Week 14: Increasing Consumer Participation in the Policy Process

In order to increase consumer participation it is necessary to educate the public about the policy process and motivate them to do be involved and recognize that they too have a voice in this process.  Participants may act as impetus or constraints in a matter of policy where they seek to either move the policy forward or fight against it by either preventing its passage or lessening the perceived negative effects of it (Kingdon, 2011).  As consumers seek to make changes they have the right to speak out and support or fight against policies according to their beliefs regarding potential outcomes of specific policies.

The presidential election of 2008 showed that internet technologies were extremely effective in increasing voting participation as they had a record year of votes cast (Kraft & Furlong, 2015). Websites like www.letsmove.gov have suggestions for parents, elected officials, schools, etc. on how they can participate in the implementation of initiatives to help in the fight against obesity.  Furthermore, the most recent participation the public can have with the policy process is the Dietary Guidelines for Americans, 2015.  As discussed on former posts the public is given the opportunity to attend meetings in person or via web streaming and make comments to let their voice be heard (health.gov, 2015).  When the report was released, we heard about it in the news and on the radio about the changes from the 2010 guidelines.  However, at that point, the developing process was over and comment periods during following the formative sessions had ended.  Corporations, special interest groups, healthcare professionals, and academia submitted most of the comments (Office of Disease Prevention and Health Promotion, 2015).  Yet, a strategy to get the layperson to know that they too can comment would be to get the word out about the dates and times of these meetings.  One way could be to make use of governmental daily emails, such as the emails that go out every day if you sign up for them on choosemyplate.gov. Of course the daily emails for choosemyplate.gov are about eating healthy, but I do think that would be a useful venue to educate the public on upcoming changes to guidelines and how they can be involved.  A  short announcement at the bottom of the email, after the healthy eating tip, would likely be sufficient.

References

Health.gov. (2015). Dietary guidelines for Americans, 2015. Retrieved January 20, 2015, from http://www.health.gov/dietaryguidelines/2015.asp

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (2nd ed.). Glenview, IL: Pearson.

Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5th ed.). Thousand Oaks, CA: CQ Press.

Office of Disease Prevention and Health Promotion. (2015). Dietary Guidelines for Americans, 2015 Read Comments. Retrieved February 22, 2015, from http://www.health.gov/dietaryguidelines/dga2015/comments/readComments.aspx

Week 13: Sustaining innovative environments

Long (2010) identifies the idea of incrementalism, that there are small changes happening frequently to policies as they remain in operation. With the Dietary Guidelines for Americans, it is evident that the former guidelines are not fully changed every five years with the newly issued guidelines. As discussed in previous posts, each five years the guidelines are revised and updated based on the most current research and evidence (health.gov, n.d.). In order to sustain the innovative environment the multiple public meetings allow anyone who wishes to view the proceedings and make comments as they deem fit. The Dietary Guidelines Advisory Council consists of experts from various fields, who are appointed every five years, so it is not a fixed group of the same people revising the guidelines each time. In addition to the immediate council members, there are subcommittees and consultants that work on specific topics within the dietary guidelines. These individuals and their varied backgrounds and experience contribute to innovation, and the development of focus committees helps to channel the creativity to the topics of interest.

I discussed my interview with Karen Zell (personal communication, March 2, 2015), the Chief of the Bureau of Nutrition and Physical Activity for the Arizona Department of Health Services, in my week 10 post and she explained some of the ways they are working to implement these guidelines on the state and local levels. She mentioned the use of different marketing techniques to get the message of “the healthy choice is the easy choice” out through websites, ads, and other campaigns in schools and in the community. Zell’s ideas and efforts for the state of Arizona represent the many individuals involved on her committees and other committees like hers to find innovative and creative ways to get a positive and fun message out about nutrition and health.

Over time, society changes and thus, policies and methods evolve to keep up with trends and technology. For example, many years ago the food guide pyramid was the conceptual model for the dietary guidelines, from 1992 to 2005 (Center for Nutrition Policy and Promotion, n.d.). I remember handouts given at school, posters at school, magnets for the refrigerator. It was a lot of propaganda distributed mostly through school, and seemed to be effective in that it reached children and families. As the internet has grown and become more accessible through multiple devices to individuals of all ages, including children, the marketing has changed to make the most use of those available resources. Websites, apps, and advertisements are all things we are seeing now to promote the different health initiatives. I think posters, handouts, and magnets could still work, however they are perhaps not as effective and far-reaching as the internet-based promotions. As the world changes, not only are there new advances in science that uncover new evidence that stimulate changes in policies (particularly in dietary guidelines for this case) but new delivery methods that are innovative enough to catch the attention of the diverse public with their varied backgrounds, needs, and frames of reference.

