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Policy AdvocacyA public health trainee’s guide

Jason Cabaj, MD MScPGY4 PHPM ResidentMay 28, 2014

Community Health Sciences

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Session Objectives

Illustrate the relevance of policy advocacy in public health practice

Outline the knowledge gap in PHPM residency training

Describe a potential solution for public health trainees:

Learning module incorporated into a wiki-based knowledge management platform

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Background

Policy Definite course of action selected from among alternatives to guide present and future decisions— Public health policy— Healthy public policy

AdvocacyIndividual and social action designed to gain political commitment or support for a health goal or program— Key method of achieving policy change and

protecting/improving health— Ottawa Charter strategy

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Successful Policy Advocacy?

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PHPM Competencies

RCPSC PHPM Objectives of Training — 1.2. Identify opportunities for advocacy— 2.1.1. Recognize situations where advocacy is required and define

strategies to effect the desired outcome— 3.3.3. Discuss mechanisms of policy development and methods of

implementation, including legislation, regulation, and incentives— 3.3.5. Conduct a policy analysis and policy evaluation— 3.7.1. Demonstrate competency in advocacy skills— 5.2.5. Contribute to the formulation of healthy public policy or

legislation at local, provincial or federal level Minimum Competencies for MOHs in Canada (2009)

— MOH competencies similar but more advanced— Highly required skills when working in a political environment

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PHPM Training

PHPM training requirements— CanMEDS

Knowledge, attitudes, skills— Broad and location dependent

Variation in academic curriculum Variation in opportunities for application

— Policy competencies Most residents have little background in political and social

sciences Focus on the Policy Cycle and on KT

o Valuable but limitedo Policy development is black box

Need to understand policy process itself to successfully engage and influence

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Proposed Solution

Development of single consolidated resource— Focus on informing public health practice

Learning module for PHPM residents Potential utility for other public health trainees

— Process Two month rotation guided by academic public health

physician preceptor (Dr. Lynn McIntyre) Targeted readings Environmental scan Policy briefs and analyses Policy scans Module development

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Learning Module

Learning module content— Policy science overview (i.e. policy 101)— Policy process theories— PHPM physician roles in policy advocacy— Advocacy methods, skills, tactics— Key policy concepts— Competency application opportunities

Policy briefs, policy analyses— Links to external resources

NCCHPP, NCCMT, PHPC, CPHA— Knowledge translation overview

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Policy Science

Theories of policy process— Policy Cycle

i.e. Stages Model/Heuristic “Textbook approach”

— Advocacy Coalition Framework Paul Sabatier

— Multiple Streams Framework John Kingdon

Policy Window

Problems

Proposals

Politics

Relatively Stable Parameters

External Subsystem Events

Long Term Coalition Opportunity Structures

Short Term Constraints and

Resources of Subsystem Actors

Policy Subsystem- Coalition A- Coalition B

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Physician Roles

Public health physicians have many potential roles— Decision maker/policy maker— Policy entrepreneur— Advisor— Coalition member— Honest broker— Medical doctor— Government employee— Expert— Private citizen— Association member

Key Policy Concepts

Valence

Rhetoric

AgendaSettingFraming

PolicyWindow

PolicyImplementation

PolicyImplications

Policy Entrepreneurs

Module

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Wiki

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Applications for Module

Two models for use— Stand alone resource

Self-learning module for PHPM resident policy and knowledge translation competency acquisition

— Elective rotation/directed study course guide Core or supplementary resource guidance document Recently used to good effect by CHS graduate student

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Summary

The world of policy is complex— Lack of existing practice focused learning resources— Custom learning module provides a concise entry point

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Thank you

Questions?

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References and Resources

Baumgartner, F.R. (2013). Ideas and policy change. Governance: An International Journal of Policy, Administration, and Institutions. 26:2, 239-258.

Canadian Public Health Association - Policy and Advocacy page Moloughny, B. (2012). The use of policy frameworks to understand public

health-related public policy processes: a literature review. Prepared for Peel Public Health. Learn about public policies and their effects on health. National Collaborating Centre for Healthy Public Policy

National Collaborating Centre for Healthy Public Policy National Collaborating Centre for Methods and Tools Public Health Physicians of Canada - Advocacy Documents Sabatier P. (ed) (2007). Theories of the policy process. Westview Press.

Cambridge. Scott, J.M, Rachlow, J.L., Lackey, R.T. (2008). The science-policy interface: What

is an appropriate role for professional societies. BioScience 58:9, 865-869.

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Key Policy Concepts

Agenda setting— Policy agenda is the issues/problems that decision makers are paying attention to

Framing — How actors seek to understand and act on complex situations

Policy entrepreneur — Individuals who may influence policy processes due to position, network, and

persistence Policy implementation

— The process of turning policy into practice Policy implications

— Social, legal, ethical, environmental, economic, political, and organization factors Policy window

— Critical period of time when policy streams converge to facilitate policy change Rhetoric

— The art of effective or persuasive speaking or writing used in policy debates Valence

— The emotional quality of an idea that makes it more or less attractive