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Using Evidence Based Public Health Policy to Prevent and Control Cancer

Using Evidence Based Public Health Policy to Prevent and Control Cancer



Presented by Beth Dodson from the Prevention Research Center in St. Louis. Presented at the 2011 Indiana Cancer Consortium Annual Meeting.

Presented by Beth Dodson from the Prevention Research Center in St. Louis. Presented at the 2011 Indiana Cancer Consortium Annual Meeting.



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  • See our chapter for notes on this
  • 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.
  • Personal visits: both us and constituents
  • Remember that these are leadership of health committeesin state legislatures.

Using Evidence Based Public Health Policy to Prevent and Control Cancer Using Evidence Based Public Health Policy to Prevent and Control Cancer Presentation Transcript

  • Using Evidence Based Public Health Policy to Prevent and Control Cancer
    Elizabeth Dodson
    May 19, 2011
    ICC Annual Meeting, Indianapolis, IN
  • “Science can identify solutions to pressing public health problems, but only politics can turn most of those solutions into reality.”
    Thomas Oliver, PhD
    Johns Hopkins Bloomberg School of Public Health
  • Objectives
    Understand the definition of evidence-based policy
    Understand some important barriers and challenges
    Explore how to overcome some of these barriers
    Illustrate principles with recent research results
  • What is a health policy?
  • Definitions
    “those laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior”
    Policies tend to influence the environment (legal, social, economic, and physical)
    Importance noted in the definitions of core functions of public health
  • At least 3 types of policy
    Formal laws, codes, regulations
    Clean indoor air policy
    Written standards that guide choices
    Engineering standards that guide street design
    Unwritten social norms
    Not ticketing for speeding 6-7 MPH above limit
    Harder to evaluate, often culturally driven
  • Policy potential
    How has health (or other) policy, today, already affected your life?
  • Top 10 public health achievements
    Motor-vehicle safety
    Safer workplaces
    Fluoridation of drinking water
    Recognition of tobacco use as a health hazard
    Each of these advances involved policy
    Centers for Disease Control and Prevention. Ten great public health achievements--United States, 1900-1999. MMWR 1999 Apr 2;48(12):241-3
  • Understanding evidence-based approaches
  • A simple definition of evidence-based public health
    “Evidence-based public health is the process of integrating science-based interventions with community preferences to improve the health of populations.”
    Kohatsu, et al. Am J Prev Med 2004.
  • Elements of evidence-based policy
  • Domains of Evidence-based Public Health Policy
  • Why worry about research & policy/practice?
    “… 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)
  • What do policymakers want or need from practitioners and researchers?
  • Three Fundamental Questions
    Is there a problem?
    Do we know how to fix it (intervention)?
    How much will it cost (financially, politically)?
    - What do all of these questions mean in the context of where we live and work?
  • Challenges and opportunities for evidence-based policyFinding the research-policy nexus
  • Because what you told me is absolutely correct but completely useless
    Where am I?
    Yes, how did you know?
    You must be a researcher
    Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me
    The problem
    Yes. How did you know?
    You’re 30 yards above the ground in a balloon
    You must be a policy maker
  • What are we learning about translating evidence to policy?
  • Examples of Policy Translation Challenges
    Clash of cultures
    Poor timing
    Ambiguous findings
    Balancing objectivity and advocacy
    Lack of relevant data
    From Brownson et al. AJPM 2006
  • Cancer Control Dissemination among State-level Policymakers
    Results from an ongoing project
  • Primary Project Goal
    Increase the dissemination of evidence-based interventions to control cancer focusing on the uptake of effective
    environmental and policy approaches
    among state-level policymakers
  • Methods: Conveying information via policy briefs
    Phase 1: Audience Research
    • Most policy briefs are text heavy and not “brief”
    • Randomized experiment
    • Compare data vs. narrative
    • Three key groups of policymakers
    • Read a brief then responded to a short questionnaire
  • Phase 1: State Selection
  • Phase 1: Policy Brief Design
  • Page 1
  • Page 2
  • Page 2
  • Pages 3 and 4
  • Phase 1: Data Collection
    • Pre-calls to legislators, staffers, and executives
    • Mailed policy briefs and surveys
    • Follow-up phone calls
    • Emailed PDF of brief and link for online survey
    • Personal visits
  • Selected results
    • Responses from 288 individuals in: Mississippi, Missouri, South Carolina, Pennsylvania, New Jersey, Oregon
    • Legislators (n=75)
    • Staffers (n=125)
    • Executives (n=91)
    • Overall, 35% response rate
  • Results
    What influences legislators’ health agenda?
  • Legislators:
    "How important are the following factors in determining what health issues you work on?"
  • Data trees on brief usefulness
  • Qualitative interviews with health committee members
  • When you hear the term “scientific evidence” what does that mean to you?
    • “Not much. The term is thrown around a lot. Science doesn’t mean it is good science.”
    • “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.”
  • Where do you go for scientific information?
