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Copyright 2008, The Johns Hopkins University and Gerard Anderson. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License . Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site.

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Page 1: What Public Health Policy Do You Want to ... - …ocw.jhsph.edu/courses/IntroHealthPolicy/PDFs/IHP_lec1_Anderson.pdf · What Public Health Policy Do YOU Personally Want to Change?

Copyright 2008, The Johns Hopkins University and Gerard Anderson. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site.

Page 2: What Public Health Policy Do You Want to ... - …ocw.jhsph.edu/courses/IntroHealthPolicy/PDFs/IHP_lec1_Anderson.pdf · What Public Health Policy Do YOU Personally Want to Change?

What Public Health Policy Do YOU Personally Want to Change?

Gerard F. Anderson, PhDJohns Hopkins University

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Section A

Overview: Interests of the JHSPH Department of Health Policy

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My Current Public Health Policy Concerns

People with chronic conditions are being treated by system designed to provide acute carePrices for medical services are much higher in the U.S. but outcomes are not necessarily betterInternational funding agencies should allocate more resources towards chronic diseasesPrices paid by the uninsured for hospital care are much higher than the insured pay

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My Current Public Health Policy Concerns

People with chronic conditions are being treated by system designed to provide acute carePrices for medical services are much higher in the U.S. but outcomes are not necessarily betterInternational funding agencies should allocate more resources towards chronic diseasesPrices paid by the uninsured for hospital care are much higher than the insured pay

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Some of the Policy Concerns of Faculty in the HPM Department

Compliance with prevention guidelines Injury preventionPublic health preparednessPromotion of physical activityGun safetyHealth care is available to everyoneWell being of seniorsEliminating disparities

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Advocating for Specific Issues

What is the most effective way to advocate for specific issues?

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Recent Publications

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Testimony in Congress

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Talk to Media

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Policy Development often Requires Analytic Methods

Most faculty in the department have . . .−

One or more areas of policy interest and they use specific methodological tools to promote/investigate/evaluate their policy interests

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My Methodological Tools

Analysis of large datasetsHealth care finance/economics

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Some of the Methodological Tools Taught in HPM

Survey designOrganization and management Cost effectivenessMeasuring quality of life/quality of careHealth care economicsEthicsProgram evaluationPolicy process

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Some of the Methodological Tools Taught in HPM

Survey designOrganization and management Cost effectivenessMeasuring quality of life/quality of careHealth care economicsEthicsProgram evaluationPolicy process

Page 15: What Public Health Policy Do You Want to ... - …ocw.jhsph.edu/courses/IntroHealthPolicy/PDFs/IHP_lec1_Anderson.pdf · What Public Health Policy Do YOU Personally Want to Change?

Section B

What Do the Policy Leaders Think are the Unaddressed Concerns in Public Health?

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The Future of the Public’s Health in the 21st Century

An Institute of Medicine committee developed 34 specific recommendations to improve the public’s healthIn your opinion, do they address the most important issues?

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Priority Setting

Which of the 34 recommendations would YOU decide to tackle first?

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Advocacy

How would YOU promote the implementation of this recommendation?

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Class Overview

Alternative models of policy processDetailed discussion of rational policy processPresentations by participants in policy processMethods used by policy analysts and policy makers

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Different Models to Understanding the Policy Process

1.

Rational

2.

Garbage can

3.

Incrementalism

4.

Cycle

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One Example of Rational Policy Process—Eight Fold Path

1.

Define the problem

2.

Assemble some evidence

3.

Construct the alternatives

4.

Select the evaluation criterion

5.

Project the outcomes

6.

Confront the tradeoffs

7.

Decide

8.

Tell your story

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Political/legal/ethicalNeed/demandEconomic/financialAssessment/evaluation

Analytic Methods Used in Developing Rational Public Health Policy

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Grading and Final

Five-page paper concerning the Eight-Fold Path and policy issue questionsFinal exam−

Short questions

Write an article on an issue in which you are particularly interested

See syllabus for more information

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Section C

Eightfold Path

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Policy Process

We are going to assume that the policy process is RATIONAL

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Other Models of the Policy Process

Incremental approachGarbage can

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Eightfold Path

There are many different ways to characterize the RATIONAL policy processWe will use a formulation by BardachOther characterizations are equally valid and may explain certain policy processes more completely or more accurately than the Eightfold Path

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Eightfold Path

Define the problemAssemble some evidenceConstruct the alternativesSelect the evaluation criterionProject the outcomesConfront the trade-offsDecideTell your story

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Define the Problem

What is the specific problem−

Be as concrete as possible

Why are you advocating a specific policy change?

