Influencing and informing public policy are explicit goals of active living research. Active living researchers, motivated by a desire to improve health, often wonder why their findings do not translate more readily into changes in the "real world" of local, state, and federal policies.
The California Center for Public Health Advocacy (CCPHA) is a nonpartisan nonprofit research and advocacy organization established in 1999 specifically to raise awareness about critical public health issues and mobilize communities to promote the establishment of effective state and local health policies. As the Executive Director of the CCPHA and a longtime public health advocate, I see two main reasons why research is not more readily translated into public policies: research is only one factor that influences the political process by which public policies are enacted, and researchers and advocates often have little experience working closely with one another. Nonetheless, research and researchers have a critical role to play at key points in the policy development process.
To highlight that role, I describe here four crucial steps in the policy development process where our Center has used research during the last 9 years to help lead statewide advocacy campaigns on three far-reaching issues in California: getting soda and junk food out of schools (2000–2005), increasing funding for physical education (2006), and requiring chain restaurants to post calorie information on menus and menu boards (2007–2008). Our experience points toward ways that researchers and advocates can work together more closely to achieve common policy objectives.
STEP 1: DEFINE A PROBLEM AND DESCRIBE IT LOCALLY, IF POSSIBLE
The most important thing researchers can do to support public policy changes is to choose research questions that have particular policy relevance. To get soda and junk food out of schools, two pieces of research had the most impact: a study by California Project LEAN (Leaders Encouraging Activity & Nutrition) showing that 95% of California schools sold fast food, such as pizza, cookies, and chips (1), and a CCPHA study showing that the rates of overweight children in California had risen from 26.5% to 28.1% in just 4 years (2001–2005) and that the obesity epidemic had worsened in 90% of all State legislative districts during that time (2). The second study allowed us to give every legislator data on the number of overweight children in his/her district. Local data like these are powerful because they help make state and community leaders accountable to their constituents and because they are appealing to the media, who want to tell a local story about important state or national issues.
STEP 2: DEVELOP AN EFFECTIVE POLICY SOLUTION
Policy makers need a reasonable and justifiable policy solution. Does that mean they need double-blind studies about the effectiveness of any proposed intervention? Absolutely not. Not once in 5 years did a legislator ask for research to prove that banning soda and junk food sales on school campuses would reduce the prevalence of childhood obesity. Instead, we brought together a National Consensus Panel – a group of 10 experts from across the country – who could legitimately recommend food standards for California schools. Although this was not research in the traditional sense, the standards recommended by Panel members (3) carried the weight of their authority and formed the starting point for our legislation and other legislation across the country. The one pertinent piece of research about the policy solution itself – pilot testing the food and beverage standards in 14 school districts around the state – turned out to be useful not because it showed health effects one way or the other, but because it showed that schools did not lose money selling healthier food (4).
STEP 3: DEVELOP A CONVINCING MESSAGE
Much of the political process is about communication. Toward that end, we work closely with a public relations firm to frame our messages – and the research on which they are based – and to develop convincing ways to tell our story.
Here, for example, was our message about school food.
- The problem: "Childhood obesity rates have skyrocketed and schools are a part of the problem – they have become soda and junk food superstores."
- The effect: "This could be the first generation of children in modern history to have a shorter life expectancy than their parents."
- The policy solution: "It is time to get schools out of the junk food business."
STEP 4: USE RESEARCH RESULTS TO EDUCATE THE RIGHT PEOPLE IN THE RIGHT WAY AND AT THE RIGHT TIME
Policymakers and their staffs are extremely busy, often responsible for a full spectrum of health, social, and economic issues. For an advocacy message to be most useful, it must be provided through a variety of channels: written materials that are clear and concise, personal visits by a combination of respected experts who share "the facts" and local residents who tell their personal stories, and a sufficient amount of well-timed media attention. In 2005, CCPHA released data on rising childhood obesity rates in California legislative districts 1 week before the legislature's final vote on the school soda and junk food bans. Similarly, at the end of the legislative session in 2006, we released data showing that more than half of California schools were not meeting minimal requirements for physical education (5), and at about the same time in 2008 we released data showing that 93% of children's meals sold at major fast food chains exceed recommended calorie levels (6). Media coverage that highlights results from key research studies like these can play a decisive role in the legislative process.
In addition to these activities in which research plays an essential part, an array of other steps can or must be included in comprehensive policy advocacy campaigns. These include identifying a powerful legislative author who will prioritize and champion the issue; mobilizing people throughout the state to establish political momentum by contacting legislators or establishing local ordinances; and continuing the campaign until legislators commit to change.
CONCLUSION: RESEARCHERS AND ADVOCATES CAN MAKE GREAT PARTNERS
Researchers and advocates each play critical and unique roles in the development of public policy. For example, researchers can answer key questions to help move the policy agenda forward, and advocates can help communicate research findings more effectively and help policy makers utilize findings in the policy development process. Nonetheless, researchers and advocates often have different temperaments and skills, making the prospect of a partnership somewhat daunting. Whereas advocates tend to highlight their subjective assessment of a situation and get right to the heart of the issue by summarizing reams of data in a brief "sound bite," researchers want to maintain their objectivity and describe their research findings and limitations more thoroughly.
If, as an active living researcher, you want your work to have a more direct impact on the policy making process, I suggest you partner with advocates working on your issues before you start your next research project. Work together to decide what research is most needed, when the findings should be released, how the findings will be disseminated to have the most political impact, and what your respective roles will be in the policy development process. Stay open to learning from one another and take advantage of each other's strengths. By coordinating efforts, active living researchers and active living policy advocates can increase their collective ability to bring about the changes in public policy that we both seek.
References
- 2000 California High School Fast Food Survey. Berkeley, CA: Public Health Institute; 2000.
- The Growing Epidemic: Child Overweight Rates on the Rise in California Assembly Districts. Davis, CA: The California Center for Public Health Advocacy; 2005.
- National Consensus Panel on School Nutrition. Recommendations for Competitive Food Standards in California Schools. Davis, CA: The California Center for Public Health Advocacy; 2002.
- Dollars and Sense: The Financial Impact of Selling Healthier School Foods. Berkeley, CA: University of California Center for Weight and Health; 2004.
- Dropping the Ball. Davis, CA: The California Center for Public Health Advocacy; 2008. Available at http://www.publichealthadvocacy.org/droppingtheball.html, accessed 22 October 2008.
- Kids Meals: Obesity on the Menu. Washington, DC: Center for Science in the Public Interest; 2008.
About the Author
Harold Goldstein is the Executive Director of the California Center for Public Health Advocacy. E-mail: HG@PublicHealthAdvocacy.org
