Tools and Resources

Tools and Resources, Chapter 2: Learning About Policy and Environmental Change

Resources

A broad range of resource materials exists on the prevention of heart disease and stroke and their related risk factors and conditions, such as diabetes, and on communication theory, research, and practice.  This guide lists examples of resources that are easy to access and apply in daily practice.

Resource No. 1
Association of State and Territorial Directors of Health Promotion and Public Health Education (ASTDHPPHE) and Centers for Disease Control and Prevention (CDC). Policy and  Environmental Change: New Directions for Public Health, Final Report and Executive Summary. Atlanta, GA: CDC; 2001.

Value
Collaborative study on the use of policy and environmental change interventions by public health agencies across the United States.  Intended to facilitate an understanding of the essential role of public health professionals in reducing the burden of chronic diseases.  Includes recommendations.

Source
Both documents available for purchase from ToucanEd from URL: http://www.toucaned.com.

Resource No. 2
American College of Cardiology (ACC) Advocacy - Working For You

Value
Resources include a guide to public policy with information on the legislative and regulatory process, effective government relations, the political toolkit, and media relations.  Also see Advocacy Weekly, Advocacy Partners, and The Digest of State Health Policies.

Source
Available from URL: http://www.acc.org*.

Resource No. 3
American Heart Association (AHA) and American Stroke Association (ASA)

Value
Details AHA and ASA advocacy activities at the national and state levels and provides facts and figures to include in communication messages.  Download the annual AHA Heart and Stroke Statistical Update.

Source
Available from URL: http://www.americanheart.org*.

Resource No. 4
Group Health Community Foundation
The quest for community health: Lessons on improving health from nine California communities. Seattle, WA: The Foundation; 2002.

Improving everyone's quality of life: A primer on population health. Seattle, WA: The Foundation; 2001.

Improving stakeholder collaboration: A special report on the evaluation of community-based health efforts. Seattle, WA: The Foundation; 2001.

Value
Three reports prepared by the Group Health Community Foundation, which served as the evaluation team for The California Wellness Foundation's Health Improvement Initiative. All are intended to help communicate the case for a population-based approach to health.

Source
Available from URL: http://www.ghcfoundation.org*.

Resource No. 5
PolicyLink. Reducing health disparities through a focus on communities. Oakland, CA: PolicyLink; 2002.

Value
A report from PolicyLink, a national nonprofit advocacy organization that works with community-based practitioners to document successes, build networks, and increase capacity to influence policy-making.  Report is prepared with The California Endowment, a California-focused health foundation.  Contains other online reports on physical activity and community mapping.

Source
Available from URL: http://www.policylink.org*.

Resource No. 6
Benton Foundation
Strategic Communications Toolkit and Sound Partners

Value
A strategic communications toolkit, archived under Legacy Projects, includes promising practices and lessons learned for nonprofit groups. Includes a Sound Partners project to encourage public radio and communities to work together  to solve health problems.  Individuals can sign up for Sound Partners Weekly Digest to obtain information on communication projects and resources.  Review the toolkit that has information on community-based journalism, partnerships, promotion, and outreach.

Source
Available from URL: http://www.benton.org* and http://www.soundpartners.org*.

Resource No. 7
The Research File. Information for professionals from the Canadian Fitness and Lifestyle Research Institute.

Value
A series of one-page handouts on communication and policy topics.  Start with these:

• Health campaigns leave lasting legacy, Reference No. 00-04
• Communicating health risks, Reference No. 99-11
• Media-based interventions, Reference No. 99-09
• Media advocacy, Reference No. 98-08
• Use of mass media, Reference No. 99-10
• Interventions for specific target groups, Reference No. 99-04
• Environmental and policy interventions, Reference No. 99-01
• Policies and community interventions, Reference No. 96-03
• Social ecological health promotion, Reference No. 98-02
• Moving communities to change, Reference No. 00-03

Source
Available from URL: http://www.cflri.ca*.

Resource No. 8
Communication Initiative

Value
Communication Initiative advances the extent and quality of communication and information for change mainly focused on international communication projects, and it may be useful in the planning of science and theory-based communication projects for other public health issues.  Its Web site presents a family tree of communication theories, concepts, methodologies, and strategies, including information on behavior change, planning models, communication for social change, development communication, social marketing, media advocacy, and participatory communication.

Source
Available from URL: http://www.comminit.com.

Resource No. 9
Making Health Communications Work. National Cancer Institute, 2002.

Value
The long-awaited update of the 1989 communication planning guide (The Pink Book).  Presents and gives examples of key principles and steps in developing and evaluating health communication programs.  Sources of additional information on each subject are included at the end of each chapter.  A CD-ROM planning tool is also available.

