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Using Evidence Based Public Health Policy to Prevent and Control Cancer,[object Object],Elizabeth Dodson,[object Object],May 19, 2011,[object Object],ICC Annual Meeting, Indianapolis, IN,[object Object]
“Science can identify solutions to pressing public health problems, but only politics can turn most of those solutions into reality.”,[object Object],Thomas Oliver, PhD,[object Object],Johns Hopkins Bloomberg School of Public Health,[object Object]
Objectives,[object Object],Understand the definition of evidence-based policy,[object Object],Understand some important barriers and challenges,[object Object],Explore how to overcome some of these barriers,[object Object],Illustrate principles with recent research results,[object Object]
What is a health policy?,[object Object]
Definitions,[object Object],“those laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior”,[object Object],Policies tend to influence the environment (legal, social, economic, and physical),[object Object],Importance noted in the definitions of core functions of public health,[object Object]
At least 3 types of policy,[object Object],Formal laws, codes, regulations,[object Object],Clean indoor air policy,[object Object],Written standards that guide choices,[object Object],Engineering standards that guide street design,[object Object],Unwritten social norms,[object Object],Not ticketing for speeding 6-7 MPH above limit,[object Object],Harder to evaluate, often culturally driven,[object Object]
Policy potential,[object Object],How has health (or other) policy, today, already affected your life?,[object Object]
Top 10 public health achievements,[object Object],Examples,[object Object],Vaccination,[object Object],Motor-vehicle safety,[object Object],Safer workplaces,[object Object],Fluoridation of drinking water,[object Object],Recognition of tobacco use as a health hazard,[object Object],Each of these advances involved policy,[object Object],Centers for Disease Control and Prevention. Ten great public health achievements--United States, 1900-1999. MMWR 1999 Apr 2;48(12):241-3,[object Object]
Understanding evidence-based approaches,[object Object]
A simple definition of evidence-based public health,[object Object],	“Evidence-based public health is the process of integrating science-based interventions with community preferences to improve the health of populations.” ,[object Object],Kohatsu, et al. Am J Prev Med 2004.,[object Object]
Elements of evidence-based policy,[object Object],Process,[object Object],Content,[object Object],Outcomes,[object Object]
Domains of Evidence-based Public Health Policy,[object Object]
Why worry about research & policy/practice? ,[object Object],“… as the pressure on resources increases, decisions will have to be made explicitly and publicly, those who make decisions will need to be able to produce and describe the evidence on which each decision is based.” (Gray, 1997),[object Object]
What do policymakers want or need from practitioners and researchers?,[object Object]
Three Fundamental Questions,[object Object],Is there a problem?,[object Object],Do we know how to fix it (intervention)?,[object Object],How much will it cost (financially, politically)?,[object Object],- What do all of these questions mean in the context of where we live and work?,[object Object]
Challenges and opportunities for evidence-based policyFinding the research-policy nexus,[object Object]
Because what you told me is absolutely correct but completely useless,[object Object],Where am I?,[object Object],Yes, how did you know?,[object Object],You must be a researcher,[object Object],Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me,[object Object],The problem,[object Object],Yes. How  did you know?,[object Object],You’re 30 yards above the ground in a balloon,[object Object],You must be a policy maker,[object Object]
What are we learning about translating evidence to policy?,[object Object]
Examples of Policy Translation Challenges,[object Object],Clash of cultures,[object Object],Poor timing,[object Object],Ambiguous findings,[object Object],Balancing objectivity and advocacy,[object Object],Lack of relevant data,[object Object],From Brownson et al. AJPM 2006 ,[object Object]
Cancer Control Dissemination among State-level Policymakers,[object Object],Results from an ongoing project,[object Object]
Primary Project Goal,[object Object],Increase the dissemination of evidence-based interventions to control cancer focusing on the uptake of effective,[object Object],environmental and policy approaches,[object Object],among state-level policymakers,[object Object]
