Expanding the Concept of Healthy Public Policy for Animals, Health, and Society

Craig Stephen

INTRODUCTION

Healthy public policy is one of five foundational strategies for health promotion (see Chapter 4). It is different than health policy. Health policy includes decisions, plans, and actions undertaken to achieve specific health care goals. Healthy public policy recognizes that health is determined by more than health services. It pays attention to a wider range of economic, social, environmental, and political policies that influence environments that enable health to happen.

A general introduction to policy is needed before discussing healthy public policy. Policies guide actions. They can be rules, regulations, laws, principles, or guidelines. Governments have policies, as do companies and families. Policies describe what is to be done, who is to do it, how to do it, and for (or to) whom it is to be done. Policies can be made in response to a problem or to an opportunity. They set roles and responsibilities. Policies can be written (like a government regulation) or unwritten (like a family policy of no computer use after 9 pm). Public policy deals with governments’ actions towards some issue. It helps establish the ideas and values that guide decisions. Policy objectives and principles are the basis for ensuing strategies, actions, and decisions.

There are three tiers to public policy: (i) laws created by a governing body; (ii) rules, guidelines, principles, or methods created by agencies with regulatory authority; and (iii) rules or practices established within an agency or organization. Public policies are influenced by political ideologies, social values, competing interests, and evidence. Good public policy leads to measurable, efficient, and positive solutions to public problems in a just way. A good public policy has few unintended side effects, and it is acceptable to the public it serves. Many One Health professionals undervalue, ignore, or misunderstand policy because their education empathized biomedical, ecological, or other social dimensions of health. But policies shape what individuals, groups, and societies do and are therefore essential One Health tools.

AN OVERVIEW OF HEALTHY PUBLIC POLICY AND HEALTH IN ALL POLICIES

Public policies have improved population health throughout history. Laws and regulations governing clean water and sanitation, food safety regulations, and labour laws, for example, made substantial impacts on public health. Policies on livestock housing and husbandry have had major impacts on animal disease control and animal welfare. Land use policies and natural resource use policies affect many wildlife determinants of health. The concept of healthy public policy was prominent in the World Health Organization’s (WHO) Ottawa Charter for Health Promotion (WHO, 1986). The Charter noted that to achieve its goals, health promotion had to be concerned with opportunities and obstacles to creating healthy environment caused by policies in non-health sectors. The WHO 2010 Adelaide Statement on Health in All Policies (WHO, 2010) built on the Ottawa Charter. The aim of Health in All Policies is to improve health outcomes through collaboration between health practitioners and those non- traditional partners who influence the determinants of health. The Adelaide Statement noted that government objectives are best achieved when all sectors include health and well-being as a key component of policy development. An evolution of the Adelaide Statement to adapt it to a One Health context could be: “the fundamental aim of Health in All Policies is to improve health outcomes through collaboration between health practitioners and those non-traditional partners who have influence over vulnerability and adaptive capacity of people and animals inhabiting the same ecosystem.”

Healthy public policy is by nature intersectoral because the health sector needs to collaborate to affect policy in other sectors. Healthy public policy requires governmental processes to coordinate policymaking across sectors through strategic plans that set out common goals, integrated responses, and shared accountability. This, in turn, requires institutionalized processes supporting and enabling cross-sector problem solving and redressing power imbalances. Careful attention to the roles and responsibilities of the various players influencing health determinants and outcomes is required. The Adelaide Statement noted that for agencies to work collaboratively with each other, civil society and the private sector, attention needed to be placed on integrated leadership, mandates, incentives, budgetary commitments, and sustainable mechanisms. These

TABLE 10.1

Conditions for Making the Health in All Policy Approach Work as Described in the Adelaide Statement on Health in All Policies (WHO, 2010)

There is a clear mandate making it imperative that the health sector systematically engages across government, with other sectors, with civil society and private interests to address the health and well-being dimensions of their activities

Cross-sector initiatives must build partnerships and trust through openness and full consultative and practical approaches

The interactions across sectors are systematically identified and considered

There are mechanisms to mediate across interests

There are explicit accountability, transparency, and participatory processes in place

Experimentation and innovation are encouraged to find new ways to integrate social, economic, and environmental goals

attributes and others (Table 10.1) mirror the conditions for successful One Health (Stephen and Stemshorn, 2016; Stephen, 2020).

