Aligning Tobacco Free Living Agendas in a Community Health Improvement Plan: A Case Study on Democratic Participation and Economic Interests in U.S. Health Policy Development

Abstract

This paper addresses the gap in studies which use democratic policy making frameworks to analyze health policy development in Community Health Improvement Plans (CHIPs). The study describes and analyzes three streams of the tobacco free living policy cycle in a Community Health Improvement Plan implemented in a Mid-Western Region of the United States from 2016 to 2020. The roles of public health interest, economic interests, and democratic participatory rights in Tobacco free health policy making are assessed. The policy making process is assessed within an integrated framework of analysis that weaves pluralist, power elite, critical democratic theories, and participatory governance paradigms into Kingdon’s (2003), streams framework which includes problems, policy, and political streams. The results of the analysis are as follows:1. There was a deficit in democratic participation, and a preeminence of state institutions and economic interest in tobacco free living policy development to the disadvantage of public health interests; 2. Both the policy making process and policy outcomes are anticipated and explained by the governance-driven democratization paradigm and elite dominance theories 3. Democracy driven governance paradigm, democratic theories, and critical theories, illuminate the shortcomings of the policy making process and design. These frameworks also provide a pathway for improving the policy practice components of Community Health Improvement Plans. Specific recommendations are provided for future designs and implementations of policy development components of Community Health Improvement plans