References

Center for Nutrition Policy and Promotion. (n.d.). Food guide pyramid. Retrieved January 30, 2015, from http://www.cnpp.usda.gov/FGP

Health.gov. (n.d.). Dietary guidelines for Americans, 2015. Retrieved January 20, 2015, from http://www.health.gov/dietaryguidelines/2015.asp

Longest. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Week 12: Healthcare Financing

Healthcare Financing

Healthcare costs are an unfailing topic of discussion in politics and will likely remain as such for quite some time. Obesity related healthcare is alarmingly costly, between $147 and $210 billion per year. Childhood obesity alone accounts for $14 billion (The State of Obesity, n.d.). It is alarming to think of such a costly condition that affects all ages and in many cases is preventable through proper lifestyle changes. Childhood obesity could potentially be the most serious of any age group because it is in those formative years that they learn about food choices and activity habits they may carry with them through adulthood. A study observed adolescents over a 5 year span as they transitioned into adulthood and found a high percentage of those individuals that became obese during that time, remained obese into adulthood, which identified a trend likely to continue into the later years of adulthood (Gordon-Larsen, Adair, Nelson, & Popkin, 2004). In addition to the many healthcare costs related to obesity, consider the converse if a high percentage of individuals had improved diets and regular exercise in their lives, other risks and health problems would be less severe as well.

The federal budget is a perpetual topic of discussion in policy and is understandably at the hub of so many policy issues especially as spending continues to increase. “Over the past 30 years, total national spending on healthcare has more than doubled as a share of gross domestic product (GDP)” (Longest, 2010, p. 313). As the government looks for ways to decrease spending and as healthcare seeks to find ways to cut costs, it seems obvious that the first place to turn should be the avertable things such as obesity. As we have discussed over the semester, there are so many factors that go into the prevention of obesity, as well as programs and initiatives in the private and public sectors. There is no simple fix to the problem of obesity however, it basically comes down to the individual’s (hopefully in a child’s case, the family’s) commitment to change and their will to maintain the positive lifestyle that lends to retaining a healthy weight.

References

Gordon-Larsen, P., Adair, L. S., Nelson, M. C., & Popkin, B. M. (2004). Five-year obesity incidence in the transition period between adolescence and adulthood: The national longitudinal study of adolescent health. The American Journal of Clinical Nutrition, 80(3), 569-575. doi:80/3/569

Longest. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

The State of Obesity. (n.d.). Fast facts: Economic costs of obesity. Retrieved April 9, 2015, from http://stateofobesity.org/facts-economic-costs-of-obesity/

Week 11: Innovators and Change Agents in Healthcare policy

Innovators and change agents are the catalysts that perpetuate progress. In context of health policy and childhood obesity, we have established what the policies and guidelines are; now in order to implement them effectively a change agent is necessary. Innovators and change agents are individuals that facilitate and bring about steps to change and maintain the sustainability of said change.

To make lasting changes to combat childhood obesity, changes need to occur on multiple levels. Much has been discussed on the policies in place and the stretch of its influence. Pieces of the policies only become accessible when attended to as the policy dictates, such as access to WIC funds and the ability to purchase only specific foods with those resources. Other types of policies that require change are more difficult to enforce because they are matters of education and personal change. For example, the Dietary Guidelines for Americans, 2015 that are coming out will not restrict or inhibit access to unhealthy foods to the public or to children. This is where the innovator and change agents play a crucial role.

In a primary care office, the providers that see children have an important message to get across to the patient and the parents. An obese child often needs to work on the following areas to work toward a healthy weight and lifestyle: increase fruits and vegetables, decrease daily caloric intake, increase physical activity, and decrease sugary and empty-calorie foods/snacks. Kotter explains that motivation for change occurs because there is a belief in the need for a change; they feel the sense of urgency and are inspired to do something about it (as cited by Campbell, 2008). A healthcare provider is in the position to motivate children and families to reach and maintain a healthy weight and to make lifestyle changes to prevent obesity. A study showed that many parents have low confidence in managing the weight of their overweight children (Phan, Curran, & Abatemarco, 2015). As a motivational provider, it is important to give the parents the sense of urgency necessary to spur them to action but also important to help the parent believe they have the ability to make the changes in the home necessary to improve the wellbeing of their children and the entire family. Each provider uses their own unique method of teaching to families, but those that truly make a positive change are the ones that are innovative in their approaches.

