The Policy Process: Strategies for Increasing Consumer Participation

When we consider strategies for increasing consumer participation in the policy process, it is important to understand that the persons who are in charge of making decisions for healthcare related interest groups and organizations have the following levels of power available to them: power based on expertise, positional power, and power based on the capacity to reward or compel (Longest, 2010). Until taking this course on Health Policy and Innovation, my ability to impact and/or my personal influence on policy making was something that I was very naive to. It seems that most people do not think their opinion really matters, or they don’t understand how government impacts their lives (Kraft & Furlong, 2013). As leaders in healthcare, it is imperative that the DNP is not only aware of their ability to impact policy making but that we are also active participants in making changes that will impact our profession and our patients. We have the knowledge and capacity to educate others and encourage them to become more involved with policy making, as it impacts our practice as nurse practitioners, patients, friends, families, and communities. In one way or another the policy process influences most aspects of our lives.

The strategy that has been most evident in increasing consumer participation in the policy process of eliminating or reducing trans fat has been that of advertising and food labeling. In many ways national advertising campaigns and federal food labeling requirements have educated and informed consumers of the trans fat content of their foods. While this may have decreased some trans fat intake, it has certainly not made a huge impact on reducing trans fats in the diets of the majority of American consumers. Is this because they are unaware of the deleterious outcomes of consuming trans fats? Or is it possible that consumers simply do not care about the negative impacts that trans fats can have on their overall health? What will make people want to change and improve their health?

Preventing disease and promoting healthy lifestyles are standards of nursing practice (American Nurses Association, 2010).  To get involved with policy changes and change the obesity epidemic, the ANA encourages nurses to educate, advocate, and create partnerships.

References

American Nurses Association (2010).  Fighting childhood obesity: Taking a stand to control and epidemic one child at a time.  Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Childhood-Obesity.pdf

Kraft, M. E., & Furlong, S. R. (2013). Public Policy: Politics, Analysis, and Alternatives (4th ed.). Thousand Oaks, CA: CQ Press

Longest, B.B. (2010).  Health policymaking in the United States (5thed.).  Chicago, IL: Health Administration Press.

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SUSTAINING INNOVATION & CONSIDERATIONS OF TIME AND SCOPE

This week we will discuss how an organization or a policy change can sustain an innovative environment. We cannot easily command innovation to occur. Innovation needs to be weaved into the fabric and culture of an organization. It requires an investment of time coupled with human and financial resources. As healthcare providers, our time is already a precious commodity and is often accounted for by the tasks, patient loads, and necessary charting. The concept of innovation is something we typically associate with ideas and implementations on a large scale. As discussed in previous weeks, the Affordable Care Act (ACA) will place an unprecedented strain on healthcare practitioners to meet the healthcare needs of thousands. Thus, the success of the ACA is dependent upon our ability as practitioners to meet this demand while continuing to provide high quality care. Policymaking is ongoing because new issues will continue to arise. Existing policy must be reviewed to determine if it is still effective and meets the purpose for which it was designed. This continued review is especially true of health care policies. Emergence of new health technology, changes in the Federal budget, and the impact of the Affordable Care Act are all reasons for policy creation and modification (Longest, 2010).

Modification takes place through regular review and when a stakeholder or a special interest group steps up. Policy feeds back into the policymaking cycle and stimulates continued policymaking (Longest, 2010). Reading about policy modification has solidified my thoughts on how important the evaluation phase of policy making is and that only through innovative modification can real strides be met. The role of oversight actors in important, specifically those at the executive branch level and how they influence bringing forth policy agenda items, and they are also instrumental in policy implementation and modification (Longest, 2010, p. 170). The policy analysis of “before-and-after comparisons” is a similar method that can be utilized when comparing pre and post outcomes of eliminating trans fat from dietary intake (Longest, 2010, p. 174).

We are still a long way off from seeing a nationwide trans fat elimination, but we have seen success in outcomes in some major areas like decreased cholesterol levels and a decline in cardiovascular related deaths (Angell et al., 2009)  in cities like New York who have an implemented policy of zero trans fat. The more success and positive health outcomes that we can account for from this campaign to eliminate trans fat, the greater the impact we can have on making this a national policy. It is imperative that we continue to look at the healthy outcomes of these preventive measures so that we can build upon the case for eliminating trans fat and improving the overall heart health of our country. These steps will need to take place in order to sustain the innovative policy changes of reducing and/or eliminating trans fats.

