Policy, Systems, and Environmental Change in Cancer Control Maryland Cancer Collaborative Annual...

Policy, Systems, and Environmental Change Policy, Systems, and Environmental Change in Cancer Controlin Cancer Control

Maryland Cancer Collaborative Annual MeetingMaryland Cancer Collaborative Annual Meeting

January 14, 2013January 14, 2013

Meredith Truss, MPP

Health Policy Analyst, Center for Cancer Prevention and Control

Maryland Department of Health and Mental Hygiene

Prevention and Health Promotion Administration

Prevention and Health Promotion Administration January 14, 2013

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Maryland Cancer CollaborativeMaryland Cancer Collaborative

The goal of the Maryland Cancer Collaborative is to work with individuals and organizations throughout the state to implement the Maryland Comprehensive Cancer Control Plan.

In addition, the Collaborative will bring together existing groups and new partners from across the state to collaborate on a common goal: reducing the burden of cancer in Maryland.


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Given limited resources, how Given limited resources, how can we maximize our impact?can we maximize our impact?

Shift the focus of cancer control programs and interventions:

Individual Behavior and Direct Services

↓

Infrastructure to Support Healthy Behavior

Infrastructure includes public policy, healthcare systems, and physical environments


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Policy, Systems, and Policy, Systems, and Environmental ChangeEnvironmental Change

Policy, Systems, and Environmental (PSE) changes enhance infrastructure

PSE changes are interventions that modify environments to provide healthy options and to make healthy choices easy for everyone


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PSE Change Cont.PSE Change Cont.

If we focus on adapting policies, systems, and environments, we can maximize resources by extending our impact to reach more people

By modifying the environmental context, we can support healthy choices across a population vs. an individual


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PSE Change Cont.PSE Change Cont.

The health impact pyramid.

Thomas R. Frieden, MD, MPHAm J Public Health. 2010 April; 100(4): 590–595.

PSE Interventions


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Individual = Counseling a 16-year old patient about sunscreen use and avoidance of artificial UVRPSE/Population = Legislation that bans tanning beds for minors


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Policy ChangePolicy Change

Policies = Rules Legislation Regulations Ordinances Organizational Policy Corporate Policy

Policy change can be large-scale (enactment of a federal law mandating that all health insurance plans cover cancer screenings with a USPSTF Grade A or B recommendation) or small-scale (a small business owner providing employees with paid time off for cancer screenings)

Policy change can drive systems and environmental change


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Systems ChangeSystems Change

Changes made to the rules and/or processes of an organization (often a type of policy change)

Focuses on changing infrastructure within a school, park, community, worksite, or health care system (delivery or insurance)

Health care system changes can ensure effective delivery and utilization of services to prevent, detect, and treat cancer


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Environmental ChangeEnvironmental Change

Changes made to the environment to promote health by making healthy behavior and choices easy (can be achieved through policy change)

Environmental change can be large-scale (e.g. installing sidewalks throughout a community) or small-scale (e.g. installing signage to mark existing park trails)

Includes physical, economic, and/or social environments


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What’s the difference?What’s the difference?

Policy Systems EnvironmentDefinition Changing laws, regulations,

resolutions, ordinances, or rules

Changing processes or rules of an organization, institution, or system

Physically changing the environment

Settings Legislatures (national, state, local), government administrations, healthcare settings, schools, worksites, community organizations (faith-based, daycare, senior center)

Healthcare delivery and insurance systems, schools, worksites, communities, parks

Physical (stores, schools, worksites, parks, health clinics/offices), economic, and social environments

Examples Increasing tobacco taxes, implementing a smoke-free policy (hospital grounds, college campus, worksite, etc.), implementing a healthy meeting policy at work

Developing a community plan that accounts for health impact of projects, reviewing and revising organizational procedures to increase cancer screening rates among patient population

Constructing sidewalks to make roads pedestrian-friendly, designating a lactation room for nursing mothers at work, offering healthy vending machine options

Overlap Smoke-free policyHealthy vending machine policy

Adding night/weekend healthcare provider/clinic office hoursZoning restrictions/limitations on fast food establishments

