TITLE:
Attend to the “Small p” Stuff: State Policy Issues Affecting Cervical Cancer Efforts
AUTHORS:
Beth E. Meyerson, Carrie A. Lawrence, Jennifer S. Smith
KEYWORDS:
Cervical Cancer, State Policy, Health System Improvements, State Program Coordination
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.8,
June
12,
2014
ABSTRACT: Background: States in the
United States have primary public health authority. This is the case with
cervical cancer, and yet little is known about state policy issues affecting
the comprehensive public health response. This study identifies and explores
state policy issues affecting cervical cancer efforts in the United States.
Methods: Key informant interviews were conducted with a purposeful sample of 15
professionals affiliated with cervical cancer prevention and treatment from
national, state and local levels; across sectors: public, private and
non-profit; and aspects of the work: screening, treatment and vaccine; program
implementation, research, coalition work, and policy. Results: Identified
policy issues were administrative and implementation oriented (“small p” policy
issues). While participants recognized the importance of laws for vaccine or no
cost screening access, the key policy issues preventing successful cervical
cancer efforts involved 1) health system complexity; 2) general lack of state
level policy, program and funding coordination; and 3) social and
organizational cultural issues affecting the adoption of national
recommendations and reinforcing program inertia. Conclusions: Understanding
state policy issues in cervical cancer is critical for public health success.
Dramatic reduction or even elimination of cervical cancer in the United States
depends upon the policy work in the “little p” policy areas such as planning
and health system organization to affect change. This will require greater
leadership and coordination of state efforts across myriad programs. It will
require health system improvements, and also the adoption of new practice and
program behaviors to capitalize on available technology to reach underserved
women.