As healthcare practitioners we also need to be aware of our responsibility to educate and inform our patients of the risks and associated   outcomes of poor lifestyle choices that they make such as diet and activity (lack of). We have the ability to recruit stakeholders and impart the need for policy changes within our local, regional, and national legislative stakeholders. We need to be the leaders that will continue to improve the health of our nation and impact policy changes that will sustain this innovation!

Reference

Angell, S. Y., Silver, L. D., Goldstein, G. P., Johnson, C. M., Deitcher, D. R., Frieden, T. R., & Bassett, M. T. (2009). Cholesterol control beyond the clinic: New York City’s trans fat restriction. Annals of Internal Medicine, 151(2), 129-134.

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Healthcare Financing: Preventive Care and Eliminating Trans Fat

This week’s topic of healthcare financing has many applications to those health policies influencing preventive healthcare services and strategies. Most of the assigned readings explained the federal budget processes and how particular branches of the government finance entitlement programs and how discretionary programs and institute changes increase or decrease the tax code. The president’s budget request and budget accounts can stipulate priority programs that he believes should receive funding. Among these budget accounts are health and education (Longest, 2010). Since the enactment of the Affordable Care Act (ACA) in 2010, we know that expanding healthcare coverage to millions of individuals will have a tremendous fiscal impact on the United States (U.S.) healthcare system. Since the beginning of Medicare and Medicaid in the 1960s this reform has been the largest change in this U.S. healthcare financial system (Kovner & Knickman, 2011).

Several organizations, including the Obesity Action Coalition (OAC), are enthusiastically involved in lobbying Congress to address preventive care measures. The Preventive Health Savings Act is explicitly valuable in the issue of determining the cost and savings that may be related to preventive health. The Congressional Budget Office (CBO) governs the financing of a program in a piece of legislation over a 10 year time frame. The OAC’s concern is that the advantages of preventive healthcare spending for chronic diseases do not always fit into those time constraints. Programs that reduce obesity or decrease complications from chronic disease states often need longer than 10 years to show their full economic or cost-savings potential. The OAC explains that without being able to credit prevention programs for long-term budgetary savings, the existing CBO scoring method for prevention-related bills grossly misleads the influence that these programs have on federal spending.

There are some unique and disturbing insights into the costs of including or eliminating trans fats in the United States. A major argument of the food industry in not wanting to remove or decrease trans fats is the associated increase in associated costs (Browne, 2013), but others have disputed that the costs of food production would have little to no change at all (BanTransFats, 2013). An interesting fact is that some food chains, like McDonald’s, have great inconsistency within their own policies and their menu in come countries prohibits the use of trans fats while other countries it is an ingredient found throughout their entire menu (Lewis, 2011). Why is such a large contradiction permitted? The locations where trans fats seem to be more prominent are due to a lack of consumer awareness, a lack of education regarding food content and nutritional value, and a lack of funding to promote change in health policy. Funding preventive care measures should be a major focus in  primary care and as leaders in healthcare, we should promote awareness of these issues.

References

BanTransFats. (2013). The campaign to ban partially hydrogenated oils. Retrieved from http://www.bantransfats.com/

Browne, J. (2013). FDA’s transfat ban may boost food prices. Retrieved from http://triblive.com/business/brownebusiness/5032356-74/trans-fats-fat#axzz3WgaIxK00

Kovner, A. R., & Knickman, J. R. (2011). The current U.S. healthcare system; Health policy and health reform. In V. D. Weisfeld, & S. Jonas (Eds.), Health care delivery in the United States (10th ed.). New York, NY: Springer Publishing Company, LLC.

Lewis, T., & Potter, E. (Eds.). (2011). Ethical consumption: A critical introduction. Routledge.

Longest, B. B. (2010). Health Policymaking in the United States (5 ed.). Chicago, Illinois: Health Administration Press.

Obesity Action Coalitian. (2013). Obesity Care Continuum Supports Preventive Health Savings Act. Retrieved from http://www.obesityaction.org/wp-content/uploads/0214-OCC-LOS-for-Preventive-Health-Savings-Act.pdf

CHARACTERISTICS OF INNOVATORS AND CHANGE AGENTS IN THE HEALTHCARE SECTOR

This week we will talk about innovators and change agents in healthcare. Innovation in healthcare systems is a process that seeks to address complex health and non-health related issues in the healthcare industry, devising new strategies and technology to target these issues; it is the driving force of change in the healthcare system (Weberg, 2009). The concepts of self- organized, relational, and empowering can be defined as the innovation that is needed in order to meet the demands of society and improve patient care outcomes through an improved educational experience and collaboration as new graduates integrate into the profession of nursing (Brown, 2009).

