health public policy analysis

Introduction Since 1986, the World Health Organization has promoted a Healthy Communities/Healthy Cities initiative, also known as the Alliance for Healthy Cities, with hundreds of participating municipalities across the world (Hancock, 1993; World Health Organization, 2018). The purpose of the Alliance for Healthy Cities is to encourage local governments to incorporate health promotion into all areas of public practice, economic policy, and urban development (World Health Organization, 2018). Goals of the Healthy Communities/ Healthy Cities approach include reducing public health risks including obesity, and promoting healthy lifestyles, public safety, and health equity.

The success of Healthy Cities programs and policies directly depends on the empowerment of nurses at all levels of practice, including community-based nurses. Because each community presents different needs, goals, and challenges, nurses in each community can collaborate with partners and stakeholders to promote and reach realistic public health goals. Healthy Communities: Relevance to the Nursing Profession The Healthy Communities/Healthy Cities approach is based on the ecological model of public health and nursing, which is systemic in approach.

Individual health is viewed as part of a whole; the individual is influenced by socioeconomic and cultural factors as well as by issues related to quality of life in the community. Public infrastructure, clean air, and normative behaviors all have a strong impact on individual decision-making, lifestyle, and attitudes towards health, healthcare, and wellness (Bowen, Barrington & Beresford, 2015; Story, Kaphingst, Robinson-O’Brien, et al., 2008).

Nurses also treat patients within the same normative environment; when nurses make lifestyle recommendations for patients, those recommendations are much more meaningful and easier to act on when the patient is supported by community infrastructure and health-seeking paradigms. Community health approaches like the Healthy Cities/Healthy Communities projects are grounded in evidence-based practice Bowen, Barrington & Beresford, 2015; Story, Kaphingst, Robinson-O’Brien, et al., 2008).

While the majority of studies focus on the impact of public policy and community nursing on obesity and related health issues, a growing body of evidence also supports public health approaches and nursing policy to reducing violence and extremism too (Weine, Eisenman, Kinsler, et al., 2016). The Healthy Communities/Healthy Cities approach is flexible, taking into account the diverse needs of heterogeneous communities and has proven successful all over the world (Hu & Kuo, 2016; Rice, Franseschini, Wallerstein, et al., 2017).

Because participation in the initiatives is fully voluntary, the implementation of the Healthy Communities approach to health promotion is generally achieved in a bottom-up fashion, although some municipalities find that a top-down approach to implementation works better. Ultimately, the mechanisms of action and specific methods of policy implementation can be adaptable to suit the needs of individual communities, their residents, and business owners. Financial Impact The financial impact of healthy cities initiatives varies depending on how the policy is implemented at the local level.

In most cases, executing a Healthy City/Healthy Community plan requires the participation of both public and private sector, creating opportunities for strategic partnerships. Healthy Cities initiatives involve public works and urban planning projects that have the dual effect of promoting health behaviors and stimulating economic growth and development in the area. Similarly, municipalities that adopt a healthy communities approach also build alliances with businesses that are committed to social responsibility.

Improving public health in the community has a positive effect on economic growth by encouraging community involvement in local businesses, encouraging foot traffic through walking and bicycle paths through the community, and also, improving health outcomes. Improving health outcomes in targeted communities reduces unnecessary healthcare expenditures, liberating healthcare resources for making improvements to critical care. Values and Ethical Principles Ethical principles guide the nursing profession.

When nurses actively participate in policy development related to the creation of Healthy Cities/Healthy Communities, they fulfill most of the core ethical objectives of the profession including patient autonomy, beneficence, equity, and social justice. Nurses are committed to care at every level of delivery: the individual, family, and community (Pope, Hough & Chase, 2016). The principle of beneficence means that nurses act in ways that benefit their patients, including their extended families, not through paternalistic actions but through patient empowerment.

