How Are Health Policies Made?

Nineteenth-century attorney John Godfrey Saxe once quipped: "Laws, like sausages, cease to inspire respect in proportion as we know how they are made." On the other hand, if you know as much as possible about the process by which public policy, including health policy, is crafted, you greatly boost your odds of making a difference in millions of people's lives. The focus here is health policy in the U.S., applying Birkland's "simplest" definition of public policy as "the things government chooses to do or not do."

Instructions

• 1

  Bring your health policy issue forward for public debate and discussion, starting with your own definition of the health problem and its possible solutions. Make sure that your case is already substantive and compelling before you open it up to the public. For example, if you are seeking better policy on preventable maternal and infant deaths in the US, marshal human stories, accurate statistics and information on possible interventions like expanded prenatal care and family planning access. Translate these into a public education campaign that allows you to set and keep control of your agenda, even as you remain open to learning from public feedback.

• 2

  Urge political action in support of your health concern. Continuing with the example of preventable maternal and infant deaths, you could gather petition signatures and thus influence local, state and/or federal officials to open up an investigation and public hearings on the matter. Enlist existing interest groups and chief executives in this effort.

• 3

  Craft a legislative proposal that both advances your cause and fits into the existing overall health policy agenda at the level of government where you are working. You could, for example, seek to increase already established federal appropriations for family planning and prenatal care services at community health centers, targeting these at the women most vulnerable to high-risk pregnancies.

• 4

  Continuously monitor and evaluate your proposal's implementation when and if it becomes law. Your original policy may be modified many times. For example, an effective pilot program for maternal/infant mortality reduction may be expanded, then later be subjected to budget cuts.