Independently investigate drivers of a policy problem, author a stakeholder assessment report, and design a policy evaluation strategy.
what are tobacco industry stakeholders
shareholders & investors
Employees, contractors
Supplier companies and farmers
Customers, distributor shops
Adult consumers, illegal minor consumers
Governments and regulators
Scientific and public health communities
Key opinion leaders, experts and academics
International organisations - UN, WHO
Standards orgs - International Organization for Standardization (for product regulation)
Law enforcement agencies, ministry of health of the country
NGOs
Media and journalists
Local communities and the general public
how can these stakeholders be identified (stakeholder involvement)
official consultations with everyone at the table
E.g. Citizen’s Assembly
policy advocacy groups to lobby for patients w CVD & cancer from tobacco
research and development - evidence based policies
social media tools → surveys & polls for opinions
stakeholders power positions (positive & negative)
tobacco supplier companies
exploit farmers (even if farmers want to stop, they cant, their life depends on the money)
they mislead society about economic importance, saying that the country depends on tobacco farming which is a huge part of the economy (GDP), so if theres regulations against that the country will suffer → thats why they back away
consumers
once ur addicted, its diffifcult to go back
depends how much support country offers and has focus on this issue (MHD programs, rehab, etc.)
Law enforcement agencies, ministry of health of the country
power to voice the negatives about illegal acts (minors accessing it, self growing), health is being destroyed (CVD and cancer)
but then depends how much focus country puts on this
Standards orgs
have power to regulate how much goes into a product, packaging, etc.
based on scientific evidence
what is the ex-ante effect in evidence informed policy
being able to ask critical questions about the research evidence available to support advocated policies
what is the ex-post effect in evidence informed policy
Ensure that evaluations of their initiatives are appropriate and that the outcomes being measured are realistic and agreed in advance
what is the ex post evaluation part in the policy cycle? (6)
To examine whether policies have the intended effect and how they can be improved, see unintended consequences
incl 6 concepts (policy problem evaluation, process evaluation, time-trend analysis, quasi experim. study, longtitudinal obs. study, economic evaluation)
May be pursued by independent researchers or researchers affiliated with the government
E.g. think tanks, research groups, national government have in-house analysts (PhD level researchers working on research)
what does policy problem evaluation in ex post look like?
WPR method: what’s the problem represented to be → Policy makes problems in a certain way by integrating particular facts and values
can see underlying assumptions of policy and reveals hidden/silenced things that are focused on
What is the problem represented to be? What assumptions underlie? How has this representation of the problem come about? What is left unproblematic in the problem representation?
what does process evaluation in ex post look like?
Examining how well a policy is delivered
esp. with qualitative methods to give in-depth information
multiple types of stakeholders need to be interviewed for a full picture (e.g. those who designed the policy, those who are affected by the policy, and those who enforce the policy)
what does time-trend analysis in ex post look like? pro & con
Examining trends in outcome measures before and after implementation, with cross-sectional monitoring data that is representative for the general population
Advantage: showing the impact of policies on the population level; produces powerful evidence for media and policymakers
Disadvantage: changes in the outcome measures may not be caused by the policy; there may b changes before implementation
what does quasi experim. study in ex post look like? pro & con, stat
Examining changes in outcome measures in a country where policy is implemented (intervention group) and comparing this to changes in outcome measures in a country/region where the policy is not implemented (control group)
to see if policy caused changes, use proximal outcome measures (awareness, support, salience) instead of distal outcome measures (health behaviors)
Advantage: showing the real-world population-level impact and still having a control group
Disadvantages: comparability of the control country/region
stat: regression analysis to see relationship between two variables, if it makes sense, then policy is good (bro im done fr)
what does a longitudinal observational study in ex-post look like? pro & con, stats test
Examining changes in outcome measures among the same group of people (longitudinal) before and after the implementation of a policy
No control group, exposure can be a variable in analysis
advantage: cheap, can be done with quantitative and qualitative methods, possible to look at within-person changes
Disadvantage: changes in the outcome measures may not be caused by the policy
stat: ANOVA to compare group means
what does cost evaluation in ex post look like?
