HSC 3624 - Disease Policy Brief
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Diseasecasestudyexample.docx
Guidelines_for_Writing_a_Policy_Brief.pdf
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Diseasecasestudyexample.docx
Alexandra Bono Chagas Disease in Bolivia
From: Secretary of Health, Bolivia
To: Minister of Finance, Bolivia
Introduction
Bolivia has the highest prevalence and incidence rates of Chagas disease in the world, with approximately 1.8 million infected and 3.7 million at risk for infection.1 2 Annually, 45,000 Bolivian deaths can be attributed to Chagas.1 4 The disease disproportionately affects individuals of low socioeconomic status residing in rural areas.3 7 The risk factors for Chagas include poor-quality housing, endemic residential location, lack of education, and receipt of blood or organ transplants.2 5 8 9 The repercussions of Chagas are the annual loss of over $255 million in both medical costs and lost revenue and the debilitating infections of millions.1 5 Consequently, our ability to develop a productive workforce is diminishing, along with the nation’s economic and social progress. In order to combat this growing problem, we must both utilize prevention methods and invest in research to improve our diagnostics and treatments.
Nature and Magnitude of the Problem
The prevalence of Chagas disease in Bolivia is the highest in the world, affecting approximately 1.8 million Bolivians—15% of our population.[endnoteRef:1] An additional 3.7 million Bolivians are at risk of infection.2 In Bolivia, Chagas is ranked the fourth most common disease.4 Mortality related to T. Cruzi infection is 8.9 per 1000.[endnoteRef:2] Annually, 45,000 deaths can be attributed to chronic Chagas, an advanced stage of the disease are developed by 20-30% of the infected.1 [endnoteRef:3] Diagnostic tests lack specificity and sensitivity, often requiring multiple blood tests before diagnosis.[endnoteRef:4] Only half of people who are treated will be successfully cured, and no treatments exist for pregnant women and children.6 When left untreated, the T. cruzi parasite attacks the cardiac and digestive systems, leading to permanent heart, esophagus, and colon damage and/or death.[endnoteRef:5] In young adults, heart failure is a common cause of death when the disease is untreated.5 6 Healthy adults most often die of complications from Chagas without knowledge of their seropositive status.1 [1: Medrano-Mercado, N., Ugarte-Fernandez, R., Butrón, V., Uber-Busek, S., Guerra, H., Araújo-Jorge, T., & Correa-Oliveira, R. (2008). Urban transmission of Chagas disease in Cochabamba, Bolivia. Memórias Do Instituto Oswaldo Cruz, 103(5), 423-430.] [2: Bolivia ncap project: Vallegrande findings. (2011, March 30). Retrieved from http://http://weadapt.org/knowledge-base/wikiadapt/bolivia-ncap-project-vallegrande-findings] [3: Bolivia. (2005). Retrieved from http://www.betterbytheyear.org/bolivia/bolivia_health.htm] [4: Time to treat chagas. (2009). Retrieved from http://www.treatchagas.org/fq_question.aspx ] [5: Chagas in Bolivia: In pursuit of an effective treatment. (2008, August 07). Retrieved from http://www.msf.org.uk/bolivia_chagas_wilma_chambi_interview_20080708.news]
Affected Populations Chagas disease affects many Bolivians. However, individuals of low socioeconomic status residing in rural areas have disproportionally high prevalence rates.2 [endnoteRef:6] Impoverished populations are 30% more likely to be infected via triatomine bug transmission and to develop chronic Chagas than higher socioeconomic classes. This is due to higher frequency rate of home infestation by infected bugs in addition to limited access to diagnostics and/or necessary treatment.5 9 The endemic area spans 60% of Bolivia, with T. cruzi-infected vectors found in seven of nine Bolivian departments. In these regions, nearly 50% of residences have triatomine infestation, with over 30% of those vectors carrying the T. cruzi parasite.2 In Cochabamba, Chuquisaca, Tarija, and Santa Cruz, prevalence of Chagas is 100% in individuals over 40.1 [endnoteRef:7] Throughout Bolivia, seroprevalence of T. cruzi antigens ranges from 16 to 71% in children aged one to six years old and 32 to 93.5% in adults.1 Prevalence among pregnant women ranges from 25 to 50%, and 8 to 38% in neonates born to infected mothers. 1 2 [endnoteRef:8] [6: UNDP / WORLD BANK / WHO Special Program for Research and Training in Tropical Disease (TDR). Tropical Disease Progress in Research 1991-1992, WHO, Geneva] [7: Arata AA, Balderrama F, Bermudez H, Navin T, Ormsby G, Torrico F, Velarde R 1994. Trabajo de la SNS CCH/Programa Piloto de Control de Chagas. La Paz, Bolivia, Ministerio del Desarollo Humano, Secretaria Nacional de Salud, 94 pp.] [8: Pless M, Juranek D, Kozarsky P, Steurer F, Tapia G, Bermudez H 1992. The epidemiology of Chagas disease in a hyperendemic area of Cochabamba, Bolivia: A clinical study including electrocardiography, seroreactivity to Trypanosoma cruzi, xenodiagnosis, and domiciliary triatomine distribution. Am J Trop Med Hyg 47: 539-546]
Risk Factors
The primary risk factors contributing to the contraction of Chagas disease include endemic residential location, poor-quality housing, lack of education, and receipt of blood or organ transplants.2 5 8 9 Many Chagas-endemic areas are located in rural regions of Bolivia, limiting access to medical services that provide diagnostic and treatment services. Many houses owned by poor Bolivians consist of adobe or straw.2 This type of housing greatly increases the likelihood of infection due to structural cracks and crevices that can shelter the triatomine bug.5 These two risk factors contribute to greater than 80% of Chagas cases.1 The lack of education increases disease prevalence because individuals are unaware of the various means of transmission and the ways by which they can prevent infection.5
Although less prevalent, mother-to-child transmission and receipt of a blood transfusion or organ transplant from an infected individual significantly increase an individual’s risk of developing Chagas. Currently, no treatment exists for pregnant mothers to cure Chagas, and consequently her infant often contracts the disease during gestation, labor or while breastfeeding.[endnoteRef:9] Additionally, 63% of potential donors in Bolivian blood banks carry the infectious parasite.8 Blood transfusions and organ transplants seropositive for the T. cruzi antigens are estimated to have a 14.8% and 7.2% risk of transmission, respectively.2 5 [9: Chagas disease. (2010). Retrieved from http://www.dhpe.org/infect/Chagas.html]
Economic and Social Consequences
Chagas has significant negative impacts on Bolivia’s progress and development, both economically and socially. The physical disability and illness caused by Chagas prevent our people from working, costing Bolivia revenue from productivity and earnings from days lost due to illness. Due to high rates of absenteeism among workers with chronic Chagas, Bolivia loses an estimated $5 million annually from potential profits.5 On average, these workers are 25 years old—our most economically productive age group.3 2 In addition to lost revenue, the annual cost of medical care in Bolivia due to Chagas is $250 million.1 The World Health Organization estimates that disability adjusted life years lost due to Chagas in Latin America are 2,740,000, the majority from Bolivia.2 Social effects emerging due to Chagas include psychological stress on individuals living in infested residences, in addition to the burden on families infected with Chagas. Research shows a decline in mental health as a result of home infestation, associated with the fear of infection.6 Lack of knowledge about disease status also harms mental health.2 6 The burden and stress of Chagas on an individual or household also harms the overall health and well-being of a family.2
Priority Action Steps
Priority action steps to combat Chagas disease must include prevention and research. In order to prevent Chagas disease, priority must be placed on utilizing insecticides, replacing common structural materials, and providing education. Insecticides must be used to kill insect vectors within residences, limiting the amount of insect-transmitted disease. Replacing standard materials such as adobe and straw in homes with plaster and metal will also help prevent the colonization of vectors. Additionally, by providing education on Chagas, awareness will be raised about prevention, diagnostics, and treatment.
Currently, both diagnostics and treatment for Chagas are expensive, inaccessible, and inefficient. Because the majority of the Chagas-infected population are impoverished and reside in rural areas, new methods for ensuring both cheap and accessible diagnostics and treatment are imperative. Diagnostics and treatment should be subsidized and medical centers should also provide mobile medical services that provide diagnostics and treatment to all remote areas. By helping individuals to learn their disease status transmission, we can reduce transmission via pregnancy, blood transfusion or organ transplant.
Presently, we must continue to utilize available diagnostics and treatment. However, research is crucial in order to find more efficient methods to improve the health of our people. Diagnostics must be developed so that one test is sufficient to diagnose, eliminating the present method of multiple serological tests. More efficient treatments must be developed that have both high cure rates and can be given to infected mothers and infants. The long-term effects of this research would be an increase in awareness of the disease and effective treatments that can be given to all, thus decreasing Chagas prevalence in Bolivia.
Bibliography
Guidelines_for_Writing_a_Policy_Brief.pdf
Guidelines for Writing a Policy Brief | 1
Guidelines for Writing a Policy Brief What is a Policy Brief? The Policy Brief is a “short, neutral summary of what is known about a particular issue or problem. Policy briefs are a form of report designed to facilitate policy-making” (Eisele, 2006). The main purpose is to “succinctly evaluate policy options regarding a specific issue, for a specific policy-maker audience” (Eisele, n.d.). Policy-makers need to make practical decisions under time-constraints, so the brief should provide evidence and actionable recommendations (Eisele, n.d.). The issue brief distils or synthesizes a large amount of complex detail, so the reader can easily understand the heart of the issue, its background, the players (“stakeholders”) and any recommendations, or even educated guesses about the future of the issue. It may have tables and graphs; usually, it has a short list of references, so the reader knows something about the sources on which it is based, and where to go for more information. Most of the time, the brief has its own “brief”--a one page “executive summary,” allowing the reader to quickly grasp the essence of the report (Eisele, n.d.). In short, “the purpose of the policy brief is to convince the target audience of the urgency of the current problem and the need to adopt the preferred alternative or course of action outlined and therefore, serve as an impetus for action” (Young & Quinn, n.d.). What are the components of a Policy Brief? (Lifted from Tsai, 2006) Executive summary The executive summary aims to convince the reader further that the brief is worth in-depth investigation. It is especially important for an audience that is short of time to clearly see the relevance and importance of the brief in reading the summary. As such, a 1 to 2 paragraph executive summary commonly includes: 1. A description of the problem addressed; 2. A statement on why the current approach/policy option needs to be changed; 3. Your recommendations for action. Context and importance of the problem The purpose of this element of the brief is to convince the target audience that a current and urgent problem exists which requires them to take action. The context and importance of the problem is both the introductory and first building block of the brief. As such, it usually includes the following: 1. A clear statement of the problem or issue in focus. 2. A short overview of the root causes of the problem 3. A clear statement of the policy implications of the problem that clearly establishes the current importance and policy relevance of the issue. It is worth noting that the length of the problem description may vary considerably from brief to brief depending on the stage on the policy process in focus, e.g. there may be a need to have a much more extensive problem description for policy at the evaluation stage than for one at the option choosing stage.
Policy Brief versus Research Paper
(Tsai, 2006) Some might say that a policy brief is more “professional” because it is geared towards readers who have a limited amount of time to make a practical decision, while a research paper is more “academic” because it pays more attention to the scholarly roots of particular arguments and judges their merit on intellectual and logical criteria. Front-loaded! Policy briefs are front-loaded: the
conclusions are on the front page! The front page needs an executive summary, providing a concise (1 or 2 paragraphs) overview of the brief’s aim and core recommendations (Kopenski, 2010).
