Finding the Right Decision-Makers
IMPACT-oriented scientists identify the policies or systems that are not working well for our patients or our communities, and then identify the decision-makers who hold the power or influence necessary to change those policies or systems.
What policy decisions can be informed about your science?
As an IMPACT-oriented scientist, you must understand who in your ecosystem controls the flow of resources (money, people, influence, etc.), who creates and revises relevant policies, and who determines the rules of the game.
Types of Policies
Governmental Policies
Governmental policies can be divided into two categories: Big P policy and small p policy.
Big P Policies
Big P policies are established by high-level decision-makers in three branches of US government: executive, legislative, and judicial. These types of policies include legislation, regulation, taxes, public budgets, and the law. They can be implemented at the local, state, or federal level.
People with decision-making capacity over big P policies on behalf of the San Francisco community include:
Small p policies
Small p policies are decisions made about how to implement big P policies. They are typically administrative and regulatory policies that are put into place by government agencies to carry out the big P policies created at the executive, legislative, and judicial levels.
Small p policies are small but mighty. They can be of immense importance for health because they define how broader policies are actually implemented on the ground.
Some examples of small p policies from different levels of government include:
| Executive Branch |
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| Legislative Branch |
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| Judicial Branch |
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Non-governmental Policies
Many of the rules we live by are established by government policies. However, many other institutions and organizations put policies into place as well. Non-governmental policymakers include organizational leaders and decision makers in healthcare systems, insurance companies, professional organizations, worksites, schools, and other sectors. Here are some examples:
| Clinic and Health System Policies |
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| Professional Organization Policies |
Professional organizations create clinical recommendations and guidelines for patient care, often referred to as Practice Guidelines. These guidelines are often informed by the research and expertise of IMPACT-oriented scientists. Practice Guidelines: An Example |
Community
Community engagement is central to the work of an IMPACT-oriented scientist. Community input helps to ensure that the policies we work on are aligned with our values of equity, dignity, and autonomy. Community engagement also ensures that the policy solutions we recommend are actionable, sustainable, and valuable to impacted communities, in addition to being evidence-informed. At UCSF, the Community Engagement program within the Clinical & Translational Science Institute is an important resource for community-based policy work.
The National Academy of Medicine recently developed a conceptual model that integrates community engagement, health equity, and policy change.