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PubMed2006

Good governance for nutrition in the Philippines: elements, experiences, and lessons learned.

Malnutrition is a multifactorial problem that needs a multisectoral solution. This article reviews the role of good governance in nutrition programs, citing the Philippines as an example. In the Philippines, these efforts are reflected in the partnership between the public and private sectors in the establishment of the country's capability in research, policy-making, and program implementation. The establishment of the different public institutions engaged in research and policy-making is discussed, highlighting the role of political will through legislation. The evolving tasks of the nutrition program are discussed by citing the tasks in two eras. In the 1970s, the challenges were limited national nutrition data, man-power, tools, and health infrastructure. The public and private institutions were able to respond by legislating national nutrition surveys and dedicated nutrition workers in each village. The challenges in the current era are improved implementation of health programs, given the devolution of health services, and the gathering of an evidence base to further strengthen and refine the strategies of supplementation, fortification, breastfeeding, and food security. In responding to these challenges, multisectoral solutions and collaboration are critical in providing an evidence base to formulate policy. The role of the private sector, with the Nutrition Center of the Philippines used as an example, is that of a supportive and collaborative partner in good governance. Finally, the lessons learned from the past decades of implementing a national nutrition program, given changes in political and economic circumstances, are summarized.

Developing Countries↗
PubMed2002

Priority setting for health technology assessment in The Netherlands: principles and practice.

The resources for health technology assessment fall short of that needed to evaluate all health technologies. Therefore, priorities have to be set. In The Netherlands, the Health Care Insurance Board tried to address this issue by developing a more explicit priority setting procedure for the Fund for Investigative Medicine, which is the most important health technology assessment programme in The Netherlands. The procedure provides one of the first examples of the application of theoretical principles for priority setting. The aim is to select those health technologies for assessment that are most relevant for policy-making. To determine the policy relevance of research proposals, different procedures for categorising, scoring, and weighting policy criteria were defined, and different classification strategies were explored. Our first experiences using the priority setting procedure are described by means of an example on low back pain. Subsequently, the procedure has been applied to research proposals submitted to the Fund for Investigative Medicine in 1998 to illustrate how decisions on the funding of health technology assessments can be guided. The results show a different rating of research proposals into one of three predefined categories of policy relevance, high, intermediate and low, implying that decisions about funding can heavily dependent on the selected procedure. Therefore, it seems to be important that the selected procedure reflects the viewpoint of the organisation wishing to set priorities. The different ratings of the research proposals using a more explicit procedure suggest that there may be scope for further development and application of the procedure.

Health Policy↗
PubMed2005

Altering state policy: interest group effectiveness among state-level advocacy groups.

Because social policy making continues to devolve to the state level, social workers should understand how advocacy and policy making occur at that level. Interest groups active in the human services arena were surveyed and data were used to test a model of interest group effectiveness in four states. The independent variables were amount of resources invested, strategy used, relationships with key actors, use of coalitions, and policy positions taken. Results indicate that the model explains low to middling amounts of the variation in group effectiveness. Results also show that the model fits different states to different degrees, indicating that social workers need to approach advocacy in different ways to achieve maximum effectiveness in altering state policy. Implications for altering state policy are provided.

Consumer Advocacy↗
PubMed1990

The political dimension in health care technology assessment programs.

This article considers technology assessment (TA) to be a comprehensive form of policy research. Technology assessment must then have a relation to policy-making; in the area of health care, TA must relate to such political decisions as resource allocation. Since policies are determined politically, i.e., by factors such as power and influence, technology assessment is, or should be, part of a political process. Technology assessment seems to be developing predominantly as a technical and professional activity, carried out in centers with no relation to the policy-making process. While the impact of technology on health, as well as such broader impacts as those on financial costs, is a key concern, political considerations and political decision-making must always be an important dimension in health care TA.

Communication↗
PubMed1998

Priorities and strategies for promoting community-based prevention policies.

The public health community faces major choices in priorities for its mission in a rapidly changing environment. One option is to place greater emphasis on public health policy development. Policy making requires a grasp of the interplay among stakeholders, policy makers, the press, and the public. A framework for gathering relevant information and guiding strategic action is a useful tool for participation in community, state, and national arenas in the interests of population health. Organization-targeted approaches can make policy advocacy, community mobilization, and public education about policy issues more effective. This requires investment in public health infrastructure.