Policy tools direct, manage, and shape behaviours through laws, regulations, strategic plans, standard-operating plans, and frameworks. The approaches described below summarize the U.S. Department of Disease Prevention and Health Promotion’s cross-sectoral policy approach to promote fruit and vegetable access and intake (ODPHP, 2020). Removing taxes from fruit and vegetables and imposing them onto foods of minimal nutritional value incentivizes consumers to buy more fruit or vegetable. Local government licensing regulations on food purveyors can influence stocking practices to make sure fruits and vegetables are consistently available. Requiring food sellers to post calories of food helps people make more informed food choices. Local food safety policies that allow fruits or vegetables from home gardens to be donated to food banks increase food accessibility. Land use policies and agriculture subsidies influence the nature of local farming practices. Policies that reduce permit costs for farmers’ markets can affect accessibility to local products. Monitoring and enforcement may be needed to guarantee compliance with the policy tools. This example illustrates how achieving policy goals (access to fruit and vegetables in this case) needs a mix of policy tools, often delivered by more than one level of government and/or more than one policy partner.

The healthy public policy and Health in All Policy approaches seem well suited to One Health and EcoHealth, but, to date, they have largely been used for human health promotion. Policy approaches for fish and wildlife tend to be restricted to environmental or natural resource departments, while livestock, poultry, and aquaculture health policies fall into agriculture or fisheries legislation. Animal health still largely falls under the purview of one sector. It is often the case that, even within one sector, the regulations and programmes intended to protect a species’ health are separate from other programmes within the same agency that influences that species’ determinants of health. Because One Health, EcoHealth, or kindred approaches require attention to a wider suite of mechanisms to promote and protect health, it is usually beyond the scope of one organization to fulfil all requirements for a comprehensive scope of activity, especially when both public and private interests intersect. An “all hands-on deck” perspective built on intersectoral partnerships is an essential attribute of effective healthy public policy leaders in the One Health world.

That health is influenced by a wide suite of policies outside of health policies is not a uniquely human situation. Policies explicitly dealing with salmon health in Canada, for example, are almost exclusively concerned with a subset of infectious and parasitic diseases, whereas the programs that influence the determinants of salmon health, like migration fidelity, clear water, fishing pressures and climate change, reside in other policies (Wittrock et al., 2019). However, principles of a healthy public policy approach for animal health or One Health are hard to find. This in part is due to the historic legislative and research focus on infectious and parasitic disease management and the usual role for private rather than public actors in designing and implementing domestic animal health management programmes. Despite this, principles for good One Health policies can be derived by integrating lessons from standard textbooks and publications on herd health and human population health (including Kahn et ah. 2005; Wittrock et ah, 2019; Bhattacharya and Bhatt, 2017; Ibrahim et ah, 2001; Radostits et ah, 1994; FAO, 2007; FAO, 1991) (Table 10.2). These principles serve as a foundation for developing and adapting healthy public policy and Health in All Policies for One Health.

HEALTHY POLICY FORMULATION AND IMPLEMENTATION

There is growing interest and debate about evidence-based policymaking. Evidence-based policy ideally translates into saying people use evidence to make policy. Two words in that last sentence cause some problems: use and evidence. Let us deal with evidence first. Few would argue that it would be wrong to base policy on irrefutable data that had been rigorously and systematically assessed for relevance, reliability, and effectiveness before paying the costs to implement the policy. But there are challenges to implementing an evidence-based approach to public policy. The first challenge comes with what is considered as evidence. In some circles, evidence is restricted to knowledge produced in accord with the standards of a relevant academic discipline. In other cases, evidence can be knowledge, skills, and practices developed by and sustained between generations w'ithin a community. Others consider evidence as what they observe and document using their own senses. An early lesson in the debates of evidence-based policy for me came during an environment impact assessment wherein a community group was incensed about the statement that “there was no evidence that this practice killed wildlife.” This statement was based on a critical review of the scientific literature to determine if there were data to fulfil well-established postulates for causation that the practice resulted in the death of free-ranging wildlife. The postulates

TABLE 10.2

Five Principles and Their Implications for Developing Healthy Public Policy in One Health

Principle

Implication

Policies are outcome based

There must be a clear definition of the preferred health outcomes across species, how they are measured, and thresholds of acceptability in order to assess programme effectiveness

There must be clarity on the population(s) being considered and the ecological or social expectations that determine the appropriate outcomes

