Policy
Policy is a set of principles, guidelines, frameworks and actions that are intended to set standards for the behaviour of individuals, groups and populations and essentially, to solve problems (Knill & Tosun, 2020). Policies exist at government level, but all companies and organisations will have their own sets of policies that may have a positive impact on the workforce (Timms et al., 2015). Policies address problems within societies by providing a platform that aims to keep the public safe and from a health perspective, by preventing or reducing diseases or conditions that impact economically and on quality of life (QoL) (Eyler, 2016). For example, Davies, (2015) recognised that incontinence was a prevalent issue impacting negatively on individuals QoL and on society in terms of the economic impact on health services. They proposed that policies should be commissioned to provide educational programmes and physiotherapy services to address these matters. Thus when a policy is established, it demonstrates an intention which can increase resources and funding in order to solve a societal issue.
What is healthy public policy?
Healthy public policy (HPP) is policy which is not specifically designed for health but ultimately has a positive impact on health (Carey et al., 2014). It is concerned with the social and environmental issues that impact on health and places an important focus on the social determinants of health (Bryant et al., 2019). The health in all policies initiative is an example of HPP which was designed so that health is addressed in all policies and sectors, including business and politics, local and national government, that is, that the impacts of a given policy on health are considered in every policy at every level (Guglielmin et al., 2018).
Examples of healthy public policy include those targeting obesity. It is said that obesity is caused by the environment in which people live which is influenced by issues such as poor access to space for physical activity, high costs of healthy food and marketing of unhealthy foods (Marmot, 2015). A recent policy, gear for change: a bold vision for cycling and walking, aims to increase active travel and proposes to invest in infrastructure that supports active travel as well as making changes to the highway code which will make it safer for the public to do so (Hirst & Dempsey, 2020). By addressing healthy public policy, it allows questions to be raised regarding the efficacy of siloed approaches to policy that focus on the individual behaviour, many of which are ineffective (Raine et al., 2014), to a focus on the wider issues that are impacting on health. Ultimately, HPP allows for the creation of environments that are conducive to the health of all (Raphael, 2015).
Policy Formulation
Policy formulation refers to the process by which an idea or a problem is transformed into an action or set of actions and the outcomes which it produces. The process of policy formulation is dynamic; there is a process, but it is not typically followed in a linear or cyclical fashion. Policy formulation begins with establishing a problem and setting an agenda to solve it. The agenda is then implemented and evaluated, and the policy may be adapted if necessary (Hansson-Forman et al., 2021).
In theory, policies must be evidence based or at least informed by evidence and in health policy, epidemiological studies provide a basis for new policies to arise (Bhattacharya, 2013; Bowman et al., 2012; Smith, 2013). Policy can also be informed by the experiences of political leaders such as the current United Kingdom (UK) Prime Minister Boris Johnson who invested £100 million in weight loss services due to the impact his weight had on the severity of his COVID-19 illness. Moreover, policy can be informed by external pressures from lay people who lobby for new policies such as seen in the gradual changes being made to domestic violence policies and laws which have the power to improve health (Crozier & Jarman-Howe, 2020; Gill & Theriault, 2005; UK Parliament, 2022).
There does appear to be a gap however, between identifying an issue through research, and forming policies or actions (Bowman et al., 2012; Kitson & Straus, 2010). This gap appears to occur due to the unrelatedness of researchers and policy makers but is potentially addressed with the use of a framework (Field et al., 2014; Smith, 2013). The framework identified that policy decision makers or all those who have a stake in actions, must become involved from the earliest stages of research through a process of co-production in order for the policy process to be successful (Smith, 2013).
Policies and power
A welfare state implements economic support such as for public pensions, healthcare and unemployment support. Welfare states are present in all developed capitalist nations to which the UK is one. The balance of equity within a nation may be dependent on the type of welfare state to which it belongs. The UK is considered a liberalist welfare state that prioritises the economic market and pro-business political parties. This has the effect of de-prioritising citizen economies and social security which increases health inequalities. In contrast, nations such as Sweden, Finland and Norway belong to a social democratic welfare state that prioritises equality, independent of employment status and as such, these countries have a higher level of health equality (Bryant et al., 2019).
Summary
Policies exist for the health and safety of the populations they serve. The formulation of policies is complex and not always derived from the best evidence available at the time. This can change but requires the coming together of all stakeholders, researchers and government bodies. Policies are driven largely by those in the highest power but every person within society has the ability to influence and change policy to create a better society for all.
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