comparative analysis of interventions in terms of cost and consequence
Helps to make the best decision for optimal resource allocation
Cost-benefit analysis: cost of the intervention is compared with the benefit from the intervention (both expressed in money)
Cost-effectiveness analysis: cost of the intervention is measured against the effectiveness of the intervention (consequences are expressed in natural units like life years gained or improvement in health status)
Cost-utility analysis: cost of the intervention is measured against the ‘utility’ related to health (expressed in quality adjusted life years, QALY’s, or disability adjusted life years, DALY’s)
what is the ex ante evaluation part in the policy cycle? (2)
how policies can best be designed and implemented
how much and which effects can be expected
experimental study and simulation study
what is the policy cycle?
agenda setting (identify issues)
formulate (impact assessment)
adopt (support & advice to regulatory bodies)
implement
evaluate (efficiency & effectiveness with ex ante & post)
support/maintenance (crisis response, feedback)
what does experimental study in ex ante look like? pro & con, stat
examine mechanism of policy that is not implemented yet
randomise study participants in experimental & control group
stat: differences in primary & secondary outcome measures
maybe t test to compare means in control and intervention group
pro: good for causal conclusions
cons: weak external validity
what does simulation study in ex ante look like? pro
Mathematical model with ‘synthetic’ data of a population to make predictions
e.g. covid predictions in the future
Each ‘individual’ in the dataset can switch between stages (e.g. healthy, diseased, dead) and this is modelled for a period of time
then, program the probabillity of switching between states is modelled with historical data on population size and distribution, mortality rates, fertility rates, disease rates, and prevalence of behaviors (e.g. substance use)
The model contains assumptions of the impact of policies, which then, the assumptions on the population are examined
advantage:
Useful for examining the impact of different policy options
used to disentangle the impact of simultaneously implemented policies
3 types of agenda
public: issues that get attention from citizen
media: issues that get attention in media
political (gov and decision agenda): issues that r discussed by policymakers for decision making
what is the multiple streams framework
helps with shaping crisis in a policy window to encourage policy creation (in agenda setting)
consists of three independent streams: problems, policy solutions, and politics
problem: tobacco smoking health issue
policy solutions: r there any policies, r they good enough
politics: who’s in power, priority focus
what is transposition
putting EU directives into national MS law
what are the 4 policy instruments to implement policy + EU instruments
govs confront public problems via the use of information (for example, public information campaigns, research inquiries, and advertising).
govs confront public problems via the use of legal powers (for example, command and control regulation, and self-regulation).
govs confront public problems via the use of money (for example, loans, subsidies, taxes)
govs confront public problems via the use of their formal organizations (for example, delivering goods via (semi-)governmental organizations, such as defence, education, water supply)
EU uses → treaties, case law from court of justice, international agreements, soft law
3 main Europeanisation theories
how well the policy fits
international relations traditions (how nations work together)
cooperative decision making culture
What is implementation and dissemination?
Dissemination: spreading evidence-based interventions to the target audience via determined channels using planned strategies
Implementation: integrating evidence-based interventions within a setting
what are the 4 steps of implementation
formulate goal w clear objectives
analyse context (stakeholders, determinants) and if there’s support for this
select implementation strategies with causal evidence that it may work
evaluate implementation (how many know the interv. what are barriers and facilitators)
what are characteristics of the innovation side that could speed up adoption of policy
which intervention is seen as better
compatibility of the intervention with “existing values, past experiences, and needs of potential adopters”
whether the potential adopters perceive it as satisfactory, acceptable
fit and relevance of the intervention
practicability of an intervention
cost impact of an implementation
what is a implementation gap
difference between what policy maker intended and what actually happens
some enabler/barrier to adoption of policies
opinion leaders: anyone powerful who can change someone opinion on tobacco (esp. in social media)
change agent: whole agencies that influence new changes within a group/org
contextual factors: political, social, organisational, culture, legislation
organisational readiness & organisation & norma/perceptions: if itll be easy for them to handle the new tobacco policy
bottom up and top down approaches
bottom up: using local/regional stakeholders (patient advocacy groups, national & regional institutions, NGOs) to influence & help government in changing tobacco policies
top down: high level decides national tobacco policy for local level/general pop.
behaviour change wheel
understand behaviour and design interventions guided by it
COMB: capability, opportunity, motivation of the individual
red part (inside) meso level, intervention functions: changing environment, educating (e.g. public tobapcco campaigns)
grey part (outside) macro level, policy categories: guidelines, legislation, fiscal measures, etc.
