Learning Activity 7:
Influencing Health Policy Change
"The biggest room in the world is the room for improvement." - Anonymous
"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." - Buckminster Fuller
Overview
Traditionally, health policy has been focused mainly on acute
care with medicine as the central hub of the health care system. In recent years, in response to the Canada Health Act and other initiatives,
a move toward more comprehensive, health and wellness focused policies have begun, at least in theory. "The Committee believes strongly that
programs and policies with respect to public health, health protection and health and wellness promotion are critical to enhancing the health of
Canadians. We believe that a coordinated and integrated approach is needed and that, once again, the federal government can and should play a
leadership role. We believe also that more funding is needed in this area. The Committee recommends that the federal government ensure strong
leadership and provide additional funding to sustain, better coordinate and integrate the public health infrastructure in Canada as well as
relevant health promotion efforts" (The Standing Senate Committee on Social Affairs, Science and Technology, 2002).
Since health and wellness are the prime foci of nursing, our profession stands in a unique position in influencing policy at both grassroots and political levels. Nurses however are not alone - most allied health professionals feel strongly that health policy must change to encompass primary health care and interdisciplinary collaboration models. "Among the policy and practice communities, it is widely recognized that a strong primary health care (PHC) system is needed to address the challenges of an aging population, and to meet the needs of the increasing proportion of people who experience chronic health conditions. A strong PHC system improves the level and distribution of population health services, buffers the effect of socio-economic factors on health and attains these outcomes at a lower cost than health systems that rely more extensively on secondary and tertiary care. As a result, primary health care renewal has been identified in Canadian policy as a key ingredient in a sustainable health care system" (EICP, 2005, p. 6).
To understand policies and how they can be changed, a technique/process called policy analysis is used. Policy analysis embraces research, clarification, design, advice, mediation, and democratization as distinct activities and uses pairs of these activities to produce six distinct, though not mutually exclusive styles. These styles include rational, client advice, argumentative, interactive, participative, and process (Mayer, van Daalen & Bots, 2001).
Ends In View
This learning activity is intended to provide learners with the opportunity to:- Analyze how health policy relates to the process of health care reform.
- Identify the components of common policy analysis models.
- Synthesize nursing's role in health and social policy analysis, revision and development.
- Recognize the importance of interdisciplinary collaborative in both primary health care reform and influencing health policy development/revision.
In Practice
1.Participate in class discussion related to health policy development, analysis and reform.
2. The EICP comprehensively rationalizes how and why health policy and reform are best done using interdisciplinary collaboration. In small groups, brainstorm ways that nurses can work with other disciplines in the Fraser Health Region (or other local region of your choice). Share your ideas with the class.
3. How does the current paradigm shift to primary health care favorably situate nursing in relation to having power, sanction, and influence in policy development and reform?
Considering that success with any of these modes of reform usually result in sub-sector reform at best, what is the best strategy for nurses who wish to work for health care reform?
4. The ICN described how nurses can influence health policy through the four components of:
- the policy process
- policy reform
- the policy environment
- policy makers
In small groups, brainstorm how nurses in BC can influence each of these four policy components.
5. Review the policy analysis models and categories presented in Apprendix 1 . Divide into eight small groups and brainstorm a mini case scenerio in which to apply the assigned model (assignment will be done in class).
In Reflection
1. Which particular health and social policies do you personally feel motivated to influence?
2.Which policies do you hear or see mentioned the most frequently in the news media? Who is addressing these policies?
References
Alexander, D. (n.d.) Organizing for Urban Sustainability: A summary model of social change.
EICP (2005). Canadian Policy Context: Interdisciplinary Collaboration in Primary Health Care. The Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative. Ottawa: The Conference Board of Canada.
International Council of Nurses. (2003).> Guidelines on shaping effective health policy. March.
Lennon, M. & Corbett, T. (2003). eds. Policy into action: Implementation research and welfare reform. Washington, DC: Urban Institute Press.
MacRae, Jr., D. & Wilde, J. (1985). >Policy Analysis for public decisions. Lanham, MD: University Press of America.
Mayer, I., van Daalen, C. & Bots, P. (2001). Perspectives on Policy Analysis: A framework for understanding and design. In Association for Public Policy Analysis and Management. Washington, DC.
Quade, E.S. & Carter, G. M. (1989). Analysis for public decisions. 3rd ed. New York: North Holland.
Patton, C. & Sawicki, D. (1993) Basic Methods of Policy Analysis and Planning. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall.
Stokey, E. & Zeckhauser, R. (1978). A primer of policy analysis. New York: WW Norton.
The Standing Senate Committee on Social Affairs, Science and Technology. (2002). The health of Canadians – The Federal Role: Final Report. Volume Six: Recommendations for Reform. Chapter 13: Healthy Public Policy: Health beyond health care.
Weimer, D.L. and Vining, A.R. 1999. Policy analysis, concepts and practise. 3rd ed. Englewood Cliffs: Prentice-Hall.ational perspective. Presentation to the Conference on the Implementation of Primary Care Reform. Queen's University, November.
IN PREPARATION:
