1. Policy Making Process and Policy Analysis
FPMU120: Health Policy for healthy lifestyles
Yuyan Shi, PHD
Department of family medicine and public health
University of California, San Diego
Spring 2016

2. Lecture Outline Announcements This lecture: Download readings
Public Health Research Day
Individual presentation
This lecture:
Learning objectives
Health policy making process
Bardach 8-fold Path for health policy content analysis
Acknowledgement: part of this presentation is derived from a presentation made originally by Dr. McMenamin in FPMU 120, Spring 2015 and These slides are used with Dr. McMenamin’s permission.

3. Announcements Public Health Research Day Individual short presentation
April 6th 2-5pm
Medical Education and Telemedicine (MET)
2-3 Panel Session in the Auditorium
3-5 Poster Session and Reception in MET
Individual short presentation
A well-defined health policy that aims to address a well-defined health behavior problem
Sign up before 4/5 or you get zero points.
Starts from Tuesday 4/5

4. Lecture Learning Objectives
Describe the steps to pass a law at federal and CA state level.
Describe the basic function, structure, and powers of the legislative & executive branches of government
To identify federal and state government organizations involved in public health policy making
To differentiate between analysis of policy making process and analysis of policy content
To identify the main steps in the policy making process
To identify the main steps in the analysis of policy content (Bardach 8-fold Path)

5. Federal Government Policy Making Process

6. *

7. *Legislative Branch Basic Function Structure of Congress
Pass legislation
Structure of Congress
Senate (2 from each state, 100 total)
House of Representatives (435 members allocated by population)
Powers Granted by Constitution
Levy taxes, collect revenue, pay debts, provide for the general welfare, regulate interstate and foreign commerce, establish federal courts, declare ware.
Source: Teitelbaum and Wilensky, Essentials of Health Policy and Law

8. *Executive Branch Basic Function Structure Powers Provide leadership
Implement legislation
Structure
The President
15 Member cabinet
Administrative agencies
Powers
Manage the cabinet
Appoint judges to supreme court
Veto power on legislation passed by congress
Issue regulations on implementation
Source: Teitelbaum and Wilensky, Essentials of Health Policy and Law

9. Federal Government Policy Making
Department of Health and Human Services
AHRQ (Agency for Healthcare Research and Quality)
CDC (Centers for Disease Control and Prevention)
CMS (Centers for Medicare and Medicaid Services)
FDA (Food and Drug Administration)
NIH (National Institutes of Health)
SAMHSA (Substance Abuse and Mental Health Services Administration)
More
Source: Teitelbaum and Wilensky, Essentials of Health Policy and Law

10. CA State Government Policy Making Process

11. CA State Government Policy Making

12. State Government Policy Making
“The Constitution gives states primary responsibility for protecting public’s health”
Organizations involved in state health policy making
Includes State Health Department
Other organizations vary by state
Local public health agencies
Source: Teitelbaum and Wilensky, Essentials of Health Policy and Law

13. Idealized Process of Policy Making
A troubling social condition comes to light and is documented.
Public officials assess the problem and its causes and to respond as efficiently as possible through such means as new legislative enactments.
Attention continues until the distressing concern is alleviated.
Source: Rochefort and Cobb. Problem Definition, Agenda Access, and Policy Choice. Policy Studies Journal. 1993;21(1):56-71.

14. In Reality… Policy Making is Complicated
Hundreds of actors
Multiple levels of government
Long time span
Technical debates
Most disputes include deeply held values, big money, and coercion at some level.
Source: Sabatier. Theories of the Policy Process. (1999)

15. Health Policy is Like a Soap Opera
Heroes
Villains
Victories
Defeats

16. Current Health Policy Disputes
Brain Break:
Take a moment to think about a health policy disputes you are familiar with
Take 2 minutes to share your interest with your neighbor
Share with the class

17. *Public Policy Making Process
Source: Texas Politics Policy Website:

18. *Bardach Eightfold Path for Policy Content Analysis1
Define the problem 2
Assemble evidence 3
Construct the alternatives 4
Select the criteria 5
Project the outcomes 6
Confront the trade-offs 7
Decide 8
Tell your story

19. Public Policy Making Process
Source: Texas Politics Policy Website:

20. *Policy Making: Step 1: Agenda Setting
Agenda setting is the process by which problems and alternative solutions gain or lose public and elite attention.
Group competition to set the agenda is fierce because no society or political system has the institutional capacity to address all possible problems that arise at any one time.
Groups must therefore fight to earn their issues’ places.

21. *Policy Making: Step 2: Policy Formulation
Policy Analysis to select best policy tool for given problem (Bardach 8-fold path)
Economic Policy Tools
Legal Policy Tools
Regulatory Policy Tools
Media Tools
Healthcare Financing Tools

22. *Policy Making: Step 3: Policy Adoption
Policy adoption can be influenced the same factors that affect the composition of policy agendas: the lobbying efforts of significant interest groups, crises, and public attention brought by the media.
Governors and mayors can adopt policies on the state or local level.
Congress plays a minimal role in policy adoption since it cannot initiate policies the way the president can.
The president has the sole ability of initiating new national policies.
Source: Boundless. “Policy Adoption.” Boundless Political Science. Boundless, 21 Jul

23. *Policy Making: Step 4: Policy Implementation
Includes all the activities that result from the official adoption of a policy.
Implementation is what happens after a law is passed.
We should never assume that a passage of the law is the end of policy making process. Sometimes laws are passed and nothing happens.

