Attend to the “Small p” Stuff: State Policy Issues Affecting Cervical Cancer Efforts

Beth E. Meyerson, Carrie A. Lawrence, Jennifer S. Smith

Indiana University School of Public Health-Bloomington, Bloomington, USA.
Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, USA.
University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, USA.

DOI: 10.4236/ojog.2014.48066                

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.

Keywords

Cervical Cancer, State Policy, Health System Improvements, State Program Coordination

Conflicts of Interest

The authors declare no conflicts of interest.

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