Introduction

Policy Development is one of three core functions of public health. Policy and advocacy are one of the 12 Maternal and Child Health Leadership Competencies. Understanding the roles and relationships of groups involved in public policy development and the implementation process is a critical skill. By building the right relationships with community coalitions, advocacy agencies (for example, AMCHP) and key decision makers (elected officials, members of executive bodies and key federal, state and local agencies) and those who have influence over them, policies may be designed and implemented that can dramatically affect the health and well being of a community. Investing time and resources into educating these coalitions, agencies and key decision makers is essential. Education, as opposed to lobbying, provides the information necessary for appropriate and effective policy development. Toward that end, this toolkit has been developed to offer assistance to our membership.

In an effort to make all of our work evidence-based, CityMatCH believes that data provides the platform for policy development. Based on the work of Dr. Milton Kotelchuck and Dr. Julius Richmond (Richmond JB, Kotelchuck M, "Political Influences: Rethinking National Health Policy," In: McGuire CH, Foley RP, Gorr A, Richards RW and Associates, editors. Handbook of Health Professions Education. San Francisco: Jossey-Bass Publishers; 1983. p386-404) CityMatCH developed the Data Use Triangle, which promotes the translation of data into action. Public health practitioners, equipped with accurate baseline and outcome measures, are able to assess need and plan, monitor and evaluate programs. By effectively translating data and incorporating public health values such as cultural competence, social justice and prevention, they are able to build political and social will and influence policies at the departmental, city, county, state, and federal levels.

Policy development has been proven to be among the most effective strategies for achieving broad public health goals. It can alter or ameliorate the forces that lie at the heart of the determinants of health. The other two core functions of public health, assessment and assurance, also play important roles. Ultimately, no core function is superior or independently sufficient. Indeed, successful policy development often relies upon strong public health capacity for assurance and assessment.

There are significant differences between policy development and program development, but both are essential to the health and wellbeing of a community and its members. Assurance is another core function of public health, and programs assure that needed personal health services are available and accessible to the individual.

Program development assures a competent health care workforce and informs, educates and empowers people concerning their health issues. Policy development, on the other hand, is broader in scope and has the potential to affect the community at large. Programs impact individuals throughout their duration, but policies can have an impact on communities for many years.

Programs can have a significant impact on reducing the effects of health disparities and disease for the individual. The focus of program development is to meet the needs of the individual, whereas the focus of policy development is the community and is more prevention oriented. By developing policies that focus on prevention and are designed to protect the health and well-being of a community, disparities in health and diseases that are directly related to them may be prevented or eliminated altogether.

The third core function of public health is assessment. Assessment includes monitoring health status to identify community health problems, diagnosing and investigating health problems and health hazards, and evaluating effectiveness, accessibility and the quality of personal and population-based health services.

The development of policies determines the rules by which opportunities are framed. They determine what is allowed or encouraged and also what is prohibited. The development of policies may lead to legislation at the federal level (for example, Medicaid), State level (for example, mandatory perinatal HIV testing for pregnant women) and local level (for example, local election laws can affect who is eligible to run for school boards, or local ordinances can require businesses to be good neighbors and clean up problems in and around their property).

Policy development can also determine the size, shape and character of communities and has the ability to affect large numbers of people by improving the environments where they live and work (for example, policies that address home remediation to prevent lead poisoning, or policies that mandate tobacco free environments). Policy development also offers protection to the consumer and can encourage people to lead healthier lifestyles. Examples of this include city ordinances to limit the number of fast food establishments or school policies to eliminate unhealthy foods from vending machines.

The Los Angeles County Tobacco Control and Prevention Program and the Center for Tobacco Policy and Organizing developed an advocacy model (The Phase Model) to build capacity. The five phases are:

  1. Community Assessment
  2. Policy Strategy
  3. Build or Broaden Coalitions
  4. Policy Implementation
  5. Policy Evaluation

Initially, the problem must be documented and the political environment investigated. This is the community assessment phase which provides the data portion of the CityMatCH triangle and functions as the foundation for policy development. The next step is to develop a policy strategy (as is represented by the Program/Action portion of our triangle). This is accomplished by setting goals (long, intermediate and short term), investigating organizational considerations, identifying constituents, allies and opponents, identifying policy/decision makers and determining tactics. The third step is to build coalitions or broaden them through recruiting, defining rolls and responsibilities and sustaining both energy and focus. The fourth step is policy implementation which requires building social and political will. This is accomplished through educating elected officials and utilizing partners who can lobby effectively. The final phase is policy evaluation, which includes developing evaluation designs, assessing goals and objectives and collecting process measures (for example, was the process effective - were the right meetings held, were they attended by the right people, etc.). By implementing these steps, the anticipated result is the development of policies that will improve the health and wellbeing of the community and its citizens.

In this toolkit you will find a variety of resources for policy development that can be used at the State and local level and examples of how CityMatCH members are advancing policy development in "leading edge" areas of MCH. Each resource utilizes one or more of the five stages of policy development identified by the Phase Model. To assist you in identifying the focus of each resource, we have assigned the following numbers/colors to each stage of policy development:

  • community assessment 
  • policy strategy 
  • coalition building or broadening 
  • policy implementation 
  • policy evaluation 

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