Policy Implementation: Policy implementation represents the stage where government executes an

adopted policy as specified by the legislature or policy action. At this stage various government agencies
and departments responsible for the respective areas of policy are formally responsible for
implementation. Policy implementation is what happens after a bill has become law (Theo Doulou and
Kofinies, 2004).

Policy implementation consists of organized activities by government directed towards the achievement
of goals and objectives articulated in authorized policy statements (Wayne Hayes: 2000).

For Eminue (2005) policy implementation refers to the process of converting human and material inputs,
including informational, technical, human demand and supports, etc. into outputs in the form of goods
and services.

In the words of Ikelegbe (1996) implementation involves the committal of funds, the establishment of
structures and methods, the hiring of personnel, the administering or executing of activities, and the
securing of policy goods, services and other intended outcomes policy implementation can be generally
understood to mean the totality of the series of procedural daily activities involved in realizing the
government policy goals and objectives, by relevant administrative institutions and legislative houses,
the courts, pressure groups and community organizations.

What is Public Health Policy?

Public health policy is defined as the laws, regulations, actions, and decisions implemented within
society in order to promote wellness and ensure that specific health goals are met.

Public health policies can range from formal legislation to community outreach efforts. Public health
policy plays a role in multiple sectors, including:

 Health care

 Insurance

 Education

 Agriculture

 Business

 And more.

A clear public health policy definition can be hard to pin down due to its multidisciplinary nature.
However, at the core of all public health policy is a singular mission towards health.

Organizations such as the World Health Organization, Centers for Disease Control and Prevention, Food
and Drug Administration, and other governmental and non-governmental agencies play a large role in
public health policy. These organizations perform research and implement education and health
initiatives for a population—creating laws and policies that ensure the society has nutritious food to eat,
clean water to drink, vaccines for the sick, and access to health care.

*** Policy in healthcare is vitally important as it sets a general plan of action used to guide desired
outcomes and is a fundamental guideline to help make decisions. The purpose of healthcare policy
and procedures is to communicate to employees the desired outcomes of the organization. They
help employees understand their roles and responsibilities within the organization. In the healthcare
environment specifically, policy should set the foundation for the delivery of safe and cost effective
quality care.***

The Importance of Public Health Policy

Public health policy is crucial because it brings the theory and research of public health into the practical
world. Public health policies create action from research and find widespread solutions to previously
identified problems.

As a public health policy official, you are responsible for initiating strategies and policies around both
health intervention and prevention. To allow your target population to flourish, you must address not
only physical health, but mental, social, and economic well-being as well.

Public Health Policy Examples

Before public health policies are implemented, policymakers and officials will go through an extensive
research process to determine what public health issues need to be addressed and formulate the best
subsequent solutions. Here are a few common public health policies that have become a core part of
society today:

1. Food Safety Policy: Food safety policies are very important to the general health of individuals
and people in society. Food-related illnesses are a significant concern, and it is the job of public
health officials to formulate policies to ensure that only food that is safe for consumption is
made available for the public.

2. Tobacco Use: Many public health officials have put measures in place to reduce the risks of
deaths and illnesses caused by tobacco consumption and smoking. Some of these policies
include increasing tobacco prices and creating tobacco-free areas in communities to protect
non-smokers from the effects of secondary smoking.

3. HIV: Public health policy plays an important role in educating the public about HIV prevention,
how to live with the virus, treatment options, and preventing stigma. Public health policies,
including increased access to testing, birth control, and medicine, have been implemented to
drastically reduce the impact and spread of the virus in various communities.

4. Alcohol: Alcohol abuse is one of the leading causes of vehicular accidents, violence, sexual
assault, health complications, and more. Public health policies are crucial in the fight to curtail
alcohol dependence and reduce its negative effects on users. Policies on alcohol differ
depending on the community, but the most common example is age restrictions in the
consumption and purchase of alcohol.

https://www.publichealth.columbia.edu/public-health-now/news/public-health-policy-definition-
examples-and-more

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Problems of Policy Implementation

Implementation is the process of turning policy into practice. However, it is common to observe a ‘gap’
between what was planned and what actually occurs as a result of policy implementation.

***There are three major theoretical models of policy implementation (Buse et al, 2005).

Top-down approach: This approach sees policy formation and policy execution as distinct activities.
Policies are set at higher levels in a political process and are then communicated to subordinate levels
which are charged with the technical, managerial, and administrative tasks of putting policy into
practice.  Political scientists have theorized that the top-down approach requires that certain conditions
be in place for policy implementation to be effective including:

 Clear and logically consistent objectives

 Adequate causal theory (to how particular actions would lead to desired outcomes) See section:
Epidemiology: Association & Causation

 An implementation process designed to enhance compliance by implementers  (using incentives

and sanctions)

 Committed, skillful implementing officials

 Support from interest groups and legislature

 No changes in socio-economic conditions that undermine political support or the causal theory
underlying the policy

 Adequate time and sufficient resources available

 Good coordination and communication

Problems associated with the top down approach:

 It is very unlikely that all pre-conditions would be present at the same time

 Only adopts perspective of those in higher levels of government and neglects the role of other
actors

 Risks over-estimating the impact of government action (neglects other factors)

 Difficult to apply where no single, dominant policy or agency is involved

 Policies change as they are being implemented

Bottom-up approach: This approach recognises that individuals at subordinate levels are likely to play
an active part in implementation and may have some discretion to reshape objectives of the policy and
change the way it is implemented.  The bottom-up approach sees policy implementation is an
interactive process involving policy makers, implementers from various levels of government, and
‘street level bureaucrats’ such as frontline staff. Policy may change during implementation.
Problems of the bottom-up approach:

 Evaluating the effects of a policy becomes difficult

 Difficult to separate the influence of individuals and different levels of government on policy
decisions and consequences. (Important for bureaucratic accountability)

Principal-agent theory:  In each situation there will be a relationship between principals (those who
define policy) and agents (those who implement policy), which may include contracts or agreements
that enable the principal to specify what is provided and check that this has been accomplished. The
amount of discretion given to the agents and the complexity of the principal-agent relationship are
affected by:

 The nature of the policy problem- including scale of change required, size of affected group,
simple vs. complex intervention, ill-defined vs. clear policy, many cause vs. single cause, degree
of political sensitivity, length of time before changes become apparent.

 The context or circumstances surrounding the problem- political and economic climate,
technological change

 The organization of the machinery required to implement the policy- number of formal and
informal agencies, amount of skills and resources required.*****
Gunn (1978 in Hunter 2003) has identified ten common barriers to effective health policy
implementation:

1. The circumstances external to the implementing agency impose crippling

constraints
2. Lack of adequate time and sufficient resources (See Box 1)
3. The required combination of resources is not available
4. The policy to be implemented is not based on a valid theory of cause and effect
5. The relationship between cause and effect is indirect and there are multiple
intervening links
6. Dependency relationships are multiple
7. There is a poor understanding of, and disagreement on, objectives (See Box 1)
8. Tasks are not fully specified in correct sequence
9. There is imperfect communication and coordination (See Box 1)
10. Those in authority are unable to demand or obtain perfect compliance

Buse K, Mays N, Walt G (2005). Making Health Policy. Understanding Public Health Series Open
University Press.
Gunn LA (1978). “Why is implantation so difficult?” Management Services in Government, 33: 169-
76.
Hunter DJ (2003). Public Health Policy. Cambridge: Polity Press.