Methods: Conveying information via policy briefs,[object Object],Phase 1: Audience Research,[object Object],[object Object]
Randomized experiment
Compare data vs. narrative
Three key groups of policymakers
Read a brief then responded to a short questionnaire,[object Object]
Phase 1: Policy Brief Design,[object Object]
Page 1,[object Object],Narrative,[object Object],Data,[object Object]
Page 2,[object Object],Narrative,[object Object],Data,[object Object]
Page 2,[object Object],Local,[object Object]
Pages 3 and 4,[object Object]
Phase 1: Data Collection,[object Object],[object Object]
Mailed policy briefs and surveys
Follow-up phone calls
Emailed PDF of brief and link for online survey
Personal visits,[object Object]
Legislators (n=75)
Staffers (n=125)
Executives (n=91)
Overall, 35% response rate,[object Object]
Legislators:,[object Object],"How important are the following factors in determining what health issues you work on?" ,[object Object]
Data trees on brief usefulness,[object Object]
Using Evidence Based Public Health Policy to Prevent and Control Cancer
Qualitative interviews with health committee members,[object Object]
When you hear the term “scientific evidence” what does that mean to you?,[object Object],[object Object]
“I like to see things that are evidence-based and peer-reviewed.”
“Scientific is the opposite of anecdotal evidence, so anecdotal evidence is what we rely on …to make our decisions, unfortunately.”,[object Object]
“We get info from the various entities and the lobbyists as well as the other organizations that are in support or against a particular issue.”
“We always check the internet first…”
“Well I have not…I don’t think I’ve ever thought I needed scientific evidence…”,[object Object]
What can you do to bridge the chasm between evidence and policy?,[object Object],Understand the process,[object Object],Find a way to be involved in the process,[object Object],Communicate information more effectively,[object Object],Utilize analytic tools,[object Object],Educate a range of “players” (staffers, advocates),[object Object],Provide training and education programs,[object Object]
Understand the process,[object Object],Vast literature in social psychology suggests policymakers mainly rely on,[object Object],Habit, stereotypes, cultural norms,[object Object],Sender credibility,[object Object],Factors affecting receptivity of policymakers to info-bearers,[object Object],Transparency of methods ,[object Object],Plausibility of analysis ,[object Object],Experts’ credentials ,[object Object],Perceived impartiality ,[object Object],Perceived track record ,[object Object],Perceived honesty,[object Object]
Understand the process,[object Object],Political context ,[object Object],policy-making less a rational act than a process of social influence,[object Object],“policy windows open infrequently and do not stay open long” (Kingdon, 1995),[object Object],important to understand which policy options have the greatest potential for adoption and when small incremental changes are the preferred option,[object Object],use of rhetoric, art of persuasion, and ability to relate to the media (so called media or policy advocacy),[object Object]

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Using Evidence Based Public Health Policy to Prevent and Control Cancer

Notas del editor

  1. See our chapter for notes on this
  2. 1. Clash of culturesLack of demand driven (practice-based), transdisciplinary research No mechanism to involve policymakers (as partners and/or collaborators) in research development and communicationPriorities often differ (health vs. roads vs. prisons)Poor timingResearch completion: years or decadesPolicy cycle: short and changingLuck (“Luck is what happens when preparation meets opportunity”)3. Ambiguous findingsConfidence intervals vs. point estimatesCaveats that come with presentation of research findings4. Balancing objectivity and advocacyRole of the practitioner(can be controversial)Affect health policy by:conducting researchcommenting on others’ researchserving on groups making recommendationsserving as expert witnesstestifying before governmental bodyworking with a coalition5. Lack of relevant dataPolicymakers often look for data thatshow public support for a particular issuedemonstrate priority for an issue over many othersshow relevance at the local (voting district) levelpersonalize an issue by telling a compelling story of how people’s lives are affected6.
  3. Personal visits: both us and constituents
  4. Remember that these are leadership of health committeesin state legislatures.