Letting the Body of Evidence Speak Volumes for Policy

It is hard to be strong in fortitude based solely on principle when you making that action alone. We co-exist with others. Policy is there to help orchestrate a health strategy to support these socially accepted goals of better health outcomes. The point of better health is to reduce pain and cheat death as long as possible. In this quest, is a clinically imperfect body one owned or owed to society? We in health policy need to take a moment to ponder this question. Whose body is it anyway that the policy is built around? What can be held as private when the collective’s health is at stake? People are embodied. Simply, each person has an acknowledged connection to his or her body. The sum of those bodies comprises the target populations that public health sets out to help. Our public health initiatives affect the whole “body” of society. Torjman (2005) put it succinctly, “At the end of the day, the formulation of public policy involves a process of making good decisions – for the public good”. Public health by nature deviates from clinical medicine in the sense that now public health is the overseer in your home, with the hopes of paternally people to leading more healthful lifestyles and improved quality of life. The narrative and public outcries can give perspective and requirement to act but above all we must make sure the policy priorities cannot be divorced from accepted evidence (Niessen et al. 2000). We in health policy are in the business of working magic to usher legislative and political changes while leapfrogging with human agency. Policy is called to strike the perfect balance between finessing risk in its favor with the most economically reasonable actions with the least of amount of societal discord. Under these terms, policy is considered effective (Nagel 1986).

Hovland (2007) warns of the gap of influence that peer reviewed research may have on policy that must be responsively more rapidly. As Hovland (2007) said, it is all about impact. I add that it is all about systemic impact over time. There are policy outfits that are more the research institute and may have more comfort in this call for evidence. Sentiment drives policy. However, data framing must ground our policy in response to social sentiment and political pressure. Calculated risk may fail to not account for are the specific systemic factors such as special interests, social media blitz or dwindling National Institutes of Health (NIH) public health funding are blockages that policy people know all too well.
The dinged battle armor of policymakers continues to be tested at every turn in this regard. Policy acknowledges the system working with supportive and against opposing social issues. Sometimes the opportunity is not taken or afforded to reintroduce the public to what policy does. In the arduous work in policy making, public health burdens change as it should in tandem with changing policy. Public health data is our friend and should remain so but sometimes policy needs an epidemiologist on speed dial. Then it is off to the races, the policy races, that is. There is no Derby Horseshoe Wreath and throngs of adorning fans at the finish. There is only a sneaky reposition of the finish line and some incremental improvements and setbacks in the state of public health along the way.

Public health calls for the judicious selection of targeted priorities. The U.S. Department of Health and Human Services’ 10-year “Healthy People” assessments tell us so and we heed the foreboding .There are times when the public require action on a health issue, that while worthwhile, that may not jive with the personal or even collective wants or the scientific evidenced priorities. Policies may react to an outcry of an event or issue that merits immediate action to a risk factor (reactive policy) (see Torjman 2005). Policies may be made for the short term or the long term concerns. We often hear of an Act being passed “in response to” an acute problem in hopes of reversing and/or reducing any residual effects of an acute event. The exigency of a particular situation demanding does not excise the fact that care must be taken in its development and implementation. However, network research by Crane (1991) has shown that if a problem from sparse to more populated problems may more quickly spread than anticipated. Health policy has to worry about medical as well as systemic spread.

“… if the incidence [of the problem] reaches a critical
point, the process of spread [within a network] will explode.” (Crane 1991)

The magnitude of the coverage of the health policy in part is defined with epidemiological evidence over time or proof of an emergent need happening now. Often in the aftermath of activating the existing policy, new developments that make evident the need for tweak or overhaul appear during the act of its use. Assessment while doing (such as outcome evaluation) is often necessary, good business. System based assessment for future policy allows for simulation of ready data to anticipate “what ifs” versus real-time trials where it is baptism by fire with no safety harness.

