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.
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