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The State Health Department’s Role in the Policy Process
A Tool for State Health Department Injury and Violence Prevention Programs
Target Audience:
CDC funded state health
department injury and violence
prevention programs
CDC funded state health
department program staff
working to prevent injuries and
violence
Purpose
To provide guidance to Centers for Disease Control and Prevention
(CDC)-funded state health departments about their important role in
informing and evaluating policy to prevent injuries and violence
through active participation in the policy process.
Policy as an Effective Public Health Tool to
Prevent Injuries and Violence
P
olicy interventions are important and can be effective community and
societal level strategies for improving the public’s health. Public health
policy interventions can influence systems development,
organizational change, social norms, and individual behavior to
promote improvements in the health and safety of a population.
State health department injury and violence prevention programs are
also well-positioned to link with other public health department
programs or initiatives (i.e., obesity prevention, maternal and child
health, or environmental health) and complementary issues such as
transportation, affordable housing, and sustainable healthy
communities so that injury prevention goals can be incorporated into
larger societal level efforts where appropriate.
A state health department injury and violence prevention
program and its partners play a significant role in:
• analyzi
ng data to identify trends and opportunities for intervention,
• researc hing, identifying, assessing, and prioritizing policy options that c an
impact injury and violence prevention,
• identifying and c onnec ting with stakeholders to gather feedbac k,
implement communication strategies, and to deliver relevant messages
and materials,
• providing science and evidence to educate decision makers about the
components and potential effec ts of policies,
• educating the public about existing policies or laws, and
• evaluating the impact of policies.
National Center for Injury Prevention and Control
Division of Analysis, Research and Practice Integration
Policy: Organizational, Regulatory, and Legislative
Policy can be defined in many ways. One applicable definition when describing public health policy is a law,
regulation, procedure, administrative action, incentive, or voluntary practice of governments and other
institutions.
Policies generally operate at the systems level, are applied to large sectors or populations, and set
the context in which individual decisions and actions are made. State health departments can engage in
various public health policy activities as outlined in CDC award documents. Other than for normal and
recognized executive-legislative relationships, no CDC funds may be used for impermissible lobbying,
including, advocating to continue or increase state health department funding from the federal government.
See CDC’s guidance entitled “Anti-Lobbying Restrictions for CDC Grantees
” for more detailed information.
Organizational (also known as internal policies) – rules or practices
established within an agency or organization, such as those developed by:
Local education agencies and/or schools or school districts e.g.,
required training for teachers on teen dating violence prevention (this
may actually be a regulation promulgated by the school board, which
in many jurisdictions is an elected body).
Private hospital or other healthcare delivery sites (e.g., physicians’
offices), e.g., a systematic, required use of an evidence-informed
program to prevent Shaken Baby Syndrome as a component of a
hospital stay for all new mothers.
Community- or faith-based organizations, (e.g., requiring volunteer
coaches to receive training and information on concussion awareness
to protect young athletes).
Governmental agencies, e.g., restricting the use of government-owned
electronic communication devices while driving by employees and
contractors (this is actually by Executive Order).
Business, industry, or corporations, e.g., health insurance company
reimbursement policies (health insurance company reimbursement
policies may be set by law).
Professional associations or accrediting organizations, e.g., CEU
requirements to demonstrate competencies in public health or injury
prevention.
Regulatory – rules, guidelines, principles, or methods created by
government agencies with regulation authority for products or services
(government agencies receive authorization to make regulations through
state laws)
State, e.g., standards regarding main drain covers and starting blocks in
swimming pools.
Federal, e.g., rules governing manufacturing of automobiles to meet
safety standards.
Legislative – laws or ordinances
Local (city or county), e.g., statute requiring working smoke alarms be
included in all residences.
State, e.g., laws allowing police to enforce seat belt laws without
requiring another violation (also known as primary enforcement
seatbelt laws).
Federal, e.g., federal law that mandates the maximum allowable blood
alcohol concentration level of 0.08% among persons operating a motor
vehicle.
There are different types of
policies and each of them plays an
important role in improving the
public’s health.
Policy interventions are particularly valuable because they are systems-based and can affect populations by
changing the context in which individuals take action or make decisions. They can influence decisions (e.g.,
requiring seat belt use) or they can create an environment or structures in which we live safer (e.g., mandating
that all cars are made with front and side airbags). While the behavior change may occur at the individual level,
policies can set the parameters for many individual choices, or where appropriate, take more direct action at the
population level. This type of population-based approach can be less expensive and more cost-effective.
