Brownson et al (2009) And the Definition of Evidence-Based Policy
The objective of this study is to examine how Brownson et al. (2009) defines evidence-based policy and to discuss the three domains of evidence. Additionally this work will consider that recently a number of agencies adopted a public health policy supporting legislation to ban the use of artificial Trans fats in restaurants and bakeries nationwide and will discuss the evidence basis for the policy. The approach of Brownson et al. will be applied in examining the three domains and in determining the evidence basis for the policy.
Brownson et al. (2009)
The work of Brownson, et al. (2009) states that public health policy has an important effect on the individual’s health status and that what is missing from the knowledge available is “a clear articulation of the definition of evidence-based policy and approaches to move the field forward.” (p. 1576) The three key domains of evidenced-based policy are reported by Brownson et al. (2009) to include: (1) process to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. (p. 1576)
II. The First Domain
The first domain or that of the “process” domain has the objective of understanding approaches that will enhance the likelihood of adoption of policy. The data sources of this first ‘process’ is reported to be “key informant interviews, case studies, and surveys of setting specific-political contexts.” (Brownson, et al., 2009, p. 1578) The example stated by Brownson et al. (2009) is related to “…understanding the lessons learned from different approaches and key players, included in state health reforms.” (p. 1578)
III. The Second Domain
The second domain or that of ‘content’ has the stated objective of the identification of “specific policy elements that are likely to be effective.” (Brownson, et al., 2009, p. 1578) Data sources in this second domain are reported to include systematic reviews and content analyses. (Brownson, et al., 2009, p. 1578) It is reported that an example is the development of “model laws on tobacco that make use of decades of research on the impacts of policy on tobacco use.” (Brownson, et al., 2009, p. 1578)
IV. The Third Domain
The third domain or that of ‘outcome’ is reported to have the objective of documentation of the “potential impact on policy.” (Brownson, et al., 2009, p. 1578) Data sources for this third domain are reported to include systems for surveillance and “natural experiments tracking policy-related endpoints.” (Brownson, et al., 2009, p.1578) Examples of the third domain reported by Brownson et al. (2009) include those of: (1) tracking changes in rates of self-reported seat belt use in relation to the passage of seat belt laws; and (2) describing the use of cost-effectiveness of child immunization requirement. (p. 1578)
V. Adoption of Public Health Legislation Banning the Use of Trans Fats in Restaurants and Bakeries Nationwide
According to the Centers for Disease Control and Prevention (2014) Trans fats were “created by chemists using a food process known as hydrogenation, where liquid oils are converted into solid fats. Trans fats, also known as partially hydrogenated oils, were intended to replace saturated fats which were found to contribute to heart disease. Unlike other dietary fats, transfats, are not essential to human health, do not promote good health and increase the risk for coronary heart disease.” (p. 1) The Centers for Disease Control and Prevention additionally reports that due to the increased risk of heart disease that “several jurisdictions have moved to “reduce or eliminate Trans fats from use in restaurants and schools.” (p. 1) Rule making and policy statements include that published on July 11, 2003, where the FDA published a final rule in the Federal Register reported to amend its regulations on food labeling requiring that artificial trans fat be listed on the nutrition label of conventional foods and dietary supplements which is reported to have gone into effect on the 1st of January 2006. Applying the first domain as asserted in the work of Brownson, et al. (2009) involves conduction of interviews with key informants relating to the listing of Trans fat on nutritional labels of food as well as conduction of case studies and taking surveys. Application of the second domain or that of content involves identifying the policy elements that are likely to be effective. This would involve conduction of systematic reviews relating to labeling of foods and dietary supplements similar to the case of labeling Trans fat. Application of the third domain as asserted in the work of Brownson, et al. (2009) will involve documenting the potential impact on policy of banning Trans fat in restaurants and bakeries and monitor the restaurant and bakeries for use of Trans fat.
VI. Public Health Systems Analyzed
The work of Mays et al. (2006) states that government authority and control serve to influence the 0 performance of the public health system and that this includes the “types of governmental jurisdictions and governance structures that exist within the systems.” (p.524) Findings in the study conducted by Mays, et al. (2006) include that “local public health systems vary considerably in the extent to which they perform essential services, and the institutional and economic characteristics of these systems appear to play important roles in shaping their performance.” (p. 528) The strongest predictor of public health services performance is reported to be that of the size of the system. (Mays, et al., 2006, p. 528) What this means is that public health systems that are of a small size face barriers in service performance even where they are well-funded and their levels of staffing are similar to those of larger public health services. In addition, it is reported that the larger public health systems have the added benefits of “larger pools of organization in the community that may be enlisted to participate in public health activities, including medical care providers, community organizations, educational institutions, local media, businesses and government agencies.” (Mays, et al., 2006, p. 524) Mays, et al. (2006) reports that larger public health systems have been found in the research to have better performance than smaller public health systems “in carrying out activities considered to be important elements of public health practice.” (p. 524)
Summary and Conclusion
Implementation of nutrition labeling for trans fat in food items will be more successful in areas with larger public health systems because there are the necessary partners in the community to conduct the needed research both prior to and following requiring trans fat labeling in food items since the larger public health system has access to more support throughout the area in which the public health system serves. In order to apply the three domains as asserted in Brownson, et al. (2009), the larger public health system will have more success in achieving its goals.
Bibliography
Artificial Trans Fat (2014) Centers for Disease Control and Prevention. Public Health Law Program. Retrieved from: http://www.cdc.gov/phlp/winnable/transfat.html
Brownson, RC, et al. (2009) Understanding Evidence-Based public Health Policy: Policy, Politics and Collective Action. American Journal of Public Health, 2009. Sept. Vol. 99 No. 9.
Mays, GP et al. (2006) Institutional and Economic Determinants of Public Health System performance. American Journal of Public Health Research and Practice. March 2006, Vol 96, No. 3.
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