why does implementation gap happen
Reasons why: resistance, not enough money, different understandings of the policy among stakeholders
what is confounding
study looking at owning a lighter and cancer cases → will show strong correlation
smoking would be a confounder, the hidden factor that actually causes the cases (instead, they focused on lighters)
Formulate what constitutes good performance for tobacco policies
decrease in smoking
decrease in cancer & CVD cases
sales of tobacco decreases
ppl are less willing to buy tobacco
QoL, improved life
attempting to quiet, successfully quitting
dependent & independent
dependent: health outcome, improved QoL, etc.
independent: the cause, such as smoking, or the lighter, or any other variables that is analysed as the cause
methdology of an evaluation study (qualitative, quantitative, sources of data, stats)
quali: interviews (about smoking behaviour, participatory approach study
quanti: depends on policy, either quasi or long. observational study
sources of data: national register for cases, sales records, interview data, PH research data
stats: depends on study either regression or ANOVA, cost-benefit analyses, etc.
what is decentralisation
"away from the centre" → handing over of the central government’s power to a lower level of the government, transfer of powers and activities to the sub-national level and actors
what are the decentralisation types
Deconcentration/administrative → shift limited managerial authority to different levels of central gov, breaking up and divesting big firms to reduce the degree of concentration
Example: Lisbon Treaty, health insurance companies
Delegation → massive leadership except for financial decision-making authority, shifting to particular functions from one person (e.g. leader or manager) to another
in administrative law → process that divides administrative action or decision-making to a lower level of agency
Devolution → political decentralization, transfer of power by a central government to local or regional administrations (tasks of policymaking, managerial, financial autonomy)
more democratic
this needs 6 requirements: constitutional reforms, development of pluralist political parties, strengthening legislature, creating local units, more active public interest groups, capacity building of decentralized authority
which type of decentralisation is more decentralised?
deconcentration is less decen. & devolution is most decentralised
difference of policy vs law
Policies are only documents and not law, but these policies can lead to new laws
laws → set standards, procedures that must be followed in society
made for justice in society
law is for society justice, a policy is framed for achieving certain goals
what are key areas in a health system reform
regulation → tobacco regulation policy
service delivery → decrease selling of tobacco
financing → financing public campaigns to stop, packaging production
resource generation & allocation → evidence from cancer research to finance the campaigns, allocate resources like nicotine patches, rehab options for addicted, education
wicked problem, how to solve
tobacco is a wicked problem with being complex, unpredictable, open-ended, resistant to solution
they have a lot of powerful stakeholders, unpredictable increasing “trends” such as vaping, hard to stop
solve: adding stakeholders to discussion (broader overview, systems thinking),
primary vs secondary stakeholder
Primary stakeholder → the ppl primarly affected by the project or intervention
Secondary stakeholder → the ppl not directly affected by the policy but can be involved directly/indirectly in decision making
types of political systems (7)
pluralism: power is dispersed throughout society, such that no one (group/person) holds absolute power
elitism: belief that a society/system should be led by elite
liberal democracy: democratic government with stable political institutions with the dissemination of power (usa)
egalitarian authoritarian: closed ruling elite, state-managed popular participation, social security system and access to health care ensured by state (cuba, china)
authoritarian-inegalitarian: associated with military government and autocratic ruling, lack voice of ppl, health policy reflected interests of elite and provision was OPP
populist: single/dominant political party, highly nationalist & leadership tends to be personalised, elites keep influence on government
traditional inegalitarian: ruled by traditional monarchs, Few opportunities for civil participation (saudi)
what are some sources of power
social/political position of an actor
organisational culture
economic position of an actor
what is a risk when trying to satisfy all stakeholder interests + solutions
very difficult to satisfy all of your stakeholders interests → dissatisfaction can come across as barriers for implementation, which can hinder the outcome of the policy itself
solutions
evidence-based
lots of stakeholders
democratic, understanding, open-minded, inclusive leadership
problem analysis steps (workshop 1 with causal mindmaps)
decide aim for solving issue
choose stakeholders
group them
find important categories
draw causal connections
make sure everythings collected
verify & review map