Q1. GOOD POLICY MAKING REQUIRE CERTAIN CRITERIA.

EXPLAIN THESE CRITERIA AND CITE

SOME PRACTICAL EXAMPLES WITH YOUR ORGANIZATION.

Policy making is the formulation of ideas or plans that are used by an organization or

government as a basis for making decisions. In the field of policy analysis, criteria are evaluative

standards that guide the processes of decision making. They allow in ranking policy options in

order of preference. The most important evaluative criterion is that the projected outcome will

solve the policy problem to an acceptable degree. Criteria can be measures, rules, standards,

and all those attributes considered relevant by the decision maker (individual or group) in a

given situation. A good policy making in the Public Health Organization would require certain

criteria:

Legal Feasibility: Consistency with current constitutional/legal framework,

national/federal/state/local mandates as appropriate.

Political Viability: Acceptability of the policy option to various relevant stakeholders that hold

political power (voters, legislators, president’s cabinet, etc.)

Sustainability: Ability of the policy option to maintain its beneficial effects in the longer term.

Social/Cultural Feasibility: Consistency with national/local traditions, policies and institutions;

acceptable for the local population.

Technical Feasibility: Availability of necessary resources and competencies.

Administrative Feasibility: Degree of ease of implementation, financial/managerial factors.

Cost Effectiveness: Achieving policy goals at the least cost.

Economic Efficiency: Maximization of satisfaction by society.

In public health, additional criteria may include:

Equity: Fair social allocation (distribution) of burdens (may be costs) and benefits among social

groups

Economic and social costs: Economic and social costs of a disease/injury; loss of productivity,

medical costs, etc...

Need to act quickly: Need to act quickly (e.g. to mitigate a disaster, to control the spread of a

disease).

Burden of disease: Burden of disease (e.g. measured by the relative number of people dead –

(mortality; measured by the relative number of people affected –morbidity, other).

Effect of the problem on special populations: (lower income, women, children, lower income,

women, children, the disabled, aged, etc.) or on the physical environment.

Safety and Privacy

Example: If the goal were to have fewer deaths and injuries as possible from traffic accidents,

what would be the most important considerations to achieve the goal?

Is it cost (to the hospitals? To the government? To the population? To certain groups in the

population?)

Is it equity (reduction among certain age groups at risk (males, teenagers, elderly? Other high

risk groups, such as pick up truck drivers, people living in urban areas?

Is it the burden of disease to certain population groups? Loss of social and economic

productivity of teenagers, etc.?)

Is it effectiveness (of measures, such as use of seat belts or child restraining seats?) And so on.

We would also need to establish the meaning of “fewer death and injuries” since achieving

100% is not possible.

Then, how much is fewer? For which injuries? What percentage? For which groups? In which

neighborhoods?

Screening Alternatives and Problem Analysis

 Large number of impacts

 Large number of possible alternatives

 Estimation of all impacts for all alternatives is impossible (and not worthwhile)

 Costly and time consuming

 Many will have similar impacts

 Some will be dominated by others

Solutions to problem

 Incomplete analysis

 Ignore some impacts

 Examine few alternatives

 Add a screening step

 Broad-brush examination of wide range of alternatives

 Eliminate unpromising alternatives

 Retain promising alternatives for detailed analysis

Example: Considering the policy problem of morbidity and mortality due to traffic accidents mainly

caused by behavioral factors related to limited use of seat belts and to drinking and driving, we know

that the following may reduce then the severity of the problem:

1. Wearing a shoulder and lap restraint.

2. Seat belt use (saves over 26 billion dollars a year if use were universal).

3. Air bags and seat belts.

4. Use of child restraints.

5. Motorcycle and bicycle helmets.

6. Reducing the number of drivers that drink and drive.

Therefore, we may develop the following alternatives and enforce existing laws to ensure that:

 All drivers wear a shoulder and lap restraint.

 All children use appropriate car seats and child restraints.

 All motorcycle and bicycle riders use helmets

1. Develop and implement health education and promotion strategies to modify behavioral factors

related to driver fatigue, driver distraction (talking to passengers, attending to children, eating or

drinking, personal grooming, looking at maps, reading, attention to electronic devices and verbal

exchanges).

2. Develop and implement health education strategies to reduce risky driver behaviors (drinking and

driving, exceeding the posted speed limit, and aggressive driving.)

3. Establish automated systems for enforcing speed limit and red light laws.

4. Establish graduated drivers licensing laws that put limits on drivers aged 16–18 (or whatever the

driving age in the country).

5. Promote transportation policies that encourage mass transit, walking, and cycling.

6. Enforce motor vehicle safety standards.

7. Reduce the number of days or hours of operation of liquor stores and bars.

8. A combination of the alternatives mentioned above.

9. Alternative 1 + Alternative 2 + Alternative 3

10. Alternative 2 + Alternative 3

11. Alternative 5 + Alternative 9

12. Alternative 4 + Alternative 3

Q2. WHEN NEW POLICIES ARE CREATED, THERE ARE GENERALLY THREE KEY THINGS

INVOLVED IN THE PROCESS. EXPLAIN THEM RELATING TO YOUR ORGANIZATION.

AGENDA SETTING: This stage refers to the process through which a policy and the problem it is

intended to address are acknowledged to be of public interest. Some authors differentiate

among several types of agendas, including discussion agendas and decision agendas. The

discussion agenda, or public agenda, includes issues that have become highly visible and have

thus become the subject of discussion. The decision agenda, or formal agenda, includes the list

of issues the government has decided to address (Cobb & Elder, 1972).