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1. Define the Problem

Use too little/too much if possibleQuantify if possibleDefine the problem, not the remedyYou may need to redefine the problem several times

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Recommendation 29

Congress should increase funding to Health Resources and Services Administration (HRSA) programs that provide support for public health students…

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What Is the Specific Problem?

Not enough money is spent on public health trainingNot enough public health trainingPublic health professionals are poorly trainedLack of funding in public health training discourages interested applicantsPublic health students leave school with too much debt

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Specific Problem

Lack of funding in public health training discourages low-income applicants

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2. Assemble Some Evidence

Data—factsInformation—facts with meaning/categoriesEvidence—information that alters behavior

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Purpose of Evidence

Assess nature of problemAnalyze features of specific policy optionsAssess the performance of similar policies

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Value of Evidence

May cause a better decisionDifferent decision may lead to a better outcomeEvidence suggests how much the situation can be improved

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Different Approaches to Evidence Collection

Use analogiesSurvey “best practice”Literature reviewCollect data

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Assemble Some Evidence—Public Health Training

Debt of public health studentsDebt of public health students vis-á-vis other professional studentsReturn on investment in public health education vis-á-vis other professional students

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Assemble Some Evidence—Public Health Training

Application rates by income level

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3. Construct the Alternatives

Policy optionsAlternative courses of actionAlternative intervention strategies

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Approach to Construct the Alternatives

Start comprehensive, but end up focusedDifficult to evaluate more than four alternatives

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Construct the Alternatives—Public Health Training

Grant program to schools based on needGrant program to students based on needGrant program to schools based on abilityGrant program to students based on ability

Page 43: What Public Health Policy Do You Want to ... - …ocw.jhsph.edu/courses/IntroHealthPolicy/PDFs/IHP_lec1_Anderson.pdf · What Public Health Policy Do YOU Personally Want to Change?

Section D

Eightfold Path II

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Eightfold Path

Define the problemAssemble some evidenceConstruct the alternativesSelect the evaluation criterionProject the outcomesConfront the trade-offsDecideTell your story

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4. Select the Criterion

Analytic—what are the consequences?Evaluative—value judgments about consequences

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Potential Evaluative Criteria

Efficiency—maximize satisfaction (utility)Equity—maximize equality, fairness, social justicePersonal freedom—maximize individual choiceCommunity—maximize solidarityLegality—is it permitted?

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Select the Criteria—Public Health Training

Efficiency—lowest administrative costEquity—need-basedPersonal freedom—greater choice if all schools have fundingLegality—funding rules established by Congress

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5. Project the Outcomes

Most difficult stepHard to predict futureHard to be realistic when an advocateHard to be certain about likely outcomes

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Project the Outcomes—Techniques

Develop analytic model(s)Develop empirical estimatesConsider alternative scenariosConsider undesirable side effectsDevelop outcomes matrix

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Project the Outcomes

How many more low-income students will choose public health as a career with grant programs?

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6. Confront the Trade-offs

Is one alternative clearly dominant?−

The best choice on all criteria

Eliminate any alternative which is dominated byanother alternativeWhich criterion is most important?

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Confront the Trade-offs: Select the Criteria

Possible criteria to evaluate alternatives−

Efficiency

Equity−

Personal freedom

Legality Assume equity is the most important criterion

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Analytic

Projections of how each option will increase the number of low-income applicants

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Confront the Trade-offs Matrix

HRSA grant program toschools based on needHRSA grant program tostudents based on needHRSA grant program toschools based on abilityHRSA grant program tostudents based on ability

Equity+

++

0

0

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7. Decide—Public Health Training

Allocate grants to students based on need

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8. Tell Your Story

Thirty secondsWho is audience?What medium to use?What is the message?

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Tell Your Story

Audience is Congressional appropriations staff

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Tell Your Story

More low-income students would enter public health if they received grants based on need. This would lead to better health outcomes in low income areas