Porter O’Grady and Malloch (2011) assert that characteristics of an innovative leader include:

  • Thinking “out of the box”
  • Listening carefully and acting at the when the time is appropriate
  • Challenge status quo, routines, barriers and unnecessary processes
  • Create a safe space for debate and ongoing dialog
  • Move ideas into actions. Move processes to outcomes

Thinking about this week’s topic allowed me to reflect on my recent discussion with Stephen L. Joseph who is the founder, President and CEO of BanTransFats.com, and also represents the organization as its attorney. Mr. Joseph is well known in the campaign efforts to reduce and eliminate trans fats. Before delving into the theoretical characteristics of innovators, describing my observed experience with Mr. Joseph is constructive. From the very beginning of my interaction with Mr. Joseph, it was evident that he exhibited many characteristics of a genuine innovator who integrated the principles of authenticity, complexity, productivity, and team leadership theories.

My discussion with Mr. Joseph generated my rumination as to what theory or model might provide an effective way to create change on federal level, such as the proposed trans fat policy change. One appropriate model for organizational change discussed by Van de Ven and Hargrave (2004) is that of social movement theory. Van de Ven and Hargrave summate the basic foundation of social movement. The foundation is described as political opportunities, framing processes, and mobilizing structures, that all possess the potential to influence the collective action. There are several models and theories that could be used to facilitate the agenda of reducing or eliminating trans fat. The advantage to this model is the adaptability of social structures to impact change and innovation.

The Doctorate of Nursing Practice (DNP) degree movement in nursing has been considered innovation by many (Chism, 2010). Recent advancements made in the nurse practitioner (NP) profession and in NP scope of practice are direct results of innovators who generate and translate idea into action. Innovators are those who find new pathways for improvement, advancement and achievement. The DNP degree is a driving force of innovation within the nursing profession and healthcare industry. Through their education and training, DNP graduates are becoming better equipped to make a profound difference in areas of clinical practice, leadership, and policy-making.

Reference

Brown, D. G. (2009). An interdisciplinary collaboration in nursing education. Teaching and Learning in Nursing, 4, 52-55. doi:10.1016/j.teln.2008.09.006

Chism, L. A. (2010). Leadership, Collaboration, and the DNP Graduate. The doctor of nursing practice: A guidebook for role development and professional issues. Sudbury, Massachusetts: Jones and Bartlett Publishers.

Porter-O’Grady, T., & Malloch, K. (2011). Thriving in Complexity. Quantum Leadership: Advancing innovation, transforming health care. Sudbury, MA: Jones & Bartlett Learning

Van de Ven, A. H., & Hargrave, T. J. (2004). Handbook of organizational change and innovation. In M. S. Poole, & A. H. Van de Ven (Eds.). New York, NY: Oxford University Press.

Weberg, D. (2009). Innovation in healthcare: A concept analysis. Nursing Administration Quarterly, 33(3), 227-237

Change Theory: Recommendations & Directions for the Future

To understand the process of change in regards to health policy, we need to initiate a discussion on change theory. Poole (2004) describes change as being planned or unplanned and also explains that change has elements of uncertainty. Change, tempo, rhythm, and pattern are all key terms (Poole) and can be identified in the this week’s assigned reading pertaining to the “primeval soup” where new and existing elements come together to influence policy change (Kingdon, 2011, p. 117). The path of health policy is greatly influenced by the ever changing waters of the “national mood, election results, changes of administration, changes of ideological or partisan distributions in Congress, and interest group pressure campaigns” (Kingdon, 2011, p. 162).

Fielding & Briss (2006) point out that by influencing health policy with evidenced based practices (EBP) changes have lead towards many advances in medicine and have brought about instrumental changes that have helped decrease infectious disease, increase access to treatment, and improved overall patient care. Policy makers need to be influenced by evidence in order to make the most informed decision. Unfortunately, influence may not be substantial enough to make the change in implementing EBP into health policy and it is not until enough voices are heard that the change theory can move foreword.