If a policy is afforded the liberty to be worked out over time without duress, policy stakeholders may relish in the ability to break down and reassess the policies before implementing them into action. But public health always has fires to put out. The epidemiology continues to shift and react to health actions and reactions, outdating the numerator. Often that urgency, which warranted, can cloud perception and impair the ability to notice critical issues undergirding the health emergency. Which public health issue cuts to the front of the line, the funded research priority or one seizing social outcry?
Health is grounded in the reducible epidemiological data and irreducible private experiences of the patients. The requirement to ground proactive policy in peer reviewed or trusted evidence is not without merit. Evidence is non-negotiable. I insist that enlisting the available evidence and observations into models. A model uses cadres of data to represent more simply what could occur in a system. There is a system beyond the static rates.

References
Crane J (1991) The epidemic theory of ghettos and neighborhood effects on dropping out and teenage childbearing. Am J Sociol 96: 1226-1259
Hovland, I. (2007). Making a Difference: M&E of Policy Research. Overseas Development Institute. http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion- files/2426.pdf. Accessed 10 April 2014
Nagel S (1986) Efficiency, effectiveness and equity in public policy evaluation. Rev Pol Res 6(1): 99-120
Niessen LW, Grijseels EW, Rutten FF. (2000) The evidence-based approach in health policy and health care delivery. Soc Sci Med. 51(6):859-869
Rose G (1985) Sick individuals and sick populations. Int J Epidemiol 14: 32–38
Torjman, S. (2005). What is policy? http://www.caledoninst.org/publications/pdf/544eng.pdf.
Accessed on 5 December 2013

(Anti-) Smoking, Complexity and U.S. Public Law 111-31

Using The United States’ The Family Smoking and Prevention Act (Public Law 111-31) as an example, complexity is inherent to anti-tobacco policy and how unexpected factors emerge once such a divisive policy is enacted. Passed during President Barack Obama’s first administration, The Family Smoking and Prevention Act (Public Law 111-31) became the most sweeping regulatory support in combatting a leading cause of preventable death in the United States that have been scientifically linked to tobacco use. The Family Smoking and Prevention Act did not take away access to tobacco to consumers of age. Tobacco is sold legally, under the continued regulatory oversight from the Federal Food and Drug Administration. Newly ‘strengthened’ regulatory powers supplied by this act works to ensure the “safest” possible tobacco products sold to U.S. consumers using the most ethical forms of marketing to the public. Safe is certainly used loosely here. The sale of tobacco as ethical is another question. But tobacco is legal to use for those of age to use the product. What is allowed from a regulatory standpoint by this Act is targeting sales, marketing and distribution channels.
Upon maximization, the virtuous goal is to optimize the desired benefit of tobacco control policy, thereby saving lives and improving quality of life from morbidity and mortality related to tobacco use.

“This legislation will not ban all tobacco products, and it will allow adults to make their own choices…We know that even with the passage of this legislation, our work to protect our children and improve the public’s health is not complete.”, President Barack Obama during the signing of the Family Smoking Prevention and Tobacco Control Act (2009)

“Deliberate or orderly steps are not an accurate portrayal of how the policy process actually works. Policy making is, instead, a complexly interactive process without beginning or end.” (Lindblom & Woodhouse, 1993).

President Obama’s statement illustrates the depth and limitations of the powers of policy and portends systemic mess that could possibly ensure even under the most noble of intention. From his statement, we can take away that the following issues are central to the prescript of the law.

1. Increasing regulation of a legal product, in this case, tobacco.
2. Blocking tobacco advertisements from children within a specified distance of schools and parks.
3. Making flavored tobacco distribution illegal. Menthol is excluded from this ban.
4. All harmful chemicals must be fully disclosed to the smoker along with graphic fear appeals on the labelling.
5. Public Safety overrides autonomous actions of the consumer. Some elements of the society, such as children, require higher ethical safeguards which require the power of policy behind it.
Is an advertisement on the way home from the park that falls outside of the banned quadrant acceptable? By the letter of the policy, it is allowed. Is it ethical at the point of exposure to the ad or to the mere possibility of exposure to the marketing? Menthol is exempt from federal ban. Menthol would be a gustatory nightmare that does not leave a smoker’s breath or lungs minty fresh. I would rethink a pint of vanilla bean and menthol ice cream, but the immense popularity of the menthol flavor in tobacco does not require a sugar cone. It requires demand. Do we have enough room on the carton? It is going to have to be microscopic font and some gory images.
I am a never-smoker but that reality does coat my social and intellectual observations of the “smoker”. When I have stood behind someone purchasing tobacco, I have marveled at the specification given by the customer when requesting a cigarette. The customer recalls with exact precision of the colors on the box, the shelf location, and the nature of acrid, intoxicating smell wafting from the creases of the box.