Source
Available from URL: http://www.nci.nih.gov.

Resource No. 10
Bray R. SPIN Works!  A media guidebook for communicating values and shaping opinion. San Francisco, CA: Independent Media Institute; 2002.

Value
A media guidebook produced by the SPIN (Strategic Press Information Network) Project.  The SPIN Project provides media technical assistance to nonprofit public interest organizations across the nation that want to influence debate, shape public opinion, and garner positive media attention.  Purchase the guide and check out other media resources and training opportunities on the Web site.

Source
Available for purchase from URL: http://www.spinproject.org*.

Resource No. 11
Wallack L, Woodruff K, Dorfman L, Diaz I. News for a change: An advocate's guide to working with the media. Thousand Oaks, CA: Sage Publications, Inc.; 1999.

Value
An often-cited resource on media advocacy strategies.  Includes chapters on shaping the story, creating news, and talking to journalists.

Source
Available for purchase from URL: http://www.sagepublications.com.

Resource No. 12
Frameworks Institute

Value
Information from the Frameworks Institute on how to use strategic frame analysis to promote policy change.  Read issue papers, starting with:

• Issue 7: Don't think about elephants
• Issue 9: A framer reads the news
• Issue 18: Strategic frame analysis [SFA] and policy- making: Where does SFA fit into our strategic plan?

Source
Available from URL: http://www.frameworksinstitute.org*.

For framing, see also Mooney C.  Breaking the frame.  The American Prospect. 2003;14(4).  Available from URL: http://www.prospect.org*.

Resource No. 13
Andy Goodman

Value
A monthly newsletter, Free–Range Thinking by Andy Goodman, profiles best practices, success stories, and resources in the field of public interest communications.  Read copies of newsletters and download a free copy of Why Bad Ads Happen to Good Causes and How to Ensure They Won't Happen to Yours, a guide on public interest print advertising.  Look in the newsletter archive for articles on storytelling as best practice.

Source
Available from URL: http://www.agoodmanonline.com.

Resource No. 14
Cardiovascular Health Branch

Value
Refer to the CDC Cardiovascular Health Branch Web site for updates on heart disease and stroke, training, conferences, and quality of care issues.

Source
http://www.cdc.gov/cvh/

The list of resources is provided solely as a service for users of this guide.  The resources cited in this guide do not constitute an endorsement by the Centers for Disease Control and Prevention or the federal government, and none should be inferred.  CDC is not responsible for the content found in these resources.  The tools in this guide are meant to guide users in developing materials for policy and environmental change.  These tools are not meant to be duplicated directly.

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Steps in the Policy Development Process and Suggested Actions to Impact the Process

Click HERE (PDF - 719K) to view the Steps in the Policy Development Process and Suggested Actions to Impact the Process flow chart.  Learn more about PDFs.

[A text version of this graphic is also available.]

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Working Toward Sustainable Local Policy Change: Steps and Examples Checklist*

This worksheet provides a general road map of the policy change process. The headings describe key stages, while the items below the headings provide steps and examples. The steps are not necessarily sequential, and many may be repeated several times during the process. The appropriateness of including any step in your effort will vary, depending on the specific goal and local policy-making process.

1. Laying the Groundwork

• Form or convene existing group
• Define structure and process for group (e.g., communication, decision making)
• Develop written vision and mission statements
• Assess needs related to achievement of vision
• Set priority goals and objectives
• Form task force for policy initiatives

2. Assessing Policy Change Options

• Assess policy(ies) needed to achieve vision and goals
• Gather information about effective practices (e.g., research and local successes)
• Use local, regional, or state data to support the need for policy
• Map stakeholders (e.g., affected population, supporters, opposition)
• Assess community readiness (interest and capacity) for specific policy changes
• Prioritize policy work, based on impact and readiness
• Analyze local policy–making process related to priority policy(ies)

3. Developing an Action Plan

• Develop policy change plan (who, what, where, when, how)
• Assess group strengths and weaknesses, and design strategies to address the gaps
• Identify key decision makers and contacts needed for policy change.  Find a champion!
• Develop budget (and fund–raising plan if needed).  Consider cost of policy enforcement as well as development.
• Create timeline, working backward from change decision date (e.g., town or school board meeting).
• Draft advocacy plan

4. Increasing Awareness and Support

• Determine key messages
• Develop communication strategies that incorporate key messages
• Develop media advocacy plan (if appropriate and feasible for local area)
• Plan awareness events (e.g., community forum, informal neighborhood gatherings)
• Plan how to respond to opposition and other concerns
• Identify key organizations to present to and recruit as supporters
• Identify other supporters and provide them with information and skills to express their support (e.g., phone scripts, talking points, sample letters, spokesperson training)

