If we are to craft a convincing political case, the public health community must build on existing knowledge and expertise to develop a more sophisticated understanding of how the political system works (Greer et al. 2017; Hoffman and Silverberg 2015). Three strategies can help make public health a political win for today’s politicians. We need to (1) make public health visible, (2) navigate diffused and non-linear decision-making processes and (3) differentiate between policy instruments (Fafard and Hoffman 2018).
Make public health visible
We can help make the political case for public health by highlighting our impact on citizens’ day-to-day lives. From routine activities, including immunization and food safety inspection, to activities that extend beyond what the public often thinks of as public health—including safe workplace regulations, pollution controls, traffic speed limits and gun restrictions—we need to consistently remind Canadians that the impacts of public health are everywhere. It is time for public health to celebrate its achievements, brand its efforts and build awareness for its contributions. Public health researchers and practitioners should consistently bring their evidence and expertise to bear on public debates and act to correct misinformation. Speaking publicly about our collective accomplishments and value will strengthen our collective political case for investment.
Navigate diffused and non-linear decision-making processes
The next step is to demonstrate value to politicians while accounting for the complex political realities that they face. Though many public health practitioners engage in the politics of public health on a daily basis, the public health community as a whole—researchers, practitioners and stakeholders—needs to develop a more sophisticated appreciation of the limits of scientific evidence as well as who policymakers are and how they are organized. For each public health issue, we need to consider that policy actors are diverse, usually diffuse, and often embedded in hierarchical policy networks (Fafard and Hoffman 2018).
More specifically, efforts to demonstrate the value of public health and influence decision-making should be tailored to the characteristics of the policy network and advisory system that exist within and across governments (Hoffman et al. 2018a, b; Groux et al. 2018; Behdinan et al. 2018). For example, the type and composition of the policy network updating school-based immunization policies is likely much smaller and less diverse in opinion and approach than the network of actors working to reduce childhood obesity (Hoffman and Silverberg 2015). These networks also differ in the types of non-governmental and non-health actors involved. Mobilization on childhood obesity will naturally overlap with education, social services, food regulation and taxation, and will involve a diverse set of civil society actors mobilized around the issue. To demonstrate its value, public health needs to increase engagement with this complexity and learn to navigate this system of diffused and non-linear decision-making.
Differentiate between policy instruments
Finally, when conducting research and designing solutions, public health researchers, practitioners and stakeholders need to consider more critically the type of policy instrument that is most appropriate for the issue they are addressing. Policymakers depend largely on four ways of achieving their policy objectives: (1) regulation, (2) communication, (3) taxation and (4) spending (see Table 1) (Fafard and Hoffman 2018). Each policy instrument requires a tailored strategy that considers the differing processes for policy development and implementation and the corresponding opportunities for the public health community to intervene. For example, public health initiatives that include new or amended legislation or regulation often include formal consultation processes, while public awareness or spending initiatives might be conceived of and designed with little opportunity for formal feedback. These more internal and opaque decision-making processes require public health researchers, practitioners and stakeholders to build relationships with policy actors and strategize with partners to communicate a clear message to multiple audiences.