Creating Public Health PolicyCreating Public Health Policy

Gail WortmannSchool Nutrition Policy

CDC’s 2005 Science Ambassador Program

Presentation OutlinePresentation Outline• Definition of policy

• Developing public health policy

• What public health policy can and cannot do

• Evaluation of public health policy

• An example of public health policy

• Your selection and evaluation of a schoolhealth policy

What is Public Policy?What is Public Policy?• Policy is action by an organization or institution to

address an identified issue through executive, legislative, or administrative means (1).

• Public health policy focuses on change to improve the health of the public.

The Start of a Public Health Policy

The Start of a Public Health Policy

Policy begins with scientific evidence that

1. Identifies a problem or place for change (2)

2. Demonstrates interventions proven effective and replicable in community settings (2)

Method of Policy MakingMethods of Policy Making

Legislation

• Passed by U.S. Congress / state legislators and signed by president / governor (2)

• Example: Children’s Health Act of 2000 –required the study of birth defects and developmental disabilities at the CDC (3)

Methods of Policy Making (con’d)

Methods of Policy Making(continued)

Regulation

• Rules made by an agency with appropriate powers (2)

• Example: adding folic acid to grain products to reduce birth defects (4)

Methods of Policy Making (continued)

Methods of Policy Making(continued)

Recommendations and guidelines

• Set by an agency (without regulatory powers) or a professional organization who has expert knowledge on a subject (2)

• Example: CDC’s guidelines for exposure to anthrax (5)

Methods of Policy Making –Intervention ProgramsMethods of Policy Making

(continued)

Intervention programs

• Nationwide or local effort aimed at changing a behavior or risk factor for a particular condition (2)

• Example: VERB program to increase activity in ‘tweens (6)

What Policy Can DoWhat Policy Can Do

• Lower the risk of being injured or becoming ill. Examples• No guns in school• Vaccinations

• Support or require changes in behavior or environment. Examples• Anti-smoking or tobacco chewing campaigns• Smoke-free buildings

What Policy Can Do – Ensure enforcementWhat Policy Cannot Do

• Ensure enforcement or support of new lawsExamples• Drinking and driving• Reduced speed limits near schools

• Enable action without a means to do soExamples• Child safety seats• Workplace standards

Policy EvaluationPolicy Evaluation

• Was the policy implemented as intended?

• Did the policy have the desired outcomes?

• Were there any unintended consequences?

• Were there any outside influences that affected the outcomes?

• What policy might have worked better?

Example of Public Health PolicyExample of Public Health PolicyRecommendation and fortification of folic acid (3)

• Neural tube defects are serious birth defects of the brain and spine.

• 50%-70% of defects can be prevented by taking folic acid before/during pregnancy.

• In 1992, the U.S. Public Health Service recommended 400 µg of folic acid daily.

• In 1998, mandatory fortification of cereal grain products with folic acid began.

Example of Public Health Policy - Recommendation

• Within 9 months, neural tube defects decreased significantly.

• Fortification continued and was re-evaluated.

• The Folic Acid Fortification Program was deemed a successful public health strategy (3).

3,0004,000

1999-20001995-1996Affected births

Example of Public Health PolicyRecommendation and Fortification of Folic Acid (continued)

Developing School Health Policy

Developing School Health Policy

Armed with your new knowledge of public health policy, you will now choose a health

policy for our school.

Choose Your Own PolicyChoose Your Own Policy

• Our issue: Obesity in Adolescents (7)

• Our goal: To choose a public health policy that will reduce/prevent obesity in our school population

• Our assignment: To check out the results of our chosen policy and evaluate the processes and outcomes

Choose Your Own “Adventure”Choose Your Own “Adventure”

Weight Monitoring PolicyMandatory Nutritional Course PolicyObesity Patch PolicyVending Machine Removal PolicyExercise Requirement Policy

Weight Monitoring PolicyWeight Monitoring Policy

The school will regularly weigh all students and keep track of their weight over time. The school board will be given ongoing reports showing weight gain/loss trends, which it wi ll share with the public.

Mandatory Nutrition Course Policy

Mandatory Nutritional CoursePolicy

The school will require all students to complete a course on proper nutrition and exercise, while keeping track of their dai ly food intake and exercise output. Passing the end-of-course test will be required for graduation.

Obesity Patch PolicyObesity Patch Policy

The school will require all obese students to wear a medicinal “patch” that will cause students to lose weight by raising their metabolic rate. The transdermal patch will be provided to students free of charge.

Vending Machine Removal Policy

Vending Machine Removal Policy

The school will remove all vending machines with high-sugar, high-fat foods and beverages from the school. Vendingmachines with healthy choices will still be available.

Exercise Requirement PolicyExercise Requirement Policy

The school will require each student to take physical education every day – no waivers for participation in sports activities. Daily lessons in physical education will center on activities and exercise.

EvaluationEvaluation• Assume your chosen school health policy has

been implemented. Time has passed and consequences, both good and bad, have arisen.

• Access the hyperlinked PowerPoint presentation “Choose Your Own Adventure: School Nutrition Policy.”

• Follow the links that show the consequences of your chosen policy.

• Evaluate your policy in light of its consequences and outcomes by using the worksheet“Evaluating Policy.”

ReferencesReferences1. Kelly M. Using Science to Make Policy for Public Health.

Presentation from the Science Ambassador Workshop, June 2003, Atlanta, GA.

2. Lagoy C. Influencing Public Health: From Research to Policy. Presentation from the Science Ambassador Workshop, June 2005, Atlanta, GA. [

3. CDC. Spina bifida and anencephaly before and after folic acid mandate - United States, 1995-1996 and 1999-2000. Morb Mortal Wkly Rep 2004;53(17);362-5. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a3.htm .

4. FDA. Folic Acid Fortification: Fact and Folly. 2001. [cited –add date]. Available from URL: http://www.fda.gov/oc/history/makinghistory/folicacid.html .

References (cont’d)References5. CDC. How to Handle Anthrax and Other Biological Agent

Threats. Emergency Preparedness & Response. 2001. [cited January 20, 2006]. Available from URL: http://www.bt.cdc.gov/DocumentsApp/Anthrax/10122001Handle/10122001Handle.asp .

6. CDC. VERB: It’s What You Do. 2004. [cited—add date]. Available from URL: http://www.cdc.gov/youthcampaign/ .

7. National Institutes of Health. NIH Obesity Research. 2005. [cited January 20 2006]. Available from URL: http://obesityresearch.nih.gov/About/about.htm .