Farm-to-school program


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PSE Change Vs. ProgramsPSE Change Vs. Programs

Setting Program/Event PSE Change

School Celebrate national nutrition month

Add fruits and vegetables to cafeteria lunch options

Community Host a community bike ride

Implement a Complete Streets policy to ensure community roads are safe for biking, walking, and driving

Worksite Hold a health fair for staff

Implement a healthy vending machine policy that offers healthy, affordable snacks

Radiology Facility Hold a low-cost mammography event

Change operating hours to include night and weekend appointments

Hospital Hold free breastfeeding courses for new moms

Implement WHO 10 Steps to Successful Breastfeeding

Adapted from http://www.cookcountypublichealth.org/files/CPPW/PSE%20Change.pdf


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Cancer Plan Examples- PreventionCancer Plan Examples- Prevention

Tobacco and Lung Cancer Chapter:– Goal 1, Obj 2, Str 4: Engage with college and

university administrators to ensure that all school campuses are tobacco-free at all times.

– Goal 1, Obj 3, Str 1: Adopt state and local policies that prohibit the smoking of tobacco products inside multi-unit housing in MD.

Ultraviolet Radiation and Skin Cancer Chapter:– Goal 2, Obj 1, Str 1: Encourage funding for the

building of covered structures and implementing signage at public beaches and parks reminding people to wear sunscreen.


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Cancer Plan Examples- DetectionCancer Plan Examples- Detection

Colorectal Cancer Chapter:– Goal 1, Obj 1, Str 3: Increase the proportion of primary care

providers and specialists who utilize evidence-based approaches such as physician recommendation for screening, client reminders, and chart review to ID patients appropriate for screening.

– Goal 2, Obj 1, Str 4: Reduce barriers to CRC screening by utilizing strategies that facilitate primary care referral to specialists for screening, facilitate screening by use of patient navigators, community health workers, or lay health advisors, and/or encourage improved coordination between primary care providers and specialists.

Breast Cancer Chapter:– Goal 2, Obj 1, Str 3: Support policies that allow work-time

release to obtain cancer-screening services.


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Cancer Plan Examples- Cancer Plan Examples- Treatment & SurvivorshipTreatment & Survivorship

Pain Management Chapter:– Goal 1, Obj 2, Str 1: Collaborate with pharmacies to ensure that

pain medication is adequately stocked in all communities and explore legislation that would require pharmacies to stock pain medication.

Palliative and Hospice Care Chapter:– Goal 1, Obj 2, Str 3: [Healthcare institutions] develop a strategic

plan that incorporates goals and tactics to institutionalize palliative care.

Nutrition, Physical Activity, and Healthy Weight Chapter:– Goal 1, Obj 5, Str 1 & 2: Implement programs in MD jurisdictions

to promote access to healthy foods and physical activity in high-risk communities (virtual supermarkets, SNAP at farmers’ markets, partnership with park & recreation program, etc.)


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Cancer Plan Example in Action: Cancer Plan Example in Action: MCC Primary Prevention & MCC Primary Prevention &

Policy CommitteesPolicy Committees

Policy Tobacco Priority: Adopt state and local policies that restrict the sale, advertising, and promotion of tobacco products by…

Prevention Tobacco Priority: Require that tobacco retailers: (a) display effective health warnings about the use of tobacco products; (2) display information on where to get help if you want to quit using tobacco; (c) ban so-called ‘power walls’ (large displays of tobacco products and ads; and (d) ban the distribution of ‘free-samples’ of all tobacco products.

Maryland Maryland Prevention and Health Prevention and Health

Promotion Promotion AdministrationAdministration

Cancer and Chronic Disease BureauCancer and Chronic Disease Bureau

Center for Cancer Prevention and ControlCenter for Cancer Prevention and Control

Prevention and Health Promotion Administration [Date]

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http://fha.dhmh.maryland.gov

Policy, Systems, and Environmental Change in Cancer Control Maryland Cancer Collaborative Annual...

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