5. Implementing Plan for Policy Change

• Draft a new policy or environmental change as you would like to see it
• Develop indicator(s) of success
• Carry out plans for recruiting supporters and increasing awareness and support
• Continually assess progress and keep leaders informed (and revise your plan as needed)
• Draft a monitoring tool to track enforcement
• Arrange testimony at meeting(s) where policy adoption/passage is discussed and voted on

6. Monitoring and Evaluation

• Celebrate policy success and thank task force, key volunteers, and the like.
• Publicize policy change!
• Provide or arrange for technical support for implementers and enforcers.
• Monitor intended and unintended outcomes of policy change.
• Monitor policy enforcement.
• Communicate monitoring results to key individuals.
• Dissolve policy project task force or move on to next policy change project.

*Provided by the Maine Cardiovascular Health Program, Department of Human Services

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AR–12 Lobbying Restrictions

CDC Program Announcement 02045 Cardiovascular Health Programs

Applicants should be aware of restrictions on the use of U.S. Department of Health and Human Services (HHS) funds for lobbying of federal or state legislative bodies. Under the provisions of 31 U.S.C. Section 1352, recipients (and their subtier contractors) are prohibited from using appropriated federal funds (other than profits from a federal contract) for lobbying Congress or any federal agency in connection with the award of a particular contract, grant, cooperative agreement, or loan. This includes grants/cooperative agreements that, in whole or in part, involve conferences for which federal funds cannot be used directly or indirectly to encourage participants to lobby or to instruct participants on how to lobby.

In addition, no part of CDC-appropriated funds shall be used, other than for normal and recognized executive-legislative relationships, for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio, television, or video presentation designed to support or defeat legislation pending before the Congress or any state or local legislature, except in presentation to the Congress or any state or local legislature itself. No part of the appropriated funds shall be used to pay the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence legislation or appropriations pending before the Congress or any state or local legislature.

Any activity designed to influence action in regard to a particular piece of pending legislation would be considered "lobbying." That is lobbying for or against pending legislation, as well as indirect or "grassroots" lobbying efforts by award recipients that are directed at inducing members of the public to contact their elected representatives at the federal or state levels to urge support of, or opposition to, pending legislative proposals is prohibited. As a matter of policy, CDC extends the prohibitions to lobbying with respect to local legislation and local legislative bodies.

The provisions are not intended to prohibit all interaction with the legislative branch, or to prohibit educational efforts pertaining to public health. Clearly there are circumstances when it is advisable and permissible to provide information to the legislative branch in order to foster implementation of prevention strategies to promote public health. However, it would not be permissible to influence, directly or indirectly, a specific piece of pending legislation.

It remains permissible to use CDC funds to engage in activity to enhance prevention; collect and analyze data; publish and disseminate results of research and surveillance data; implement prevention strategies; conduct community outreach services; provide leadership and training; and foster safe and healthful environments.

Recipients of CDC grants and cooperative agreements need to be careful to prevent CDC funds from being used to influence or promote pending legislation. With respect to conferences, public events, publications, and "grassroots" activities that relate to specific legislation, recipients of CDC funds should give close attention to isolating and separating the appropriate use of CDC funds from non-CDC funds. CDC also cautions recipients of CDC funds to be careful not to give the appearance that CDC funds are being used to carry out activities in a manner that is prohibited under federal law.

Source:
Centers for Disease Control and Prevention. AR-12 Lobbying Restrictions. CDC Program Announcement 02045: Cardiovascular Health Programs, 2002.

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Suggested Communication Interventions

Below are some examples of specific communication interventions states can implement to fulfill each of the program components required of State Heart Disease and Stroke Prevention Programs. Your state does not necessarily need to implement all of the interventions described below, nor is this an exhaustive list. Use these resources to give you ideas about how to use communication strategies to fulfill your program components and achieve your goals of influencing policy and environmental change.

Capacity Building States

Develop and Coordinate Partnerships: Use The Blue Book to develop a mini-brochure and/or a PowerPoint presentation about what policy and environmental change is and how it can be an effective approach for motivating behavior change. Consider using examples of past public health successes that employed this approach to strengthen your case. Share the brochure and/or presentation with existing partners when you meet with them to achieve buy-in.*

Based on knowledge of who your target audiences are for promoting policy and environmental change (e.g., community members in key legislators' districts, local associations of professionals impacted by proposed policy or environmental interventions), make a list of organizations and key stakeholders that would be crucial in influencing these audiences. Be sure to include those that have existing publications or other channels for communicating with these audiences. Schedule face-to-face meetings to get partnership buy-in from each organization or stakeholder not already committed.*

Develop Scientific Capacity to Define the Cardiovascular Disease Burden: Develop a fact sheet of striking, but readily understood, statistics that you and your partners can use in your communication with target audiences, such as policy makers. For example, work with epidemiologists to identify statistics or pull data from your state's Stroke Atlas and "translate" them into meaningful, concrete terms. For instance, compare a number with something visual and well known: "More African American men die of stroke each year in this state than people attend the Super Bowl."*

Develop a fact sheet and talking points about your state's stroke burden that partners can use in their advocacy efforts.*

When your state publishes burden documents or other reports on CVD data, send copies to legislators. Be sure to include charts, graphs, and other visual aids highlighting key points about the state's CVD burden.

