The Politics of Health #2
Last week I wrote about how public health needed to address issues from a political standpoint… I am of the opinion that most of us will agree that we must embrace the political process in order to be successfull. One respondent quoted a professor that said “One good piece of legislation will save more lives than 1000 smoking cessation workshops”.
The other comments seemed to agree that politics is important “public health is the body politic”. So, since we tend to agree on this point lets take it further.
What would we say about a pharmacist having very little understanding of organic chemistry? Or a Social worker lacking the basic understanding of say Skinner or Prochaska?
Just like Pharmacy, social work or health education… the political world is based in theory!
If public health folks enter the politic world expecting that logic, epidemiology and sound judgement will win over policy maker… we are doomed to fail.
There was a theory in political science called “Rational Choice” that attempted to explain how policy makers decide what ideas become laws. It goes like this: Option A has 6 benefits and 2 shortfalls… Option B has 6 shortfalls and 2 benefits… Option C has 4 benefits and 4 shortfalls. Therefore, Option A should be the correct option ans should become policy. OHHHH how failed. First this theory requires accurate and COMPLETE information for the policy maker. Second… Even with accurate and complete information, some people will not make Option A their Choice because they have friends that think Option C is better. (anyone say smoking ordinance?)
The rational choice principle of policy making has gone by the wayside… Yet Public Health practice regarding policy making (in administration class and so forth) rely on rational choice as the basis of their actions (remember all of our actions should be based on theory… we just didn’t realize that we were using a theory). We exect that if we show policy makers enough “evidence” ans statistical analysis, they will form policies favorable to our agenda.
Community organizing discussions are based on a different policy theory… And this is where I find hope in advancing the policy process in our profession… It is called the Advocacy Coalition Framework. This theory is one in which coalitions form to promote their policy ideas… even when they are unlikely bedfellows.
Take for instance an effort to address teenage drug use in the community… Community organizing says that we should marshal all the community resources that are willing to participate and address the issue with good education and community involvement… Evidence based practice shows this works… but the policy process would ask us… Who else wants the same thing we do. The advocacy coalition framework tells us that we will be more successful in getting our ordinace (or law) passed if we team with other powerful organizations that have the same core beliefs.
Our core beliefs are health, empowerment, and equality. Who else shares these beliefs? Is there any group in your community that we would normally NOT expect to help us that has the same CORE beliefs?
The Key is to base our policy efforts on theory… not wishful thinking…
From the Heart of the Rockies.
TDUB
Kelly House
Mark J Kittleson
Margaret Sullivan
Maria Alexandrova
jodyearly
Shanell L. McGoy
Mainul Mustafa
M. Helen Hogue
Yuba
Okony K. Cham
Kamrun Mustafa
This is a good message, but incomplete, which is probably the result of trying to keep it brief. You do not include the need to gain an understanding of the most immediate needs and desires of the community groups and members critical to the advocacy effort. This is accomplished by giving them an ooportunity to list their priorities and helping them address some of these, even if they are not the health priorities of the community organizer(s). Once the coalition is successful in satisfying whatever need or desire the local folks want, the coalition gains strenth to accomplish additional goals, including health goals considered most important by the community organizer(s).
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