Case Synopsis

Robin Scherbatsky, a public health nurse at Lambton Public Health in Sarnia, Ontario, plans to advocate for public funding of the more accurate interferon-gamma release assay (IGRA) test for latent tuberculosis infection (LTBI). She wants the IGRA to be covered by the Ontario Health Insurance Plan the same way the tuberculin skin test, which also tests for LTBI, is covered. Although IGRA tests are more expensive than tuberculin skin tests, IGRAs are very accurate and effective at reducing unnecessary treatments given to people falsely diagnosed with LTBI, and this results in cost savings for the public payer. Given that the Ontario government is regarding preventative health interventions as soft targets for reduced funding, Robin is worried about whether her future advocacy activity will be successful. Robin has formed working relationships with local stakeholders such as health facilities, physicians, general practitioners, and nurses through advocating to them about how to test and treat LTBI and tuberculosis. She has to decide how to best advocate for this issue, making sure she has used all available and potential resources. The case aims to provide foundational knowledge of relevant political models and theories by applying them to Robin’s example.

Case Objectives

  1. Understand the building blocks, models, and theories behind policy changes such as Kingdon's three streams model and the policy triangle model.
  2. Apply political models and theories to a given context by categorizing the information describing a situation into a model's basic elements.
  3. Develop strategies to advocate for public policy change regarding public health interventions based on the application of political models and theories.

Case Study Questions

  1. What are the contextual factors influencing Robin’s future advocacy efforts?
  2. How can Robin use political models, such as Kingdon’s three streams model and the policy triangle model, to better understand these contextual factors and how they influence her advocacy efforts?
  3. How should Robin proceed with her advocacy given Ontario’s current political context?


Tuberculosis, LTBI, advocacy, context, evidence, framing, models, political climate



Recommended Citation

Alhalbouni, S., Courtney, E., & Speechley, M. (2020). Policy Change and Public Health: Obstacles to Advocating for Public Health Interventions in: McKinley, G. & Speechley, M. [eds] Western Public Health Casebook 2020. London, ON: Public Health Casebook Publishing.