Reflection on values and ethics of a public policy issue

In this research article, I chose a tobacco control policy topic that has been a big debate for decades. It strives to protect public health by preventing people, particularly children and teens, from becoming addicted to tobacco, assisting them in quitting, and reducing the adverse impacts of tobacco use. I have been focusing on the health and economic effects of tobacco consumption such as diseases, disability, tobacco-related health care costs, smoking expenses, and high mortality rates, which leads me to believe that this policy issue requires a change to eliminate and prevent such negative societal impacts. Although the government and health or nursing profession officials and stakeholders have been at the forefront to put legal and regulatory policies regarding tobacco usage, I think there is need to change this policy accordingly.

The tobacco industry has been ignoring this health policy by using tactics that resist government regulation. The tactics include but not limited to conducting public relations campaigns, funding political parties, buying scientific expertise to build controversy about the established facts, hiring lobbyists to influence the policy and corrupting the public officials. Hence, it has been quite hard to achieve the goals and objectives of the tobacco control policy.

Relevance of the tobacco control policy issue

The health or nursing professionals are the center for community empowerment. Tobacco may expose both the smokers and nonsmokers to disease risks such as heart disease and lung cancer to adults, asthma, pneumonia, chronic ear problems and bronchitis in children and can result in irritation and annoyance. It is a significant health threat to many people thus quite relevant (Patelarou, 2013). The Comprehensive Smokeless Tobacco Health Education Act of 1986 in the Federal Tobacco Control Efforts of America requires that the department of health should publish reports to the Congress on smokeless tobacco and issue health warnings on the cigarette packages every two years. The health professionals such as the nurses have been playing a crucial in the tobacco control through the provision of effective interventions that are against smoking. They utilize strategies like counseling patients and clients to quit smoking as it is detrimental to their health. Over the years, the medical and nursing associations have to acknowledge and assume greater responsibility in the promotion of smoke-free practices facilities among the staff and patients (Brossart, 2014). However, the existing scientific literature identifies various barriers to tobacco control and cessation. They include perceptions of a little receptivity to the tobacco interventions and time pressure and competing demands during the patient contacts.

Financial impact of the tobacco control policy

The financial of this public policy can be explained from two perspectives that include the costs of smoking and costs reduction prevalence. The private individuals, families, employers and taxpayers have to incur the face value of the cigarette purchases and the economic and health implications arising from smoking practices. The community has to incur expenditures in the treatment of smoking-related illnesses such as drugs and the administrative expenses. Government agencies and charitable organizations within a community have to incur a lot of expenditures which is an increase in tax burden to the society. However, there are net benefits that are derivable from investing in the tobacco cessation programs as people shall no longer incur financial costs of health and life insurance after their family stops quit from smoking tobacco.

Values impact on the policy issue

In this tobacco control and cessation issue, I would recommend that there is a total ban on planting and trading tobacco, cigarette manufacturing and smoking. The patients who continue smoking should be deterred from further treatment as a way to discourage others from smoking. However, the principle of non-maleficence underpins my perspective of tobacco control and cessation. It necessitates that there should be no harm to the society or patient involved. This step may also impact family, friends, and relatives who work in industries that produce tobacco after government order for closure to end cigarette manufacturing and smoking.

Policy brief

This public policy brief is addressed to Dr. Robert Califf, the head of Food and Drug Administration (FDA) in the US. The FDA authority that regulates the manufacturing, marketing, and distribution of the tobacco products and can take a further action necessary in the future as means to protect public health. Brossart et al. (2014) argue that the tobacco control programs should foster motivation to quit through the policy changes and media campaigns. It is important to incorporate new changes into the tobacco control policy as a way to increase the awareness of health risks resulting from smoking tobacco by people in the society especially the youth and children. Implementing evidence-based policies can be the key to success in the comprehensive tobacco control programs. According to Radwan et al. (2012), tobacco has been the most severe public health challenge, and nursing professionals play a crucial role in the control and cessation of tobacco smoking among individuals. They argued that physicians and the nurses have positive attitudes towards these programs compared to administrative employees. Moreover, they proposed that it is paramount to educate people on the dangers associated with second-hand smoke exposure and establish better measures for enhanced protection. The study provides evidence that nursing research in the tobacco dependence treatment contributes to the development of divine interventions and options for smokers.

The ISNCC Tobacco Position Statement (2014) proposed that nurses can deliver evidence-based interventions through the following ways, involvement in the community actions, promoting a tobacco smoking free environment, helping smokers and patients quit and prevention of uptake. The World Health Organization calls for nurses worldwide to be fully educated on the effects associated with tobacco products, collaborate with other non-health care professionals in the control programs and become non-smoking role models in the workplace. The inclusion of tobacco control policies and cessation measures and strategies in the curricula of the medical and nursing schools can be an effective action in helping millions of smokers to quit such unhealthy behavior in the community. Therefore Dr. Califf has to implement the options discussed in this paper to ensure achievement of the goals and objectives of tobacco control policy. Further, it has to apply other recommendations from WHO which has been at the forefront to ensure the cessation of smoking cigarettes and other tobacco related products that are detrimental to the health of people in the society.

Challenges of addressing tobacco control policy issue

The tobacco industry has been a major a derail in tobacco control by using deceitful practices that undermine public health. The continuous use of the interference strategies such as undermining scientific evidence and corruption and leveraging political influence prohibit cessation of tobacco smoking in many countries. Secondly, many states have failed to implement recommended initiatives and inadequate internal monitoring of the proposed programs such as the total ban of tobacco selling and recruitment or accountable and reliable workforce to ensure implementation of the control measures. Thirdly, there has been a political polarization mainly from the opponents to the local smoke-free policy thus killing any proposed legislation regarding tobacco control. Furthermore, the policy adoption campaigns require an enormous amount of financial and human resources when developing projects to be utilized by organizations and communities. Lastly, the cultural differences among populations pose a great challenge in addressing this policy as different people have various perceptions regarding tobacco smoking and its impact on the smokers.

Primary options and interventions

In ensuring efficiency in tobacco control policies the following options and interventions should be taken into consideration by the head of food and drug administration. Firstly, they should enforce a total ban on the advertisement, promotion, and sponsorship of tobacco products to prevent targeting of males and females of all ages from the tobacco industry. Secondly, it is paramount to incorporate gender into the tobacco control measure by empowering gender-sensitive efforts geared to empower individuals when claiming smoke-free environments. Moreover, making tobacco products less affordable through an increase in tobacco tax and enforcing legislation requiring 100% smoke-free environments of all the indoor work and public places can be a better option for policy makers.

Strengthening the health systems is a crucial option. They achieve this step by making tobacco cessation advice available to health care nurses and ensuring low-cost pharmacological treatment through the support quitlines and several other community initiatives. Additionally, it is crucial to warn members of the public about the dangers resulting from tobacco through the appropriate packaging of warning levels and obtaining a free media coverage of the anti-tobacco activities. Another policy option includes monitoring tobacco use through recording the population-based and nationally representative data periodically on the key indicators of cigarette smoking among the youths and children. It is also significant to reduce the number of tobacco retail outlets through the imposition of a moratorium when granting licenses to new retailers as a way to promote and enforce restrictions on tobacco products at a point of sale. The Food and Drugs Administration should increase the age of those permitted to purchase such risky goods and services from the current one and require disclosure of the manufacturers’ incentives that they give to the retailers. County commissions, city councils and local boards of health should come up with smoke-free ordinances that aim at educating policy makers on the importance of effective implementation of evidence-based policy measures and strategies in the tobacco and cessation programs.

These primary options and interventions are tangible because they aim at transforming tobacco promotion, selling, and usage. Additionally, they shall change the users and nonusers’ knowledge, attitudes, and practices as a way to community growth and development. It aids in the achievement of a comprehensive tobacco control program by promoting cessation and reducing initiation.