References

Campbell, R. J. (2008). Change management in health care. The Health Care Manager, 27(1), 23-39.

Phan, T. T., Curran, J. L., & Abatemarco, D. J. (2015). Disparities in parent confidence managing child weight-related behaviors. Patient Education and Counseling, 98(1), 85-89. doi:http://dx.doi.org.ezproxy1.lib.asu.edu/10.1016/j.pec.2014.10.016

Week 10: Change Theory

The concept of change is universally applicable to every policy topic because it is trying either to change a system, process, or protocol, from an old way of doing things or to prevent a new policy from changing current practice.

I had the opportunity to interview Karen Zell (personal communication, March 2, 2015), the Chief of the Bureau of Nutrition and Physical Activity for the Arizona Department of Health Services. She talked a lot about the programs currently in place to fight childhood obesity and the new direction they are hoping to take to make a stronger impact on the public to focus on nutritious choices and healthy habits.

She identified her goal as the prevention of obesity, and much of what she talked about included changes they are working toward, and the changes that they have observed. One change was with the WIC program in 2009 with a revamping of how the funds were distributed and the designation of monetary allotments for specific foods. The WIC package was changed to be in greater alignment with healthy choices, therefore milk and cheese were decreased to age appropriate portions, whole grains (bread in particular) were introduced, juice was decreased to age appropriate portions. Specific vouchers are provided for fresh fruits and vegetables in hopes to increase purchase and consumption. They found that a lot of these vouchers were being cashed to buy fresh fruits and vegetables, but they wanted to improve this even more so fast and easy version of vegetables (frozen and canned) were included as well. These changes caused a five percent increase and helped improve the utilization of these important WIC funds (K. Zell, personal communication, March 2, 2015)..

Another big project she is working on is the website eatwellbewell.org that the Bureau of Health and Nutrition Services maintains. This website is entitled “Champions for Change” and provides opportunities for individuals to be involved in making these changes on a personal/family level, school, or community levels. This website includes nutrition games for children, recipes with five ingredients or less, activities, and other helpful information for the public. Another change from the usual techniques in raising awareness of nutrition and childhood obesity is the theme of messaging for positive improvement, and messaging to get people to engage. They are hoping to make it possible through education and resources that “the healthy choice is the easy choice” (K. Zell, personal communication, March 2, 2015).

Frieden, Dietz, and Collins (2010) similarly identified getting the message right, by promoting a positive image for healthy food, improving the context of physical activity, and changing the attitudes of individuals about the healthy choices. The essence of change is to find something successful and build upon it. If the initial approach is not effective then modifying the angle may help, but sometimes an entirely new idea is necessary. Thus, change comes as we keep trying to solve problems and seek unique ways to find answers and success.

References

Arizona Nutrition Network. (2015). Champions for change. Retrieved from http://www.eatwellbewell.org/

Frieden, T. R., Dietz, W., & Collins, J. (2010). Reducing childhood obesity through policy change: Acting now to prevent obesity. Health Affairs, 29(3), 357-363.

Week 9: Privacy Protection

Privacy protection is a major concern in this technological age, not only with health information, but any kind of personal information. The worldwide web has granted access by the masses to immeasurable cyber venues, and many of which that ask for personal information. With so many concerns about personal information, the Health Insurance Portability and Accountability Act (HIPAA) bring peace of mind that our health information is protected (US Department of Health and Human Services, n.d.). With that reassurance we can go to the doctor and entrust our health information with a group of strangers and believe it will be safeguarded.