However, the ultimate effectiveness of a policy intervention depends on numerous factors, including the level of
awareness, education, and compliance to the policy by the public as well as resources to support a policy’s
implementation (e.g., enforcement capacity, education and training, and
availability of programs to support and
enhance policy implementation). For example, a texting while driving law may be passed in a state, but public
understanding regarding the specifics of the law may impact compliance. Compliance often requires
enforcement. Police need to know how to determine if someone is texting and b
e willing to pull an offender over
for texting. If none of these other policy or practice elements are in place, the intent of the law will not be
realized.
CDC funds can be used for many policy-related activities. For instance, they may be used by state health
departments to work directly on policy-related matters across their equivalent branch of state government. Non-
governmental CDC awardees and nongovernmental sub-
awardees, however, have stricter parameters on the use
of federal funds for any lobbying-related activities. See AR-12 and the guidance for more detail.
Role of State Health
Departments in the
Policy Process
While most state health department
staff are accustomed to playing a
major role in identifying problems,
some agencies or programs may be
less involved in other critical domains
of the policy process, including
policy analysis, strategy and policy
development, implementation,
evaluation, and stakeholder
engagement. Participating in these
parts of the policy process can help
to ensure that public health policy
solutions are based on the best
available science and evidence,
reflect and respond to audience
needs and realities, and are updated
as evidence evolves.
Public health agencies have a role to
play in all types of policy initiatives
(organizational, regulatory, and
legislative). CDC funds cannot be
used to grass-roots lobby, or to
encourage members of the public to
contact their elected representatives
at the federal, state, or local levels to
urge support of, or opposition to,
proposed or pending legislative
proposals.
State health departments have an important role to play
in all domains of the policy process
1
:
• Problem identification – analyze and communicate the
problem
• Policy analysis – identify possible interventions
• Strategy and policy development – prioritize interventions
• Policy enactment – provide evidence as requested by decision
makers
• Policy implementation – support implementation through
education, training, technical assistance, and guidance
1
CDC http://www.cdc.gov/stltpublichealth/policy/
State
health departments play an important role in using s cientific evidence and epidemiological data to
educate both internal and
external decision makers and partners about health issues and the potential effect
of a policy intervention on a
public health issue such as injuries and violence. Allowable activities related to
contact with public policymakers vary by state; therefore it is important to consult internal agency rules, and
state and
federal laws to
ensure full compliance. For instance, applicable federal provisions include Sections
503(b) and (c) of the Fiscal Year 2015 Consolidated Appropriations Act, CDC’s policy AR-12, and applicable
regulations f
ound at 2 C.F.R. Part 200, et seq. These provisions provide restrictions and prohibit
impermissible lobbying with CDC funds. State health departments may use CDC funds to work with other
agencies within the Executive Branch of their state government on policy approaches to health issues as
part of normal executive-legislative relationships.
Education – gives factual information—data, program description, scientific evidence of effectiveness of
prevention measures, goals, current budget, people served, and accomplishments—without conveying a
value judgment or linking to legislative action (e.g., laws, pending legislation, appropriation, regulation, or
other policy decision). State health departments may use CDC funds to educate the public about health issues
and their public health consequences.
Advocacy – conveys general support for a cause, promotes best practice, supports a national
recommendation, but does not seek a specific policy outcome or decision. CDC funds may be used to s upport
a generalized policy such as “clean air” without a recommendation for a particular standard in law or
regulation. CDC funds cannot be used to grass roots lobby, e.g., to encourage members of the public to
contact their elected representatives to urge support of, or opposition to, proposed or pending legislative
proposals.
Direct Lobbying
– includes any attempt to influence legislative or other similar deliberations at all levels of
government through communications that directly express a view on proposed or pending legislation and
other orders and are directed to members of staff, or other employees of a legislative body or to
government officials or employees who participate in the formulation of legislation or other orders.
CDC funds may also be used for the below-described activities to the extent consistent with applicable
provisions discussed above.
Examples of State Health Department Policy Activities
Below is a list of specific activities state health department program staff can undertake in each stage of the
policy process.