There have been many proposed strategies to help influence evidenced-based policy making decisions.  Liebman (2013) discussed a method and believes that there should be a federal pay by success program that would allow the policy makers to be paid and allowed to work if they have success with their position. This type of program would be promoting that the most optimal evidenced based outcome is reached at any given time. In the article from Liebman, it is discussed that pay by success was for state and local activity but this could be applied to officials in charge of policy making as well or even at a federal level. This is only one such solution to help change for the future. Change has many proposed methods but EBP in regard to health policy is a step that seems only fitting since health care advances are more grounded in EBP.

Where does trans fat fit in? Eating foods that contain trans fat, such as cookies, pizza, doughnuts, cakes, and many other snack foods, are directly linked to developing heart disease and an increased mortality rate (Kiage et al., 2013). It is because of evidence based research we know that trans fat consumption raises our low density lipoprotein (LDL), or “bad”, cholesterol and also reduces our high density lipoprotein (HDL), or “good”, cholesterol (Vesper et al., 2012). We also know that trans fat has been linked to developing obesity, heart disease, strokes, and type 2 diabetes. It is thanks to this type of research that the Food and Drug Administration, the World Health Organization, and the American Heart Association have all made recommendations to reduce trans fat consumption and have greatly impacted the health policy as it relates to banning trans fat.

References

Feilding, J., & Briss, P. (2006). Promoting evidence-based public health policy: Can we have better evidence and more action?. Health Affairs25(4), doi: 969-978; 10.1377/hlthaff.25.4.969]

Kiage, J. N., Merrill, P. D., Robinson, C. J., Cao, Y., Malik, T. A., Hundley, B. C., & Kabagambe, E. K. (2013). Intake of trans fat and all-cause mortality in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. The American journal of clinical nutrition97(5), 1121-1128.

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (Updated 2 ed.). London, United Kingdom: Longman Publishing Group.

Liebman, J. (2013). Building on recent advances in evidence-based policymaking. Results for America,https://myasucourses.asu.edu/bbcswebdav/pid-8843701-dt-content-rid-33354252_1/xid-33354252_1

Poole, M. S., & Van de Ven, A. H. (Eds.). (2004). Handbook of organizational change and innovation. New York, NY: Oxford University Press.

Vesper, H. W., Kuiper, H. C., Mirel, L. B., Johnson, C. L., & Pirkle, J. L. (2012). Levels of plasma trans-fatty acids in non-Hispanic white adults in the United States in 2000 and 2009. JAMA307(6), 562-563.

Policy governing access to data and privacy protection in an electronic and genomic age

While banning trans fat has been at the forefront of my weekly topics, this week we will be taking a slight detour as we discuss an important aspect of modern healthcare: access to data, privacy protection, and electronic health records (EHRs). The key points from the readings this week focus on electronic health records, privacy protection, direct-to-consumer (DTC) genetic testing, and at what level these policies regarding health information are regulated. The healthcare documentation laws expanding to electronic medical records (EMRs) and the vulnerability of patient confidentiality and protection is a delicate balance. These transitions have caused a significant concern for health care consumers to keep their health records protected and private.

Established in 1996 and then reformed a few years later, The Health Insurance Portability and Accountability Act (HIPPA) or “The Privacy Rule” is a set of federal rules that govern how health information is utilized and disclosed (Pritts, 2008; U.S. Department of Health and Human Services, 2014). Pritts (2008) echoes the importance of maintaining patients’ basic right of privacy as a necessary component to human well-being. Privacy and protection of records also advocates for personal autonomy, individuality, and self-respect (Pritts, 2008).

DTC genetic testing has come under much scrutiny as it is growing more popular in the United States (US). Due to growing consumer interest, greater awareness of the Human Genome Project, and the American consumers’ desire to access self-governed healthcare, many companies began offering genetic testing directly to the public. One issue with this type of advanced technology availability is that the majority of these DTC genetic tests do not have any pre-market review requirements nor do they need approval from the Food and Drug Administration (Hogarth, Javitt, & Melzer, 2008). Although several of the large professional organizations such as the American Medical Association (AMA) support genetic testing performed without a licensed health care professional (Caulfield & McGuire, 2012), perhaps this is an area that advanced practice nurses need to step in and advocate on behalf of the patient and demand expert consultation in order to disseminate the results. Comprehensive genetic testing should include consultation with a healthcare professional and an evaluation including the implications of the results. Are advanced practice nurses better equipped to fill this professional role? With the questionable validity of these companies, lack reputability of the DTC tests, and absence of medical counseling it is easy to see how consumers could easily be misled into making inappropriate health care decisions. It seems that the only way to get consistent regulation throughout the US is by way of federal regulation, but currently DTC genetic testing is dealt with on a state to state basis.