Patient empowerment depends on knowledge and information, but also on awareness and access of public health services. Communities that have robust healthy infrastructure are beneficent communities, and nurses have an ethical obligation to participate in urban planning that reflects the core goals of public health and health promotion. The beneficent parameters of a healthy city include features like high quality housing that is affordable for all socioeconomic groups, sustainability, food and water security, safety and freedom from violence, access to healthy food and exercise, and access to quality healthcare (Hancock, 1993).

Healthy Cities/Healthy Communities also promote the principle of patient autonomy. Nurses promote patient autonomy by encouraging patients to make decisions based on available information and resources. Patients are not coerced in any way to access or utilize public health resources or community services, but those services are available and the patient and family members are aware of those services. Finally, Healthy Cities/Healthy Communities promote social justice and health equity.

The fundamental tenets of the nursing and public health policy include the assurance that all residents of the community have the opportunity to live as a high a quality of life as possible. Policy Brief: Healthy Communities Audience and Decision Makers Uriel Jones, Mayor of Puerto Santa Lucia, is the primary audience for this policy brief. As a chief decision maker in the Puerto Santa Lucia community, Jones has the ability to make the top-down executive decisions that affect economic policy, business development, infrastructure changes, and citywide public health policies.

Jones has worked with nurses and public health advocates before, and is therefore a sympathetic audience. However, Jones also needs to know that the business community in Puerto Santa Lucia supports the initiative and is able to participate in the decision-making process. Review of Literature To consider making changes to community policy and transforming Puerto Santa Lucia into a Healthy Community, Jones should be made aware of emerging literature and the corpus of nursing research substantiating the efficacy of the proposed changes.

For one, changes made to local community infrastructure have a direct and immediate bearing on quality of life in the community as well as global health outcomes. “Land-use and transport policies contribute to worldwide epidemics of injuries and non-communicable diseases through traffic exposure, noise, air pollution, social isolation, low physical activity, and sedentary behaviors,” (Sallis, Bull, Burdett, et al., 2016, p. 2936).

Institutional changes, political commitment, capacity building, innovative public planning, and other partnership-based local solutions have been shown to promote “overall sustainable urban health development,” (Hu & Kuo, 2016). Rice, Franceschini, Wallerstein, et al. (2017) also show how communities like Puerto Santa Lucia stand to benefit financially from improving the brand identity of the municipality, which would therefore improve the area’s attractiveness to investors.

Research also shows that a top-down approach might help improve public health in tangible and measurable ways, by increasing equitable access to healthy food sources, promoting healthy lifestyles, and creating a normative culture of health (Bowen, Barrington & Beresford, 2015; Story, Kaphingst, Robinson-O’Brien, et al., 2008). The proposed policy change directly addresses the ethical imperative of social justice and equity, which would help establish Puerto Santa Lucia as a leader in sustainable, equitable community development.

Research shows that especially when it comes to preventable health issues like obesity, which can be addressed through nursing advocacy and interventions, community-level issues like public infrastructure and public policy, have a direct impact on health outcomes. For example, “obesogenic nutrition environments are spatially patterned such that they cooccur in areas with larger proportions of low-income and minority populations,” (Bowen, Barrington & Beresford, 2015, p. 290).

The low-income neighborhoods of Puerto Santa Lucia can enjoy improved health outcomes, higher quality of life, and sustainable economic growth through a concerted effort at creating a Healthy Community. While macro-level policies can be helpful, driving down overall costs, impacting public health announcements, media, and advertising, ultimately the immediate and daily life factors like having parks, walking paths, and cycling paths are issues over which mayors like Smith have direct control. The proposed changes imply both bottom-up and top-down approaches to public development.

When cities like Puerto Santa Lucia solicit the active participation of nurses and nursing coalitions into their public planning departments, they can achieve measurable outcomes in accordance with the ethical values and goals of the Healthy Cities/Healthy Communities objectives. Improving the local application of Healthy Communities initiatives has the potential to reduce healthcare costs, improve the economy, and also enhance all quality of life factors including social justice, affordable housing, and health outcomes.

