Presented by Beth Dodson from the Prevention Research Center in St. Louis. Presented at the 2011 Indiana Cancer Consortium Annual Meeting.

1. Using Evidence Based Public Health Policy to Prevent and Control Cancer Elizabeth Dodson May 19, 2011 ICC Annual Meeting, Indianapolis, IN

2. “Science can identify solutions to pressing public health problems, but only politics can turn most of those solutions into reality.” Thomas Oliver, PhD Johns Hopkins Bloomberg School of Public Health

3. Objectives Understand the definition of evidence-based policy Understand some important barriers and challenges Explore how to overcome some of these barriers Illustrate principles with recent research results

4. What is a health policy?

5. Definitions “those laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior” Policies tend to influence the environment (legal, social, economic, and physical) Importance noted in the definitions of core functions of public health

6. At least 3 types of policy Formal laws, codes, regulations Clean indoor air policy Written standards that guide choices Engineering standards that guide street design Unwritten social norms Not ticketing for speeding 6-7 MPH above limit Harder to evaluate, often culturally driven

7. Policy potential How has health (or other) policy, today, already affected your life?

8. Top 10 public health achievements Examples Vaccination Motor-vehicle safety Safer workplaces Fluoridation of drinking water Recognition of tobacco use as a health hazard Each of these advances involved policy Centers for Disease Control and Prevention. Ten great public health achievements--United States, 1900-1999. MMWR 1999 Apr 2;48(12):241-3

9. Understanding evidence-based approaches

10. A simple definition of evidence-based public health “Evidence-based public health is the process of integrating science-based interventions with community preferences to improve the health of populations.” Kohatsu, et al. Am J Prev Med 2004.

11. Elements of evidence-based policy Process Content Outcomes

12. Domains of Evidence-based Public Health Policy

13. Why worry about research & policy/practice? “… as the pressure on resources increases, decisions will have to be made explicitly and publicly, those who make decisions will need to be able to produce and describe the evidence on which each decision is based.” (Gray, 1997)

14. What do policymakers want or need from practitioners and researchers?

15. Three Fundamental Questions Is there a problem? Do we know how to fix it (intervention)? How much will it cost (financially, politically)? - What do all of these questions mean in the context of where we live and work?

16. Challenges and opportunities for evidence-based policyFinding the research-policy nexus

17. Because what you told me is absolutely correct but completely useless Where am I? Yes, how did you know? You must be a researcher Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me The problem Yes. How did you know? You’re 30 yards above the ground in a balloon You must be a policy maker

18. What are we learning about translating evidence to policy?

19. Examples of Policy Translation Challenges Clash of cultures Poor timing Ambiguous findings Balancing objectivity and advocacy Lack of relevant data From Brownson et al. AJPM 2006

20. Cancer Control Dissemination among State-level Policymakers Results from an ongoing project

21. Primary Project Goal Increase the dissemination of evidence-based interventions to control cancer focusing on the uptake of effective environmental and policy approaches among state-level policymakers

23. Randomized experiment

24. Compare data vs. narrative

25. Three key groups of policymakers

27. Phase 1: Policy Brief Design

28. Page 1 Narrative Data

29. Page 2 Narrative Data

30. Page 2 Local

31. Pages 3 and 4

33. Mailed policy briefs and surveys

34. Follow-up phone calls

35. Emailed PDF of brief and link for online survey

37. Legislators (n=75)

38. Staffers (n=125)

39. Executives (n=91)

41. Legislators: "How important are the following factors in determining what health issues you work on?"

42. Data trees on brief usefulness

44. Qualitative interviews with health committee members

46. “I like to see things that are evidence-based and peer-reviewed.”

48. “We get info from the various entities and the lobbyists as well as the other organizations that are in support or against a particular issue.”

49. “We always check the internet first…”

51. What can you do to bridge the chasm between evidence and policy? Understand the process Find a way to be involved in the process Communicate information more effectively Utilize analytic tools Educate a range of “players” (staffers, advocates) Provide training and education programs

52. Understand the process Vast literature in social psychology suggests policymakers mainly rely on Habit, stereotypes, cultural norms Sender credibility Factors affecting receptivity of policymakers to info-bearers Transparency of methods Plausibility of analysis Experts’ credentials Perceived impartiality Perceived track record Perceived honesty

53. Understand the process Political context policy-making less a rational act than a process of social influence “policy windows open infrequently and do not stay open long” (Kingdon, 1995) important to understand which policy options have the greatest potential for adoption and when small incremental changes are the preferred option use of rhetoric, art of persuasion, and ability to relate to the media (so called media or policy advocacy)

54. Be involved in the process Five key areas predict health policy capacity in public health practice: 1) a well-organized agency including an effective organizational structure and central liaison responsibilities 2) talented staff 3) clear communications between the public health agency and policymakers 4) effective negotiation skills 5) active participation

55. Be involved in the process Consider a continuum of advocacy Raise general awareness Publish an article Present at a professional meeting Communicate findings to policymakers Develop short policy summaries Make data understandable to policymakers Actively lobby for a particular issue Conduct media advocacy

56. Communicate information more effectively “All politics is local.” The policy choices of elected officials are often designed to support their interest in being re-elected or re-appointed Agenda often don’t drive re-election, rather political parties Calculate statistics at the voting district or even precinct level than at the city level Make personal contact Break material down into bulleted or otherwise highlighted text (policy briefs) Use charts or graphs illustrating key points Explore the use of storytelling

57. Better utilize analytic tools (resources) Systematic reviews (like the Community Guide: www.thecommunityguide.org) Cost data Cost-effectiveness data Health impact assessments

58. Educate/advocate with a range of “players” For example, legislative staff members Gatekeepers and opinion shapers Often have a great deal of influence in forming the priorities of an elected official Build their knowledge and understanding of evidence-based approaches to policymaking Legislative staff seem to prefer longer, detailed reports Elected officials prefer short summaries Educate and engage the media

59. Provide training and education programs Most public health training programs focus on more analytic methods Yet lack more applied skills Look for models Many advocacy groups sponsor meeting and trainings to demonstrate the value of academic, industry, and government research Informal approaches may be even more effective One on one meetings What works in your own setting?

61. To make progress it is important to understand barriers and all three domains of EB policy

62. Try to understand what is reasonable and potentially effective in your local situation

64. Phase 2: Collaboration with Indiana State Public Health Department Overarching goal: Build capacity to design, implement, and evaluate evidence-based public health policy Indiana’s policy goals and PRC goal-specific activities Goal Comprehensive statewide smokefree air Goal Increase tobacco taxes Goal Complete Streets Goal Increase elementary school PE to 30 minutes/day Activities Create policy briefs for lobby day with Indiana Campaign for Smokefree Air ( ICSA) Working with Indiana Tobacco Prevention and Cessation (ITPC) to create and update several sets of briefs for local settings Activities Activities Working with health department to create policy briefs Activities Working with health department to create policy briefs Activities addressing all goals: 1. Evaluation of five-year health policy work plan 3. Baseline survey to assess: skills and competencies in EBPH, translating science to policy; communicating with media & policymakers/doing advocacy 4. MIYO training for health department 5. Creation/sharing of Netscan tool for partner use

65. Acknowledgements Acknowledgements Project Team Ross Brownson Matt Kreuter Debra Haire-Joshu Doug Luke Tim McBride Katie Stamatakis Mike Elliott Nora Geary Chris Casey Tim Poor Nikki Caito Chris Wintrode Stephanie Chalifour Funding National Cancer Institute Collaborator National Conference of State Legislatures