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Public Health Agenda Setting in Louisiana: An Applied Index and Implications for Community Development Policy

Article excerpt

The purpose of this study is to contribute to community development from a public health policy perspective. One tenet of community development is the notion of shared experiences, whether historical, cultural, social, or otherwise. Within the context of this sharing, too, is public health, and the synergy between public health and community development is crucial to the well-being of a given population. Perhaps no place captures the effects of a relatively unhealthy synergy more than Louisiana, a state that has long struggled to increase the well-being of its residents in terms of public health and community development outcomes. Given the state's current public policy environment in which the public health budget continues to experience severe cuts, addressing the health of the population becomes even more difficult in terms of identifying and prioritizing public health needs for governmental action. This study presents an applied public health index (PHI) that equitably and systematically identifies and measures health variables directly related to improving public health outcomes in Louisiana, and in so doing discuss the implications for community development policy.

Keywords: race; public health; community development; disparity; Louisiana

Introduction

Agenda setting is a term used in public policy literature that refers to the process of how issues move from a relatively individual or grassroots level to one of only a few issues recognized and acted upon by governmental entities in order to address a virtually unlimited need or desire with limited resources (Kingdon, 1984). Public policy and political science scholars have long been fascinated with understanding how issues move to a governmental agenda in order to command public resources, and because issues must be identified and recognized before governmental action can be taken, agenda setting is considered by many such scholars to be the most important part of policy making, see for example seminal works by Baumgartner and Jones (1993), Kingdon (1984, 1989, 1994), Cobb and Elder (1983), Cohen, March, and Olsen (1972), Schattschneider (1960) and Lindblom (1959).

Public health, too, has a history of attention from scholars, though not in terms of agenda setting. One of the earliest concepts of public health (Winslow, 1929) describes it as the science and art of disease prevention; prolonging life; and promoting health and well-being through organized community effort for the sanitation of the environment; the control of communicable infections; the organization of medical and nursing services for the early diagnosis and prevention of disease; the education of the individual in personal health; and the development of the social machinery to assure everyone a standard of living adequate for the maintenance or improvement of health. At the heart of the definition are concepts still practiced in public health today: the policymaking process and the activities of public health agencies and health improvement (Kelly, Speller, & Meyrick, 2004).

For public health issues, determining how issues gain the attention of policy makers and eventually public resources has serious implications for resource allocation as well as which health conditions receive prominence in research dollars and eventually the indirect benefits of research such as special treatments or even cures. As Allotey and Reidpath (2002) state, "health resources are not infinite and therefore some mechanism is required for deciding upon their allocation. Tools and policies are needed for this process and underpinning these, is a measure of the health of the population" (38).

Scholarly attention to agenda setting in public health has commanded attention from scholars as well. For example, several scholars adapted ideas from the work of Kingdon (1984). Kingdon's model of agenda setting describes "streams" of problems, policies and politics that are pulled together by "policy entrepreneurs" and pushed through "policy windows" to public agendas at opportune times (Kingdon, 1984). …