Therefore, the Mayor of Puerto Santa Lucia is motivated by a strong set of data-driven, evidence-based solutions. Challenges Challenges to making policy changes include the need to solicit funding and other perceived financial impediments, and the time it takes to realize public health behavioral changes. Behavioral changes require normative culture changes, which can take years to manifest.

However, case studies in Taiwan, Latin America, North America, and Europe offer the small town of Puerto Santa Lucia the chance to see how other municipalities have overcome similar challenges and realized their public health goals (Hancock, 1993; Hu & Kuo, 2016; Rice, Franceschini, Wallerstein, et al., 2017). To overcome specific challenges, the community needs to conduct a needs assessment, and make strategic interventions accordingly.

Forming relationships with stakeholders, attracting investors from the nonprofit, government, and private sector, the mayor can begin implementing public health policies immediately and then roll out additional changes over the course of the next five, ten, and twenty years. The Healthy Cities/Healthy Communities goals are long-term in nature. Primary Options and Interventions Primary options and interventions should be tangible and realizable. These options and interventions will be multifaceted, addressing multiple public health objectives including obesity reduction, health promotion, and normative changes.

The role of the public health nurse and nurse advocate includes “protecting against environmental hazards, preventing injuries, promoting and encouraging healthy behaviors and environments, responding to disasters and assisting communities in recovery, and assuring the quality and accessibility of health services,” (Weine, Eisenman, Kinsler, et al., 2016, p. 4). Therefore, the interventions should focus on constructing safe public parks and walkways.

Constructing new public walkways that are well-lit and conveniently located achieves several core, measurable, and tangible objectives such as reducing the dependency on automobiles, while also making public spaces safer and more enjoyable for all residents. Small steps, taken incrementally and monitored over time, will help the municipality reach desired health outcomes within an established budgetary and time frame. “Individual behavior change is difficult to achieve without addressing the context in which people make decisions,” (Story, Kaphingst, Robinson-O’Brien, et al., 2008, p. 266).

Therefore, the mayor of Puerto Santa Lucia is also urged to form strategic partnerships with the private sector. Partnering with major supermarket chains and independent small business alike, the community can establish ground rules for health promotion. Encouraging small-scale community gardens, offering free gardening classes at the community center, and liberating the rules on farmer’s markets and small community vendors are specific and tangible steps that can be taken to promote public health goals in the community.

Likewise, the municipality can increase its awareness and regulation of the media and marketing channels, to stimulate a normative environment. If funds allow, inviting high profile celebrity guest speakers to partner with the city’s brand might help to encourage a culture of health in Puerto Santa Lucia. The mayor also needs to work closely with local law enforcement, which needs to embrace the community policing model more readily and involve the public in the decision-making process related to patrols, and non-antagonistic interactions with residents.

Proposed Course of Action I. Form coalitions and workgroups A. Public-Private Partnerships B. Civil engineering and public works projects C. Parks service II. Delegate tasks to each workgroup III. Monitor results IV. Self-assessments A. City council and executive level administrative assessments B. Quantitative analyses 1. Health outcomes a. Obesity: Measured by rates and prevalence b. Diabetes, heart disease: Measured by rates, prevalence, severity 2. Surveys a. Community/resident perceptions b. Perceptions by law enforcement, educators, businesses, and other stakeholders. c.

Perceptions of nurses and healthcare workers Action Plan Target Organization: City Hall City Hall has expressed interest in committing to the Healthy Community initiatives, forming strategic partnerships, and dramatically changing the ethical and goal-driven framework of community development. Public planning, housing, real estate development, transportation infrastructure, and other core areas will be motivated by public health outcomes and social justice ethics. City Hall has expressed interest in the Healthy Cities/Healthy Communities project for several reasons.

