1. Problem Definition and Agenda Setting FPMU120: HEALTH POLICY FOR HEALTHY LIFESTYLES YUYAN SHI, PHD DEPARTMENT OF FAMILY MEDICINE AND PUBLIC HEALTH UNIVERSITY OF CALIFORNIA, SAN DIEGO SPRING 2016

2. Lecture Outline  Announcements  Individual presentation on health policy topics  This lecture: Learning objectives Problem definition Agenda setting Homework assignment #1 Voluntary assessment of Dr. Shi Acknowledgement: part of this presentation is derived from a presentation made originally by Dr. McMenamin in FPMU 120, Spring 2015 and 2016. These slides are used with Dr. McMenamin’s permission.

3. Announcements  About clicker quizzes in class  Public Health Research Day April 6 th (tomorrow) 2-5pm Medical Education and Telemedicine (MET)  Homework #1 due 4/14/2016 12:00pm  TA Liangdao Li office hour starts this week

4. Announcements This is Public Health Week  Build a nation of safe, healthy communities  Help all young people graduate from high school  The relationship between increased economic mobility and better health  Social justice and health  Give everyone a choice of healthy food  Preparing for the health effects of climate change  Provide quality health care for everyone  Strengthen public health infrastructure and capacity Source: http://www.nphw.org/http://www.nphw.org/

5. Previously in FPMU 120…  Described the basic function, structure, and powers of the legislative & executive branches of government  Identified federal and state government organizations involved in public health policy making  Differentiated between policy analysis of the policy process and analysis of policy content To identify the main steps in the policy making process To identify the main steps in the analysis of policy content

6. Lecture Learning Objectives  To identify the role of problem definition in the policy formulation process  To describe the various types of problem definition tools and how to use them  To describe the types and models of agenda setting  To understand the assignment and expectations for Assignment #1

7. The Guiding Frameworks of the Course 1. Agenda Setting2. Policy Formulation3. Policy Adoption 4. Policy Implementation 5. Policy Evaluation 1. Define the Problem 2. Assemble the Evidence 3. Construct the Alternatives 4. Select the Criterion 5. Project the Outcomes 6. Confront the Tradeoffs 7. Decide 8. Tell your Story Steps in the Policy-Making Process Steps in the Policy Analysis Process Class 3,4 Class 3

8. *Problem Definition  What is a “problem” A special condition of severity where corrective action is long overdue.  When does a condition become a “problem” A crisis (i.e. a focusing event) Measurement indicates a condition has reached a crisis level (i.e. obesity epidemic)  Example: electronic cigarettes https://www.youtube.com/watch?v=Ccn1ZbwQ6ww

9. *Problem definition decides…  Who will be interested  Where policy debates should take place  Which values are implicated  What policy options should be used to solve the problem Source: Stone, Deborah A. Policy paradox and political reason. Harper Collins, 1988.

10. Problem Definition: Gun Violence (Sandy Hook)  Gun accessibility (Victims’ Families) http://www.theguardian.com/world/2013/apr/13/sandy-hook-radio-gun-control  Mental Health (Republicans) http://www.huffingtonpost.com/2013/02/12/republicans-mental-health-care-gun- control_n_2640166.html  Unsafe Schools (NRA: National Rifle Association) http://thehill.com/video/in-the-news/274275-nra-calls-for-armed-guards-at-every-school

11. Problem definition determines… Problem DefinitionGuns are too accessible Mental health system is weak Good guys need guns to fight bad guys Who will be interested Where will policy debate take place? Which values are implicated? What policy options are implicated?

12. Problem definition determines… Problem DefinitionGuns are too accessible Mental health system is weak Good guys need guns to fight bad guys Who will be interested NRA, Public Health Mental Health System NRA, Public Health Where will policy debate take place? Constitutional Rights: 2nd Amendment Mental health arenaEducation arena Which values are implicated? LibertySecurity What policy options are implicated? Regulation of fire arms Increased funding of mental health; Limit guns for those with mental illness Funding for police/fire arms in schools

13. *Problem Definition Tools 1.Symbols 2.Causal Models 3.Numbers/Facts Source: Stone, Deborah A. Policy paradox and political reason. Harper Collins, 1988.

14. *Symbols  Anything that stands for something else  Four aspects of symbolic representation Narrative stories Synechdoches Metaphors Ambiguity Source: Stone, Deborah A. Policy paradox and political reason. Harper Collins, 1988.

15. The Power of a Narrative Story https://www.youtube.com/watch?v=hAYnm5OltL4 Compared to a plain text: “Long-term heroin use can destroy every aspect of your life, from your physical health to your finances, career and relationships.”