Attitude to Health↗
PubMed1992

Physicians and the state in the U.S.A. and Israel.

The paper focuses on two patterns of policy-making: a professional pattern in which physicians dominate, and a political pattern in which state authorities take the lead. It looks into the causes of the emergence of each of these patterns and their consequences, in terms of the equity of the health services and their efficiency. The U.S.A. and Israel provide examples for the professional and political patterns of health policy making. The causes for the development of the political pattern in the U.S.A. are grounded in the social salience of medical care, in physicians' economic power, and in the individualistic political culture. The politicization of health services in Israel came about owing to the low placement of health on the social agenda, the proletarianization of physicians, and the hierarchical administrative culture. Analysis of the results indicates that Israel portrays more equity in health services. However, in terms of efficiency results are mixed. In both countries, changes are taking place in opposite directions: more politicization in the U.S.A.; less in Israel.

Cross-Cultural Comparison↗
PubMed1996

Quality of life research and health technology assessment--a time for synergy.

Measuring quality of life and assessing technologies are both increasingly prominent in health care systems. This growth has accompanied growing concern over aging populations and health care expenditure growth. Nevertheless, there appears to be unrealized potential for synergy between quality of life research and technology assessment. In this paper, we consider the roles and challenges facing quality of life research in three domains: research-particularly clinical trials of therapeutics; clinical situations and policy-making. We then examine the potential for synergy in these domains and conclude that expanding collaboration will strengthen both fields and intensify their impact in research, clinical practice and policy-making.

Humans↗
PubMed1999

The psychology of social influence and healthy public policy.

Social-psychological research has led to effective health interventions based on social influence processes. For example, school-based substance abuse prevention programs using the social influences model consistently produce better results than programs emphasizing only health information. Other areas of application have been prevention of AIDS, marketing social action programs, community-wide health promotion, anti-prejudice intervention, aggression control, crime and injury prevention, and resource conservation. Yet another area for application is the emerging field of health promotion, which seeks to cross traditional boundaries to build healthy public policies in all sectors of society. A comprehensive social influences approach is needed because education alone is not likely to change fundamental ideas about where the responsibility for health rests. Current assignment of responsibility to the health sector and victim-blaming will be difficult to defeat. Positive changes at the required levels will depend on better understanding of how to instill health promotion values in policy arenas beyond the health care sector and better understanding of the dynamics of policy-making behaviors and related social influence processes. Social psychologists can and should assist the health promotion field to meet these challenges by conducting descriptive and intervention research on the psychology of social influence processes in public policy-making arenas.

Delivery of Health Care↗
PubMed2003

Congress, health care, and congressional caucuses: an examination of the Diabetes Caucus.

Caucuses have become a critical feature of the congressional landscape, yet are neglected in the literature on health-policy making in Congress. The principal goal of the article is to use the Diabetes Caucus as a case study to highlight this significant yet underappreciated political actor in the health-policy realm in Congress. The exploration, which draws on information gathered from thirty-two interviews with members of the Diabetes Caucus and their staff, will contribute to an increased understanding of both Congress's operations in the health area and the potential impact of caucuses on health-policy making. The article emphasizes particular characteristics relating to the membership and objectives of the Diabetes Caucus. In addition, the study stresses that the group had the requisite political momentum to achieve legislative successes when a policy window opened in the 105th Congress because it served much like, in the terminology of John Kingdon, a "policy entrepreneur".

Advisory Committees↗
PubMed1991

Tax administration as health policy: hospitals, the Internal Revenue Service, and the courts.

Since 1969 federal tax policy has permitted nonprofit hospitals to turn away indigent patients or to transfer them to public hospitals. The Internal Revenue Service made health policy, but its officials remain convinced that they were not making policy at all. Convinced that it was reasoning from legal principles, the Revenue Service accepted the hospital industry's view of the history and purpose of hospitals. The federal courts further obscured the problem. Moreover, the Revenue Service took no interest in the effects of its ruling on the services provided by tax-exempt hospitals until 1989. We describe these events and seek to explain them by linking the recent history of health policy to the assumptions that govern the making of tax policy. We conclude that the making of health policy by tax officials who are not accountable for it and who believe that they are not making policy at all is not in the public interest.