Persuasive course of action

The head of the FDA authority should reach out all the sectors of the community before they start planning for effective ways to guide their efforts. It is essential to invite a variety of organizations and demographic segments to ensure their participation process in the policy process. They include civic organizations, education institutions, business owners, faith communities, lawyers, health organizations, medical professionals, youths and young adults among others. Also, there is need to determine the short-term goals that facilitate forward movement of the core strategies. Thus it shall enable them to get a deeper understanding of both internal and external environment regarding policy, politics and global health. Additionally, it is essential to take necessary actions and steps that focus on identifying the resources, gaps, objectives and barriers that may deter the implementation of the changes to this policy in the future. The restrictions may include preemptive laws, limited funding to tobacco campaigns, a strong tobacco lobby, and vocal public opposition. Lastly, it is essential to translate the individual problem by framing it from a behavior perspective to a social issue that focuses on presenting a long lasting solution.

For the decision maker to avoid the challenges described above it is crucial to implement the following strategies. First, they should aim at creating sustainable financing mechanisms and develop clear statements of objectives basing on a transparent, inclusive and well-communicated process. There should be flexibility in the implementation methods and ensure the available capacity is not exceeded. The head of FDA authority should be opportunistic and develop an independent insight towards policy development as a means to overcome political polarization challenge. Lastly, they should avoid policy planning process overload, focus on what is imperative and make a consistent use of nationally collected data regarding tobacco control.

Evaluating the success of the policy brief

The tobacco control proponents should have created powerful coalitions that represent the general public, ensure gaining of adequate knowledge regarding the political climate and engagement of technical assistance providers. Moreover evaluation of the ability to manage the gaps between members of the research community and the state or local health departments. Tobacco control partners should show their efforts in policy messaging, delivery and action. They should be able to make the mid-course corrections, identify and discard the elements of the system that are not working efficiently (Political Pipeline, 2013). There should also be evidence of the efficient use of media in educating the public on the policy initiatives and ensure regular discussion of the issue on the news and reinforce the evolving social norms. Furthermore, there should be a clear evidence in matching policy strategies to the overall control goals. The legislation should show a consistent implementation of the smoke-free laws. The public health officials have to help in drafting, enacting and defending the policies.

Identification of the organization

World Health Organization has been expressing its interest in the change of the tobacco control policy issue. It provides future health interventions, enhancing awareness of tobacco control and leveraging resources and forces towards the attainment of the goals and objects of the amended policy issue.

Three CBPR principles to use

The first principle to apply includes the integration of knowledge and intervention for the mutual benefit of all partners involved. It calls for dissemination of the findings provided on an ongoing process through the use of multiple strategies and utilizing the results to facilitate proper development of the interventions and policy change. The second one includes addressing of health from both the positive and ecological perspectives. The CBPR for health aims at focusing on problems that are relevant to the local community and include individuals, immediate and broader context in which they live. The third principle shall be the facilitation of equitable and collaborative involvement of all the partners in the phases of research. It calls for researchers to recognize inequalities existing amongst them thus promote information sharing, and decision making power.

In approaching the WHO, I will have to take part in their tobacco campaigns worldwide and participate in community projects that aim at control and cessation of tobacco smoking. To achieve collaboration with the organization I shall to provide them with my research and recommendations on this policy issue. Hence there shall be an integration of my knowledge and their findings and come with a concrete solution that can help decision makers to fully implement the proposed strategies without facing stiff opposition from other members.

Alignment of the goals

The goal of WHO involves coming up with effective ways of ensuring tobacco reduction, creating smoke-free environments and incorporation of gender in tobacco cessation and control. My goal includes adopting policy changes that can guarantee a heath community that is free of disease and risks resulting from smoking cigarette and use of other products. It shall be appropriate to ensure engagement of parties involved, creating accountability for all individuals and regular communication of the importance of the control programs to the community. Hence, it calls for leveraging of my research projects with WHO study to determine the physical, technological and financial resources required in matching the policy strategies with the overall goals. The cultural humility shall support the development of mutually beneficial relationships.

