CDC Train Exam!
window of opportunity conditions
(1) is congruent with the national mood; (2) enjoys interest group support; (3) lacks organized opposition; (4) fits the orientation of the prevailing legislative coalition or administration; (5) is technologically feasible; and (6) has budget workability.
Resource allocation WHO principles:
- WHO: "ethical principles of resource allocation" ^ efficiency ^ fairness ^utility
developing new policy options (Policy analysis)
- broad, systematic perspective
Exploring available options (Policy analysis)
- environmental scan - grey literature - peer-reviewed literature, grey literature, and policy documents from stakeholder groups, professional associations, and non-profits. - social determinants of health lens
Evidence base policy: tobacco
1) Background of cig smoking: - 443,000 premature deaths - 5.1 million years of potential life lost - $97 billion in productivity losses annually 2) policy - tobacco excise tax increases - 10% increase in price of cigs = reduced consumption by 4%
STEP 3: Develop a strategy for furthering adoption of the policy solution
1) Clarifying operational issues - how policy will operate + steps for implementation - identify considerations + assistance from those who will adopt policy (jurisdiction + info needs) 2) sharing information - key stakeholders - state, tribal, local and territorial governments - federal agencies -community based organizations -decision makers 3) potential products - background white paper (data of health impact, feasibility, budget + economic impact) - bibliography and data compendium - presentation of policy priorities or recs - policy brief: summarize policy options and recommended action 4) conducting additional background work - no prioritized or ready for "prime time" need other steps
policy analysis competency key behaviors:
1) Demonstrate an understanding of the factors involved in the selection, design, development, implementation, and evaluation of policy interventions to improve population health 2) Employ policy analysis methods ^ problem definition ^ collect + analyze background info relevant to cause of problem ^identify policy options assess policy options against relevant criteria: risks, benefits, costs, feasibility ^ select course of action 3) Prepare communications regarding the selected course(s) of action (e.g., presentations, decision memos or policy briefs which include a recommendation for action) 4) Identify and understand roles and perspectives of key stakeholders at federal, state, or local levels. 5) Understand economic analysis methodologies (e.g., cost-benefit analysis or cost-effectiveness analysis) and their use in assessing policy options or existing policies.
STEP 2A: Identify and describe policy options
1) Identify - research policy options by: literature review, surveying best practices, environmental scan - include alternate and opposing POVs - include maintaining status quo 2) Describe - describe each policy option: ^ process + structure ^ health impact, feasibility, economic + budgetary impact
Using the NPHPS can:
1) Improve organizational and community communication and collaboration 2) Educate participants about public health and the interconnectedness of activities 3) Strengthen the diverse network of partners within state and local public health systems 4) Identify strengths and weaknesses to address in quality improvement efforts 4) Provide a benchmark for public health practice improvements
STEP 1: identify the problem or issue
1) clearly identify problem/issue 2) synthesize data - burden (# people affected) - frequency - severity - scope (outcomes) 3) Be specific, look at: - contributing risk factors in literature 4) frame problem to illuminate possible policy solutions
PH role in policy
1) deliver evidence-based science to inform decision-making. 2) provide knowledge of existing health systems, public health methods and approaches, and strategy development 3) assess opportunities and risks and analyze issues, trends, programs, and resource allocations 4) form strategic partnerships and facilitate policy analysis, formulation, and intervention design and evaluation 5) conduct performance and impact evaluation
does the problem have potential policy options? (Policy analysis)
1) different levels of government, e.g., federal, state, or local, or in different sectors, e.g., public or private 2) vary depending on the different type of entities involved, whether government, professional associations or non-profit organizations.
causes of selected problem (policy analysis)
1) discovering, collating, interpreting, critiquing, and synthesizing ideas and data that others have already developed 2) publications: peer reviewed literature, white papers from conferences, briefs from reputable sources, statistics from public health agencies, government reports, and position papers. Newspapers, magazines, blogs, and social media, among others, can also be important sources for a public health practitioner to review. 3) stakeholders: "those who are intensely interested in the outcomes of policy debates in a particular area." Additionally, they suggest that a health policy analyst should "place [him- or herself] in as many stakeholders' positions" as possible so as to "understand their differing perspectives on the real impact of a proposal."