Expressions of Interest Good for Business One of the reasons why City Hall has committed to the proposal for Healthy Cities/Healthy Communities is that participation improves the brand identity of the city, attracts investors, stimulates tourism, and promotes overall economic development. The case studies in Asia and Latin America show how similar initiatives at the local level have achieved financial objectives, reducing unnecessary healthcare burdens while also stimulating economic development in multiple job sectors (Hu & Kuo, 2016; Rice, Franceschini, Wallerstein, et al., 2017).

The result is a win/win scenario, whereby nurses achieve public health objectives, the city achieves its economic development goals, and residents enjoy a higher quality of life in a more desirable geographic location. Public Health Performance Local hospitals and healthcare organizations have a direct interest in improving public health outcomes, for ethical, legal, and financial reasons.

City Hall is a primary stakeholder in public health, as data-driven health outcomes have a strong bearing on how the municipality will attract future investments in the healthcare sector from both government and private funding sources. Moreover, a city with low pollution, high quality of life, and a healthy lifestyle will attract the businesses and residents that will construct a better tomorrow.

Offering patients information about how they can improve their health and be empowered with knowledge is one thing; providing residents with the public infrastructure they need to fulfill their own personal health objectives is yet another. Three CBPR Principles Community-based participatory research (CBPR) is a multifaceted approach to change. The fundamental principle upon which CBPR is based is empowerment. Rather than focus on individual health promotion, a more systemic, ecological view is taken, one that acknowledges the social and political determinants of health (Mendes, Plaza & Wallerstein, 2014).

The CBPR approach also empowers each resident of the community; it is fully participative, because residents are genuinely treated as “full and equal partners in all phases of the research process,” (Holkup, Tripp-Reimer, Salois, et al., 2004, p. 162). Power is shared among various stakeholder groups. Even when CBPR seems inefficient due to its participatory decision-making and implementation process, the goals are more sustainable and achieve the ultimate objectives of social justice. In fact, CBPR is committed to the principle of social justice.

Community organizations take part in the decision-making process, making the overall policy development more of a bottom-up process, even when it was initially driven by top-down decisions. The CBPR process capitalizes on existing resources, reducing waste, and also recognizes that residents may identify with multiple intersecting identity markers based on ethnicity, socioeconomic class, gender, professional status, and other factors. Although its primary emphasis is empowerment and advocacy, CBPR is also evidence-based, driven by empirical data and case studies and not based on political or economic expediencies.

The community itself becomes a learning organization, committed to growth and change even as it remains focused on collective goals in the realm of public health, public safety, empowerment, economic development, and quality of life. Assessments of policy changes are quantitative, even while they take into account perceptions and public opinions. Mixed-methods approaches are best because of the way they combine qualitative and quantitative data. Finally, CBPR approaches are sustainable, driven by long-term goals that benefit future generations of the community.

How to Approach and Initiate Collaborative Process Approaching community organizations begins by leveraging existing partnerships with stakeholder groups including business associations, community-based health organizations, development companies, and City Hall. An initial set of meetings will establish further partnerships and alliances. Social media and other digital networking tools can then be used to organize town hall-style meetings to cultivate the participatory approach to self-governance and public health decision-making at every level of community organization.

Alignment of Goals The goals of City Hall align perfectly with the goals of the Healthy Communities public policy. City Hall is committed to making Puerto Santa Lucia more livable, more sustainable, and more attractive for future residents and businesspeople. Attracting investors and homeowners depends on making systematic, planned, and sustainable improvements to public infrastructure, and improving overall quality of life factors.

Improvements to public infrastructure directly lead to improvements in public health outcomes, when those urban planning initiatives have the input of healthcare workers, healthcare advocates, and most importantly, residents. Action Steps 1. Networking and coalition building 2. Each group builds its own strategic plan and takes actions accordingly 3. Development and implementation of metrics for self-assessment. Roles and Responsibilities and Collaborative Evaluation Plan Each member of the team has specific roles.