Transcript Slide 1

Annual Meeting of the
CARMEN Observatory on
Chronic Non-Communicable Disease Policy: “Mobilizing for
Action”
May 12-13, 2008
Hilton Montreal Bonaventure Hotel
MAKING THE CASE: The Power of Policy
Arguments
Cristina Puentes-Markides
Public Policy, Regulation and Health Financing
Area of Strengthening Health Systems and Services
PAHO/WHO
Policy Decisions ….
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Policy requires decisions
Decisions require at least:
 Facts and anticipated consequences
 About values, what matters, priorities and preferences.
 A process to integrate facts and values in analysis and
constructive deliberation. (NRC, 1996)
Yet,
 Policy problems are “wicked” / “ ill-defined”
 Scientific evidence/data are insufficient to generate action.
 Beliefs, ideology, interests often drive public policymaking.
 Often too much data, too little wisdom.
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Argumentation in Public Policy
For individual positions
In public deliberation
In practical politics.
Can be useful at various stages of the policy process
 When positions are being taken or developed
 When positions are declared and agendas set
 When a decision is being made.
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Argumentation in Public Policy
 Not equivalent to a quarrel
 Not equivalent to proof
 Prominent role of communication, deliberation and dialogue
 Policy argument
 Not to prove or disprove
 Not only to argue for or against
 To support a claim of what needs to be done
 An effective policy argument must assume, assert the facts,
definition, interpretations, assumptions, value, consequences
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Knowledge Approaches Needed in Policymaking
Episteme: “what is objectively true”
Universals, objective, repeatable rules, codified, corresponds to modern
scientific ideal, achieved with the aid of analytical rationality.
Techne: “what works in place.”
Concrete, pragmatic, variable and context dependent, arts/craft, capability, tacit
knowledge.
Phronesis: “‘where are we going?; is it desirable?; what must be done? what
should we do”
Pragmatic, variable, context dependent, requires consideration, judgment,
choice, experience, emotional intelligence.
Metis: savvy, cunning, street smart. Great politicians and leaders have it.
Tim Tenbensel . The role of evidence in policy: how the mix matters. School of Population Health
University of Auckland Panel Track: 4) Evidence Based Policy
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Perceptions and Framing
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Perceptions about chronic diseases
Gerard F. Anderson. Physician, Public, and Policymaker Perspectives on Chronic
Conditions. Arch Intern Med. 2003;163(4):437-442.
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Obesity Example
Groups
Antiobesity
researchers
Obesity
Frames
Fat
acceptance
activists
Policy Argument
As illness
As risky behavior
Threat
• Obligation of the sick to seek • Epidemic (works an emotionally
treatment.
charged metaphor.)
• Fat people are too lazy or
• Eating disorders and weight
self-indulgent to manage
obsession concerns mostly upperweight.
middle-class women and girls.
• Risky behaviors (overeating
Neglecting obesity is a form of
and inactivity) are immoral.
class bias.
• Fat bodies evidence
preventable illness and
moral failings.
Body diversity
Human rights
• Fatness is a natural and
largely inevitable form of
diversity.
• Focus on weight is
counterproductive.
• Higher weights are as risky
as smoking
Antiobesity
activists
Fat
acceptance
researchers
Meaning
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• Body weight is not a reliable
indicator of one’s diet or physical
activity.
• Obsession with obesity stigmatizes
fat bodies and neglects dangerous
weight loss and inadequate health
care.
• Weight obsession is hazardous to
your health.
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Framing: How to analyze who is blamed and burdened in
public debate
Individualizing Frames
Systemic Frames
Causes limited to particular individuals
Limits governmental responsibility for
addressing it.
Responsibility falls on government., business,
larger forces.
Invite governmental action
Public Discourse
Biological
Behavioral factors
Burden to powerful groups
Involuntary, universal,
environmental,
knowingly created risk
Interpreted from Lawrence, Regina G. Framing Obesity: The Evolution of News Discourse on a Public Health Issue.
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The International Journal of Press/Politics 2004; 9; 56
Agenda and Agenda-Setting
Agenda
“The list of subjects or problems to which government officials,
and people outside of government closely associated with
those officials, are paying some serious attention at any
given time …
the agenda setting process narrows [a] set of conceivable
subjects to the set that actually becomes the focus of
attention.” Kingdon’s 1984:3
• Political, conflictive, competitive among issue proponents
• Contingent on ability to influence, power and position of groups,
preferences of decision-makers.
• Almost unlimited number of issues, some don’t make it.
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POLICY STREAM
PROBLEM
STREAM
Alternatives, solutions,
policy communities,
feasibilities. Hidden cluster
of participants dominate.
Indicators, events,
definitions, values,
collective action. Policy
entrepreneurs aware of
the problem.
POLITICAL
STREAM
National mood, public
opinion, electoral politics,
consensus building,
Visible cluster of
participants dominate.
Kingdon’s Agenda Setting Model
Window of Opportunity
(predictable, unpredictable)
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Policy Entrepreneur
Analogy of a surfer, waiting on the board to catch the wave:
“They
bring several key resources
into the fray: their claims to a
hearing, their political connection
and negotiating skills, and their
sheer persistence. Items’ chances
of moving up on an agenda are
enhanced considerably by the
presence of a skilful
entrepreneur.” (Kingdon, 1995)
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Policy entrepreneurs
Storytellers
Networkers
Practitioners, bureaucrats
and policy-makers often
articulate and make sense of
complex realities through
simple stories. Sometimes
misleading, yet their
narratives are very powerful.
Policy-making usually takes place
within communities of people who
know each other and interact. If you
want to influence policymakers, you
need to join their networks.
Engineers
Fixers
Often, a huge gap between what
politicians and policy-makers
say they are doing and what
actually happens. Researchers/
analysts need to work not just
with the senior level policymakers, but also with the 'streetlevel bureaucrats'.
Policy making is essentially a political
process. You don’t need to be a
Machiavelli, but successful policy
entrepreneurs need to know how to
operate in a political environment when to make your pitch, to whom
and how.
Source: ODI
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A successful argument depends partly on
Recognizing how the policy/political climate shapes effectiveness.
Recognizing frames, perceptions.
Awareness of complexity and potential tensions
Recognizing and taking advantage of policy windows.
A policy entrepreneur, someone willing to invest time and energy
for policy change
Ability to integrate different types of knowledge (episteme, logos,
techne) for policy relevance.
Power, position
Reputation, prestige, political clout, credibility (ethos), ability to
appeal to the emotions of the audience (pathos) and ability to
present good reasons/logic (logos).
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1. Currently, are chronic diseases (as a package or
specific diseases/conditions) issues in the
policy agenda of your government?
2. Can you identify the policy frames used?
3. What was the policy window (the coupling of
the problem, the solutions, the political climate)
that made it possible?
4. If they are not in the policy agenda, in your view
what can you do as a policy entrepreneur to
help it happen?
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