Some may argue that disallowing the consumer access to data, EHRs or DTC genetic testing we would be infringing upon an individual’s right to information or technology. Information is not necessarily a bad thing, but the sensitive nature of healthcare information needs to be dealt with in a way that consumers understand the information that they are receiving. If information lacks understanding, it cannot be thought of as knowledge!

References

Caulfield, T., & McGuire, A. L. (2012). Direct-to-consumer genetic testing: Perceptions, problems, and policy responses. Annual Review of Medicine, 63, 23-33.

Hogarth, S., Javitt, G., & Melzer, D. (2008). The current landscape for direct-to-consumer genetic testing: legal, ethical, and policy issues. Annu. Rev. Genomics Hum. Genet., 9, 161-182.

Pritts, J.L. (2008). The importance of value of protecting the privacy of health information: The roles of the HIPPA privacy rule and the common rule in health research. Retrieved fromhttp://www.iom.edu/~/media/Files/Activity%20Files/Research/HIPAAandResearch/PrittsPrivacyFinalDraftweb.ashx

U.S. Department of Health and Human Services. (2014). Indian health service: Health insurance portability and accountability act (HIPPA). Retrieved from http://www.ihs.gov/hipaa/

Private Sector Innovation and Trans Fat Policy Advancement

What does innovation mean to you? Who has are the innovators of policy?

  • The United States (US) Department of Commerce described the private sector as an instrument of innovation (2012) that is fueled by a competitive and free-market American economy which propels the innovative spirit of our country.
  • Although innovation can be thought of as either process or a product, in health care it is typically viewed as a product (Lanier, 2013)
  • Windrum & Koch (2008) explain that many people wrongly believe that the private sector develops innovations when the public sector is lacking the ability to be innovative.

The US government plays an indisputable role in health policy making and “…its role as a provider of health services in government facilities, most of the resources used in the pursuit of health in the U.S. are controlled by the private sector” (Longest, 2010, p. 8). According to Orient (2010) the private sector has more funding at their disposal, less legal formalities to overcome, and a greater influence than government on Americans’ thoughts and perceptions. The more that is read about public sector versus private sector involvement in policy making, the perceptions of the two sides varies greatly depending upon the source. In some literature it seems that they place responsibility and power on the public sector (government) and other readings seem to believe that it is the private sector (businesses, organizations, corporations, retail stores, etc.) that are in control. Often the research that is conducted is also largely affected by who is backing it, private or public. The research, especially in regards to the food industry, can have a huge impact on what policy making decisions are made and will often persuade or dissuade the policy agenda. The food industry has been known to involve itself in research at times when the findings would promote their products (Mercola, 2015) but in rare cases like that of trans fat, the food industry has proven that they can be persuaded by research that their products or process may need to be changed or improved upon.

The World Health Organization (WHO, 2015) acknowledged that through product reformulation that the private sector can contribute to limiting the amount of saturated and trans fats in processed foods. The WHO also believes that it is the role of the private sector to review the established marketing strategies to children in particular with those foods that contain unhealthy ingredients such as trans fats. Currently the issue of banning trans fat does seem to have gained most of it’s victories through the private sector. These initial victories then allowed them to gain the media attention and public interest which led to continued victories among the public sectors. It seems to me that if the public and private sectors were more willing to collaboratively work for the sake of improving the health of society, then this would be a true display of innovation.

“To ensure meaningful change takes hold, government and industry must collaborate” (University of Western Ontario, 2010).

References

Lanier, J. A. (2013). Leading innovation: Insights on organizational structure. Strategic Leadership Review, 3(2), 16-22

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Mercola, J. (2015). The unexpected implications of industry involvement in trans fat research. Retrieved from http://articles.mercola.com/sites/articles/archive/2015/02/22/trans-fat-research-bias.aspx

Orient, J. M. (2010). Testimony on the Influence of Private Foundations on Public Policy. Journal of American Physicians and Surgeons, 15(1). Retrieved from http://www.jpands.org/vol15no1/orient.pdf

University of Western Ontario. (2010). Food and health: Advancing the policy agenda. Ontario, Canada: Author.

