The relevance of stages heuristics model to influence the development of healthy public policies

Contents

I Introduction
II Background
III The policymaking process
IV Stages heuristic model
V Issue of relevance
VI Implication: Eight steps for developing healthy public policies workbook

--By Kim Bergeron, Health Promotion Consultant, Health Promotion Capacity Building, Public Health Ontario  

I Introduction

Healthy public policies are generally defined by a strong concern for health and equity that includes identifying health impacts of a policy being implemented. [1] They are developed to improve physical, social, economic or environmental conditions, including health inequities. [2] The aim of this article is to identify whether the stages heuristic model (a model taking complex policy steps and refining them into manageable stages) is relevant to justify continued use by public health and health promotion practitioners when influencing the development of healthy public policies.

The ideas outlined in this article are based on a literature review that was conducted by searching a number of databases (MEDLINE, Embase, PsycINFO, CINAHL, Health Business File, SocINDEX, Scopus, PAIS International) to identify relevant articles published in English over the last seven years.

II Background

The reasons people engage in healthy or unhealthy behaviours, and the types of policies that exist to make choices easier or harder are numerous, multifaceted, and complicated. Moreover, a system of individual, social, cultural, environmental, economic and political factors adds layers of complexity [3] as does inter-organizational and network relationships at the local, provincial, federal and international levels. [4] Therefore, public health and health promotion practitioners need to consider that the “whole is greater than the sum of its parts,” [5] meaning that it is not possible to separate out these different factors independent of each other, but requires a holistic approach to solving complex problems, that evolves over time. [3] This holds true when working to influence the policymaking process. [5,6]

III The policymaking process

The policymaking process is comprised of a large number of actors including decision makers, institutions, and citizens. [7] The process often includes defining the problem, using evidence to identify solutions to solve the problem, engaging in knowledge brokering and transfer in order to influence the actions of decision makers related to policy outcomes. [7] Of important note is that this process does not happen at one point in time, but happens over a long period and can encompass different people at different points in time. [4] Therefore, there is a desire to make something potentially complex and overwhelming more simple and manageable. One way to do this is to use theoretical concepts to break up the policymaking process [8] and the “best known public policy framework is the stages heuristic model.” [4, p.310]

IV Stages heuristic model

This model has endured over 60 years (first cited in 1956) as a way to explore and understand the policymaking process and “remains a useful heuristic to explore a complex world.”  [4, p.iii7] The term heuristic means to simplify how to make judgements and decisions. [9] This model provides a basis to understand the policymaking process as a fluid cycle of stages with the key stages being agenda setting, policy formation, decision making/policy adoption, implementation, and evaluation. [7, 10] It also offers a way to take something complex and break it down into manageable ‘stages’ as a means to ensure policy success. [5]

Criticisms of the stages heuristic model exist. For example, that “this model does not indicate what factors are determinant in driving policy forward” [10, p.5] and that the model fails to address the complexity of policymaking. [11] Another example is that it does not “address the dynamics of multiple, interacting, iterative and incremental cycles of action at many different levels of mutual and reciprocal action at the same time.” [11, p.83] Historically this model was presented as a linear process that happens in a very orderly sequence in which equal time is allocated for each stage. [12] However, according to the National Collaborating Centre for Healthy Public Policy (NCCHPP) “it is understood that these stages sometimes occur simultaneously, sometimes appear in inverse order and are sometimes rapidly skirted…each of these stages corresponds to several “moments” in the life of a policy, which are related to specific activities associated with the policy.” [10, p.1] As per the NCCHPP’s briefing note, Figure 1 visually outlines this turbulent flow and represents the complexity and inter-relationship between the stages. [10]

Figure 1: Stages in policymaking: a turbulent flow [10, p.2]

Figure 1: Stages in policymaking: a turbulent flow [10, p.2]
 

Some advantages offered by applying this model includes that the model “disaggregates the policy process into manageable segments,” [13, p.6] thus making it simple and understandable, “makes it possible to identify different ‘moments’ in the life of a public policy and to adapt information sharing, persuasion and action strategies as appropriate,” [10, p.5] and helps identify where public health and health promotion practitioners may contribute to the policy making process. [13]

V Issue of relevance

Several theories and models have been developed. [14] However, all theories and models that were highlighted in the literature had disadvantages. For example, Real-Dato found when comparing the Advocacy Coalition Framework, Punctuated-Equilibrium Theory and Multiple Streams Approach that “they too suffered from the inability to state clearly underlying processes nor do they pay attention to the end results; policy outputs of policy decisions.” [15, p. 121] A literature review prepared for Peel Public Health identified that “no single policy model offers a fully comprehensive description or understanding of the policy process as each answers somewhat different questions.” [13, p.4] Lastly, the NCCHPP’s briefing note on the stages model concluded “the stages model can illuminate only part of the complexity of public policy processes and, most importantly, like other models, it has no predictive ability.” [10, p.6] Together, what this tells us is that the stages heuristic model still has relevance as no other theory or model has been identified as the leading model, and that other models similar to the stages model have disadvantages.

VI Implication: Eight steps for developing healthy public policies workbook

The results of this literature review are being used to inform the revision of Public Health Ontario’s eight steps for developing healthy public policies workbook. The theoretical underpinning of these steps is the stages heuristic model. Figure 2 provides an overview of the eight steps organized into three stages: planning, implementation and evaluation.

Figure 2: Eight steps for developing healthy public policies [16]

Figure 2: Eight steps for developing healthy public policies [16]
 

These eight steps closely mirror the five common stages of the stages heuristic model of agenda setting (identify, describe and analyze the problem), policy formation (identify and analyze policy options, determine and understand decision makers and influencers, assess readiness for policy development, develop an action plan), policy implementation (implement the action plan and facilitate the adoption and implementation of the policy), and policy review (monitor and evaluate the policy). This forthcoming workbook will explain what each step is about, why it is important and strategies to consider during implementation. Examples, supplementary resources and tips will be provided to assist public health and health promotion practitioners to understand and apply this eight step, three stage model. This workbook is planned to be completed in Winter 2016 and will be advertised in the OHPE bulletin upon release.

References

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