Public Health Policy Making Phases


The decision-making process through which public health policies are made in the United States can be separated into distinct phases, each with its objectives, operating guidelines, motivating factors, and set outcomes (Longest, 2010). Although these phases are exceedingly interactive and interdependent, it is possible to delineate and describe them as distinct phases with unique roles and responsibilities. It is with this understanding that the present paper aims to not only discuss the operation and modification phases of the policymaking process but also to illuminate the role of interest groups in the policymaking process.

Operation and Policy Modification Phases

The operation phase of the policymaking process can be defined as involving “the actual running of programs or activities as promulgated in the specific legislation” (Kronenfeld, 2005, p. 61). The phase is a major component of the policy implementation process which aims to ensure the program becomes fully operational on the ground. In a dental public health program aimed at ensuring the fluoridation of public water supplies, for example, this phase would pertain to implementing the processes and activities that will ensure all public water supplies are fluoridated as per the specific legislation that was passed into law. Here, it is important to base the fluoridation legislation on accurate premises of how the program would work at the state, local, and community levels to prevent problems during implementation. It is also important to ensure that all organizations and agencies implementing the dental public health program have the relevant information to reduce implementation challenges (Kronenfeld, 2005; Longest, 2010).

The modification phase of the policymaking process is where stakeholders revisit all prior decisions that have been made within the policymaking framework to investigate if they are meeting current needs and/or how they could be revised to reflect the changes on the ground (Longest, 2010). Available literature demonstrates that “as a new law is implemented, problems with the rules as specified may become clear and modification of rules and regulations can occur” (Kronenfeld, 2005, p. 61). In the water fluoridation program, for example, the rules may be specific on the amount of fluoride that is to be added to public water supplies to reduce oral health diseases. However, upon implementation, it may be found that the amount of fluoride is too high for some communities due to their genetic makeup, leading to health complications. In such a scenario, the flaw discovered should be addressed in the modification phase by changing the rule on fluoride level to accommodate the affected communities.

Role of Interest Groups

Lastly, interest groups play a significant role in shaping the policymaking landscape, particularly in terms of brokering changes in health policy, building bridges across disparate interests, and working together through formal and informal coalitions to safeguard their welfare (Heaney, 2006). In the example provided, multinational corporations that manufacture toothpaste may from powerful interest groups and coalitions to ensure that the water fluoridation program does not inhibit their revenues. Community organizations may also form informal communication networks and vow to oppose the program unless their request for better infrastructure is addressed. Although infrastructure and water fluoridation are not related, policymakers may find themselves incorporating an element of infrastructure development in their program due to the power of interest groups. These examples serve to demonstrate that interest groups can rely on their formal and informal sources of power to influence the policymaking process in their favor or to ensure that they benefit in the policy process despite the justifications used.


Heaney, M.T. (2006). Brokering health policy: Coalitions, parties, and interest group influence. Journal of Health Politics, Policy & Law, 31(5), 887-944.

Kronenfeld, J.J. (2005). The changing federal role in the U.S. health care policy (2nd ed.). Westport, CT: Praeger Publishers.

Longest, B.B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

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