U.S. Department of Commerce. (2012). The competitiveness and innovative capacity of the United States. Washington, D.C: Author.

Wilde, P. (2013). Food policy in the United States: An introduction. Routledge.

Windrum, P. & Koch, P. M. (Eds.). (2008). Innovation in public sector services: entrepreneurship, creativity and management. Edward Elgar Publishing.

World Health Organization. (2015). Global strategy on diet, physical activity, and health. Retrieved from http://www.who.int/dietphysicalactivity/childhood_private_sector/en/

Policy Implementation: How does Medicare, Medicaid, and the Affordable Care Act compare to Trans Fat policy?

Healthcare policy encompasses the activities that are enacted by the government to promote the health and well-being of the public (Kraft & Furllong, 2015). Medicare, Medicaid and the Affordable Care Act (ACA) are all examples of the extremely complex implementation process of United States (US) healthcare policy and reform in the United States. Many of the presidents, beginning with Theodore Roosevelt, have attempted to initiate health care reform but mostly with minimal success (Kingdon, 2010). Within health policy there are numerous policy actors and variable that can influence the implementation process or can conversely stop it altogether. Generally battles involving health policy are often handled in incremental steps rather than major leaps and this is why the victories that led to the enactment of Medicare, Medicaid, and the ACA have been monumental (Kingdon).

Much of health policy reform is aimed to provide health coverage for the nation. Let’s look at some historical moments in health policy reform:

  • 1960s: President Lyndon B. Johnson initiated legislation that created programs such as food stamps and Head Start; he also implemented Medicare and Medicaid (Kingdon). Medicare was established in order to provide health insurance for US citizens who are 65 and older and/or those who qualify for disability. Medicaid was established to provide health insurance for low-income citizens (Longest, 2010).
  • 2010: President Barack Obama signed the Patient Protection and ACA into law which has been the most significant regulatory change to US healthcare since the implementation of Medicare and Medicaid (Kingdon).
  • 2012: The US Supreme Court upheld the constitutionality of the ACA (Researcher, 2013).

Kraft & Furlong explain that the programs of Medicare and Medicaid constitute 40% of government spending and that these programs are overwhelmed with fraud and abuse that total somewhere near $100 billion each year! Clearly something here is no longer working and is in need of reform.

A major difference between the policy implementation of Trans Fats and these major health reforms is just that; it was not fought on nationally significant level and enforced with the backing of any US president. Trans fat policy was initiated by public interest groups and advocates which started at a local level and then followed with taking this reform to the state level with mixed success (Assaf, 2014).  The Robert Wood Johnson Foundation studied preventive services in the US and while they found that some preventive services offer good value for low health care costs (Researcher, 2013) they also concluded that by preventing some chronic disease processes and allowing persons to live longer you are consequently increasing health care costs in other facets. The Trust for America’s Health (Researcher, 2013) found that out of 84 studies that relied on community-based preventive efforts had significant results in reducing US health care costs among these populations. And even still exists a third argument that many Americans hold; is it really the government’s business to step in a implement policies that will ultimately tell people what they can or cannot eat? The trans fats battle becomes an issue of government responsibility versus government authority.

Have you ever taken a math class that 0.5 rounds down to zero? Well, on your labeling of trans fat it is exactly that! It seems that with the evidence pointing to trans fat intake still not near a low enough level that is recommended for heart health (Honors, Harnack, Zhou, & Steffen, (2014) that there is still much work to be done at the local, state, and federal levels.

References

Assaf, R. R. (2014). Overview of Local, State, and National Government Legislation Restricting Trans Fats. Clinical therapeutics, 36(3), 328-332.

Honors, M. A., Harnack, L. J., Zhou, X., & Steffen, L. M. (2014). Trends in Fatty Acid Intake of Adults in the Minneapolis‐St Paul, MN Metropolitan Area, 1980–1982 Through 2007–2009. Journal of the American Heart Association,3(5), e001023.

Kingdon. (2010). Agendas, Alternatives, and Public Policies, Update Edition (2nd ed.). London: Longman Publishing Group.

Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5th ed.). Thousand Oaks, CA: CQ Press.

Longest, B. B. Jr. (2010). Health Policymaking in the United States. Chicago, IL: Health Administration Press.

Researcher, C. Q. (2013). Issues for Debate in American Public Policy: Selections from CQ Researcher. CQ Press College.

