department has developed programmesbased upon a socio-environmental model of disease which specificallytargets social systems rather than individual behaviour forchange. Elements of this approach include extensive media reportson the health implications of such issues as welfare benefits,poverty, unemployment and housing; health education programmesto stimulate a critical understanding of the causes and structureof social inequality; health advocacy initiatives to influencepolitical and legislative reforms; and a community developmentorientation which involves the department in broad-based coalitionsworking towards healthy social change. Most recently, the departmenthas become a resource to groups attempting to create employmentand service community needs through cooperative forms of economicdevelopment. Several examples of the department's programmesin each of these areas are provided. To meet the challenge of the World Health Organization's AlmaAta Declaration, health educators must examine their own potentialto act as social-change agents, and must become more sophisticatedin the political analysis of their practice.     

Preventing alcohol problems using healthy public policy

This paper, using the Canberra Consensus Statement (WHO, 1988)as a basis, focuses on the role of public policy in minimizinghann from alcohol misuse. The statement identifies three componentsthrough which such goals may be achieved demand reduction, supplyreduction, and others. The paper firstly examines the usefulnessof the document in guiding public policy initiatives. Secondly,we examine some theoretical and practical problems that mayarise flve formulating and implementing its recommendations.In doing so we identify some of its strengths and weaknessesand suggest a nsumber of future directions for healthy publicpolicy.     

Health impact assessment: a tool for healthy public policy

Healthy Public Policy is one of the key health promotion actions. Advancement of Healthy Public Policy requires that the health consequences of policy should be correctly foreseen and that the policy process should be influenced so that those health consequences are considered. Health Impact Assessment is an approach that could assist in meeting both requirements. Policies often produce health impacts by multiple indirect routes, which makes prediction difficult. Prediction in Health Impact Assessment may be based on epidemiological models or on sociological disciplines. Health Impact Assessment must be based on an understanding of, and aim to add value to, the policy-making process. It must therefore conform to policy-making timetables, present information in a form that is policy relevant and fit the administrative structures of policy makers. Health Impact Assessment may be used to inform health advocacy but is distinct from it. There is a danger that Health Impact Assessment could be misunderstood as health imperialism.     

Making healthy public policy; developing the science by learning the art: an ecological framework for policy studies.

During the 1980s increasing attention has been given to the view that a vast array of public policies have great potential for health promotion and that this potential ought to be developed. After briefly discussing the basis for this concept and its policy implications, this article turns to a major corequisite for making healthy public policy a political reality: learning how to do it. Where healthy public policy exists, how did it happen? This is a question that calls for a new generation of policy studies, one that is relevant to advocates of healthy public policy within and outside governments. An ecological framework of policy-making is proposed for such studies, delineating the social climate, key players, and strategic action. From it, operational indicators and study methods are suggested, in order to learn some general principles, within a real-world context, of how to develop public policies that are healthful.     

Multisectoral lessons from healthy communities

The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.