CDC's role
1) identify + describe policy options for PH problems 2) economic + budgetary impacts 3) identify EB policy solutions + gaps in evidence
Key Steps
1) identify the problem or issue 2) identify an appropriate policy solution - identify & describe policy options - assess policy options - prioritize policy solutions 3) develop a strategy for furthering adoption of a policy solution
Measure options against these 3 criteria (to start)
1) impact on PH - you can conduct an assessment of whether the policy option will have a differential impact on segments of the population - look at the risk and protective factors, morbidity, and mortality, and do so from a perspective of equity 2) feasibility - Legal feasibility The policy cannot violate constitutional, statutory, or common law rights; it also must be within the realm of authority of the decision-making authority to implement. - Political feasibility - A policy which faces strong political opposition may not be feasible to implement, even if it is widely perceived as being legal. Social and cultural contexts vary greatly in different areas. A policy that galvanizes opposition in a particular location may be more acceptable in a different place. Remember that this criterion is not static—cultural shifts can occur that cause a policy to be accepted where it was previously opposed. When this happens, a window of opportunity may exist. - Operational feasibility - It is also important to understand the robustness of a policy—how it will "hold up" during an involved implementation process, which has administrative complexities or delays. Does the implementing authority have the expertise and resources necessary to implement the policy? 3) fiscal and economic impact: assessing the potential fiscal and economic impact of a policy option - Cost analysis analyzes the program or implementation costs and cost of illness associated with a policy option. - Cost effectiveness analysis - compares both the costs and health outcomes of alternative policy options. - Cost-utility analysis - a form of cost-effectiveness analysis that uses quality-adjusted health outcomes, such as Quality-- Adjusted Life Years (QALYs) or Disability-Adjusted Life Years (DALYs). - Cost-benefit analysis - standardizes both costs and benefits in dollars and compares all costs against all benefits during a specified period of time.
identifying the problem (policy analysis step 1: defining the problem)
1) policy analysts will identify a public health problem by reviewing surveillance data or study results, other functional experts such as epidemiologists, health scientists, and community public health officials
communicating methods
1) policy brief 2) white papers 3) press release 4) podcast
How you can articulate PH problems + possible solutions (Policy analysis)
1) policy briefs and documents 2) "best practices" or "promising practices" 3) "editorials/discussion pieces"
CDC Policy Process (we are only focusing on first 2)
1) problem identification 2) Policy Analysis 3) Strategy and Policy Development 4) policy enactment 5) policy implementation
Defining the scope of the problem (policy analysis step 1: defining the problem)
1) problem statement (quantify when possible) - "who, what, when, where, and how" 2) not scope to point to potential solutions or actions 3) free of bias 4) not every problem statement will neatly fit the "who, what, when, where, and how" frame
STEP 2B: Assess Policy Options
1) use table to rate policy options (https://www.cdc.gov/policy/analysis/process/docs/Table1.pdf) - for each criterion: write concerns about amount or quality of data 2) Use another table to assess each option independently against criteria (https://www.cdc.gov/policy/analysis/process/docs/Table2.pdf) - can have "no policy change" - grounded in evidence, but subjective
10 great PH achievements
1) vaccine-preventable diseases - US immunization policy 2) tobacco control 3) prevention and control of infectious diseases 4) maternal and infant health -mandatory folic acid fortification of cereal grain products (defects) 5) cardiovascular disease prevention 6) occupational safety 7) motor vehicle safety 8) public health preparedness and response 9) cancer prevention 10) childhood lead poisoning prevention
prioritization process questions (some subjective)
Are the policy options addressing incremental or comprehensive change? Is one more important to you than another? Are there certain stakeholder groups that are a target population? Different policy options can be utilized by different stakeholders. What are the timing parameters? Will this policy change occur at a pace that is acceptable to stakeholders and others involved?
10 PH services
Assess and monitor population health status, factors that influence health, and community needs and assets Investigate, diagnose, and address health problems and hazards affecting the population Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it Strengthen, support, and mobilize communities and partnerships to improve health Create, champion, and implement policies, plans, and laws that impact health Utilize legal and regulatory actions designed to improve and protect the public's health Assure an effective system that enables equitable access to the individual services and care needed to be healthy Build and support a diverse and skilled public health workforce Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement Build and maintain a strong organizational infrastructure for public health
PH Impact questions
How does the policy address the problem or issue (e.g., increase access, protect from exposure)? What are the magnitude, reach, impact, and distribution of benefit and burden (including impact on risk factor, quality of life, morbidity, and mortality)?What population(s) will benefit? How? When?What population(s) will be negatively impacted? How? When? Will the policy impact health disparities / health equity? How? What are the projected short- and long-term outcomes? Are there gaps in the data/evidence-base?
visually illustrate your analysis so that decision makers can arrive at a decision with a clear and organized understanding of risks and benefits.
