Ever wonder how local and Indigenous governments update public policies to become healthy public policies? Are you curious about who is involved in the process, and how to determine if policy has been changed or influenced? On November 10, 2022, BC Healthy Communities hosted a webinar as part of the PlanH Creating Healthy Public Policy Local Government Speaker Series “Navigating the Public Policy Pathway” to support people working on policy to identify how and where they can intervene to make change, and to learn how to capture that change. (HPP videos)
What is ‘healthy’ public policy (HPP)?
Policies, Public Policies and Healthy Public Policies (HPP) – these all relate to local governance.
Florence Morestin, our speaker from the National Collaborating Center for Healthy Public Policy used a powerful quote from Milio (2001) during her talk to explain how “healthy public policy improves the conditions under which people live: secure, safe, adequate and sustainable livelihoods, lifestyles and environments, including housing, education, nutrition, information exchange, child care, transportation, and necessary community and personal social and health services.” (See presentation slides here)
Specifically, healthy public policy brings together different perspectives from various sectors across communities, such that decisions taken, and the actions (or inaction) pursued serves to improve the health and wellbeing of everyone. HPP intends that the decisions and actions made by local and Indigenous governments are equitable and brings different voices and perspectives to the decision-making and implementation processes (Cramer, n.d.).
Models for policy setting and research
John Kingdon’s Agenda Setting Model (1984) describes the policy process as being about the flow and timing of three streams: problems, policies, and politics. People recognize problems, generate solutions for public policies changes, and engage in civic actions such as voting or lobbying to respond to the problems. Policy change occurs when the three streams converge, often thanks to a policy champion who pushes a particular solution for a problem onto the policy agenda. Researcher Carol Weiss (1977) offers three main types of research to follow for policy change: data, ideas, and advocacy or argument. Our speaker, Morestin, describes producer-push, user-pull, and exchange as three points of entry to the policy change process (2015).
What are policy tools and how do we get started with an intervention?
BC Healthy Communities’ (BCHC) Stephanie Neilson spoke about the different entry points as a specific actor and where they work. For example, how are advocates that work with community organizations linked to solutions (research)? Are decision makers linked to champions? Once a problem is defined, and a solution is developed or established, there needs to be an opportunity for initiatives or changes to be adopted. These opportunities are called ‘policy windows’ and they open because of a change in government, a swing in national mood, or a new budget, or crisis to address. It is the timing of the different events within the three streams, along with someone who is willing to invest time and energy to champion the idea or proposal, for items to get added to the agenda.
Actors and allies involved in the policy change process
For some individuals and organizations, an opportunity to participate in the policy process is through research and/or advocacy, so a key question is what kind of research is being done as a solution to the problem? An example of this is BCHC’s work around “equity”. Bringing an equity lens on research and decision-making work in BC shows how problems affect people differently and that these solutions require specific opportunities, power and resources. This ongoing work, will, over time, permeate the policy process space as it percolates through different communities across the province.
Morestin also made a strong statement that when Public Health Authorities meet with Local Governments this interchange does not equal collaboration. Policy change requires intentional actions and long-term engagement through sustained relationships. Basically, she made the point that HPP updates take time, mutual understanding, trust and then, collaboration. Formal collaboration arrangements (e.g., in the form of grants or Memorandums of Understanding) can support the process. However, collaboration initiatives may first come very informally from public health actors, government actors, and their allies, such as citizen groups, local businesses and community organizations before a formalized process begins. She used the work of Pamuk (2022) who advocates that we should not “neglect bottom-up sources of knowledge” for policy change insights. In other words, informal and formal data should be utilized.
How to know if policy has been changed or influenced
The following framework was developed for use by IDRC (2002-2003) and is useful to reflect on when capturing the change that happens before the actual policy change occurs. Expanding policy capacity is about creating and maintaining institutional capacity to do the research and analysis, and to communicate those ideas to people. Broadening policy horizons is about the conversations that people are having – networking through various channels, for example, or introducing new ideas to frame debates. And finally, there are the actual changes that occur – the modifications of existing policies or programs or the fundamental redesign of programs or policies.
Where to find money and resources to help start HPP work
BC Healthy Communities PlanH provides cash grants and capacity support to communities across the province towards creating and sustaining healthy public policies. Over 20 communities have recently been given grants, as well as access to tools and resources to change and influence policy processes, such as the HPP Webinar Series held three to four times per year. One BCHC grantee community, the City of Kelowna, has been developing processes such as an equity framework that can be used for modifying policies in future. Creating a space for different perspectives broadens policy horizons to re-frame old debates and frame new ones around the concept of “equity.” This work also expands local policy capacities as researchers and City employees work across departments to break down silos and build tools for researchers, decision makers, advocates, city planners and others to modify existing policies.
Cramer, J. (n.d.). The Issue: Healthy Public Policy. BC Healthy Communities. https://bchealthycommunities.ca/the-issue-hpp/
Kingdon, John. (1984). Agendas, Alternatives and Public Policies. Boston Toronto: Little Brown & Company.
Milio, N. (2001). Glossary: Healthy public policy. Journal of Epidemiology & Community Health, 55(9), 622-623. https://doi.org/10.1136/jech.55.9.622
Morestin, F. (2015). Knowledge sharing and public policies: A representation of influence processes. National Collaborating Centre for Healthy Public Policy. https://ccnpps-ncchpp.ca/knowledge-sharing-and-public-policies-a-representation-of-influence-processes/
Pamuk, Z. (Apr. 8, 2022). Politics and expertise: How to use science in a democratic society. LSE Impact Blog. https://blogs.lse.ac.uk/impactofsocialsciences/2022/04/08/politics-and-expertise-how-to-use-science-in-a-democratic-society/
Weiss, Carol (1977). “Research for Policy’s Sake: The Enlightenment Function of Social Science Research”. Policy Analysis, 3 (4): 531-545.
By Connie Allsopp, PlanH Delivery Lead and Stephanie Neilson, Evaluation Lead