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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.
References
Ballard J (1989) The politics of AIDS. In Gardner H (ed) The politics of health: The Australian experience. Melbourne: Churchill Livingstone, pp.349-375.
Barraclough S (1992) Policy through legislation: Victoria's Tobacco Act. In Gardner H (ed) Health policy: Development, implementation and evaluation in Australia. Melbourne: Churchill Livingstone, pp.183-210.
Brown VA (1992) Health care policies, health policies or policies for health. In Gardner H (ed) Health policy: development, implementation and evaluation in Australia. Melbourne: Churchill Livingstone, pp.91-117.
Duignan P and Caswell S (1989) Evaluating community development programs for health promotion: problems illustrated by a New Zealand Example. Community Health Studies 13(1): 74-81.
Gardner H and Barraclough S (1992) The policy process. In Gardner H (ed) Health policy: Development, implementation and evaluation in Australia. Melbourne: Churchill Livingstone, pp.3-28.
Goode J (1981) The health policy process in Victoria. Community Health Studies 5(3): 206-215.
Greenberg D and Robins P (1986) The changing role of social experiments in policy analysis, Journal of Policy Analysis and Management 5(2):340-362.
Hogwood BW and Gunn LA (1984) Policy analysis for the real world. Oxford: Oxford University Press.
Kay K (1986) Chlamydia: The Medicine Group Report. Sydney: The Medicine Group.
Kingdon JW (1984) Agendas, Alternatives and Public Policies. Boston: Little, Brown & Co.
Kouzes JM, Mico PR (1979) Domain theory: an introduction to organisational behaviour in human service organisations. Journal of Applied Behavioural Science 15: 449-469.
Kovacs GT, Westcott M, Rusden J, Asche V, King H, Haynes SE et al (1987) The prevalence of Chlamydia trachomatis in a young sexually active population. Medical Journal of Australia 147(11-12): 550-552.
Morell JA (1979) Evaluation and social service: an analysis of conflict and proposals for change. In Schulberg HC and Jerrell JM (eds) The evaluator and management. Beverly Hills: Sage Publications, pp.21-35.
O'Hara J (1986) The media coverage of AIDS. Metro 71(Spring): 14-17.
Polsby NW (1984) Political innovation in America: the politics of policy initiation. New Haven: Yale University Press.
Sexually Transmitted Diseases Committee (1985). Report to the NSW Department of Health: Overview and Recommendations. (Lawson J, Chair). Sydney: NSW DoH.
Sun-Herald (1985) Disease, Infertility link. Sun-Herald 04 August: 36.
Sunday Telegraph (1985) New disease causes infertility. Sunday Telegraph 04 August: 13.
Sydney Morning Herald (1984) Venereal diseases a 'national epidemic'. Sydney Morning Herald 26 September: 5.
WHPRC Women's Health Policy Review Committee (1985) Women's health services in NSW. Final Report (LoPo F, Chairperson). Sydney: Parliament of NSW.
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