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Critique of policy option(s) The aim of this element is to detail shortcomings of the current approach or options being implemented and therefore, illustrate both the need for change and focus of where change needs to occur. In doing so, the critique of policy options usually includes the following: 1. A short overview of the policy option(s) in focus 2. An argument illustrating why and how the current or proposed approach is failing. It is important for the sake of credibility to recognize all opinions in the debate of the issue. Policy recommendations The aim of the policy recommendations element is to provide a detailed and convincing proposal of how the failings of the current policy approach need to change. As such this is achieved by including: 1. A breakdown of the specific practical steps or measures that need to be implemented 2. Sometimes also includes a closing paragraph re-emphasizing the importance of action. Appendices Although the brief is a short and targeted document, authors sometimes decide that their argument needs further support and so include an appendix. Appendices should be included only when absolutely necessary. What a persuasive Policy Brief should be (Lifted from Young and Quinn, n.d.) As with all good marketing tools, the key to success is targeting the particular audience for your message. The most common audience for a policy brief is the decision-maker but, it is also not unusual to use the document to support broader advocacy initiatives targeting a wide but knowledgeable audience (e.g. decision makers, journalists, diplomats, administrators, researchers). In constructing a policy brief that can effectively serve its intended purpose, it is common for a brief to be: FOCUSED All aspects of the policy brief (from the message to the layout) need to strategically focused on achieving the intended goal of convincing the target audience. For example, the argument provided must build on what they do know about the problem, provide insight about what they don’t know about the problem and be presented in language that reflects their values, i.e. using ideas, evidence and language that will convince them. PROFESSIONAL, NOT ACADEMIC The common audience for a policy brief is not interested in the research/analysis procedures conducted to produce the evidence, but are very interested to know the writer’s perspective on the problem and potential solutions based on the new evidence. EVIDENCED-BASED The policy brief is a communication tool produced by policy analysts and therefore all potential audiences not only expect a rational argument but will only be convinced by argumentation supported by evidence that the problem exists and the consequences of adopting particular alternatives. LIMITED To provide adequately comprehensive but targeted argument within a limited space, the focus of the brief needs to be limited to a particular problem or area of a problem.
Do’s and Dont’s (Kopenski, 2010) Avoid technical, legalistic, economic or academic jargon! Presentation needs to be professional as suits a public document. Use correct grammar and spelling, and appropriate spacing, font, point, headings and sub-headings. Facilitate readability through images, catch-phrases, layout choices, and the provision of data as graphs or charts.
Guidelines for Writing a Policy Brief | 3
SUCCINT The type of audiences targeted commonly do not have the time or inclination to read an in-depth 20 page argument on a policy problem. Therefore, it is common that policy briefs do not exceed 6 – 8 pages in length (i.e. usually not longer than 3,000 words). UNDERSTANDABLE This not only refers to using clear and simple language (i.e. not the jargon and concepts of an academic discipline) but also to providing a well explained and easy to follow argument targeting a wide but knowledgeable audience. ACCESSIBLE The writer of the policy brief should facilitate the ease of use of the document by the target audience and therefore, should subdivide the text using clear descriptive titles to guide the reader. PROMOTIONAL The policy brief should catch the eye of the potential audience in order to create a favourable impression (e.g. professional, innovative etc) In this way many brief writers many of the features of the promotional leaflet (use of colour, use of logos, photographs, slogans, illustrative quotes etc). PRACTICAL AND FEASIBLE The policy brief is an action-oriented tool targeting policy practitioners. As such the brief must provide arguments based on what is actually happening in practice with a particular policy and propose recommendations which seem realistic to the target audience