Through the lens of the policy topic of childhood obesity and Dietary Guidelines for Americans, there is not a lot to be said about policy to regulate privacy other than what has been said in so many ways over the years about HIPAA. However, the policy work for genomics applies to the obesity prevention endeavor. The direct to consumer (DTC) genetic testing holds many issues for policymakers and consumers. Controversy abounds and multiple policy recommendations exist on DTC in attempts to regulate companies and protect consumers. Some recommendations require companies to provide adequate education on benefits and limits of tests, quality of genetic processes, full disclosure of scientific processes, and requirement to see health care provider prior to completing the testing. One of the purposes of DTC is to identify genetic traits and disease susceptibilities found on an individual’s genome. DTC companies market that they can inform the healthy lifestyle changes a person can make by helping an individual customize their plan according to their genetic risks (Caulfield & McGuire, 2012). As we know, exercise and a proper diet have great health benefits in health promotion and disease prevention. This kind of lifestyle change or maintenance thereof does not need any confirmation of lab test to identify that it is good personal health to do so. An individual that may have a genetic condition that predisposes them to obesity should still maintain a healthy diet and exercise to do all on their part possible to not add to the overweight problem due to excess consumption of calories. Perhaps when other conditions are being considered and it would be helpful to identify the genetic risk factors, then in that case the regulations should be in place. Beyond good health practice, patterns and examples for children to follow make an impact on their habits and behaviors developed over time.

References

Caulfield, T., & McGuire, A. L. (2012). Direct-to-consumer genetic testing: Perceptions, problems, and policy responses. Annual Review of Medicine, 63, 23-33. doi:10.1146/annurev-med-062110-123753

US Department of Health and Human Services. (n.d.). Health information privacy. Retrieved from http://www.hhs.gov/ocr/privacy/

Week 8: Private sector innovation and policy advancement in childhood obesity

Especially since the Dietary Guidelines Advisory Committee (DGAC) recently released the report for the new Dietary Guidelines for Americans, 2015, it seems many groups in the public and private sector have much to say about the changes. There are companies that are fighting and criticizing the changes and looking for ways to undermine the evidence the DGAC presented by capitalizing minutiae in wording and terminology so as to make their product sound a bit more healthy than the new guidelines currently give them credit for (monster comment). One particular organization that has been vocal in the support of the new guidelines is the Center for Science in the Public Interest (CSPI). The CSPI has the mission to advance policy that will promote nutrition, health, and food safety for the public (Center for Science in the Public Interest [CSPI], 2014). They have initiated many projects of great import including efforts that have led to the changes in nutrition facts labeling for packaged foods, vending machines, restaurant menus, and so forth. These initiatives assist in the operation of the dietary guidelines by educating and innovating ways to help the public to understand and make healthy choices. They also publish the Nutrition Action Healthletter that provides articles on health and nutrition to thousands of Americans and Canadians (CSPI, 2014). As such an influential group with far reaching publicity, they have an effective method of assisting in the education of the policies and how they affect individuals. With the new information from the DGAC report, some of the dietary guideline changes are being discussed and debated in blogs, news articles, and publications, and consumers need credible sources to turn to for their information that can give them objective answers to their questions.  In addition families with children struggling with overweight and obesity issues need further education and motivation through other sources to help them have the motivation and support to make the lifestyle changes necessary to reduce and then maintain a healthy weight.

Another especially influential organization is the American Academy of Pediatrics (AAP) whose purpose is to promote the health and welfare of children, adolescents, and young adults through support and education to the professionals that care for the pediatric population. As multi-faceted organization, the AAP fulfills multiple objectives in advocating for children in many ways. Some of the purposes of the AAP include:

  • Develop and publish many of the major guidelines that inform preventive health care for the pediatric age group
  • Advocacy and voice for applicable policies at the federal and state levels
  • Education for best evidence, guidelines, protocols, and procedures for pediatric  professionals
  • Education to the public on health matters
  • Research and publications
  • Community-based projects that improve access to care and provide other essentials and benefits for children.     (American Academy of Pediatrics, n.d.)

As nutrition is a crucial piece to the health promotion and disease prevention puzzle for children and adolescents, the AAP’s purposes as listed above, each play a part in support of the dietary guidelines policy and works to improve its effectiveness.As the public and private sector work together in the operation of healthcare policies, the progress expands through the synergy created by such cooperation.

    References

American Academy of Pediatrics. (n.d.). AAP facts. Retrieved March 5, 2015, from https://www.aap.org/en-us/about-the-aap/aap-facts/Pages/AAP-Facts.aspx

Center for Science in the Public Interest. (2014). About us. Retrieved March 5, 2015, from http://www.cspinet.org/about/index.html