Policies are evidence based

There must be a standard acceptable to partners on the nature of biological, ecological, and social evidence to consider when making decisions and how to accommodate varying levels of reliability, validity, and representativeness of that evidence

Health management priorities need to be identified through health needs assessments that consider the health of the interacting species influenced or influencing the issue of concern and input from affected communities and stakeholders to align organizational strategic planning and the management

Policies emphasize all levels of prevention consistent with the population health model involving the determinants of health

Policies need to be attentive to how to prevent long-term harm or premature losses after events, harmful events resulting in health impacts, risk factors leading to harmful events, and other populations from becoming at risk, as well as consider how the needs for prevention vary' across species Policies require a variety of mechanisms to achieve outcomes, including directives, plans, and courses of action that may be required by law or proffered for implementation of norms and practices

Policies must be adaptable to heterogeneity resulting from different ecological, biological, or social conditions

There must be a balance between standardization and customization of interventions and how policy actions will vary with species and context

Policies must be attentive to unanticipated or secondary consequences on subsections of the population(s) of concern and other ecological, biological, or social attributes impacted by the policies

Policies and their associated actions should not impede the health status or access to health determinants for the entire population nor those populations unintentionally or intentionally impacted by health management decisions The evaluation of health policy includes both normative and empirical inquiries that may be applied to all its component considerations

could not be fulfilled, partly due to data speaking against the association, partly due to conflicting data, and partly due to data gaps. The community group, on the other hand, rejected this conclusion because "Billy saw it happen.” The lesson that different people accept different types and standards of evidence upon which to make policy decisions was made crystal clear in this case.

The second concern with the statement “people use evidence to make policy” comes from the word use. Do decision-makers use all available evidence in an objective and balanced way, or do they only select evidence that supports their view or distort evidence with arbitrary safety factors to suit the needs? How do political agendas, economic motivators, or cultural values influence people’s willingness to use the various forms of evidence available to them, without prejudice or favour? Allegations of technical and political bias in the production and use of evidence in policymaking needs to be balanced with the good intentions of those who seek to take ideology and politics out of the policy process by regularly and systematically bringing research and knowledge into the policymaking process. The key take away message is that evidence is increasingly playing a central and influential role in policymaking, but policymakers use other types of information besides research evidence. What is regarded as evidence and how it is used will depend on the nature of the policy and the political situation.

Strehlenert et al. (2015) presented a four-stage process for evidence-informed public policy formulation and implementation. Their model mirrors the typical policy process. It starts with Agenda Setting. In this stage, the “problem” finds its way onto the formal policy agenda. A lot needs to happen before this stage is initiated. A problematic situation needs to be identified by a person or group. An understanding of why the situation is problematic and some options for what should be done need to be in place. There next needs to be some activities by a proponent for a policy change to get government engaged, helping them to see they need to be engaged, either alone or with other groups. Some problems will inevitably not make it onto the government agenda due to competing interests, lack of time, competition with other problems, or lack of an apparent government role.

Once a problem is on the government’s agenda, the next stage is Policy Formulation when possible actions are proposed, debated, and drafted. Policy goals and outcomes along with indicators by which they will be achieved and measured are developed at this stage. Evidence, dialogue, and advocacy not only help get a problem on the policy agenda but also help set realistic and reliable goals and indicators during the policy formulation stage. After a policy is adapted, a plan must be made for the next stage, Implementation. Stakeholders’ views, expert and professional opinions, values, traditions, pressure groups, and the pragmatic realities of the situation policymakers face will influence how or if a policy is implemented. Target audiences must be made aware of the new policy and outreach and support provided to ensure its uptake. Resources and partnerships must be secured and adapted to enable implementation under realistic and sometime heterogeneous settings and circumstances.

The next stage of policy formulation is Maintenance. This is the stage where the policy tools and actions become part of normal business. Incentives, disincentives, education, outreach, and other approaches are needed to maintain these behaviours. Chapters 9, 12, and 20 talk more about methods and approaches to promoting and maintaining behaviour changes. The final stage in policymaking is Evaluation. This is a critical but sometimes forgotten stage of the policymaking process. Evaluation is needed to see if the policy’s effects are aligned with the policy objectives and if any unanticipated or unintended effects arose. It should examine if the policy is still relevant and useful. The results of the policy evaluation should cycle back to the Agenda Setting stage when the evaluation finds a need to amend or discontinue a policy, starting a new policy cycle.

 
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