Problem Identification
• Collecting, analyzing, summarizing, and
interpreting data and other scientifically based
information relevant to the frequency and
severity of injuries and their consequences
•
Describing the problem in clear, compelling ways,
including groups that are affected
(demographically, geographically, etc.), how their
lives are impacted (personally – individual stories
often illustrate this impact best), and that there
are proven ways to prevent the problem
• Developing data reports highlighting changes in
health conditions over time
• Developing policy or issue briefs highlighting
strategies based on the best available evidence
• Proactively disseminating data to inform possible solutions
• Signing memorandums of understanding with state and local agencies to access new data sets
• Implementing surveys to collect new data
• Conducting data analysis to answer key questions
Policy Analysis
•
Developing formal analyses of legislative bills and drafting white papers and other internal issue memos as
requested as part of the recognized role of the state health department in the formal legislative process
• Finding common goals or synergy with complementary issues, such as affordable housing and reducing
greenhouse gas emissions
• Using data and other scientific information to identify policies that consider the health effects (positive and
negative), based on the best scientific information available, are based on needs and realities of intended
audiences, and include evidence-based practices
• Maintaining information about the health and cost impact of injury prevention policies and distributing to
interested parties
• Identifying synergies with other state health department initiatives (such as those focused on preventing
obesity) that affect injuries and collaborate on developing data and disseminating information for decision
makers
• Identifying and analyzing the impact of existing injury prevention policies
• Conducting a feasibility analysis of potential policy intervention strategies
• Providing
information to partners including schools and organizations working on developing voluntary
organizational policies
• Developing best practice documents or recommendations for evidence-based interventions
Strategy and Policy Development
• Participating in coalitions, networks, etc. to inform others about the health impact of policies
• Conducting feasibility analysis related to implementation or enforcement (e.g., executive governmental
partner agencies, law enforcement, schools, etc.) of a proposed policy intervention
• Using communication strategies to improve compliance with existing policies
• Developing a partnership plan that identifies stakeholders and potential ways to engage with them
• Developing one pagers on potential policy interventions with benefits, costs, and barriers to
implementation
• Conducting
health and economic analysis of the burden of injuries and their consequences and estimating
how much evidence-based prevention efforts will avert health care costs from an organizational, public
sector, or societal perspective
• Providing training on policy, systems, and population-based approaches
• Developing a state injury prevention agenda or state health agenda that includes injury prevention if
requested by state health department leadership
Policy Enactment
• Conducting analysis to validate components in proposed bills as part of the formal legislative process in
which the state health department participates (e.g., bill review)
• Developing information briefs with key scientific findings for multiple audiences
• Providing invited testimony
• Meeting with policy makers, if requested, to educate them about the burden of injuries and their
consequences and evidence-based interventions
• Providing data, information, stories and technical assistance as requested
Policy Implementation
•
Raising awareness of or helping to implement existing policies that support preventing injuries and their
consequences
•
Working with partners to educate and engage with the public around the existing policy intervention and
implement programs to enforce existing policies that address preventing injuries and their consequences
• Working with enforcement entities to ensure policies are implemented appropriately and consistently
Policy Evaluation
•
Evaluating the effectiveness of existing or proposed policies (considering program implementation and
cost)
• Documenting successes in policy education, implementation, or evaluat
ion to share with other state health
departments and partners to promote best practices in the future
• Sharing evaluation data with policy makers and the public
Restrictions and Implications
There are restrictions on the use of CDC funds for certain activities. In addition, each government agency may
have limitations for its employees relating to lobbying or contact with public policymakers. It is important to
work within states’ systems and with CDC project officers to determine what activities are allowed within the
formal legislative process. Also, as noted, please refer to CDC’s AR-12 and Guidance
for more information.
Summary
Injury and violence prevention policy
strategies have the power to
influence systems development,
organizational change, social norms,
and individual behavior to improve
the health and safety of a
population. State health
departments can employ a range of
allowable activities to weigh in on
policies that have the potential to
reduce injuries and improve
population health.
Legislativ e proposals include legislation, appropriations, regulation, administration action, or Executiv e Orders. Anti-Lobbying Restrictions for CDC grantees:
http://www.cdc.gov /grants/documents/Anti- Lobbying_Restrictions_for_CDC_Grantees_July_2012.pdf
Background and Acknowledgements
Th
e Centers for Disease Control and Prevention’s (CDC’s) National
Center for Injury Prevention and Control (NCIPC) has identified
polic y as an important focus area for inc reasing health impac t.
Through the Core Violence and Injury Prevention Program (Core
VIPP) and others, they are c ommitted to working with state health
department partners in informing policy strategies to prevent
injuries and violence.
This document was developed in collaboration with an external
review committee of state health department injury and violenc e
prevention program directors and the Safe States Alliance. The
Safe States Alliance is a national non-profit organization and
membership association whose mission is to serve as the national
voic e for state and loc al injury and violence prevention
professionals building a safer, healthier America. We are grateful
for their critical feedback and insightful comments.