24. *Policy Making: Step 5: Policy Evaluation
Is the Policy addressing the problem?
How is the policy implementation proceeding?
If the problem is not fixed:
Revise the policy?
Issue new regulations?

25. Bardach Eightfold Path for Policy Content Analysis1
Define the problem 2
Assemble evidence 3
Construct the alternatives 4
Select the criteria 5
Project the outcomes 6
Confront the trade-offs 7
Decide 8
Tell your story

26. *Policy Analysis: Step 1: Define the Problem
Problem definition decides…
Who will be interested and affeted
(Individuals vs. marijuana producers)
Where policy debates should take place
(Health care system vs. state regulation vs. federal regulation)
What policy options should be used to solve the problem
(do nothing vs. legalization)

27. *Policy Analysis: Step 2: Assembling Evidence
Evidence should:
Assess the nature and extent of the problem.
Examine the policy environment - what is operationally and politically feasible?
Help identify policy alternatives.
Help assess proposed alternatives and project outcomes.

28. Policy Analysis: Step 2: Assembling Evidence
Evidence comes from:
Conducting literature searches.
Conducting a targeted search of the web.
Reading bill analysis and hearing testimony.
Reviewing public opinion polls.
Interviewing people by phone or in person.

29. *Policy Analysis: Step 3: Constructing Alternatives
Identify potential policy options to solve the problem.
Make a list of all alternatives you may want to consider.
Always include in your first approach the alternative of “Take no action.”
Research policies in other countries, states, counties
Identify policies used to address similar problems
In the FINAL stages limit the alternatives to 2 or 3.

30. Policy Analysis: Step 3: Constructing Alternatives
An example for marijuana regulation
Policy Type
Definition
Countries Example
Full prohibition
Marijuana use is criminal offense and subject to criminal control.
Most countries in the world
Depenalization
Marijuana use is criminal offense, but the severity of punitive consequences is reduced by various alternatives.
Canada, France, UK
Decriminalization
Marijuana use is regulated by non-criminal statues or interventions; criminal processing and punishment are replaced with civil or administrative sanctions.
Belgium, Denmark, Italy, Russia, Australia, US
Partial prohibition
Criminal laws associated with marijuana use are selectively enforced, or marijuana use is allowed at select spaces or populations.
Canada, US, Netherlands
Commercialization
Marijuana production, sale, and use are legal.
Uruguay, US

31. Policy Analysis: Step 3: Constructing Alternatives
What could be alternatives to control unprotected sex among teens?

32. Policy Analysis: Step 4: Select Criteria
Goals/values
Equity/Equality
Efficiency
Security/safety
Liberty
Practical Considerations
Politically feasible
Technically feasible
Effectiveness
Socially acceptable
Cost

33. *Policy Analysis: Step 4: Select Criteria
Relevance: does the intervention contribute to the health needs of the target population? Is it consistent with policies and priorities?
Progress: how do actual results compare with projected or scheduled results?
Efficiency: what are the results in relation to resource expenditure of the intervention?
Effectiveness: to what degree does this particular intervention attain its objectives?
Impact: what is the effect of the activity on overall health and related socio-economic development?
Collins, T. "Health policy analysis: a simple tool for policy makers." Public Health (2005):

34. *Policy Analysis: Step 5: Project the Outcomes
Think through what the potential outcomes are for each policy
Review existing evidence
Examine similar policies elsewhere
Be REALISTIC!
Explore both intended and potential unintended consequences.

35. Policy Analysis: Step 5: Project the Outcomes
An example of marijuana legalization
Recreational marijuana use remains illegal: costs for law enforcement efforts, fines for possession, no tax revenue, no impacts on marijuana use.
Recreational marijuana use becomes legal: increase tax revenues by X million, increase marijuana use in adolescents and adults, people from nearby states likely to purchase from CA as well.

36. *Policy Analysis: Step 6: Confront the Trade-offs
Determine which criterion is most important?
Equity? Liberty? Safety?
Create a matrix to see if one policy alternative is the clear winner
Eliminate any policy alternative which is dominated by another alternative across criteria

37. Policy Analysis: Step 6: Confront the Trade-offs
An example of recreational marijuana legalization.

38. *Policy Analysis: Step 7: Make Decision
What would you do if you were the decision maker?
Which policy would you recommend, and justify your choice!
Example: why legalize recreational marijuana?
Tax revenue increases
Big support from voters
Politically feasible in California
Respect individual liberty
Opens many opportunities to regulate marijuana
Example: why not legalize recreational marijuana?

39. *Policy Analysis: Step 8: Tell Story
Effective communication of first 7 steps is key!
Think about who your audience is
Think about what medium you will use to convey your message
Keep it brief and clear

40. Next lecture Policy Making Process Policy Strategies Policy Evaluation
Mass media tools
Pre-post and RCT
Policy process and analysis
Economic tools
Quasi-experimental design
Problem definition and agenda setting
Legal tools
Cost-effectiveness
Regulatory tools
Interest group
Cost-benefit
Healthcare financing