    • “My most trusted source…I have a lot of constituents who bring items to me or ask me about things and I collect data from them…”
    • “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…”
  • What can you do to bridge the chasm between evidence and policy?
  • What can you do to bridge the chasm between evidence and policy?
    Understand the process
    Find a way to be involved in the process
    Communicate information more effectively
    Utilize analytic tools
    Educate a range of “players” (staffers, advocates)
    Provide training and education programs
  • Understand the process
    Vast literature in social psychology suggests policymakers mainly rely on
    Habit, stereotypes, cultural norms
    Sender credibility
    Factors affecting receptivity of policymakers to info-bearers
    Transparency of methods
    Plausibility of analysis
    Experts’ credentials
    Perceived impartiality
    Perceived track record
    Perceived honesty
  • Understand the process
    Political context
    policy-making less a rational act than a process of social influence
    “policy windows open infrequently and do not stay open long” (Kingdon, 1995)
    important to understand which policy options have the greatest potential for adoption and when small incremental changes are the preferred option
    use of rhetoric, art of persuasion, and ability to relate to the media (so called media or policy advocacy)
  • Be involved in the process
    Five key areas predict health policy capacity in public health practice:
    1) a well-organized agency including an effective organizational structure and central liaison responsibilities
    2) talented staff
    3) clear communications between the public health agency and policymakers
    4) effective negotiation skills
    5) active participation
  • Be involved in the process
    Consider a continuum of advocacy
    Raise general awareness
    Publish an article
    Present at a professional meeting
    Communicate findings to policymakers
    Develop short policy summaries
    Make data understandable to policymakers
    Actively lobby for a particular issue
    Conduct media advocacy
  • Communicate information more effectively
    “All politics is local.”
    The policy choices of elected officials are often designed to support their interest in being re-elected or re-appointed
    Agenda often don’t drive re-election, rather political parties
    Calculate statistics at the voting district or even precinct level than at the city level
    Make personal contact
    Break material down into bulleted or otherwise highlighted text (policy briefs)
    Use charts or graphs illustrating key points
    Explore the use of storytelling
  • Better utilize analytic tools (resources)
    Systematic reviews (like the Community Guide:
    Cost data
    Cost-effectiveness data
    Health impact assessments
  • Educate/advocate with a range of “players”
    For example, legislative staff members
    Gatekeepers and opinion shapers
    Often have a great deal of influence in forming the priorities of an elected official
    Build their knowledge and understanding of evidence-based approaches to policymaking
    Legislative staff seem to prefer longer, detailed reports
    Elected officials prefer short summaries
    Educate and engage the media
  • Provide training and education programs
    Most public health training programs focus on more analytic methods
    Yet lack more applied skills
    Look for models
    Many advocacy groups sponsor meeting and trainings to demonstrate the value of academic, industry, and government research
    Informal approaches may be even more effective
    One on one meetings
    What works in your own setting?
  • Overall Summary
    • Health policy development is crucial to health yet not always rationale and timely
    • To make progress it is important to understand barriers and all three domains of EB policy
    • Try to understand what is reasonable and potentially effective in your local situation
    • Find a way to be an advocate!
  • Collaboration with Indiana State Department of Health
  • Phase 2: Collaboration with Indiana State Public Health Department
    Overarching goal: Build capacity to design, implement, and evaluate evidence-based public health policy
    Indiana’s policy goals and PRC goal-specific activities
    Comprehensive statewide smokefree air
    Increase tobacco taxes
    Complete Streets
    Increase elementary school PE to 30 minutes/day
    Create policy briefs for lobby day with Indiana Campaign for Smokefree Air ( ICSA)
    Working with Indiana Tobacco Prevention and Cessation (ITPC) to create and update several sets of briefs for local settings
    Working with health department to create policy briefs
    Working with health department to create policy briefs
    Activities addressing all goals:
    1. Evaluation of five-year health policy work plan
    3. Baseline survey to assess: skills and competencies in EBPH, translating science to policy; communicating with media & policymakers/doing advocacy
    4. MIYO training for health department
    5. Creation/sharing of Netscan tool for partner use
  • Acknowledgements
    Project Team
    Ross Brownson
    Matt Kreuter
    Debra Haire-Joshu
    Doug Luke
    Tim McBride
    Katie Stamatakis
    Mike Elliott
    Nora Geary
    Chris Casey
    Tim Poor
    Nikki Caito
    Chris Wintrode
    Stephanie Chalifour
    National Cancer Institute
    National Conference of State Legislatures
  • Questions and notes from the field
    • How do your experiences with policymakers compare with ours and our findings?
    • How do the various levels at which policy is made (local, state, federal) impact your involvement with the policy process?
  • Thank you!
    Elizabeth Dodson