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Where health research and health policy meet ... Or do they?
Rosemary Aldrich
Newcastle Environmental Toxicology Research Unit, Royal Newcastle Hospital, NSW
Abstract
The factors determining policy are many and varied, and include political expediency (Morell 1979), decision maker agendas (Kouzes & Mico 1979), and the intrinsic appeal of the policy issue (Hogwood & Gunn 1984). The process of health policy formulation has received critical attention over the last decade, specifically whether evaluation of program outcomes has any real influence on the refinement of policy. Duignan and Caswell (1989) in giving a brief account of the history of policy and program evaluation, suggested that early evaluators of social programs believed that an outcome of evaluation research would be the redetermining of policy according to evaluation results. However, one review of major program evaluations found that such findings tended to be ignored or to inhibit the policy making process (Greenberg & Robins 1985).
Using New South Wales (NSW) Health's Chlamydia Control Campaign (CCC), implemented from 1989 to 1991, as a case study, a retrospective qualitative analysis attempted to answer three questions:
- How did the issue of chlamydial infection acquire status as a policy area, attract decision maker attention and subsequent departmental funding?
- How were decisions made about the program structure and message; and
- How well were the program plans implemented and what barriers were there to program implementation as intended?
This paper addresses the first question, and tracks the process of issue awareness and policy development to the point where funding for a health promotion program was secured. The political, social and organisational factors directing the policy process are detailed, and the extent to which 'research' influences policy formulation is highlighted. As well, the CCC policy process is analysed in terms of a model from the policy analysis literature, to illustrate how policy status might be achieved for a public health issue.
The process of putting issues before policy decision makers has been discussed by policy theorists Hogwood and Gunn, who have proposed a model which describes six criteria which, if one or more are fulfilled, predict which issue is more likely to achieve policy status (Hogwood & Gunn 1984). The criteria are:
- The issue has reached crisis proportions and can no longer be ignored
- The issue has achieved particularity where the issue has come to represent a bigger problem
- The issue has an emotive aspect or a human interest angle which attracts media attention
- The issue seems likely to have wide impact
- The issue raises questions about power and legitimacy in society; and
- the issue is fashionable in a way which is difficult to explain but easy to recognise.
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