Nope…Yes, the box right there on the second shelf next to the Ultra non-filtered. I want those menthol non-filtered buy one, get one. It will be debit card. And a lighter.

Cigarette smokers have been found to have very high levels of brand loyalty (see Dawes, 2013). The smoker knows the brand, down to the flavor, even recalling the specifications of the box that they want. At times, perhaps another perceived equivalent cigarette will do just this once and buy a comparable brand if the requested one is not available (Dawes, 2013). For others, not having their brand is a game breaker. Dawes (2013) in his analysis of U.S. cigarette consumer panel data uncovered the strong power of perception in cigarette branding.
1. A smoker that purchases high end cigarettes most likely will not lower the expectation of the quality perception by buying a generic brand.
2. If there is a female aesthetic on the box, men will not bite at all even when the call of nicotine gnaws. They will look for a cowboy or something testosterone driven in marketing appearance.
3. Price point does matter.
4. If you want overwhelming consumer loyalty, market to a smoker.
(Dawes, 2012)
But is packaging the end of the story? It is only one of parameters churning.
Voluntarily taking the smokes off of the shelves is a different animal altogether. What if a pharmacy decides to no longer sell tobacco which in 2014 was being tried? The smoker may choose to patronize a competing pharmacy that still sells the desired product. In order to offset the loss of sales in tobacco, what other measures will be set in place by the corporation to keep the smoker in their pharmacy a happy customer for other durable goods or leverage opportunities to bring in more new customers to offset the effects of losing smokers’ business? From a public health standpoint, good job for removing tobacco. From a business standpoint, will that smoker decide to move his prescriptions to a rival pharmacy? From a system dynamics view, a business move that diminishes returns is a negative feedback while increasing returns is positive (see Sterman, 2000). While there are standalone pharmacies that only dispense medication, many pharmacies double as quick convenience stores. A smoker is a goldmine. There will be medications on the horizon, if not filled already, to treat the morbidities related to smoking.
How can the tobacco removal spin work, really? Will the spiel from the CEO announcing the policy to remove the tobacco products lose resonance once the Twitter frenzy ensues farther diluting the intended corporate message. Once a message is viral on social media, the more removed the policy machine becomes and the message becomes more susceptible to distortion and emotion. Does the removal of tobacco tricked to higher prices across all products in order to make up for the projected loss of profit? Does a nonsmoker care about using a tobacco free business if he never bought or consumed the product at that time of service? What effect, in the long term, will removing tobacco from one chain have on tobacco related outcomes? Will other pharmacy chains follow suit? As you can see, these policy tentacles overlap and intertwine.
References

Dawes, John G., Cigarette Brand Loyalty and Purchase Patterns: An Examination Using US Consumer Panel Data (August 9, 2012). Available at SSRN: http://ssrn.com/abstract=2126951 or http://dx.doi.org/10.2139/ssrn.2126951.

Lindblom, Charles E. and Edward J. Woodhouse. 1993. The Policy Making Process, 3 Edition.Upper Saddle River, NJ: Prentice Hall.

Sterman, J. (2000). Business Dynamics-Systems Thinking and Modeling for a Complex World. Boston: The McGraw-Hill Companies.

 

FYI- FAMILY SMOKING PREVENTION AND TOBACCO CONTROL AND FEDERAL RETIREMENT REFORM (US Public Law 111-31)

http://www.gpo.gov/fdsys/pkg/PLAW-111publ31/pdf/PLAW-111publ31.pdf.

Arts Humanities and Complex Networks final call for papers March 28, 2014

Invitations for submissions for

Arts, Humanities, and Complex Networks
— 5th Leonardo satellite symposium at NetSci2014

taking place in Berkeley at the Clark Kerr Campus of the University of California,
on Tuesday, June 3, 2014.

Deadline for submission: March 28, 2014.

