Policy and Strategy for Improving Health and Wellbeing

Lesley Coles, Elizabeth Porter, Lesley Coles, Elizabeth Porter

• Publisher: Learning Matters
• Year: 2011
• ISBN:
  9780857250087
• Edition: 1
• Topic: Medicina
• Subtopic: Sanità, amministrazione e assistenza pubblica

As health policy at a national level has ever increasing impact on local health services, it is essential that public health students understand how the development and implementation of policy and strategy provide the framework for improving quality, innovation, productivity and prevention in the delivery of healthcare.

The book is divided into two sections, with section one covering a strategic overview of national policies, and section two giving specific local implementation of policy examples to support section one. Case studies and examples will help the reader to understand the policy and strategy and to apply them to their local setting.

chapter 1
Policy: What Is It? How Is It Made?

Susie Sykes

Meeting the Public Health Competences

Core area 3: Policy and strategy development and implementation to improve population health and wellbeing

This chapter will help you to evidence the following competences for public health (Public Health Skills and Career Framework):

• Level 5(b): Awareness of the complexity of the policy context and how policy is made;
• Level 7(b): Knowledge of the policy setting context and the process of policy development;
• Level 7(e): Understanding of the concepts of power, interests and ideology in policy development;
• Level 8(b): Understanding of the strategic context of policy development.

This chapter will also assist you in demonstrating the following National Occupational Standard(s) for public health:

• PHP35: Advise on how improvement can be promoted in policy development;
• PHP36: Contribute to the formulation of policy specifically focused on improving health and wellbeing.

This chapter should also be useful in demonstrating Standard 10 of the Public Health Practitioner Standards:

Standard 10: Support the implementation of policies and strategies to improve health and wellbeing outcomes – demonstrating:

a. knowledge of the main public health policies and strategies relevant to own area of work and the organisations that are responsible for them;

b. how different policies, strategies and priorities affect own specific work and how to influence their development or implementation in own area of work;

c. critical reflection and constructive suggestions for how policies, strategies and priorities could be improved in terms of improving health and wellbeing and reducing health inequalities in own area of work.

Overview

This chapter will help you to consider what is meant by the term policy – and, in particular, health policy – and examine the importance of it and the role it plays in public health. It will explore the different approaches to policy making and the various stages involved in the policy-making process. It will help you to consider the key drivers of policy, and will look at the role of political and ideological factors, research and evidence, stakeholders and actors, and contextual issues in getting public health issues on to the policy agenda and in influencing the shape of policies.

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Introduction

Public health practitioners are continually called on to implement organisational, local or national policy directives. A clearer understanding of how these policies have been formed, and why they have taken the shape they have, enables the practitioner to assess them more critically, gauge their potential effectiveness and implement them more successfully. Understanding the policy development process also enables the public health practitioner to recognise the opportunities that exist to influence the policy-making process and to see themselves as part of the political process that underpins public health.

What is ‘policy’?

The term policy is one that enters the dialogue of public health practitioners on an almost daily basis. Policy governs and informs the planning and implementation of both strategies and projects, and provides a framework for the professional development of the workforce. This creates an understanding of the term that Jenkins has described as a tacit, practical working consensus (Jenkins, 2002, cited in Hodgson and Irving, 2007, p23), and for many operating within this working consensus the defining element of a policy is that it is embodied within a single written document (Green, 1995). However, on closer scrutiny, it is clear that it is not an exact or clearly defined term, and very often cannot be traced to one written source or document. Rather, policy takes on different forms, operates within different parameters, is arrived at following different processes, and is represented and communicated in many different ways.

ACTIVITY 1.1

Consider how you would define the term ‘policy’? What key features distinguish something as a policy?

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Numerous definitions of the term have been offered in the literature, many of which emphasise two aspects: ‘decision’ and ‘action’. For many, the fundamental definition of a policy is that it is a set of decisions made by those with responsibility for an area of public life (Buse et al., 2005). Hill (2005) makes the link between decisions and action, describing how a complex decision network may be involved in producing action. Thus policy is not static but a shifting phenomenon that may evolve with time as it is implemented and reviewed. Hill (2005) goes on to describe how policy is not necessarily expressed as a single decision, or indeed within a single document, but is often represented in a collection of decisions that relate to previous and existing policies. Indeed, policy decisions may not be explicit, but may remain implicit and simply understood as being the agreed position on an issue. ‘Non decision making’, or maintaining the status quo, may be as important in establishing a policy position as action-based decisions (Crinson, 2009). As Walt (1994) highlights, policy should be seen as something that governments say they will do, what they actually do and what they decide not to do.

For many, though, policy is about change and addressing an identified problem or achieving a specific goal. Titmuss’s often quoted definition embodies this when he describes policy as the principles that govern action directed towards given goals. The concept denotes action about means as well as ends and it, therefore, implies change: changing situations, systems, practices, behaviour (Titmuss, 1974, p23). Indeed, for Torjman (2005), the selection of a destination or desired goal is the core of policy development. This perspective was represented in New Labour’s view of policy as part of its modernisation of government: Policy Making is the process by which governments translate their political vision into programmes and actions to deliver ‘outcomes’ – desired changes in the real world (Cabinet Office, 1999, para. 2.1).

Decision making requires some form of legitimacy and Colebatch’s definition emphasises policy as the maintenance of order in society through legitimate authority that is informed by relevant expertise (Colebatch, 2002). It is clear that policy can be dictated at an international, national, regional, local and organisational level, but that the decision makers must have the appropriate authority to do so. As such, these decisions will be influenced by the values of those decision makers, leading Easton (1953) to describe policy as the authoritative allocation of values. This is not to say that policy is defined only by decisions made by what Buse et al. (2005) term the policy elite. Policy is also the result of the actions taken by professionals during the implementation stages of policy making (Barrett and Fudge, 1981). The issue of influencing policy through implementation will be looked at in more detail later.

It is helpful to see policy as an umbrella term embodying other terms, such as public policy or the general actions and regulations put in place by government, health policy – or those regulations that relate specifically to the health of the population, whether this is the allocation of resources, development and management of services or measures to reduce inequalities in health and social policy – or the actions and regulations designed to protect and improve the social welfare of a population. It is important to add to these types of policies the term healthy public policy. This is the positioning of health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health (World Health Organization (WHO), 1986, p2). Thus, healthy public policy is more than policy put in place to govern healthcare – it is concerned with the role of all government departments in creating conditions that support and promote health, and ultimately reduce inequalities in health.

Characteristics of policy

Jenkins (2002), in his analysis of definitions of the term policy, identifies a number of core propositions that underpin them.

• Policy is an attempt to define, shape and steer orderly courses of action, not least in situations of complexity and uncertainty.
• Policy involves the specification and prioritisation of ends and means, and the relationships between competing ends and means.
• Policy is best regarded as a process, and as such it is ongoing and open ended.
• The policy process is, by definition, an organisational practice.
• The policy process is embedded in and is not distinct from other aspects of organisational life.
• Policy appeals to, and is intended to foster, organisational trust – that is, external trust of organisations, and trust within organisations – based upon knowledge claims and expertise.
• Policy appeals to, and is intended to foster, organisational trust based on legitimate authority.
• Policy is about absences as well as presences, about what is said as much as what is not said.
• Policy may be implicit as well as explicit.

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ACTIVITY 1.2

Consider what the difference is between:

• policy;
• strategy;
• programme;
• guidelines.

Comment

While a policy represents the decision makers’ position on a particular issue, a strategy represents the high-level plan or course of action that will be taken to bring about change. A programme can be defined as an intervention or series of interventions that have been developed to achieve particular aims and objectives. Guidelines offer the practitioner an outline of how to operate based on best practice when undertaking a particular activity.

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Despite the difficulties in agreeing a definition of the term, it is clear that policy plays a crucial role in managing both the health service and health inequalities. The complex nature of health and its wide determinants, the size of the health sector and huge cost of the health service, as well as the potentially life-and-death nature of the field mean that strategic decision making and planning are essential. Milio (1986) identifies five key ways in which policy supports health:

1. fiscal/monetary – incomes and incentives;
2. regulation;
3. provision of goods and services;
4. supporting participation;
5. research, development, information and education.

ACTIVITY 1.3

Identify a public health issue that you are involved in addressing. What policy exists to address that issue and underpins the work you do?

Using Milio’s framework, consider in what ways this policy supports the issue. Does the existence of a policy on this issue help or hinder you in your work?

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As indicated above, policy can be developed at organisational, local, regional, national and even international levels. While it is possible to take different ideological positions regarding the extent to which the state should exert control and make policy on health and social issues, it is clear that its role has expanded in recent decades. Indeed, governments have a duty to ensure that the conditions...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword from the Series Editor
• Foreword from Professor Vari Drennan
• Author Information
• Introduction
• chapter 1. Policy: What Is It? How Is It Made?
• chapter 2. Political and Ideological Context of Policy
• chapter 3. Strategic Context of Policy: A Look at UK Policy for the Four Nations
• chapter 4. Communicating and Implementing Policy and Strategy to Improve Health and Wellbeing
• chapter 5. Developing a Strategy for Implementation of Policy
• chapter 6. Tackling Health and Social Inequalities
• chapter 7. Social Determinants of Health – Housing: A UK Perspective
• chapter 8. Social Determinants of Health – Child Poverty: A Northern Ireland Perspective
• chapter 9. Development and Implementation of Policy – Children and Young People: A Welsh Perspective
• chapter 10. Communities and Health: A Scottish Perspective
• chapter 11. Lifestyle Factors – Nutrition: An English Perspective
• chapter 12. Lifestyle Factors – Substance Use and Misuse: A UK Perspective
• References
• Index