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Health Policymaking

In this lecture, Anna Kalbarczyk reviews the Health Impact Pyramid and its use in health policymaking. (Step 3.4)
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ANNA KALBARCZYK: Welcome to this section on health policy making. I would like to begin with a reflection question. What do you understand by the term policy engagement? What does it mean to you? I’ll use the material in this lecture to explore different facets of this question. Maybe write down your response now and come back to it at the end of the recording. Now I’ll ask the question what is policy engagement? It involves governments, stakeholders, communities, and individuals working together to achieve complex societal goals. It includes participating effectively in the policy-making process and aspirations regarding how to have a positive impact on the lives of people in different societies and countries.
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One polio eradication official in Ethiopia said, “There is a high level of support from the political leaders. Polio eradication is given a high priority. The planning and strategy developments are supported with implementing partners. And the interest of community members are reflected in it. As the vaccine is given orally, it has high acceptance and good participation from the community side.” So here we see how engaging with a variety of stakeholders and obtaining support from political leaders can lead a program to successfully reaching populations. And this highlights both the process and the value of policy engagement. Policy engagement can serve many roles, but largely it helps to increase visibility of the program and garner support across the national, subnational, and district levels.
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Some examples from our data highlight the importance of policy engagement and the different purposes it serves. Here on the slide, we have a quote from a country program staff in India. “One of the things I would like to highlight– right from the beginning, a lot of political ownership in the program was there. So you could see people organizing for the program. I give credit to the government. Also, because the accountability mechanism like the district task forces that came into act. A district manager could be accountable for the work, which had a big impact and gave learning lessons.” Policy engagement has the power to increase ownership of policies by policy makers and can also help create or enforce accountability mechanisms.
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So let’s continue with this question. Why is policy engagement important in health programs? Another answer is that policy engagement serves as a tool to advocate for funds in order to sustain the program in the context of very few remaining cases. The polio eradication initiative has come a long way. But as with most programs, the last mile is the most difficult. And this is for a number of reasons. You may now be trying to access the most hard-to-reach populations. And perhaps you’ve been engaging with communities and policymakers for a long time. Given political cycles, individuals and decision-making goals may have changed. Continuous policy engagement can keep the health program on the agenda and among a country’s health priorities.
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Policymaking also brings together a diverse group of stakeholders from across national levels to commit and together chart a plan it’s this participatory and collaborative approach that can help achieve buy-in as officials at different levels are able to craft the approach. One WHO representative at the global level recalled this process in Ethiopia and said, “So he created this thing called the high-level advocacy meetings or something like that in Ethiopia. They were a brilliant success because he was able to get local leaders of the community with these high-level advocacy meetings at Ethiopian state or regional government levels engaged in and committed to polio. It was a dramatic change.
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And there happened to be, because it was a regional technical advisory group, there were people from the Sudan ministry of health there. And this door cracked open. And we shoved our feet through and dragged the project in with us. And a couple of years later, there was a polio project in South Sudan.”
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Now that we’ve established some rules that policy engagement can play and their value in promoting and sustaining interventions, I would like to describe this health impact pyramid, which portrays the impact of different types of public health interventions to improve health. At the base of this pyramid, it indicates interventions with the greatest potential impact. And these are efforts to address socioeconomic determinants of health. Then as we move up the pyramid, there are interventions that change the context to make individual default decisions healthy, such as policy interventions, which is our focus today. By engaging with policy and key stakeholders, the aim is to change the context and thus reach broader segments of society.
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Socioeconomic factors and changing the context really overlap significantly and may be perceived as a constituent of a single domain. In the next section, we’ll talk about some of the considerations and approaches for changing the context and for addressing socioeconomic factors through policy.

Anna Kalbarczyk, DrPH, MPH
Bloomberg School of Public Health, Johns Hopkins University, USA

Please take a few moments to review the reading A Framework for Public Health Action: The Health Impact Pyramid. The final section reviews some practical applications of the health impact pyramid.

Do any of these applications apply to your context? Are there other practical applications for the health impact pyramid that you can think of?

We invite you to post your thoughts in the discussion.

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