Develop an Inventory of Policy and Environmental Strategies: Gather information from local hospitals and other large health care providers about the guidelines their providers follow for treatment of high blood pressure and how they enforce or promote these guidelines. Summarize this information in a white paper or position paper that partners can use in their media advocacy activities and persuasive presentations.

Develop, Update, and Implement a CVH State Plan: Ask partners who are active in your priority populations what newspapers, radio stations, TV stations, and other media outlets are most widely used among these populations in your state.*

Once your communication plan has been developed, work with a partner organization or your workgroup to hold a press conference announcing the new or increased focus on improving CVH in your state and on policy and environmental changes that could influence CVH. Time the press conference so you can simultaneously release new data about the CVD burden in your state.

Use the program goals and objectives specified in your communication plan to draft key messages for your initiative. Put a discussion of the draft messages on the agenda for one of your workgroup meetings.*

In your Heart Disease and Stroke Prevention State Plan, list your partners and the communication strategies each will use to achieve the plan's goals.

Provide Training and Technical Assistance: Start an e–newsletter for state and local health department staff on how they can get involved with policy and environmental change activities. Develop a PowerPoint presentation based on The Blue Book that State Program staff and partners can use to promote policy and environmental change when giving presentations and meeting with policy makers. Successful environmental change strategies from tobacco prevention, water fluoridation, and lead poisoning, to name a few, can be used as talking points and illustrative examples.*

Hold media training for spokespersons, such as State Program staff and partnering organizations, on how to craft and use communication tools such as press releases, Op–Eds, and advertisements. Provide sample materials from this guide or past projects.*

Develop Population-Based Strategies: This guide is designed to help your state develop, implement, and evaluate communication interventions—which are population-based strategies—to address heart disease and stroke and related risk factors through policy and environmental change. For specific approaches and tactics related to stroke, high blood pressure, and heart disease, see pages 13-15.

Develop Culturally Competent Strategies for Priority Populations: Include specialty media appealing to priority audiences in your media contact lists.*

Solicit feedback on any proposed strategies from partners representing your priority populations. Ask them which strategies will be most persuasive for these populations and what resources and relationships the partners can leverage to implement them. For example, if these partners tell you that faith communities are the most effective means of reaching priority populations, find out what connections and relationships they have in state or regional faith organizations.

Develop handouts and talking points about signs and symptoms of heart attack and stroke, and ask community partner organizations active in your priority populations (e.g., churches and community service organizations) to give talks to groups in their communities.

*Chapters 5 and 6 address these interventions in greater detail.

Basic Implementation States

Implement Population-Based Intervention Strategies Consistent With the State Plan: See program component 6 for Capacity Building states.

Implement Strategies Addressing Priority Populations: See program component 7 for Capacity Building states.

Specify and Evaluate Intervention Components: Urge partners to report to states on their successes ASAP, since these can serve as model strategies for other State Heart Disease and Stroke Prevention Programs. Keep a file of minutes from each workgroup or partner meeting to document partnership development.*

Modify the tracking form in the guide as necessary for monitoring news coverage on the policy and environmental issues your state is trying to influence. Assign someone from your staff or workgroup to gather and maintain files of all newspaper, TV, radio, or Web coverage on the topic.*

Implement Professional Education Activities: Write an article about how stroke center certification will support neurologists, and work with professional associations to publish the article in their member newsletters.*

Work with health care provider associations to develop a new or implement an existing continuing medical education (CME) course on guidelines for blood pressure treatment. Give a speech or provide an exhibit on the criteria for stroke center certification at health care provider association meetings.

Collaborate on Secondary Prevention Strategies: Assist your State Federally Qualified Health Centers to coordinate health education for diabetics and their families with the centers' care guidelines.

Work with a local hospital to write an article educating physicians about the guidelines for putting patients on cholesterol-lowering statin drugs and the importance of this treatment. Work with the hospital to include this information in the communication vehicles for reaching admitting physicians, such as physician newsletters.*

*Chapters 5 and 6 address these interventions in greater detail.

Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion