Lecture 11 - healthy public policy PDF

Preview

Summary

healthy public policy...

Description

Lecture 11 – Health Promotion: Healthy Public Policy What is Policy and Public Policy?  Policy = priorities, guidelines and rules that guide how resources are allocated and how citizens function in society o Funding for breast screening tool o CHN Standards of Practice  Public policy = policy at any level of government o Nursing Act and RHPA o Canada Health Act Policy/Public Policy Impacts: • CHN roles/responsibilities • Health outcomes for communities Policies are priorities, guidelines and rules that guide how resources are allocated and how we function within society. Policies can be individual or group based and are typically based off of interests, values, rules or expectations and are set in the context of an environment. Key political stakeholders, clients and citizens that live within a community influence policies. Public policies are policies that are developed through all three levels of government (federal, provincial, municipal). Policy decisions are influenced by decision makers both government and non-government bodies that create societal outcomes that influence the SDOH. These outcomes can be positive, negative or non-decision or can include a combination factors that create current/future challenges for CHN and/or influence health outcomes for a community. Public policy formation developed the Regulated Health Professions Act and the Nursing Act, which define our scope of practice. In a community specific context, we also have legislative documents such as the Home Cart Act, which is legislation that outlines what we can and cannot do as nurses. Policy  not outlined by legislative documents but is outlined by standards. For example, in community health nursing we have the CHN standards of practice, which frames functions of public health and home care nursing. Within these standards, it functions to branch and specialize nursing care (ex: public health and home care nursing competencies are different from one another). In community health we see policy formulation through the function that we absorb as community health nurses. We typically facilitate or develop policy ourselves. For example: we facilitate access to services, set timeframes for walk in clinics, allocate resources such as providing organizational funding to medical screening equipment!

Public policy in CHN is also set out by legislation. In the context of community health nursing, the legislation addresses the social determinants of health such as federal tax distribution and Canada Health Act. Public policy in this context looks at key factors and legislative documents that impact the SDOH. Policy: Individual Policy: • Have I followed my nursing instinct and process? • Based on: interest and beliefs • Decision makers: personal choice, professional bodies, CNO, client Organizational Policy: • Determines hiring, salaries, complaints • Based on: values, beliefs, organizational mandates, professional regulation • Decision makers: board of directors, departmental services, unions, professional bodies Government Public Policy: • Guide decisions and actions related to societal interests • Example: health care expenditure, impact on social determinants of health, legislation developed surrounding the impact on these factors • Based on: political views, agendas, and platforms, societal beliefs and values, • Decision makers: federal, provincial, territorial, and municipal levels of government. CHN practice evolves with influences of the socio-political environment. Key decision makers and policy makers shape the context in which community health nursing takes place and the health outcomes we see. If policy is deconstructed, we follow policies that can be individual, organizational and government public policy. All three types of policy have key functions in how we practice and achieve outcomes for our clients. Patient’s First Report is a key document that guided and formed public policy. It has shifted the way we provide care, moving resources away from the hospital and into the community. Important because you can see how resource allocation has evolved over the years based off public policy. States of Public Policy: • Welfare State o Social cohesion • Neo-liberalism o Individualism Depending where you live in the world will ultimately determine your health. Usually that health is determined by the social structures and public policy that are in place for the individuals living in that community or country.

