Working with policy makers at all levels

Joan R Villalbí, MD, MPH

Agència de Salut Pública de Barcelona

Comité Nacional de Prevención del Tabaquismo, Spain

An outline

• Levels of health and their determinants

• Public health and public policy

• What shapes public policy?

• Policy, public opinion and the media

• What is to be done?

• Experiences from professional organizations

• Experiences on environmental health issues

Determinants of health

Levels of health reflect how people live and work, rather than the outcome of health services

Public health and public policy

• Spain: public spending is 37% of the GDP.

• Many issues are subject to regulation (and regulatory policies often are developed at the EU-level).

• Public policy influences health, beyond what public health and health care services do.

What shapes public policy?

• The ideology of governments

• The public good (is it an absolute concept?)

• Often, public policy is a compromise between different options: elected politicians in office search consensual positions

Policy, public opinion, and the media

• Public opinion is crucial for political decision making

• Media are a strong influence in shaping public opinion

• We need to work with the media to influence public policy

What is to be done?

• Organization, independent of government

• Coalition building around big issues

• Strategy definition

• Communication infrastructure

The public policy making process: 3 steps to consider

• Enter issue in agenda

• Policy approval

• Policy implementation

Professional organizations

• Our experience in the public health and health administration society (SESPAS)

• Our experience in the Spanish coalition for smoking prevention and its European counterparts (CNPT-ENSP)

SESPAS• A professional and scientific organization,

established in 1985, with some 4000 members, most of them through smaller professional or geographic organizations.

• A Journal, indexed in Medline• A Congress every two years• A web (www.sespas.es)• A report in every Congress on health and the

health system, available as book and in the web. • Membership in EUPHA

SESPAS

Lessons in PP from SESPAS

• Difficulties in focusing in relevant issues

• Competition among key people and organizations

• Visibility attained, effectiveness low

• Permanent staff required to maintain presence

• Better results with single-issue projects: tobacco

Tobacco control: key issues

• Ad ban

• Taxes and price

• Smoke-free areas

• Helping smokers quit

Tobacco control: Spain in the mid90s• Isolated individuals, little

coordination• Duplicating efforts,

competing for resources and visibility

• Concentrating in educating teens, helping smokers quit

• Frustration and need for a change

PaísPaís TVTV RadioRadioVallas Vallas

publicitariaspublicitarias PrensaPrensa CineCinePatrocinio de Patrocinio de

actos culturales actos culturales y deportivosy deportivos

Alemania

Austria

Bélgica *

Dinamarca

España **

FinlandiaFrancia

Grecia

Irlanda

Italia

Luxemburgo

Países Bajos

Portugal

Reino Unido

Suecia

Prohibición legislativaRestricción legislativaAcuerdo voluntario Permitido No información

LeyendaLeyenda

Fuente: Tobacco policy in Europe. WHO-Europe, 1996.Fuente: Tobacco policy in Europe. WHO-Europe, 1996. ** Está sólo limitada en los medios dependientes de la Administración del Estado.** Está sólo limitada en los medios dependientes de la Administración del Estado.

La publicidad del tabaco en los países de la UE

Index dels preus del Marlboro, ajustats per PPP. Unió Europea, 2000.

0

50

100

150

200

El CNPT (Comité Nacional de Prevención del Tabaquismo), pretende colaborar con todos los profesionales, entidades e instituciones implicadas en la prevención y control del tabaquismo en España.

CNPT: organizing to influence policy making

Policy development• National tobacco control strategy documents• Position papers on key issues• Seminars to build consensus

Communication• Web: collecting key documents and links• Globalink, e-lists• Journal• Contacts

CNPT: results

• Stronger coordination and networking

• Introduction of tobacco policy in the agenda

• Visible improvement in media

• Highlights:– Annual Congress (2001, 2002, 2003)– National Plan for Tobacco (January 2003)– Vote on ad regulation in EP (December 2002)

10 commandments for lobbying1. Know where is the power.

2. Be very well informed of your positions.

3. Defend your credibility: it’s your greatest asset.

4. Act before things happen.

5. Be short for very busy people.

6. Be pragmatic.

7. Adapt your message to different publics.

8. Recognize the limits for your action: what you won’t do.

9. Always cultivate contacts, not only when needed.

10. See beyond immediate priorities.

(from HazteOir.org)