Public sector impact on trans fat policy and efforts to overcome the disparities

As mentioned in previous posts, BanTransFats.com has played a major role in contributing to the battle to eliminate trans fats in our foods. This all began when this public interest group initiated a lawsuit against Kraft in 2003 to remove trans fats from Oreos (BanTransFats.com, 2014). This particular case gained a tremendous amount of media coverage and led to the most intense discussion to date regarding food regulation among consumer advocates, food producers, public sector researchers, and government agencies (Kent, 2010). Further actions by this same group have also led to the banning of trans fat in the state of California which was first initiated in the city of Tiburon by the group’s founder Stephen Joseph (BanTransFats.com). The majority of victories for trans fats policy initiatives have come mostly from public sector influences that began at local levels.

What is a Gini coefficient? Don’t worry this isn’t a calculus class, but I will try to explain a little further how to make better sense of the Gini coefficient and likewise, the Gini indexes. Kraft & Furlong (2015) describe the Gini coefficient as a graphical way to look at a populations equality or inequality by looking at the percentile of income by the quintiles of families. Makes sense yet? Way back in high school my economy teacher taught us a very simplified way of looking at these numbers and somehow it stuck, so hopefully this explanation will help someone too. The coefficient measures the percentage of a country or state’s income distribution. If a particular place has a coefficient of 0 it would mean that every one in that place receives exactly the same income and if a coefficient of 100 existed, it would represent that one person received all of the income. Lower number generally mean more equality and higher numbers would then represent greater inequality. It also seems that the Gini coefficient can vary quite significantly depending upon the source providing the data. One example of how vastly different this number can be is that the US was given a Gini of 38 (Organization for Economic Cooperation and Development, 2013) and also 83.4 (Wolff, 2012). This is just one example of how important it is not to just see a figure or one piece of data and take it as it is.

The food stamp program was put into place by the United States Department of Agriculture (USDA) to provide low-income households with coupons that they can use to purchase food (Kraft & Furlong, 2015) . This program is also called the Supplemental Nutrition Assistance Program (SNAP) and several states issue out the benefits on an electronic benefit transfer (EBT) that works similarly to a debit card. According to the USDA (2012) the SNAP program provides an average of $72 billion each year to over 44 million recipients. Unfortunately many states have permitted SNAP recipients the ability to use their EBT cards at fast food establishments which clearly do not promote people to make healthy dietary choices. Recently in Arizona bill 2051 was introduced as a hope to eliminate the usage of SNAP benefits at fast food establishments (Snyder, 2015). In some states there have been programs or incentives introduced to encourage the purchase of healthier food choices by SNAP recipients, but Shannon (2014) explains that debates that surround such programs are complicated because SNAP research tends to look at successes on a national scale instead of at the level of those healthier programs that were initiated.

There is still much work to be done to reduce and eliminate trans fat in the US! It seems that it is likely that action will need to be taken at a national level to eliminate or sufficiently reduce trans fats in the US food supply and production, but until then be mindful of the policies and regulations within your cities and states. Something that I find astonishing and heartbreaking is looking at the number of proposed bills within many of the states to reduce trans fat in public schools that were never passed (National Conference of State Legislatures, 2013) . Why is it so unhealthy for us to consume trans fats, but yet we continue to serve it in so many states in our public schools? Similarly, we know that fast foods aren’t healthy but we allow those who are living below the poverty line to continue to spend their SNAP benefits at these locations. If you think these things need to be changed, if you think these things are wrong…get involved in your city, county or local schools and improve the way we eat! We may have chosen to work in the healthcare industry, but we still are part of the public sector and our voices won’t be heard unless we do something!

References

Babones, S. (2012). U.S. Income distribution: just how unequal?. Retrieved from http://inequality.org/unequal-americas-income-distribution.

BanTransFats.com. (2014). The campaign to ban partially hydrogenated oils. Retrieved from http://www.bantransfats.com/index.html

Kent, J. A. (2010). Kent and Riegel’s Handbook of Industrial Chemistry and Biotechnology: Vol. 1. Springer Science & Business Media.

Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5th ed.). Thousand Oaks, CA: CQ Press.

National Conference of State Legislatures. (2013). Trans fat and menu labeling legislation. Retrieved from: http://www.ncsl.org/research/health/trans-fat-and-menu-labeling-legislation.aspx

Organization for Economic Cooperation and Development. (2013). Growing risk of inequality and poverty crisis hits the poor hardest. Retrieved from http://www.oecd.org/newsroom/growing-risk-of-inequality-and-poverty-as-crisis-hits-the-poor-hardest-says-oecd.htm

Shannon, J. (2014). What does SNAP benefit usage tell us about food access in low-income neighborhoods?. Social Science & Medicine, 107, 89-99.

