CDC's Policy Analytical Framework
This document provides a guide for identifying, analyzing, and prioritizing policies that can improve health. The policy analytical framework (Figure 1) expands on domains I, II and III of the CDC's Policy Process (Problem Identification, Policy Analysis, and Strategy and Policy Development). The goals of this document are to
- Improve the analytic basis for identifying and prioritizing policies that can improve health
- Improve the strategic approach to identify and further the adoption of policy solutions.
The key steps include
CDC plays an important role in identifying and describing policy options to address public health problems, analyzing policies to understand their potential health, economic and budgetary impacts, and identifying evidence-based policy solutions and gaps in the evidence base. Note that federal law prohibits lobbying related activities by CDC at the federal, state, and local level.
FIGURE 1: THE POLICY ANALYTICAL FRAMEWORK (DOMAINS I, II, III OF CDC’S POLICY PROCESS)
Domain 1: Problem Identification
Step 1: Identify the Problem or Issue
The first step is to clearly identify the problem or issue you are trying to address. Synthesize data on the characteristics of the problem or issue, including the burden (how many people it affects), frequency (how often it occurs), severity (how serious of a problem is it), and scope (the range of outcomes it affects).
It helps to define the problem or issue as specifically as possible—for example “lack of access to fresh fruits and vegetables” (instead of “obesity”) or “barriers to sustaining HIV treatment” (instead of “HIV/AIDS”). A way to look for these is as contributing factors or risk factors in the literature on the public health problem. This level of specificity can help you understand how best to address the problem. In addition, it is also useful to frame the problem in a way that helps illuminate possible policy solutions. For example, “providing safe places for people to be physically active in their communities” (which has clear policy solutions) instead of “increasing physical activity” (where the policy options are not as clear).
Domain 2: Policy Analysis
Step 2a: Identify and Describe Policy Options
Research possible policy options relevant to the problem or issue you have identified and described. Potential strategies for gathering evidence include
- reviewing literature on the topic,
- surveying best practices (including best practices in other problem/issue areas),
- conducting an environmental scan to understand what other jurisdictions are doing.
Be sure to collect evidence that addresses alternative and opposing points of view on the problem or issue and include the option of maintaining the status quo.
Describe (Table 1)
The first step is to describe each of the policy options you have identified. Answer the overarching questions to describe the process and structure as well as the questions for each of the three interrelated criteria: health impact, feasibility, and economic and budgetary impacts (Table 1). To focus attention on the key components of each criterion, we developed a list of sample questions for each. Not all questions are appropriate for all problems or issues; furthermore, questions beyond those noted here should sometimes be considered. Addressing these questions will enable you to assess policy options in Step 2b.
In answering the questions, it is possible to pull from different sources and types of evidence. Keep in mind that some sources and study design are of higher quality (see link—table showing varying strength of different types of evidence). If you find that data are lacking on the specific policy, consider data from similar policies used to address a different problem or issue.
Step 2b: Assess Policy Options
Use the answers to the questions from Table 1 to rate the policy options. Also, for each criterion, note whether or not there are concerns about the amount or quality of data.
At this step, assess each option independently against the criteria included in the Table 2. If appropriate, include “no policy change” as an option. Although the ratings you provide should be grounded in data and evidence, they are inherently subjective. Table 2 is intended to be a guide. In order to justify your ratings, it may be helpful to systematically document the evidence, data, and reasoning you used to assign the rating in a separate matrix.
Note about scoring: If possible and appropriate, consider ways to quantify the rankings. For simplicity sake, we have presented a basic option here—rating as “low,” “medium” or “high.””. For clarity, the economic and budgetary descriptors are “less favorable,” “favorable,” or “more favorable.” However, you may be able to use more robust, empirical data (return on investment, lives saved, etc.) as available.
Step 2c: Prioritize Policy Options
On the basis of the ratings you assigned in Step 2b, evaluate policy alternative against each other and prioritize the policy option(s). Criteria are not intended to be examined in isolation. Which policy(s) you prioritize will depend on the weight you place on the three criteria and the overall analysis.
Domain 3: Strategy and Policy Development
Step 3: Develop a Strategy for Furthering Adoption of the Policy Solution
Once a policy solution has been prioritized, the next step is to define a strategy for getting the policy enacted and implemented. For CDC, this will include clarifying operational issues, identifying and educating stakeholders and sharing relevant information, and conducting additional analyses as appropriate to support adoption, implementation and evaluation.
Clarifying Operational Issues
Identify how the policy will operate and what steps are needed for policy implementation. Identify considerations and assistance for those who will adopt the policy (e.g., state/local government, organizations), taking into account jurisdictional context and information needs.
To help describe and disseminate the results of the analysis, you will want to share relevant information with key stakeholder groups, including state, tribal, local and territorial governments, other federal agencies, community-based organizations or groups, and decision-makers.
In developing products, keep in mind the stakeholders’ information needs and preferred ways of receiving information. Potential products might include:
- A background white paper that summarizes data related to health impact, feasibility, and budget and economic impact of prioritized policy
- A bibliography and data compendium
- A presentation of policy priorities or recommendations
- A policy brief or multiple policy briefs that summarize policy options or recommend actions
Conducting Additional Background Work
If policy is not prioritized or ready for “prime time” (e.g., because it has low feasibility, insufficient data on health impact, insufficient stakeholder support), there may be other steps you can take. If data are insufficient, consider developing a policy research agenda that identifies key questions that need to be addressed. Also, consider a more incremental policy to address the problem or issue.