American Hospital Association↗
PubMed2003

Health impact assessment of agriculture and food policies: lessons learnt from the Republic of Slovenia.

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices.

Agriculture↗
PubMed2000

Using practice guidelines to allocate medical technologies. An ethics framework.

Clinical practice guidelines are expanding their scope of authority from clinical decision making to collective policy making, and promise to gain ground as resource allocation tools in coming years. A close examination of how guidelines approach patient selection criteria offers insight into their ethical implications when used as resource allocation or rationing instruments. The purposes of this paper are: a) to examine the structure of allocative reasoning found in clinical guidelines; b) to identify the ethical principles implied and compare how guidelines enact these principles with how explicit systems-level rationing exercises and health policy analyses have approached them; and c) to offer some preliminary suggestions for how these ethical issues might be addressed in the process of guideline development. The resulting framework can be used by guideline developers and users to understand and address some of the ethical issues raised by guidelines for the use of scarce technologies.

Biomedical Technology↗
PubMed2000

The significance of definitions of success in program evaluation.

In program evaluation, determining whether a program is reaching its goals is key to evaluating program success. Having an understanding of the stated goals of each organization within a system rather than simply knowing the formal system goals can aid in program development and inform policy making. Evaluability assessments were used initially as a means of learning how Philadelphia delinquency prevention programs define success. Subsequent surveys of programs were conducted to ascertain whether any changes in definitions of success had occurred. Examination of programs' definitions of success over time has facilitated program development and policy making.

Adolescent↗
PubMedDate not supplied

[Pressure or legitimization? Power and alternatives in the planning and adoption of health reforms in Costa Rica, 1988-1998].

Policies are made in response to the rationale of pressure and legitimization, which join forces in many different ways. This work analyzes the planning and adoption of the health reforms undertaken in Costa Rica between 1988 and 1998. It questions whether political parties, international financial institutions and the technical and bureaucratic elites in each sector can be taken as sufficiently explanatory of themselves. Empirical evidence would suggest that apart from investigating the individual interests of the agents involved, one must also consider the sector reforms that are actually available internationally. The paper draws this discussion into the larger scenario of policy making in Latin America and draws links between this and other stages in policy making and other moments in the construction of the State.

Costa Rica↗
PubMed1993

Health reform impasse: the politics of American ambivalence toward government.

This paper presents two interrelated arguments: it rethinks conventional understanding of the policy-making process and analyzes an important substantive issue regarding public opinion. The substantive issue involves the public's deep ambivalence toward government reforms: Americans are simultaneously supportive of significant reform and uneasy about expanding government involvement. The critical question is what, if any, impact this public ambivalence will have on policy deliberations. Answering this question requires an analysis of the role of public opinion in policy-making. Investigation of historic as well as contemporary health reform suggests that the impact of public opinion varies, depending on the character of both public opinion and the policy issue. The public's preferences are not especially influential when they are characterized by uncertainty or when an issue is not salient, but strong and sustained sentiment can affect agenda setting, interest group leverage over government officials, and policymakers' formulation of detailed administrative arrangements.

Attitude↗
PubMed1998

The National Bioethics Advisory Commission: bridging the tension between scientific and public policy analysis.

During the period between the early 1980s to the mid 1990s, the U.S. was distinguished from most other developed countries by its lack of a national-level public body to assist the government in its policy-making on topics of biomedical ethics. While Canada, Denmark, France, Spain, and other countries regularly sought advice from public commissions on issues ranging from reproductive technologies to euthanasia, the U.S. relied on myriad state commissions, court decisions, and academic bodies. The result was a pattern of policy-making that was slower and more unpredictable than that of its peers. With the 1996 appointment of the National Bioethics Advisory Commission (NBAC) by President Clinton, there has been a change in the process of U.S. public policy development. This article provides an overview of the NBAC and highlights recent areas of focus and related recommendations.

Advisory Committees↗