Policy analysis table (decision matrix)
policy analysis & PH goals
Provide a clear and organized structure for analyzing problems and considering solutions. Provide policy makers and other stakeholders with scientific evidence as they consider various policy alternatives objectively and comprehensively. Help all parties consider crucial aspects of a policy, including scientific evidence, economic impacts, social effects, and trade-offs. Aid the translation of science into evidence-based policy.
provide a framework to assess capacity and performance of public health systems and public health governing bodies
The National PH Performance Standards (NPHPS)
no lobbying for federal fund disseminating policy recs
U.S. Code Title 18, Section 1913 apply to: apply to CDC/HHS employees, grant recipients, subrecipients, and agents acting for such recipients or subrecipients, including participants of conferences supported by federal funds and cooperative agreements Federal funds may not be used in any part for any activity designed to influence the enactment of legislation
feasibility questions
What are costs associated with the policy?For public (federal, state, local) and private systems to enact, implement, and enforce the policy?For individuals? What is the value of the benefits (i.e., economic value of the health outcomes)? How do the costs compare to the benefits?What are the cost savings or return on investment (ROI)?How are costs and benefits distributed?What is the timeline for budgetary and economic return on investment?
fiscal and economic questions
What are costs associated with the policy?For public (federal, state, local) and private systems to enact, implement, and enforce the policy?For individuals? What is the value of the benefits (i.e., economic value of the health outcomes)? How do the costs compare to the benefits?What are the cost savings or return on investment (ROI)?How are costs and benefits distributed?What is the timeline for budgetary and economic return on investment?
Why is it important to prioritize policy options?
assists decision-makers in identifying the ones on which they should focus their limited resources
weighting scheme
criteria or components of a criterion would not be equally considered as you assess the candidate options. When consulting with leadership and colleagues, you may design a weighting scheme (depending on the relative importance of each criterion or components). You would then apply the weights in a scoring system you would design to prioritize the options.
How does the government use policy analysis?
develop and implement laws, regulations, procedures, administrative actions, incentives, or voluntary practices and evaluate their impact.
a proactive, systematic collection and review of internal and external information about events, trends, and expectations.
environmental scan
STEP 2C: prioritize policy options
from rating assigned in 2B, evaluate policy alternatives against each other + prioritize policy options
Grey literature refers to documents issued by governmental agencies, academic institutions and other groups. These documents include papers, reports, technical notes, newsletters, working papers, theses, government documents, bulletins, fact sheets, conference proceedings, and other documents. Grey literature is not distributed or indexed by commercial publishers.
grey literature
a good tool to help you determine the potential differential impact of a policy on various populations.
health impact assessment (HIA)
where there's not a clear winner, it may be useful for you to unpack the criterion categories and conduct analysis on ___ components, rather than the criterion as a whole
individual
Can the CDC lobby at the federal, state, and local level?
no
What is one of the 3 core PH functions?
policy
law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions
policy
systematic process involving the use of quantitative and qualitative methods to identify, compare, and select policy interventions that will achieve objectives and maximize outcomes most efficiently - second domain
policy analysis
articulates the "key behaviors" Policy analysis comprises
policy analysis competency
Establishing criteria for evaluating policy options (policy analysis)
policy options assessed against criteria you establish to help further assess viability - compare the options against each other to determine the relative strengths and weaknesses of each and to build an analysis that clearly illustrates the trade-offs in each option.
Policy decisions are frequently reflected in
resource allocation
conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.
social determinants of health
modifying existing policy options (Policy analysis)
social, civic, cultural and economic contexts in which the health problem has been identified is critical when assessing whether previously successful (or failed) policy options would (or would not) work as well in your case.
PH practitioners sometimes have to provide recommendations that involve policy before all variables are known or with limited evidence. T or F
true
Ranking Criteria (policy analysis)
your ranking scale will likely be based on the priorities of the team, leadership, decision-makers, or stakeholders and the severity of the public health problem