Resources Lesson 1: Policy Implications of Prevention
Many countries have developed national policies, and these can be subject to change over time as governments change and introduce different policies and priorities.
Within the UK National Health Service, there is a developing emphasis on prevention, and you can explore the policies being developed in Delivering Triple Prevention: a Health System Responsibility.
Australia has a ten-year plan for a National Preventive Health Strategy, which has had input from many national bodies.
In Africa, the development of the Africa Centres for Disease Control and Prevention (Africa CDC) is designed to "provide strategic direction and promote public health practice within member states through capacity building, minimisation of health inequalities, and promotion of continuous quality improvement in the delivery of public health services. It will also guide in the prevention of public health emergencies and threats through partnerships, science, policy, and data-driven interventions and programmes in line with international standards and WHO recommendations."
There are also national policies for particular disease problems, such as described here Non-communicable disease prevention policy process in five African countries.
This summary from the United States Food and Drug Administration outlines the FDA's role in regulating the manufacturing, distributing, and marketing of tobacco products in the US under the Family Smoking Prevention and Control Act. It explains the different restrictions that have been implemented at a national level to control tobacco use in the population. Read the entire page.
A recent global initiative, the Health in All Policies is defined as: "Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity." and can be found on a WHO site here.
Further exploration of a global approach is made in the paper Towards a comprehensive global approach to prevention and control of NCDs by McKee et al. Although the topic is Non-Communicable Disease, the principles are relevant to all aspects of prevention policy. The authors state: "We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal ¿one-size fits all¿ approach of relatively simple prevention-oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors."
This guide provides an overview of some solutions that have been developed for global tobacco control (WHO Framework Convention on Tobacco Control, Global Hearts Initiative). Interventions for non-communicable disease prevention and control that are endorsed by the World Health Assembly include the MPOWER, SHAKE, and HEARTS packages. The authors also provide a summary of recommended actions for authorities, healthcare providers, and commercial establishments that can be implemented to support tobacco control and reduce tobacco use. Read the sections "Solutions" and "Opportunities" from pages 14-17.
But what is the science behind prevention policy?
This paper, Understanding Evidence-Based Public Health Policy, by Brownson et al is worth reading. Most of the policies described relate to prevention. The paper abstract says:
"Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts).
We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy.
Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence."
Policy and evidence into action
"Translation of research evidence into policy and practice is challenging for disease prevention researchers. This problem is not new: despite John Snow's mid-nineteenth-century insights that providing clean water prevents cholera, this disease still devastates the urban poor in developing countries. A report of the World Health Organization suggests that "... toxic combination of bad policies, economics, and politics is, in large measure, responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible” is how the paper Translating active living research into policy and practice: One important pathway to chronic disease prevention by Giles-Corti et al in the Journal of Public Health Policy starts. While the paper is concerned with chronic disease, the principles are generally relevant. The paper includes: "10 strategies that may facilitate translation of research into health-enhancing urban planning policy. Strategies include interdisciplinary research teams of policymakers and practitioners; undertaking explicitly policy-relevant research; adopting appropriate study designs and methodologies (evaluation of policy initiatives as 'natural experiments'); and adopting dissemination strategies that include knowledge brokers, advocates, and lobbyists."