Snyder, J. (2015). Bill 2051 will ban the use of EBT for fast food. Retrieved from http://thevoice.gccaz.edu/?p=2154. 

United States Department of Agriculture. (2012). SNAP monthly data. Retrieved from http://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap.

Wolff, E. N. (2012). The asset price meltdown and the wealth of the middle class (No. w18559). National Bureau of Economic Research.

The Process of Policy Making: Statutes & Regulations of Trans Fat

I’m not sure that everyone remembers this video, but for me this acts as a reminder that children and adults may need a dose of playful education to get them interested in the legislative processes of our United States government.

Where to begin in trying to understand this highly complex problem?

Let’s try to simplify some terms:

A statute is a law enacted by a legislative body of a government, whether federal or state (Godwin, Ainsworth, & Godwin, 2012). At the federal level these are passed by United States Congress and at the state level statutes are passed by State Legislature. At a local level statutes are usually referred to as ordinances. Legislative bodies write statutory law.

A regulation is a detailed rule that outlines exactly how a statute will be enacted (Godwin, Ainsworth, & Godwin). Regulations are written, amended, and appealed by administrative agencies. Oleszek (2013) describes that both professional and non-professional persons make up these agencies that have the ability to write regulations that may not only expand their own discretionary authority but also undermine legislative intent!

First, we need to know at which level(s) of law our topic more effected by; federal law, state law, or local law. Each of these has it’s own uniquely established route as to how policy is made. The ban on trans fat was initially taken up at the federal level in 2003 when the Food and Drug Administration (FDA) published a ruling to the Federal Register that amended the regulation to include trans fat to be listed on food labels (Committee on the Review of Food and Drug Administration’s Role in Ensuring Safe Food & Wallace, 2010). Since 2003 have come many recommendations (Chopra & Nanda, 2012) from organizations such as the US department of health and human services, the American Heart Association, the American Medical Association House of Delegates, and the World Health Organization Food and Agriculture Organization (WHO/FAO) but only In more recent years the trans fat ban has been battled at both state and local levels through legislative regulations (National Conference of State Legislatures, 2013). It is interesting to know that the system for creating and enacting statutes is such an involved process, that even if a statute is deemed unconstitutional it is not removed until an additional statute is created and approved to delete it (Oleszek). Longest (2010) also describes that the legislative process as being one that requires a tremendous amount of commitment and practice. As far as health policy is concerned Longest describes that policies can be the result of either statutory or regulatory mechanisms, but then goes on to describe that policies can also come as a result from judicial decisions.

So who is is working to help the legislative process in banning trans fat? When I looked into the success of California’s trans fat ban, the same organization that won the legal battle against KRAFT in “the Oreo Case” had a supporter on their side in the form of a California Assembly Member Tony Mendoza (Ban Trans Fat, 2008). During his time with the California Assembly, Tony Mendoza’s first legislative act was introducing a bill in hopes of eliminating trans fats in California (Ban Trans Fat).

Although it’s been said before and certainly you’ve heard this before…get involved in your elections, get to know who you’re voting for, find out what their views are on the issues that are important to you and your job in health care, and VOTE!!!

References

Ban Trans Fats. (2008). The campaign to ban partially hydrogenated oils. Retrieved from http://www.bantransfats.com/

Chopra, H. K., & Nanda, N. C. (Eds.). (2012). Textbook of Cardiology (A Clinical and Historical Perspective). JP Medical Ltd.

Committee on the Review of Food and Drug Administration’s Role in Ensuring Safe Food & Wallace, R. B. (2010). Enhancing Food Safety : The Role of the Food and Drug Administration. Washington, DC, USA: National Academies Press.

Godwin, K., Ainsworth, S. H., & Godwin, E. (2012). Lobbying and policymaking: The public pursuit of private interests. SAGE Publications.

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL:  Health Administration Press.

National Conference of State Legislatures. (2013). Trans fat and menu labeling legislation. Retrieved from: http://www.ncsl.org/research/health/trans-fat-and-menu-labeling-legislation.aspx

Oleszek, W. J. (2013). Congressional procedures and the policy process. SAGE.