States of public policy refers to how policies are organized and the level of control that the government, individuals or capitalism (industry) has on the health of our communities. Welfare state  includes having government control oppose to market control. Provides the basic infrastructure to meet the health needs of the community. These programs and legislation can include universal health service act as well as social assistance program. These are provided to us and are usually provided through the redistribution of taxes. Neoliberalism  includes an increase in market control and a decrease in government control. Market control means that profit and funding either through industry or individuals guides how health care is set up. This looks at private sector health care and how money is distributed. An increase in neoliberalism leads to private health care services. This is problematic in countries with a huge gap between those who are rich and poor, as the poor cannot afford health care whereas the wealthy can afford it. Individualism/social cohesion  individualism coincides with neoliberalism. With neoliberalism it outlined that we have an increase in market control. Within that we would have an individualized focus of people paying for their access to health. Whereas with welfare state, we look more so at the concept of social cohesion as money that is allocated through the government creates stable networks and social systems where individuals can access health care regardless of how much they make. Important to understanding how we develop public policy depending on the area where we practice community health nursing. Decision in Health Policy: • Municipal (local) Government • Commissioner & Medical Officer or Health • Local are Member of Parliament (Oshawa, Pickering/Ajax etc.) • Provincial Government • Member of Provincial Parliament • Minister of Health and Long-term Care • Federal Government • Member of Parliament (MP) • Minister of Health 

Decision makers and bodies, those who have a large say in what health priorities are important and how money is spent have a direct impact on our role as a CHN and how we practice to address the SDOH.  Depending on the political parties involved the priorities for health shift. There may be a shift in focus, such as from acute care to community care (ex: Patients First Report). There will also be different trends in focus (ex: removal of fitness taxes).  Members at all levels of government are elected by the community to represent their needs or are appointed into a position of power. Municipal government is responsible for health decisions at a regional level. This government involves a committee (ex: Durham Health and Social Service Committee) that include local

MPs and the medical officer of health that discuss and make decisions about health needs in the region. Provincial government is responsible for the health of the province and provincial legislation. Involves key MPs and the minister of health (ex: Dr. Eric Hoskins) to set provincial health priorities and targets. Since Dr. Hoskins has been in power we have seen a shift in spending on hospital repairs, stopping wait list child care fees, and addition of the Zostavax to be accessible to the elderly. Within the federal government the minister of health is responsible for overseeing healthfocused government agencies: health Canada, PHAC, Canada Health Act, and the universal health care system. The federal government also have MPs who are elected and in collaboration delineate and decide how health care dollars are spent and on what resources. Healthy Public Policy:  Healthy public policy  “decisions, plans, and actions that are undertaken to achieve specific health care goals within a society.”  An explicit health policy can achieve several things: o Defines future visions of health o Establish targets and points of reference o Sets priorities and defines roles for all involved o Builds consensus and informs people of health inequities The SDOH are specifically linked to policy areas and health outcome. Health inequalities can be created, exacerbated, or alleviated by public policies. Healthy public policy requires that communities, their elected representatives, and public servants work together to achieve social justice and minimize health inequities. As a CHN, healthy public policy is a key element to be aware of and involved in. Community health nurses need to advocate for social justice to minimize health inequities, establish and write policy that can increase accessibility to health care, reduce income disparities, advocate for vulnerable populations and work together to achieve positive health outcomes. Aim of Healthy Public Policy:  The ultimate goal is health promotion  “To create a supportive environment to enable people to lead healthy lives”  Focus on reducing inequities among populations  To address the social determinants of health

The Stages Model:

  





 

The stages of change model provide us with a framework to examine public policy The process of developing policy are outlined in sequential order starting with agenda setting and moving to policy evaluation but it is a fluid model Agenda setting  identifies a problem that is of interest to the public. o ”The agenda” is a good example of moving forward community concerns that influence the priority health issues. o To set an agenda item the community must identify a situation, identify the problem within the situation, propose solution(s) and place pressure on government structures and influences that they feel would impact the development of their solution. Policy formation  includes examining and visiting various policy solutions, develop a standpoint on one of the proposed solutions, identifying that it is an effective solution and writing a policy to propose the identified solution. o Power relationships in this phase are key. Implementation  a plan is set into place, which has an outcome on policy. The implementation of a policy has a complex structure and key political influences that must be taken into consideration when you go to implement your policy. Evaluation  verifies if the policy aligns with the goals and intent of the policy Adaptation  individuals or the community adopted change based off the policy

Model is very useful if were developing policy to take into consideration the complexities of the situation and to identify the problems and solutions that exist.

