The formulation phase of health policymaking includes two distinct and sequentially related parts: agenda setting and legislation development (see the shaded portion of Figure 5.1). Each part comprises complex sets of activities in which policymakers, as well as those who would influence their decisions and actions, engage.
The result of the formulation phase of policymaking is policy in the form of new public laws or amendments to existing laws. The public laws or amendments pertaining to health that eventually emerge from the formulation phase are initiated by the interactions of a diverse array of health-related problems, possible solutions to the problems, and dynamic political circumstances that relate both to the problems and to their potential solutions. Before anything else can happen in the sequential policymaking process, some mechanism must initiate the emergence and subsequent movement of certain problem/solution combinations through the process in which public laws are developed as potential policy solutions to the problems.
A useful way to think about how this aspect of the policymaking process unfolds is to consider the following: At any particular time, there are a great many problems or issues related to health. Many of them have possible solutions that are apparent to policymakers. Often these problems have 161
Figure 5.1 A Model of the Public Policymaking Process in the United States: Agenda Setting in the Policy Formulation Phase
Preferences of individuals, organizations, and interest groups, along with biological, cultural, demographic, ecological, economic, ethical, legal, psychological, social, and technological inputs
POLICY FORMULATION PHASE
Formal Enactment of
Window of Opportunity*
*The window of opportunity opens when there is a favorable confluence of problems, possible solutions, and political circumstances.
Formal Enactment of
POLICY IMPLEMENTATION PHASE
POLICY IMPLEMENTATION PHASE
Feedback from individuals, organizations, and interest groups experiencing the consequences of policies, combined with the assessments of the performance and impact of policies by those who formulate and implement them, influence future policy formulation and implementation.
alternative solutions, each of which has its supporters and detractors. Diverse political interests that pertain to the problems and to their potential solutions overlay the existence of problems and potential solutions. Agenda setting, a crucial initial step in the policymaking process, describes the ways in which particular problems emerge and advance to the next stage.
Once a problem that might be addressed through public policy rises to a prominent place on the political agenda—through the confluence of the problem's identification, the existence of possible policy solutions to the problem, and the political circumstances surrounding both the problem and its potential solutions—it can, but does not necessarily, proceed to the next point in the policy formulation phase, development of legislation. Kingdon (1995) equates the movement of certain problems, along with their associated potential solutions, to the point at which legislation might be developed to address the problems with their passing through a window of opportunity (see Figure 5.1).
At this second point in policy formulation, policymakers put forth specific legislative proposals: One can think of these as hypothetical or unproved potential solutions to the problems they are intended to address. These proposals then go through a process involving carefully prescribed steps that can, but do not always, lead to policies in the form of new public laws or, more likely, policies in the form of amendments to previously enacted laws.
Only a small fraction of the potential universe of problems that might be addressed through public policy ever emerge from agenda setting with sufficient impetus to advance them to the point of having specific legislative proposals developed as a means of addressing them. And even when they do, only some of the attempts to enact legislation are successful. The path of legislation—that is, of policy in the form of public laws—can be long and arduous (Hacker 1997). The details of this path that pertain to agenda setting are described in this chapter and, in regard to the development oflegislation, in Chapter 6.
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