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Governmental bodies, as well as political parties and businesses, are highly concerned about public health. To improve the provision and quality of healthcare services, affecting people’s well-being positively, they develop a plan of action to influence the current situation. In other words, they create a health policy that applies to various aspects of health. It may deal with environmental protection or health promotion, etc. Each policy-making process follows the policy cycle that “comprises several stages: (1) problem definition, formulation, and reformulation; (2) agenda-setting; (3) policy establishment (i.e., adoption and legislation); (4) policy implementation; and (5) policy assessment” (Friis, 2010, p. 123). Further, these steps of the policy cycle will be discussed in more detail, using an up-to-date example.
There are a lot of public health-related issues that attract the attention of policy actors. Among them, air pollution is treated as one of the most critical problems and the greatest global environmental threats. It causes various respiratory and heart diseases, resulting in about 7 million deaths annually. Moreover, it can also lead to cancer that is extremely difficult to treat. The World Health Organization (WHO) emphasizes that air pollution is associated with major non-communicable diseases. It happens because such particles as “nitrogen oxides (NOx), sulfur oxides (SOx), ozone and particulate matter with the latter” penetrate the lungs, leading to adverse health outcomes (UNECE, 2017, p. 3).
Moreover, WHO has recently classified it as a carcinogen, emphasizing the fact that poor women, children, and the elderly are the most vulnerable population that suffers from this issue. It is estimated that about 200,000 individuals die from air pollution only in the US. More than 100,000 of these cases are associated with emissions from vehicles and power generation (Vidal, 2014). As the reduction of adverse health influences caused by outdoor pollution cannot be controlled by the population itself, the public health sector and its authorities are to develop and implement policies aimed to improve this situation.
The representatives of the general public are involved in policy development. These individuals are the ones who are affected by the issue itself. The policy is based on their health conditions and outcomes related to air pollution. Moreover, they can urge policy development consulting doctors and attracting attention to this problem. Even though outdoor air pollution includes those elements provided by nature, the majority of harmful particles are spread because of human activities. In this way, people create a situation that requires improvement. Finally, they are the consumers of the advantages provided by the policy.
Healthcare organizations and their representatives are those parties that conduct research studies to receive the information needed to develop and assess the health policy. WHO, for instance, focuses on those health-related problems that affect the world’s population, so it is not surprising that it discusses air pollution (Neira et al., 2017). It describes those issues that are caused by this carcinogen and provides guidelines that should be followed to improve the situation. For instance, it is expected that the U.S. Environmental Protection Agency will urge the development of cleaner diesel fuel and usage of alternative energy sources. In addition to that, improvement is expected due to the avoidance of burning leaves, trash, and wood. People are also encouraged to change their gas equipment to the electric and solar ones.
Air pollution is discussed during sessions related to environmental health policies and opportunities. For example, Lynn Goldman revealed her concerns regarding these environmental problems and their influence on people’s health (Pool, 2014). As the dean of the School of Public Health at George Washington University, she urged the representatives of the National Institute of Environmental Health Sciences and to inform policy-makers regarding the necessity to address this problem. When their demand is satisfied, governmental bodies will ensure that all stakeholders are aware of the change and meet it.
Assessment and Evaluation
The last stage of the policy cycle is focused on its effectiveness. The policy is to be assessed and evaluated so that it can be determined if the desired goals are achieved. As a result, it is maintained through the comparison of quantitative information gathered before and after the implementation. Various types of assessments are to be considered to avoid uncertainty in the decision-making process. The authoritative evidence is obtained from a real situation, which ensures that the implemented alterations can be used further. The most valid epidemiologic studies that are conducted in the framework of assessment are usually in the form of quasi-experimental designs even though the quality of randomized control trials tends to be better.
