Choose Effective Policies & Programs:
Key Activities

The questions are simple but the answers may not be. Don’t rush this step. Your goal will guide the next steps of your work.

What does your community need? Think about what you hope will be different as a result of your efforts. What is your goal?

As you answer the why does it need it question, think about the data and focus on differences or inequities in health outcomes across groups in your community. What data can you use to define the problem? What data support your solution? Who should benefit from your solution?

We like Answering the Three Key Questions for Advocacy Campaigns to help you get clear on your goals. “Nine Questions” A Strategy Planning Tool for Advocacy Campaigns takes you beyond these questions to see how your goal will set the stage for change efforts.

The “Why Use Data?” Action Learning Guide also provides you with the opportunity to reflect on how data can support your health improvement work, identify and understand inequities, and tell a story or answer a question about your community’s health.

Make it visual. A visual tool, like a logic model, can help you see how strategies link to long-term results. Logic models can help you think through what you want to achieve and why. They also play an important role in your evaluation.

• We like to use the Tearless Logic Model to turn the traditional logic model approach into a user-friendly process. It breaks the process into a series of engaging questions. It is an especially helpful early planning tool. The questions are also useful at other points in the process.
• Need to brush up on logic models? Check out Program Development & Evaluation Logic Models for examples, templates, and a training guide.

Start with What Works for Health

What Works for Health is a great starting place to find ideas to address your community’s priorities. Our evidence team searches out, assesses, and summarizes the best available evidence. They look for policies and programs that can help improve health behaviors, clinical care, social and economic factors, and the physical environment. This information can give you a sense of what works, what might work, and what does not work. What Works for Health supports the use of tried and true strategies as well as innovative approaches to thorny problems.

What Works for Health Navigation Tips

• Search by keyword (e.g., obesity, poverty)
• Browse strategies by decision maker, health factor, or evidence rating
• Use Choosing Your Strategy to understand and apply evidence ratings

Look at…

• The Evidence Rating to get a sense of how likely each strategy is to work, based on best available evidence
• The Expected Beneficial Outcomes to understand what each strategy can accomplish
• The Disparity Rating to get a sense of how a strategy will likely impact disparities or gaps among:

• Socio-economic groups
• Racial or ethnic groups
• Geographic areas (i.e., urban vs. rural)

• The Implementation Examples & Resources to get ideas of how you might move forward.

Defining What Works

Other groups also assess and rate policy and program effectiveness. You might find different kinds of evidence to support strategies and different labels describing how well they work (e.g., promising practice, best practice, model program, etc.). These labels (and how groups arrive at them) are not apples-to-apples comparisons. Each group has its own criteria and labels. It’s important to understand what they mean. As an example, check out our explanation of the evidence ratings in What Works for Health.

(You may find it helpful to look at some of these sites along with What Works for Health.)

From Tried and True to New and (Maybe) Improved

There’s a time and a place for innovation. If you’re deciding whether to come up with a new approach or adopt an existing one, consider:

• How well do existing strategies fit your community’s culture and needs?
• How much time and resources does your community have to spend?
• Can you evaluate your innovative strategy?

Use your goal to measure your options. (Hint: What Works for Health is a go-to tool for considering the impact.)

You’ll also want to consider other dimensions of impact:

• Human impact. Who will benefit from each strategy? Who will be harmed by each strategy? How?
• Equity impact. How does each strategy affect those with the greatest needs in your community? Who should benefit?
  What Works for Health’s disparity rating considers gaps in outcomes among:
  • Socio-economic groups
  • Racial or ethnic groups
  • Geographic areas (i.e., urban vs. rural)

The Racial Equity Impact Assessment tool can help you consider how different racial and ethnic groups will likely be affected by a proposed decision. These assessments are best conducted during the decision-making process. Example use: Iowa and Connecticut lawmakers have used racial and ethnic impact assessments to examine the likely impacts of proposed sentencing laws.

• Level of impact. Will the strategy impact individual people, organizations, or the community as a whole? Will it change the environment or existing rules to support healthy choices? We like to use the Intervention Planning Matrix to map each strategy's level of impact.
• Length of impact. Will the strategy create short-term change? Can you sustain it over a long period of time?
• Cost-benefit. Are there foreseen or unintended impacts that could outweigh the potential positive outcomes of the strategy? Will it end up widening health inequities in the community? How would you avoid them? For example, there is strong evidence that higher tobacco taxes reduce smoking rates. However, smokers with low incomes will feel a negative financial impact. One way to lessen this unintended impact is to make cessation support available in low-income communities at low or no cost.

Program vS. Policy

Programs and policies both have important roles to play in community change.

Programs help people meet current needs. They can make a real difference in the lives of the people they serve. For example, programs that help low-income families pay for heat in the winter can reduce financial burdens. Programs that deliver hot meals to the elderly can provide a stable source of food.

