1. Working together to combat Non-Communicable Diseases (NCD) in [insert jurisdiction here] through Policy Changes, Community Engagement and Collaborations

2. Learning Objectives NCDs: definition and relevance
Policy, Politics and the Public’s Health
Policy 101: Overview of policy changes and how to make it happen
The importance of gathering support: definition and key principles of Community Engagement and Collaboration

4. World Health Organization, 2006
Definition of Health
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. …The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
“Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”
World Health Organization, 2006

5. Impact of policy and community on NCD
The Innovative Care for Chronic Conditions (ICCC) framework, depicts the complementary nature of working across the disease continuum in a comprehensive way, and emphasizes community and policy aspects of improving care.
The full article, with detailed explanations of each component, can be found at

6. Policy Making… Alignment is key!
An Illustration of Kingdon’s Non-linear Framework for Policy-making.
First, an issue needs to be recognized as a “problem” by politicians, policymakers and the overall community before it can be raised in the policy-making agenda.
In this case, the problem has been defined world-wide by the WHO Commission on Social Determinants of Health (CSDH) (Chapter 4) and the 2011 United Nations High-Level Meeting on the Prevention and Control of Noncommunicable Diseases.
-increase burden of disease and death
-rising health care costs
-larger percentage of health care budget being spent on off-island referrals or care at the later stages of life, rather than on prevention
Secondly, proposals for solutions to the problems are required, in other words – “policies”.
Successful policies are technically sound, culturally and ethically acceptable and resource-appropriate – both in terms of finances, but also in human resources needed to implement and monitor the policies.
Involvement from multiple interested organizations and the community “stakeholders” is critical to every step of the policy-making process. This helps to work out conflicts, arise at compromise and achieves wide-spread buy-in and support even before the official policy is proposed.
Thirdly, the “politics” environment must align and the timing must be appropriate.
-financial crisis
-establishment of a new government
-election campaigns
Who helps to raise health issues in policy-making agendas?
-public health
-policy makers
-community leaders
-private industry
-many partners
Lippo K, et al. Health in All Policies, Ministry of Social Affairs and Health, Finland, 2013, Section 1.3, p 15-17

7. Changing Policies: An Overview
What do we mean by policies?
Written or unwritten guidelines that governments, organizations and institutions, communities, or individuals use when responding to issues or situations
You address:
__ Official government policies.
__ Policies made by government bureaucracies, and by public services such as police and health departments.
__ The policies of foundations and other private funders.
__ Policies of businesses or media.
__ Policies adopted by the community as a whole.
Why try to change policies?
__ Addressing policies can start a community conversation about the issues in question.
__ Changing policy is easier in the long run than fighting the same
battles over and over again.
__ Changed policies can change people's minds and attitudes.
__ Changed policies have effects on the next generation.

8. Changing Policies: An Overview
Who should try to change policies?
__ A broad-based coalition.
__ An organization that works with those affected by the policies in question.
__ A grass roots community initiative.
__ A concerned professional association.
__ A determined individual.
When should you try to change policies?
__ It's an election year.
__ The issue first arises.
__ A crisis is reached, and it's clear the current policy isn't working.
__ Public opinion has reached critical mass.
__ There's a specific debate about the issue.
__ New information changes perceptions about the issue.
__ A publication or other source brings an issue to the public
attention.

9. Policy 101 Policy-Making Steps
WHO’s Enhancing Health Policy Development: A Practical Guide to Understanding the Legislative Process
Important Considerations: Intended and Unintended Consequences
[list considerations pertinent to your jurisdiction here] (See PIHOA Toolkit, Things to Consider section)

10. Policy 101 [mention necessary stakeholders here & lead organization]
Explain the different between “Small P” versus “Big P” changes.
Small Ps are policy, systems, and environmental changes happening within an organization or a smaller group of individuals (e.g. single churches, departments, villages, etc.). System changes in Small P settings pertain to the changes in practices or customs of that single organization.
Big Ps are policy, systems, and environmental changes happening throughout an entire state, nation or region (e.g. entire Palau, entire Guam or entire State of Chuuk, etc.)

11. The Elements of Community Engagement: equal slices of a pie
“The purpose of community engagement is to inform, educate, consult, involve and empower stakeholders in both health care or health service planning and decision making processes to improve the health care system.”
–LHIN, 2011
The Elements of Community Engagement: equal slices of a pie
Additional recommended readings:
 Community Engagement Guidelines and Toolkit (by Local Health Integration Network Ontario, 2011)
Pgs. 5-23: Definition of community engagement and the core principles involved;
Provides worksheets and templates to assist in planning Community Engagement activities; community engagement planning worksheets (for Small and Big Projects)
Source: The Manchester Community Engagement Toolkit

12. Engaging Traditional/Cultural Leaders
Checklist:
Understand that culture affects the social organization and leadership structure of groups.
Learn about each group's social organization and have found the structural points for bringing the groups together.
Meet with ethnic and cultural group leaders, discussed with group members their culture and heritage, and gathered information on the various cultural groups.
Determine how various institutions (e.g., churches, families) function in the different cultural groups.
Understand the importance of building on existing cultural traditions in a group in order to engage the members in your effort.
 Understanding Culture, Social Organization, and Leadership to Enhance Engagement (by The Community Tool Box, 2013)
An online resource that contains 46 Chapters providing useful, step-by-step guidance in community-building skills.