Advocacy Coalition Framework: ACF helps us understand how various competing actors work together to create change over time by utilizing a variety of tools and understanding how problems are shaped and how

actions are made based off the decision within a social context. There are relative stable system parameters that outline if there is a problem, the good aspects to the problem, whether or not there is equal distribution of resources and whether or not the fundamental socio-cultural values & social structure support a need for change. Also looks at external events that affect a health issue or a framework for a public policy. We see that policy is typically formed when there is changes within the socio-economic conditions within a community, changes in public opinion, when there is changes in systematic governing coalitions involved in advocacy work and when policy decisions are made from impacts from other subsystems. When we take into consideration the stable system parameters and the external system events we can analyze the constraints and resources of those subsystems. This is what helps coalitions frame a policy or action to advocate for policy change.  

Coalitions are a driving force in change A coalition is a group of people  can be service providers, community citizens, researchers, activist agencies, unions etc.

    

Everyone in the coalition hold the same core beliefs that are guiding principles and values that drive change. Focus of this model is about change over time through policy development Policy is developed/changed when coalitions use a variety of legal & priority actions This framework highlights the development of public policy through coalitions emphasizing the external agents and recognizes that members of the coalition are the key players needed to advocate and change policy Coalitions use guidance mechanisms to guide change that are strategic and can include: direct participation in organizations, litigation, publication and evaluation report, change in appointees and significant change in legislation

A good example of a coalition that has impacted public policy is MADD! Healthy Public Policy: The Process

Key Players:  Gate Keepers (decision makers)  Stakeholders (influencers) Examples:  House of Assembly (province, legislation containing a policy)  Cabinet (elected representatives selected by Premier- decision making power)  Community  Board of Directors (organizational level but also has power to implement change or not implement changed based on legislation)

* Health Promotion = political activity (Raphael, 2006)   

There are two types of players that make decisions and influence change in policy development: gate keepers and stake holders Gate keepers  bodies that hold power to make decision on public policy change Stakeholder  those who can influence gate keeper decision makers and hold vast amount of knowledge and/or expertise on the health issues that requires change

Example: Food Labeling  A pediatrician, CHN, teacher, concerned parent and government officials formulated a coalition to look at the impact of the health issue of not labeling food. They brought forward information to the cabinet and house of assembly to pass legislation for food manufactures to place labels on their products.  The coalition would be the stakeholder and the gate keepers would be the house of assembly and the cabinet who ultimately made the decision.  If you wanted to implement a healthy food strategy, it would be important to connect with local school board so they only provide healthy choices in the schools. This lead to the healthy beverages act. You can see how gate keepers and stakeholders have an equal responsibility in creating and making decisions about policy to influence and enable people to make informed choices and take control over the factors that influence their health. Examples of Healthy Public Policy: Advocacy  Rent control  Building subsidized housing units  Social assistance re-structuring Program Planning, Implementation and Evaluation  Write smoke free policy with organization  Develop reports as influential stakeholders  Develop guidelines for clients to access Nicotine replacement therapy There is an abundance of public policies that shape and form how we interact and function within our community, how we experience illness as well as how we practice CHN. We know that public policy has the largest impact on the health of communities at large. Policy supports people’s health and enables them to take control over the factors that influence health (social determinants of health). Advocating for social justice and providing a voice for those in need who would not otherwise have a voice. By providing a voice we are able to impact how policy is built, particularly through the gate keepers that make those decisions.

Program planning, implementation and policy evaluation can be an influential stakeholder or a gatekeeper for public policy. Activities for Building Support for Policy: • Media advocacy o Press conference o Mass media (billboards, radio, television) o Posters, pamphlets • Interpersonal o Debriefing sessions with key decision makers o Presentation (present a solution about a health issue) • Public Events o Public forum o Marches Our ultimate aim as a CHN is to promote health of the community and we know that public policy has the largest impact on the health of communities at large. Policy supports people’s health and enables them to take control over the factors that influence health. To reach our goals we are able to adopt a variety of activities to act as stakeholders or to support gate keepers to make informed decisions....