TO SEE PAPERS PRESENTED AT LAST FOUR CONFERENCES SEE

http://ahcncompanion.info/ 

 

 

Melanie Mitchell Introduction to Complexity online course starting March 31

Dear friends and colleagues,

Please let your students and colleagues know about Santa Fe Institute’s free online course, Introduction to Complexity, which I teach at http://complexityexplorer.org.  The course has no prerequisites and is open to anyone with an interest in complex systems.  The course is free of charge.
 
The next offering starts on Monday, March 31, and people can enroll anytime during the course.  Some reviews from past students can be seen here.    
 
If you haven’t already seen our site, please check out our “Explorer” section, which may be useful to you as a teacher or researcher in complex systems.  
 
I encourage you to forward this to anyone you think will be interested.  Thanks for your help in getting the word out about our courses.    
 
All the best,
 
Melanie
 
Melanie Mitchell
Professor, Portland State University and Santa Fe Institute

Course offering: mathematical sciences in obesity research UAB

The mathematical sciences including engineering, statistics, computer science, physics, econometrics, psychometrics, epidemiology, and mathematics qua mathematics are increasingly being applied to advance our understanding of the causes, consequences, and alleviation of obesity.  These applications do not merely involve routine well-established approaches easily implemented in widely available commercial software. Rather, they increasingly involve computationally demanding tasks, use and in some cases development of novel analytic methods and software, new derivations, computer simulations, and unprecedented interdigitation of two or more existing techniques. Such advances at the interface of the mathematical sciences and obesity research require bilateral training and exposure for investigators in both disciplines. This course on the mathematical sciences in obesity research features some of the world’s finest scientists working in this domain to fill this unmet need by providing nine topic driven modules designed to bridge the disciplines.

For full details of the course, please refer to the application & draft agenda on our website at http://www.soph.uab.edu/energetics/shortcourse/first.  You may apply online at http://www.soph.uab.edu/energetics/shortcourse/first/application.

Limited travel scholarships are available to young investigators.

Please apply prior to Fri 3/28/2014. Accepted applicants will be notified no later than Fri 4/04/2014.  Women, members of underrepresented minority groups and individuals with disabilities are strongly encouraged to apply.

New! Journal of Policy and Complex Systems (JPCS)

The Journal of Policy and Complex Systems (JPCS) has published its inaugural issue. The JCPS aims to promote professional and public understanding of the relationship between policy studies and complex systems thinking, evolving greater understanding and engagement. Through its publication, JPCS hopes to establish a venue for reporting results of exploring, developing, and evaluating policies using cutting edge computational approaches to policy research, including complexity theory, agent-based modeling/simulation, chaos theory, fractals, dynamical systems, and the science of networks. It also aims to establish a repository of data and systems developed through research efforts reported in the journal. It is the hope of the journal and all of those involved in its publication, to bring together a community of multi-disciplinary and inter-disciplinary scholars to address common societal concerns, including social scientists, natural scientists, computational scientists, humanists, policy analysts, public administrators, and policy makers.

The first issue can be found at: http://www.ipsonet.org/publications/journals/108-publications/open-access/journal-on-policy-and-complex-systems

Mirsad Hadzikadic, Ph.D.
Editor in Chief, Journal of Policy and Complex Systems
Professor, Department of Software and Information Systems
Director, Complex Systems Institute
Faculty Director, Health Informatics Professional Science Master’s
Director, Data Science and Business Analytics Professional Science Master’s
UNC Charlotte/SSST Program Director
College of Computing and Informatics / The Graduate School
343-A Woodward Hall
UNC Charlotte
Charlotte, NC 28223
cciweb.uncc.edu/~mirsad<http://cciweb.uncc.edu/~mirsad&gt;
704-687-8643

Book manuscript flurry update

Well, I have been buried in finishing the book. I am not complaining. It is amazing how the mere publication formatting of a Word document makes one feel more accomplished. Well the manuscript is due next month…So here is where things stand.

I continue to find material that could be added but that does not translate to a should. Choose and parse wisely.

I have approached scholars who have offered their expertise to the book. Stay tuned!

I have mastered RightsLink for securing reprint permissions.

My SNA community has led me to NODEXL to visualize my networks for the book. Thanks bunches.

I will need to learn to index. Lord, help me.

I can see the light.