6 Steps for a compelling Policy Brief (Lifted from Young and Quinn, n.d.) 1. Issue: examine the issue you will be dealing with. Answer these questions: is the issue general or specific? How general/specific? 2. Audience: take your primary audience into serious consideration. Your brief should be tailored to the needs of your audience. It makes a fundamental difference for how you must frame your analysis and your recommendation. Is your audience an individual (i.e. Prime Minister) or an organization (i.e. the Government as a whole)? 3. Actors: identify the relevant actors for the issue you are dealing with. This is an essential step, since you will have to analyze their interests in order to make sensible and viable policy recommendations. Identifying the relevant actors is also essential to produce a good assessment of the context and of the interests that are plug into the issue. 4. Interests: once you have identified the relevant actors, it is necessary to analyze their interests. What are the actors' interests? Which of the relevant actors have similar interests to your audience? Which ones have different interests? How different? This step is important both for the context part of your brief and for the critique of policy options/policy recommendations. Without a clear identification of the actors involved in the issue and their interests, your brief will result vague, and therefore not useful. 5. Recommendations: your policy recommendations should reflect the above analysis. Remember that, according to the issue and the audience, your recommendation(s) might not suggest the best policy, but instead the most viable one. This should not limit your recommendation to just compromise policies. If you want to recommend radical change, you can; remember though that such radical action has to be implemented in some ways. 6. How-To: the last step is to suggest your audience the way to 'sell' the policy to its public (the public could be other members of the organizations, voters, other parties, etc.). This last step helps your audience build support/consensus to implement the policy you recommended.
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Online Resources You can check the following policy briefs online to serve as your guides in writing your own policy briefs: Food and Agriculture Organization of the United Nations Policy Brief on the 2007-08 Rice Price Crisis: http://www.fao.org/docrep/013/am172e/am172e00.pdf The Poverty and Economic Policy Policy Briefs on Food and Fuel Crises on Cambodia, Ghana and the Philippines: http://portal.pep-net.org/documents/download/id/16735 http://portal.pep-net.org/documents/download/id/16736 http://portal.pep-net.org/documents/download/id/16737 The Poverty and Economic Policy Brief on Effects of the GFC in the Philippines: http://portal.pep-net.org/documents/download/id/16739 The Royal Children’s Hospital Policy Brief on Evidence-Based Practice: http://www.rch.org.au/emplibrary/ccch/Policy_Brief_21_-_Evidence_based_practice_final_web.pdf Submission Guidelines: 1. All submissions should be in MS Word Format (.doc, .docx), 2 pages in length and should be in a 2-column form. 2. Images, tables, charts and graphs present in the layout of the Policy Brief should be submitted separately, i.e., all .jpg, .png, .bmp, .gif, .psd, etc., should be submitted individually. 3. Check policy briefs from the Poverty and Economic Policy (PEP) Website (www.pep-net.org), particularly those from the Community-Based Monitoring System (CBMS) to serve as guides in preparing your policy briefs.
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References: Eisele, F (n.d.). Preparing a Policy Brief Issue [PDF Document]. Retrieved from https://www.courses.psu.edu/hpa/hpa301_fre1/IBInstructions_fa02.PDF Kopenski, Marc (March 2010). Policy Briefs. Retrieved from the Richmond University Website http://www.richmond.ac.uk/content/library/subjects/politics/policy-briefs.aspx Tsai (May 2006). Guidelines for Writing a Policy Brief [PDF Document]. Retrieved from http://jhunix.hcf.jhu.edu/~ktsai/policybrief.html. Young, E. and Quinn, L (n.d.). The Policy Brief [PDF Documnet]. Retrieved from http://www.policy.hu/ipf/fel-pubs/samples/PolicyBrief-described.pdf Young, E. and Quinn, L (n.d.). The Policy Brief: Instructions [PDF Document]. Retrieved from http://sobek.colorado.edu/~salucci/teaching/teaching_portfolio/assets/Policy_Brief_instructions.pdf
Prepared by the Community-Based Monitoring System (CBMS) Network Coordinating Team 10th Floor Angelo King International Center
Estrada corner Arellano Streets, Malate, Manila Philippines 1004
Telephone: (02) 5262067 Email: [email protected]; [email protected]
Website: http://www.pep-net.org; http://www.cbmsphilippines.webs.com/