Policies address the conditions and environments that impact health in communities. They create the standards for how a community or specific organization will operate. A policy-based approach may address the root cause of why too many people face a need in the first place.

• Policies that change the environment or social norms have the potential to benefit more people. These policies make the healthy choice the easy choice, and ensure that everyone in a community has a fair and just opportunity for good health. 
• Programs also have policy considerations. What policies do you need to implement the program now and in the future?

You can learn more about what policies are and find examples of some policies in our Getting Started with Policy Change Action Learning Guide. 

To answer that, start with some high-level questions.

• Is the strategy a good fit for our partnership?
• Is our community ready and able to support our chosen strategy?
• Do we have what we need to implement and evaluate the strategy?
• Does our community's political environment support our strategy?
• Have we included those most affected by poor health in choosing a strategy?

The next two Key Activities help you consider your community’s context.

The following questions help you know if your community is ready to support your strategy. (Hint: involving the community along the way helps build support.)

• Do community members understand the issue we seek to address?
• Is it important to them?
• Is our strategy supported by people who are most affected by poor health or health inequities?
• Do community members understand how a potential strategy will impact the issue?
• How readily does our community accept change?
• Do community members support current strategies that aim to address the issue? How about similar strategies addressing other issues?

Your community can help you influence those who have the power to give you what you want. The next Key Activity, Consider Your Stakeholders, asks you to identify key decision-makers and those who influence them.

Values

The policies a community implements reflect its values. What we do and where we put our resources demonstrates what is most important to us.

Nearly all policies are based in one of four values: Equity/Fairness, Efficiency, Liberty/Freedom of choice, and Security/Future. What does your community value most? As you explore this question, it’s important to include a variety of perspectives.

Resources

Readiness also means having what you need to implement and evaluate your strategy. Consider the following questions when thinking about resources.

• Can we leverage existing resources and assets? For example, could you work with others who have different resources to build on existing efforts? Could your strategy complement existing efforts? Did you create an asset map earlier in your process? If so, it could come in handy as you consider this question.
• Do we have to pursue funding to make our strategy happen? The Act on What’s Important step includes guidance on identifying resources to support your activities. The Funding Guide: Securing Additional Resources for Community Health Improvement includes key elements that should be in place before you pursue funding.

• Do we have funding to evaluate our strategy?

It’s helpful to brainstorm three types of stakeholders:

• Community Members. The people who are affected, and all those with vested interests. This might include residents (especially those most impact by inequities), advocacy groups, non-profit agencies, and businesses.
• Decision-makers and their influencers. Those who have the power to influence or make decisions about the change you want. This might include elected and appointed officials or lobbying groups.
• Implementers. Those tasked with making the strategy work and sustaining them long-term. This might include administrators or employees. This is an important group – a strategy only works if it’s implemented or enforced.

For each group of stakeholders, consider:

• Why do they care about this issue?
• Who gains from the strategy? Who loses?
• Would they support, oppose, or be neutral to your policy or program?
• Who are the key decision-makers for your policy? How do they feel about the strategy? Can you influence them? (Hint: What Works for Health strategies include potential decisions-makers on the left navigation menu.)
• What information do you know about stakeholders? What do you need to know?
• Who can influence the decision maker? How do they feel about the strategy? We like the Sphere of Influence tool to help you quickly brainstorm who can influence key decision-makers.

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You can read more about understanding power and influence in the Identify Allies and Opponents key activity in our Act on What’s Important step.

Read more about power and influence in our Act on What’s Important step.

Partnership

Is the proposed strategy consistent with your mission and priorities? Have you attempted a similar strategy in the past? If so, what was the outcome? What were the challenges?

Deciding which strategy to implement

When deciding on a strategy, these steps can help guide the way:

1. Generate a list of your top choices.
2. Ensure that your process has been inclusive.
3. Decide on your chosen strategy.

List Your top choices

It might be helpful to use voting or decision-making procedures. This process can be loosely structured or follow a formal process. Learn more about decision-making processes in the Focus on What’s Important guide. Learn more about these procedures in the Focus on What’s Important guide.

Check your inclusiveness

Reflect on how inclusive your process has been. How were those most impacted by the issue engaged in considering strategies? How have their lived experiences and opinions guided the decision?

Choose a strategy

Pull together what you know about your top strategy choices, their impact, and your community to make a decision. Use the What Do You Want? Choosing a Local Policy Goal tool to work through a set of criteria that can help you select a policy or systems change goal for your community.

Do we need to adapt the strategy?

Policies and programs may not be a fit for your community straight “out of the box.” Policies and programs don’t always travel well. You may need to adjust the strategy to fit your community. Adapting tested policies and programs or trying innovative strategies means your evaluation needs to be more rigorous. Is what you're doing working as intended? Do you need to course-correct? Find more in our Evaluate Actions step.