The SpringerBriefs series in Public Health Ethics offers “concise but substantial” coverage of pressing public health issues…Now I need to be concise for once.

Thanks to the editorial team. Thanks to my Orgcomplexity community for the positive vibes and encouragement.

ONWARD.

MBF

The Ethos of Batman- Human Metachanges in Muscular Motion

Bruce Wayne and his alter ego, Batman, is the epitome of dynamic contradictions.Not unlike Batman’s character struggles, character is built and questioned constantly, often without a law in sight.  Since we are tied to people who talk to each other and make social gestures that have to be recognized, the allegory of the gestures of Batman will be used in the following pages to demonstrate how dynamic systems of trust and relationship were right in front of us all along.

As the alter ego of Bruce Wayne, Batman’s identity rests with his strong sense of citizenship with the inhabitants of Gotham City as well as his fixation for vengeance. After the untimely deaths of Bruce Wayne’s parents, his sole purpose was fixated on righting wrong his way. Heroes or, even more interesting counterparts, the anti-heroes in comics are hyper-real. I, the hero, am good, which is obvious by my fluttering cape with the symbol emblazoned on my pectorals. You, the villain, in body skimming spandex sans cape or even the run-of–the-mill town crook, are not good. The anti-hero is downright malevolent (or perhaps just clueless). The duelists compete in a “language of gestures” (Mead, 1938). To Mead, meaning in the world is made through signals and gestures as a kind of social behaviorism (Mead, 1938). The hero saves the world from ruin. The crowned hero takes a right to the kisser. The miscreant falls ungracefully off the cliff on the outskirts of the city. The physical nooks and crannies around Gotham City are incredibly unexpected and diverse, would you not agree? The hero often appears out of thin air. The villain plunders for power and perhaps less importantly material gain. The hero prevails is immediately absolved for throwing city property at said villain. What brought the hero to that place?

Mead (1938) related this idea of gestures to primarily verbal communication. However this idea can be broadened beyond the spoken word. The superheroes in the bout use verbal and physical fighting so as to “make the gestures (the) same”. The villain gets squashed to smithereens by before mentioned city property then hobbles alone to the dark lair to hatch the next scheme. The higher level of cognitive significance of communicating started with those fisticuffs. But mind you, Batman returns to the dank dark cave…alone to live with consequences of his actions.

 Both hero and villain are tortured in levering heuristics that each in itself could wreak havoc with stability.  Each side of the superhero ethical equations brings undeniable fervor and passion. Bruce Wayne was pushed by a strong drive to avenge. But do superheroes or we mere mortals work primarily off of emotion? Should policy view society as one of rationalized competition for limited resources or one where there is collaboration? For that matter, how should be view “communities of solution” in the same fashion? I do not remember Batman having a brewski in the Arkham Asylum with The Joker. But people tend to demonstrate an allegiance to a side (if only for appearances) to maintain social accord or to leverage advantage.

Any change called metachanges, such as a misplaced physical punch or even a faulty ethical decision, could have major repercussions on the already delicate balance of power. The crooks are transporting from the city dock outdated cathode televisions that conceal booty. Batman swoops down. Good prevails. Bad is defeated for now. But will that Gotham peace last or be the most beneficial in the long term? Does Batman’s moral center waver?  

 

In part, policy must manage the social and ethical principles linked to the nature of these metachanges. Those in policy game realize all too well that the broader politicized arc is really a generalization of all those metachanges. Those metachanges, some perhaps deemed inconsequential or undiscovered, can have widespread dynamic changes on the larger social system. To that end, tackling these real world metachanges can lead to the large visible health payoff that society requires and expects resolution with their morning coffee. The villain is foiled and all is right in our Gotham until the same burgeoning health concern comes back on the top of the policy docket. Batman found the sweet spot briefly, retreating to his bunker wearing his dented Batsuit to the sage advice of his comrade, Alfred. Policymakers reenter the policy bunker, dodging the heuristics minefield, while shrouded by a porous cloak of political stability. The citizens of Gotham haunt them all in public health while some take a long drag on their cig to calm the nerves. It is back to the drawing board.

 

Reference:

Mead, George (1934) Mind, Self, and Society, ed. C.W. Morris (Chicago: University of Chicago Press)