Action steps

In ensuring the specific goal to WHO goal, the following action steps are necessary. It is paramount to establish a precise definition of the community and identify partners and to build a sustainable network with organization members. Moreover, it is essential to focus on learning an etiquette of community engagement, developing new methodologies of approaching the issue and lastly insisting on the improvement of the translation and dissemination plans.

Roles and responsibilities of organization members

In ensuring capacity building among partners, the members should facilitate the mutual transfer of knowledge regarding community history and grant proposal preparation. Their role of problem-solving shall include using the ecological approach through a provision of multiple determinants regarding diseases and well-being of people in the community as a whole.

Elements of developing of collaborative evaluation plan

Firstly, it is significant to make sure that there is a participation of all parties at all the stages of policy making and having the desire to meet the shared goals and needs of a community. As a result, there shall be recognition of the community as a unit of identity and empower the power-sharing process. Secondly, it is necessary to ensure community engagement and ownership of both the product and process. Hence it will be easy to involve all members in the analysis and dissemination of results. Other elements include linguistic appropriateness and cultural prevalence that emphasize on sustainable collaboration for community health improvements.

Evaluating success of the plan

The local participants should identify the gaps in delivery, necessary services and ensure public safety. There should be adequate provision of resources, technical assistance, and training. Thus, it is paramount regularly provide data and set up priorities regarding the appropriate policies to work on and avoid those that are not helpful to the community. State agencies should promote effective collaboration to ensure law enforcement of suggested policy changes (Political Pipeline, 2013). Every officer has to be responsible and accountable for each performance. Lastly, there should be frequent use of books and team meetings to ensure proper circulation of information.

Strengths

The top-down approach can help in the realization of the focused of all resources from an individual managed application, and thus, the first implementation becomes the showcase for identity management solution. Moreover, the funding agencies may necessitate detailed plans implemented. Hence it is easier to evaluate as an individual is under control of all the action steps required.

The bottom-up approach makes it simpler to engage the partners and thus building up a momentum of collaboration among the parties involved in the policy issue changes. Secondly, networking facilitates the possibility of using free resources and make it easier in engaging the target group who are the community members. Another strength involves an easy adaptation to the different needs and social problems of individuals.

Challenges

The top-down approach solution usually provides a limited coverage in the first phases of implementation and decision makers may not realize benefits rapidly. On the other hand, bottom down approach may become cumbersome to evaluate and can be legitimate towards the funding agencies. Moreover, it is driven by the existing infrastructure rather than the ongoing policy process.

The bottom-up approach shall be the most appropriate approach in addressing the tobacco control policy issue since it enhances collaboration and networking among parties involved in the policy changes and thus can give an opportunity for implementing effective evidenced based control cessation program.

References

Brossart, L., Russell, S.M., Walsh, H., Wachtel, A., Edison, L., Bach, L., Schell, S., Israel, K., Mohr, A. & Luke, D. (2014). Policy strategies: a tobacco control guide.

ISNCC Tobacco Position Statement (2014). Retrieved on April 5, 2017 from,

https://www.ons.org/advocacy-policy/positions/policy/tobacco

Patelarou, E., Vardavas, C., Ntzilepi, P., Warren, C., Barbouni, A., Kremastinou, J., Connolly, G. and Behrakis, P. (2013). Nursing education and beliefs towards tobacco cessation and control: a cross- sectional national survey (GHPSS) among nursing students in Greece, vol. 9(1): 4.

Political Pipeline, (2013). Top-down and Bottom-up Approaches within Implementation. Retrieved on April 5, 2017 from,

https://politicalpipeline.wordpress.com/2013/02/21/top-down-and-bottom-up-approaches-within-implementation/

Radwan, G. Christopher A Loffredo, Rasha Aziz, Nagah Abdel-Aziz and Nargis Labib (2012). Implementation, barriers and challenges of smoke-free policies in hospitals in Egypt. BMC Research Notes.