Policy is everywhere. A policy is simply a plan of what to do in a situation that has been agreed to by a group of people. There can be a household policy on screen time, a farm policy on milking hygiene, or a government policy on land use. Public policy is what a government does or does not do about a problem that is in the public interest. Policies can come as laws, regulations, incentives, programs, or services. Something must be a collective problem rather than a purely individual problem for it to make it onto the government policy agenda. Health promoters need to be aware of the social and political context of change so that the requested policy change can be framed in a manner that resonates with the departments, agencies, and politicians who can influence the policy agenda as well as with the communities being served (Beland and Katapally, 2018). Framing your desired change in a way that addresses the strategic priorities of government and community partners will have more success than simply asking them to change policy to address your priorities.

The Stages Model (Anon, 2003) describes a policy change process. It starts with agenda setting wherein the problem is seen to be of public interest. From a policymaker’s perspective, a new policy is appropriate when (i) the community asks for it, (ii) an issue has reached crisis proportions, and/or (iii) there is a long-standing major issue with little progress (CCHD. 2020). To get on the policy agenda, the situation needs to be recognized as being problematic, proposed solutions should be available, and someone needs to engage with government to influence the situation. The next step is to draft the policy. At this stage, political power dynamics plays an influential role. Government actors see how the problems and solutions match their mandate while advocates for change try to get their priorities high profile. After the decision is made to implement the policy, success can be influenced by the type and complexity of the problem, the size and speed of the expected change, the human and financial resources available to implement the policy, and the government structures and regulations in place to enforce or encourage policy implementation. The Stages Model helps health promoters identify different steps in the public policymaking so that they can appropriately adapt information sharing, persuasion, and action strategies.

Because health is influenced by factors beyond health care, the creation of health promoting public policy depends on the collaboration with and among multiple government departments to achieve health goals. Such a collaboration is not easy to establish or continue. There are eight key elements that can lead to positive partnership: (i) a shared mission aligned to the partners’ individual or institutional goals; (ii) a broad range of participation from diverse partners and a balance of human and financial resources; (iii) leadership that inspires trust, confidence, and inclusiveness; (iv) effective multi-way communication; (v) clear formal and informal roles; (vi) trust; (vii) attention to the political, economic, cultural, social, and organizational impacts; and (viii) evaluation for continuous improvement (Corbin. 2017).


Improving people’s access to information and their capacity to use it effectively is the key to empowerment (Nutbeam, 2000). Health literacy is concerned with helping people obtain, process, and understand health information and services


Some Influences on Different Aspects of Health or Environmental Literacy

Literacy Aspects


Ability to seek. find, and obtain health information

  • • Knowing how to access information
  • • Impediments and opportunities to access information
  • • Timing and medium for information deliver)'
  • • Trustworthiness of information sources

Ability to comprehend the accessed information

  • • Perceived utility of the information
  • • Relevance of outcomes and information to the individual
  • • The use of plain language or jargon

Ability to interpret, filter, judge, and evaluate accessed information

  • • Complexity of the information
  • • How cause-effect relations are perceived or understood
  • • Ability to weigh different types of information

Ability to communicate and use the information to make a decision to act

  • • Comprehension of the information and its relevance to change
  • • Knowing how to overcome impediments to action

Source: Adapted from Nutbeam, 2000.

needed to make appropriate decisions. Environmental literacy is similarly concerned with a person’s understanding, skills, and motivation to make decisions that consider his or her relationships with natural systems, communities, and future generations. Effective health and environmental literacy involve more than ensuring people can access and read information. They also involve developing skills and attitudes that motivate people to seek and use knowledge and improve their self-efficacy and confidence. Many factors influence health literacy (Table 9.6). As with all the theories and models introduced in the chapter, interventions to promote health or environmental literature need to be tailored to the personal and situational factors in the populations of interest.


Helping people make decisions that are good for themselves, their communities, their animals, and their ecosystems needs a systematic approach to developing their health and environmental literacy and creating social environments that will make change acceptable, feasible, and effective. Leading positive change requires us to understand what motivates and empowers people to move from the status quo to an unknown future. This chapter has only scratched the surface of the plethora of theories and models that have been developed to understand the process of change. Chapter 20 provides a case example of how these theories have been used to combat plastic pollution to benefit wildlife and communities in the Caribbean. Other case studies presented in this book implicitly or explicitly illustrate that to make change, we have to be more effective at helping people make good choices and doing so requires more than only giving them new information in the hopes they will do what we think is right.


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