34.4: Advancing Health Care Policies
By the end of this section, you should be able to:
- Identify evidence-based policies linked to social and economic improvements.
- Discuss the Health in All Policies (HiAP) approach to address health needs.
- Defend policies that promote health and prevent harm.
- Support the development of policies based on population findings.
Health policies shape every client’s interaction with a health care team member. Their influence may be invisible if they are effective or extremely visible in cases where a policy is not providing a good outcome. When a policy no longer meets the needs of the people that it was intended to help and protect, it needs revision. Sometimes policies require revision because technology and current practice have advanced beyond the scope of the issue. This section will explore how nurses can use data and community partner resources to improve health policy.
Using Evidence-Based Policies
Using evidence-based policies is especially important in health care planning to ensure that interventions are safe and effective, reach the intended population, and use available resources. Evidence-based policies are developed from reliable data and statistics rather than intuition and personal opinion. A wealth of free government resources for current evidence-based practice (EBP) guidelines exist, as discussed in Evidence-Based Decision Making, and these resources can be used for the development of EBP policies (National Institutes of Health [NIH], 2023). Healthy People 2030 is based on the concept that evidence-based policies can improve the country’s overall health by addressing direct health needs as well as SDOH. The Healthy People 2030 website has a library of downloadable evidence-based tools and educational materials (ODPHP, 2020c). Laws and policies at the local, state, and federal levels related to Healthy People 2030 are in place to improve the safety and well-being of Americans.
Another resource for evidence-based practice is the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically review the evidence of effectiveness and develop recommendations for clinical preventive services (USPSTF, 2023). The Health Resources and Services Administration’s [HRSA] Bright Futures program provides evidence-based clinical guidelines for mothers and children (from birth through age 18) to help increase the quality of primary and preventive care (HRSA, 2023a).
Evidence-based resources (EBRs) are published reviews of intervention evaluations and studies to improve health. The Healthy People 2030 website has organized them into intuitive topics so you can easily find what you are looking for. There are hundreds of EBR resources for SDOH, populations, health conditions, health behaviors, settings, and symptoms.
Health in All Policies
The CDC’s Health in All Policies (HiAP) is “a collaborative approach that integrates and articulates health considerations into policy making across sectors to improve the health of all communities and people” (CDC 2020c). The HiAP approach is a framework intended to help governmental programs and nongovernmental organizations in planning their policies and outreach campaigns. The goals of HiAP are to
- promote health, equity, and sustainability,
- support collaboration between community partners,
- benefit multiple partners,
- engage community partners, and
- create structural or process change that is long-lasting.
HiAP recognizes that health depends on SDOH —factors beyond health care—and that they are often beyond the scope of traditional community health activities. Promoting healthy communities requires addressing those SDOH, such as transportation, education, access to healthy food, economic opportunities, and more to achieve the most benefit from planned interventions (Tucker, 2014).
Using HiAP and Healthy People 2030 goals increases the potential for state, territorial, and local health departments to improve health outcomes (ODPHP, 2020c). An example of a HiAP approach is a city planning policy that creates zoning for a new retirement community for older adults. During the planning phase of construction, the project team would perform an impact assessment of the proposed location. One assessment would be the potential health implications for the residents based on possible sites for the new community. If the community is built near a swampy area of marshland that is a breeding ground for mosquitos, what is the potential for West Nile virus and other mosquito-borne illnesses? If the location is close to a busy highway, how might the increased airborne pollutants affect the residents? If the community is built on the outskirts of the town, can existing public transportation options meet the unique transportation needs of the senior residents? Is there easy access to health care in proximity to the proposed location? Asking these and other questions using the HiAP approach helps guide the project team’s decision-making across all areas to maximize health-enhancing options and to minimize potential health risks for the future residents (CDC, 2020c). Leading the Way to Improving Population Health discusses HiAP in more detail.
This short video from the American Public Health Association discusses the application of HiAP in the context of malaria prevention.
Watch the video, and then respond to the following questions.
- What SDOH influence the incidence of malaria?
- How do non-health agencies play a part in HiAP?
- How did the different groups in the video work together on the malaria reduction project?
Nurses’ Role in Advancing Health Care Policies
When nurses work to defend policies that improve health care outcomes, they are ultimately advocating for their clients. Nurses experience the daily influence of policy and politics in health care. As the largest group in the global health care workforce, nurses are uniquely positioned to observe the ways in which health policy affects clients and their communities (Kovner, 2023). Nurses are crucial to defending health policy because they spend much of their time interacting with clients and understanding their needs. Nurses can relay successes and limitations to policymakers, whether directly through contact with their legislators or through the collective voice of a nursing organization like the ANA (Pollack-Porter et al., 2018).
The ANA has worked to defend provisions of the ACA since it was introduced in 2010. One of the policies it has focused on is the information technology initiative. The ANA has advocated for electronic health record s (EHRs) to promote client safety, joined health information technology alliances such as the Healthcare Information and Management Systems Society and the Alliance for Nursing Informatics, and developed educational products for e-health campaigns. Not all nurses were happy about the change from paper charting to EHRs, so the ANA worked to defend that policy by educating nurses about the improvements in client safety offered through the use of computerized client charts (ANA, 2023).
The information obtained by collecting data on a group of interest can be used by policymakers to tailor planned activities and interventions to directly target the members of that group (Leal, 2022). Nurses can support this process by keeping careful records of health needs and barriers to improved health in the selected client group. As discussed in Advocating for Population Health, nurses can also act as advocates for policy development when they identify a health gap in a client population.
An example of this is nurse Judith Haber’s work to create interest in policies aimed at whole-person care for people who use Medicare. Dental care is not a covered benefit for these individuals unless the issue is related to very specific effects of medical treatment (such as pulling teeth that are loosened by treatment for cancer). Sixty percent of Americans aged 65 and older are enrolled in Medicare , and unless they purchase a private dental coverage policy, they must pay for all dental treatment out of pocket. Dr. Haber and her colleagues in the Oral Health Nursing Education Practice (OHNEP) program (a national nursing oral health initiative) have worked with the Centers for Medicare and Medicaid Services to improve access to dental care for several years. While dental care is not yet completely covered, through the efforts of these nurses, Medicare has been expanded to include benefits to clients with medical conditions (like artificial heart valves) that are impacted by oral health (Kovner, 2023).
Some applicable advocacy strategies for any nurse include joining a national nursing organization to draw attention to health disparities with a collective voice. Politics and policy are at the core of health care planning and improvements to population health, and by using the power of organized lobbying, nurses can create awareness of issues that will drive the development of policies to address these issues (Brokaw, 2016).