1. Introduction to module Ann McNeill ann.mcneill@kcl.ac.ukann.mcneill@kcl.ac.uk

2. Learning objectives Understand the aims and learning objectives of the module Understand the module structure and sessions Have some background knowledge of speakers Have some things to think about during the module!

3. Contemporary advances in evidence based policy, prevention & practice Wk 1: Introduction, evidence and policy Wk 2: Drug policy Wk 3: International tobacco policy, alcohol, cannabis Wk 4: Prevention Wk 5: Alcohol, opioids, writing press releases Wk 6: Workforce development, drugs & driving Wk 7: Drugs in workplace, development of clinical policy & protocols Wk 8: Tobacco & clinical practice Wk 9: Module Revision

4. Assessments 11/12/13 Submission deadline for written30% assignment A Ministerial briefing and press release from a policy/research project/paper 1000 words, inc 250 word press release 15/1/14 Module Exams MCQ – 1 hour20% 24/1/14 Essay 50% 2000 words – titles to be provided week 3.

5. Aims of the module Introduce the concepts of policy development, including legislative responses to addictions & how they have evolved over time Explore the processes that impact on real world translation of evidence into policy Explore the development of clinical practices & procedures, including the factors that mediate the transfer of evidence & policy into practice Introduce the concepts of universal, selective & indicated prevention strategies Introduce the students to current/recent research projects conducted within the Addictions CAG

6. Learning outcomes for module Comprehensively discuss & analyse policy development & the critical political debates in response to addictions (including legislative perspectives) Critically analyse how evidence influences policy, discuss how policies can be evaluated & assess prevention concepts & programmes Appraise critically current or recent addiction research projects & their implications for practice & policy Discuss & critically analyse how experts develop national practice/clinical practice & the influence of policy & evidence

7. What is policy A policy can be considered as a ‘Statement of intent’ or a commitment Decision-makers can be held accountable for their ‘policy’

8. What is a strategy? The big picture. An overarching term, longer term framework, carefully designed plan of action, can contain lots of policies But we tend to use the terms policy & strategy interchangeably

9. Some things to think about during the module 1.Policy: drug – specific policy or general public policies (is one more important than the other?)

10. Healthy public policy Public policy comprises public issues identified for attention by the government, and the courses of action that are taken to address them Healthy public policy, concept promoted by the WHO, highlights the potential impact that all government policies can have on health. Healthy public policy is policy that makes explicit the impact it may have on health Oxford Handbook

11. Characteristics of healthy public policy Recognition of the important influence of economic, social and physical environments on health Cooperation between health and other sectors of government Commitment to social equity Facilitation of public participation » After Draper 1988, from Green & Tones, 2010

12. Some things to think about during the module 2. Ethical issues – e.g. Individual liberties. When is legislation required?

13. The Intervention Ladder Eliminate choice Restrict choice Guide choice through disincentives Guide choice through incentives Guide choices thru’ changing default policy Enable choice Provide information Do nothing Adapted from Nuffield council on Bioethics. Public health: ethical issues

14. “Nudge” ‘it is legitimate for choice architects to try to influence people’s behaviour in order to make their lives longer, healthier and better” – Thaler and Sunstein, 2008

15. Some things to think about during the module 3.How are policies made?

16. Key influences in policy making To what extent is a policy based on rational decision making What other factors are involved, for example: – Ideological beliefs and values – political, morals, religion, culture, social traditions – Economic considerations – Political acceptability – Democracy, eg voting, public pressure – Legal advice, court judgements – International obligations – Evidence-based research about ‘what works’ – Compromises – Crises – Easiest option?

17. Policy Cycle Evaluation Reformulation Initiation Adoption Implementation Adapted from Milio, 1981

18. Some things to think about during the module 4. Who influences policy development?

19. Players Policy makers (politicians/bureaucracies) Policy influencers (groups in/outside of government) Media (influence both policy makers’ and public’s understanding of, and attitude towards, an issue) Public (consumers, taxpayers, voters, whose opinion will ultimately affect the adoption of the policy) – users Academics? Health professionals? Adapted from Green & Tones, 2010

20. Some things to think about during the module 5. Can policies have negative effects?

21. Unintended negative effects Health impact assessment: the prospective estimation of potential impacts of a proposed policy/programme on a population’s health, or any combination of procedures or methods by which a proposed policy/programme may be judged as to the effects it may have on the health of a population Kemm and Parry, 2004

22. Some things to think about during the module 6. How much emphasis should be placed on prevention?

23. Some things to think about during the module 7. How do we ensure clinical practice is evidence-based?