16. The Power of Metaphors Coach Potato: a person who spends little or no time exercising and a great deal of time watching television

17. *Causal Models  Assign responsibility using a causal model.  A cause implies a solution (but does not state a specific policy option)  Identifies victims and oppressors; heroes and villains.

18. *Numbers Illustrate:  The size of problem.  How it is changing over time.  Used to prove "stories" are true.  Serve as symbols of precision, accuracy, objectivity, authority. Quantify if possible!

19. Power of Numbers: Obesity Example

20. *Strategies for success  Problem Definition is more successful if: greater social significance less technical associate with emotional symbols long-term relevance clear cause model

21. Problem Definition Examples Brain Break: Take a moment to think about a health policy issue you are familiar with Write down two different ways the problem could be defined Take 2 minutes to share your interest with your neighbor

22. Agenda Setting  The number of potential issues are larger than the number that can be considered  How do issues get on the agenda?  What strategies are successful?

23. *Two Types of Agendas  The Public Agenda Achieve a high level of public interest and visibility  The Formal Agenda Problems are on a formal agenda where decision makers seriously consider

24. Impacts of Media Coverage in Public Agenda https://www.youtube.com/watch?v=GZ8AdMcXBXI

25. *Models of Agenda Building  Outside Initiative  Mobilization  Inside Access Source: Cobb Ross and Ross. Agenda Building as a Comparative Political Process. American Political Science Review, Vol 70, pp. 126-138, March 1976.

26. *Outside Initiative Model  Emphasizes nongovernmental sources of policy initiation.  Most successful for groups weak in material resources but large in number.  Groups representing lower status interests in society use this more.  Applies to actions of groups OUTSIDE government.  Create pressure on decision makers to move issue onto formal agenda Source: Cobb Ross and Ross. Agenda Building as a Comparative Political Process. American Political Science Review, Vol 70, pp. 126-138, March 1976.

27. *Mobilization Model  Move issue from formal to public; requires support of public to implement.  Needed when a policy requires widespread, voluntary compliance.  Source is a political leader; problem making policy visible. Source: Cobb Ross and Ross. Agenda Building as a Comparative Political Process. American Political Science Review, Vol 70, pp. 126-138, March 1976.

28. *Inside Access Model  Policy originates in government or group with access to formal agenda.  Inside group articulates grievance or policy.  Issue reaches formal agenda more easily because of position of initiating groups.  Attempt to exclude participation of public; seeks private decisions within government. Source: Cobb Ross and Ross. Agenda Building as a Comparative Political Process. American Political Science Review, Vol 70, pp. 126-138, March 1976.

29. Homework Assignment #1 Details see course website http://www.ucsdfpmu120.org/homework- 1.htmlhttp://www.ucsdfpmu120.org/homework- 1.html

30. Homework #1: Issue Brief  You will prepare an issue brief on a health behavior topic of your choice, which must include the following: Who are you representing What is the problem: clear definition of the problem or issue at hand Why important: sufficient background information for the reader to understand the importance and context of the identified problem What causes the problem: a causal model Summary of existing policies for this problem Conclusion about problem, importance, and existing policies References used in the creation of the issue brief Resources the reader can consult to gain more information on the identified problem

31. Grading Rubric  Clearly defined health problem and who are you representing (5 pts)  Background is sufficiently detailed to understand context of the problem (10 pts)  Cause of the problem is discussed (5 pts)  Current policies to address this issue are summarized (5 pts)  Data are used to describe magnitude of the problem (5 pts)  References are identified (must use at least 5) (3 pts)  Resources are identified (must list at least 3) (2 pts)  Overall writing style & meets formatting requirements: (5 pts)

32. Specifics  Maximum of 2 pages, double-spaced, 1-inch margins, 12-point font  Submit your brief through TED by 4/14/2016 12:00 pm.  You do NOT need to suggest a solution to your problem.

33. Examples of Issue Brief  Electronic cigarettes http://www.astho.org/E-Cigarettes-Issue_Brief.aspx (first two pages)  Hookah smoking http://www.lung.org/assets/documents/tobacco/hoo kah-policy-brief-updated.pdfhttp://www.lung.org/assets/documents/tobacco/hoo kah-policy-brief-updated.pdf (page 1-5)  Obesity http://www.nhlbi.nih.gov/health/educational/wecan /healthy-weight-basics/obesity.htm

34. Next lecture Policy Making Process Policy process and analysis Problem definition and agenda setting Interest group Policy Strategies Mass media tools Economic tools Legal tools Regulatory tools Healthcare financing Policy Evaluation Pre-post and RCT Quasi-experimental design Cost-effectiveness Cost-benefit

35. Assigned Reading Brownell and Warner The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879177/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879177/