13. Lessons Learned: Exploring Yapese Beliefs on Death and Dying
Community Engagement
Lessons Learned: Exploring Yapese Beliefs on Death and Dying
“…participation from local authorities, [must be obtained], such as the chiefs’ council in Yap—Council of Pilung (Yap Proper) and the Council of Tamol (Neighboring Islands).”
–PCEED Project, 2010
Know the protocols in engaging traditional and cultural leadership in [insert jurisdiction]
For more on Engaging Specific Groups, read
The Manchester Community Engagement Toolkit
Gathering Support is an important part of making policies. Key principles when gathering support will be explained further through the Community Engagement and Collaboration sections.
 The Manchester Community Engagement Toolkit (by Manchester City Council)
Pgs : Provides guidelines on how to engage specific groups in the community, relevant to the youth, the older people, gender equality, LGBT, etc.
Pgs : Information based around the community engagement processes of informing, researching, consulting, involving, devolving decision-making and supporting community action; sets out core skills used in community engagement, such as planning, facilitation and communication.

14. Collaboration Have a clear organizational relationship
Specify expectations and needs
Outline a communication guide/chart
[mention /insert organizational chart/ communication diagram here]
 Collaboration Guide for Pacific Island Cancer and Chronic Disease Programs (by CDC, 2013)
Pgs. 5-38: A CDC-developed Collaboration Guide for Pacific Island Cancer and Chronic Disease Programs (or the Pacific Island Collaboration Guide), to help CCC programs and coalitions and other chronic disease and school-based programs and coalitions work together; includes practical advice and tools for staff working in CCC programs in the Pacific that are funded by the Centers for Disease Control and Prevention’s (CDC’s) National Comprehensive Cancer Control Program (NCCCP) and their CCC coalition partners

15. How a Bill Becomes a Law
 How a bill becomes a law

16. How to Make a Policy Happen: Let’s Recap!
1. Identify a specific need.
2. Gather support.
3. Approach a policy maker.
BIG “P” = City, county, state, national
Small “P” = Workplace, storeowner, school board, etc.
4. Continue raising public awareness.
5. Stay in contact with the sponsoring policy maker.
6. Attend meetings where the policy is introduced and discussed.
7. If the policy is enacted:
Thank the supporters and the policy makers publicly and monitor the enforcement of the policy.
8. If policy is NOT enacted:
Thank the policy maker for their support and review the process. Ask yourselves: Why did it fail? What can we do differently next time?
How to Make a Policy Happen:
1. Identify a specific need. You must be able to answer the following questions.
• Why should this be done? (data drives the process)
• Who will help you get this moving?
• Have you done your homework?
Who will this policy affect? Who are the potential adversaries? What are the possible counter arguments they will have? Decide how you will respond to their counter arguments. Evidence (data) is hard to fight!
2. Gather support.
• Educate the public on the issue through a variety of
sources over a period of time.
• Frame the issue in terms of why it is needed and what is at stake if we don’t make change.
3. Approach a policy maker.
• City, county, state, national
Workplace, storeowner, school board, etc.;
MEET IN PERSON ONE-ON-ONE; Provide them with data and rationale
• Be clear, specific focused and concise
• Make their job easy
4. Continue raising public awareness.
• Editorials
• Advertisements
• Guerrilla tactics involving a diversity of community publications
5. Stay in contact with the sponsoring policy maker.
• Ask what you can do to help
• Be prepared to address questions and concerns
• Provide data, new information, strategies, etc.
6. Attend meetings where the policy is introduced and discussed (if applicable).
• Be prepared to clearly identify:
Why there is a need? What will happen once the policy is in place? What will happen if it does not go into place?
7. If the policy is enacted:
• Thank the supporters
• Thank the policy maker publicly
• Monitor the enforcement of the policy
8. If policy is not enacted:
• Thank the policy maker for their support
• Review your process. Ask yourselves:
Why did it fail? What can we do differently next time?
Source: faceproject.org

17. Thank you!
 For more on Policy Making Processes in the USAPI, see Module 2 of the PIHOA Policy Toolkit [insert link to toolkit here]