Political Will: A Bridge Between Public Health Knowledge and Action
By Lezine, DeQuincy A Reed, Gerald A
We propose a new model of the public health policy cycle: the Bridges From Knowledge to Action model. Many prevention initiatives require policy change to achieve broad implementation. Political will, society’s commitment to support or alter prevention initiatives, is essential for securing the resources for policy change. We focus on the role of political will in developing and implementing public health policy that integrates scientific evidence and community participation. (Am J Public Health. 2007;97:2010-2013. doi:10.2105/AJPH.2007.113282) Most population- based public-health approaches that could prevent death and disability require social and political support to have a lasting effect. That support is often reflected in policy, the “laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior.”1(p1207) For example, policy initiatives contributed to the control of infectious diseases,2 declines in smoking,3 reductions in heart disease and stroke,4 safer motor vehicles and highways,5 and safer worksites. 6 We present a health policy model intended to harness social and political support (i.e., political will) to improve public health.
METHODS
Richmond and Kotelchuck7,8 identified 3 essential components for advancing public health policy: knowledge base, social strategy, and political will. Although many reports recognize the importance of a knowledge base and strategy for action, political will has garnered less attention.
Political will is “society’s desire and commitment to support or modify old programs or to develop new programs. It may be viewed as the process of generating resources to carry out policies and programs.”8(p388) Political will is based on “public understanding and support.” 7(p451) Here, public refers to both government leadership and the broader community.9 Public support can influence public health outcomes when economic, social, and intellectual resources are committed to address an issue. The following model presents possibilities for applying political will to advance health policy.
RESULTS
The goal of the Bridges From Knowledge to Action model is to develop and implement public health policy on the basis of scientific evidence and community participation. We conceptualize the health policy process as a cycle that uses new information and ongoing public support to sustain preventive action. Each phase within the cycle of the Bridges From Knowledge to Action model attempts to integrate processes from previous public health frameworks (Table 1) with the 3 essential components7-9 described earlier. We focus on the role of political will.
Gathering Information
The knowledge base about a public health issue can help guide policy formation, and political will expedites the development of a knowledge base (Table 2). The process is cyclical; community groups use data to convince policymakers to appropriate more resources for studies that might produce new data for community groups to use.
Preparing to Develop a Strategy
The groups concerned with an issue must develop a consensus about when the knowledge base is sufficient to develop a strategy for action. Although consensus building is difficult, several approaches foster the political will necessary to gather groups together and decide on appropriate actions (Table 2).
Drafting the Strategy
To design a comprehensive strategy, many stakeholders (e.g., basic and applied scientists, public health practitioners, community members) must collaborate to balance scientific evidence with the feasibility of potential interventions. Political will is applied to secure resources for the strategy process (Table 2).
Preparing for Action
With a strategy in hand, the goal is to prepare for sustained action by further developing political will. Again, community groups can work with scientists to assess and develop the political will for policy implementation (Table 2). Collaborative workgroups might consider using economic analysis,18-20 community readiness assessment,12 social marketing approaches,21 environmental scans,22,23 or implementation climate assessment.13,24
Taking Action
By first developing political will, communities might be able to implement appropriate goals from the strategy for a longer duration. Public officials and legislative bodies can adopt or renew initiatives, appropriate resources, and shift public opinion.14,25 Later, the support of people who enact initiatives (e.g., public health practitioners, health providers) and the affected populations will determine implementation outcomes.13 If all stakeholders are collaborating to address a health issue (Table 2), then the strategy is more likely to succeed.
Evaluation
After taking action, community-based experiences can be incorporated into the knowledge base for the next iteration of the cycle (Table 2). In addition to tracking health outcomes, ongoing evaluation could document process results such as growth of political will, levels of implementation, and policy change.26-28
DISCUSSION
Many efforts to create broad and sustained prevention initiatives will require policy change. The Bridges From Knowledge to Action model suggests that attention to specific phases in the development and implementation of public health policy might improve the chances of success. We argue that it is particularly important to devote time and attention to developing political will. Although political will is an “essential component” for advancing public health policy,7-9 the concept has been understudied.
The Bridges From Knowledge to Action model and many applications of political will are based on reviews of previous literature and anecdotal experience but have yet to be tested. Although this is a preliminary model, it can contribute to the ongoing dialogue about bridging public health knowledge and action.
References
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DeQuincy A. Lezine, PhD, and Gerald A. Reed, MSW
About the Authors
DeQuincy A. Lezine is with the Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY. Gerald A. Reed is with the Suicide Prevention Action Network USA, Washington, DC.
Requests for reprints should be sent to DeQuincy A. Lezine, PhD, University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd, Box Psych, Rochester, NY 14642 (e- mail: dequincy_lezine@ urmc.rochester.edu).
This article was accepted May 25, 2007.
Contributors
Both authors jointly developed the concept and wrote and reviewed drafts of the article, and contributed to the final revision.
Acknowledgments
DeQuincy A. Lezine was supported by the National Institute of Mental Health (grants T32MH020061 and P20MH071897).
The authors would like to thank Lucy Davidson, Gerald Weyrauch, Elsie Weyrauch, Yeates Conwell, and Kerry Knox for their critical review of and comments on earlier versions of the article.
Human Participant Protection
No institutional review board approval was required for this study because no human participants were involved.
Copyright American Public Health Association Nov 1, 2007
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