Risk assessment is vital for policy development because it provides an opportunity to find out what adverse outcomes can be faced if it is implemented. A risk is the likelihood of negative consequences, being aware of it, policymakers can improve their initiatives for them to cover all possible gaps. Considering environmental health, risk assessment allows revealing those situations that can potentially lead to losses or harm. In this way, their management can also be discussed. Risk research focuses on both short-term and long-term effects faced by humans and ecosystems. As a rule, it is conducted in the following steps:
- Hazard identification. Professionals need to provide evidence that proves that some agents affect people’s health negatively. These hazards are often associated with toxic substances. In the framework of air pollution, attention is to be paid to the negative influences of such particles as NOx and Sox, etc. It should be pointed out that particular human activities increase their amount and worsen the quality of care. The most common health outcomes are to be outlined as well. It is possible to speak of cancer and respiratory diseases.
- Dose-response assessment. The association between the dose level of harmful particles and the occurrence of adverse health outcomes is critical because it allows identifying the most vulnerable population and the worst possible effects. In this way, the development of initiatives can be streamlined. In the framework of air pollution, WHO developed guideline levels for particulate matter because, with their increase, the number of people suffering from chronic respiratory levels increased as well (Neira et al., 2017). Unfortunately, they were not met when expected.
- Exposure assessment. The focus on the individuals affected by the exposure is significant because it allows making policies more concrete. Also, the description of the toxicants is to be provided. In this way, professionals explain how the representatives of the general public are affected by air pollution, determining why people from urban regions are at the highest risk of having issues.
- Risk characterization. The summary of the previously mentioned assessments allows for describing risks in detail. For instance, the time of exposure and its level can be associated with particular health outcomes.
Being aware of all this information, professionals can manage risks. In other words, they develop various actions aimed at the control of exposures and the improvement of public health. Policy implementation is one of the risk management options.
The policy focused on the reduction of air pollution may face some limitations because of the lack of research. It can be difficult to identify the levels of pollutants and their major sources. Air pollution monitoring may be maintained worse in some areas, which will affect the quality of the evidence and the effectiveness of the policy. Nevertheless, professionals believe that urban outdoor air pollution is to be addressed first of all because people who live in developed countries and big cities are extremely affected by the emissions associated with vehicles and plants. Urban development is often considered to be the main risk factor for outdoor air pollution.
The implementation of the appropriate policy is likely to reduce adverse effects of particulate matter, as such changes were already observed: “the implementation of the Clean Air Act has had a noticeable effect including the reduction of criteria pollutants by 69% between 1980 and 2013” (Jaworski, 2017, para. 18). Even though it cannot be denied that the previously used initiatives focused on the enhancement of air quality were successful, they are not enough to cope with the current situation. Technological and industrial development leads to the development of new hazards. In addition to that, the poor transport infrastructure of developing countries continues polluting the air. For example, “67% (1043/1546) of the high-income European cities monitored by WHO fail to meet WHO guidelines levels for PM2.5” (Neira et al., 2017, p. 604). Thus, it is vital to initiate the development and implementation of new health policies focused on the reduction of air pollution.
Thus, receiving information based on research on the population’s well-being, policy actors identify those problems that require immediate solutions. They set priorities and involve other parties for the formal adoption of a policy and its implementation into practice. Finally, repeated research allows assessing the policy and identifying its influences on public health. Right now, attention should be paid to the policy aimed at the reduction of air pollution, because this global issue affects people of all ages and leads to numerous deaths.
Friis, R. H. (2010). Epidemiology 101. Sudbury, MA: Jones and Bartlett Learning.
Jaworski, S. (2017). Ambient air quality and environmental health. Web.
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Neira, M., Fletcher, E., Brune-Drisse, M., Pfeiffer, M., Adair-Rohani, H., & Dora, C. (2017). Environmental health policies for women’s, children’s and adolescents’ health. Bulletin of the World Health Organization, 95(8), 604-606.
Pool, R. (2014). The nexus of biofuels, climate change, and human health. Washington, DC: The National Academic Press.
UNECE. (2017). Air pollution and health. Web.
Vidal, J. (2014). WHO: Air pollution ‘is single biggest environmental health risk’. Web.