For a policy to be placed on the agenda, there seem to be certain prerequisites. Individuals or

groups must acknowledge that a situation is problematic, identify the problematic aspects of

the situation, propose solutions, and engage in activities that influence the government and

pressure it to intervene, including identifying groups that can play an active role in addressing

the problem (Ripley, 1985, in McCool, 1995, p. 159). A wide range of literature covers this stage
and examines the strategies that groups of actors use to get a policy placed on the

government’s agenda. Therefore during agenda setting, the basic things involves are as follows:

• Identifying a problem situation and collecting evidence indicating the magnitude of the

problem. This information is intended for decision makers as well as other stakeholders.

• Documenting the importance of a problem and its determinants.

• Challenging frameworks.

• Identifying the decisive, relevant data for characterizing the problem.

For an issue to be included on the decision agenda, the situation must be perceived as

problematic. Public health actors can assume, therefore, that the information required at this

stage should focus on the significance of a problem and its impact on public health. It is also at

this stage that causal agents are identified; that is, the relationship between a phenomenon

and its determinants.

POLICY FORMULATION, ADOPTION (OR DECISION MAKING) AND IMPLEMENTATION: At the

stage of formulation, the public administration concerned examines the various policy options

it considers to be possible solutions. It should be noted that coalitions of actors strive, through

the use of advocacy strategies, to gain priority for one specific interpretation of both the

problem and its solution. It is at this stage that power relationships crystallize, determining the

direction a policy will take.

Adoption is the stage during which decisions are made at the governmental level, resulting in a

decision that favours one or more approaches to addressing a given problem.

A policy’s implementation parameters are established, which can directly affect the eventual

outcome of the policy. Several factors combine to determine the actual effects of a policy and

how well it achieves its objectives. Factors noted by Sabatier and Mazmanian include:

• The type and complexity of the problem addressed,

• The magnitude of the expected change and the groups targeted by the policy,

• The human and financial resources devoted to implementation, and

• The administrative structures and regulations that will be put in place to support

implementation of the policy (Sabatier & Mazmanian, 1995).

Note that high demands are placed on the technical administrative apparatus at this stage, and

on groups associated with this policy sector. The term policy network is often used to refer to

the actors within the government, as well as the stakeholders associated with a policy sector,

who are in a sense experts in the area. This policy network will have a major influence on how

the policy is implemented.

POLICY EVALUATION: It involves evaluation of a policy, to verify whether its implementation

and its effects are aligned with the objectives that were explicitly or implicitly set out. This

evaluation can be carried out by the government apparatus, by consultants or by civil society

(Howlett & Ramesh, 2003). Therefore during evaluation, the basic things involves are as

follows.

•Developing monitoring mechanisms.

• Revealing discrepancies between the policy’s expected and actual results.

• Performing complex evaluations.

For public health actors who wish to take part in the production of public policies, these key

things provide a framework for reflecting on the processes surrounding development of a

public policy. With the help of these benchmarks, public health actors can reflect on relevant

questions and identify the players involved with a public problem at different stages, as well the

opportunities for intervention, which constitute so many entry points into the policy

development process.

REFERENCES

Anand, Sudhir, F. Peter and A. Sen. Public Health,, Ethics and Equity. (2004) Oxford University Press. (pp.

15- 33 and 93-106).

Kraft, M. and Scott Furlong. Public Policy: Politics, Analysis and Alternatives. (2004). CQ Press, Chapter 6:

Assessing Policy Alternatives.

Munger, Michael. Analyzing Policy: Choices, Conflicts and Practice. (2000). New York: W.W. Norton.

(Chapter 11, Cost Benefit Analysis)

Marc Suhrcke, Rachel A. Nugent, David Stuckler and Lorenzo RoccoChronic Disease: An Economic

PerspectiveLondon: http://www.oxha.org/initiatives/economics/knowledge/publications/oxha-

chronic-disease-an-economicperspective.pdf

Pal, Less (2000). “There ought to be a law!” Instrument choice: an overview of the issues. Carleton

University Research and Statistics Division. CA. Strategic Issues Series. rp02-

10e.tp://canada.justice.gc.ca/en/ps/rs/rep/2002/rp2002-10.pdf

Patton, C. y D. Sawicki. (1993) Basic Methods of Policy Analysis and Planning. Englewood Cliffs, NJ:

Prentice Hall. Second edition. (Chapter 8: Displaying Alternatives and Distinguishing among

Them.)
Rice, Thomas. (April 1997). Can markets give us the health system we want? Journal of Health Politics,

Policy and Law. 22(2): 383-425.

Stone, D. (2001) Policy Paradox: The Art of Political Decision-making. Revised Edition. New York: W. W.

Norton & Co., pp. 163-187 (Numbers). (Handout)

US Department of Health and Human Services. (1997) Cost-Effectiveness in Health & Medicine. USDHHS,

Washington DC. (Chapters 1 and 2, Pp. 1-33, Cost-Effectiveness Analysis as a Guide to Resource

Allocation in Health: Roles and Limitations; Theoretical Foundations of Cost-Effectiveness

Analysis).

Weimer, David L. and Aidan R. Vining. Policy Analysis: Concepts and Practice. 3rd edition. (2004).

Prentice Hall. (Chapter 11: Goals/Alternatives Matrices.)