Public Policy Blog

This was a barn-burner.  I haven’t checked out this many books from an actual library since like 2001.   In a mini-emergency, I had to concoct a diagram/graphic IN Microsoft Word so those will have to be dropped in here later as they didn’t exactly translate-don’t judge me!  It’s not perfect, but it’s mine.

I give you:

Applying Punctuated-Equilibrium Theory (PET), Multiple Streams Model (MSM), and Advocacy Coalition Framework (ACF) to the Healthy, Hunger-Free Kids Act of 2010

November 27, 2012

Western Michigan University

Introduction and Background

Over the past three decades, childhood obesity rates in America have tripled.  Today, nearly one in three children in America are overweight or obese (Centers for Disease Control (CDC), 2012). The numbers are even higher in African American and Hispanic communities, where nearly 40% of the children are overweight or obese. If we don’t solve this problem, one third of all children born in 2000 or later will suffer from diabetes at some point in their lives (Hedley, 2004; Let’s Move!, 2012). Many others will face chronic obesity-related health problems like heart disease, high blood pressure, cancer, and asthma (American Heart Association (AHA), 2012)

Let’s Move! is a comprehensive initiative, launched by the First Lady, Michelle Obama dedicated to solving the problem of obesity within a generation so that kids born today will grow up healthier and able to pursue their dreams (Let’s Move!, 2012).  Combining comprehensive strategies with common sense, Let’s Move! is about putting children on the path to a healthy future during their earliest months and years, giving parents helpful information and fostering environments that support healthy choices, providing healthier foods in our schools, ensuring that every family has access to healthy, affordable food and, helping children become more physically active (2012).

At the launch of this initiative in February of 2010, President Barack Obama signed a Presidential Memorandum creating the first-ever Task Force on Childhood Obesity (White House, 2010) to conduct a review of every program and policy relating to child nutrition and physical activity in order to develop a national action plan to maximize federal resources and set concrete benchmarks toward a national goal to end the problem of childhood obesity within a generation (Department of Health and Human Services (DHHS), 2012). The Task Force recommendations focus on the five pillars of the First Lady’s Let’s Move! initiative:

• Creating a healthy start for children
• Empowering parents and caregivers
• Providing healthy food in schools
• Improving access to healthy, affordable foods
• Increasing physical activity

The goal of the action plan was to reduce the childhood obesity rate to just five percent by 2030 – the same rate before childhood obesity first began to rise in the late 1970s. In total, the report presented a series of 70 specific recommendations, many of which had potential to be implemented right away.  A product of this initiative was improving child nutrition which became the focal point of the Healthy, Hunger-Free Kids Act of 2010:

Therefore, I have set a goal to solve the problem of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight. The First Lady will lead a national public awareness effort to tackle the epidemic of childhood obesity.  She will encourage involvement by actors from every sector — the public, nonprofit, and private sectors, as well as parents and youth — to help support and amplify the work of the Federal Government in improving the health of our children.  But to meet our goal, we must accelerate implementation of successful strategies that will prevent and combat obesity. Such strategies include updating child nutrition policies in a way that addresses the best available scientific information, ensuring access to healthy, affordable food in schools and communities, as well as increasing physical activity and empowering parents and caregivers with the information and tools they need to make good choices for themselves and their families. To succeed, these efforts must be strategically targeted, and accountability should be clear. They will help our children develop lifelong healthy habits, ensuring they reach their greatest potential toward building a healthier and more prosperous America.

The legislation authorizes funding and sets policy for United States Department of Agriculture’s (USDA) core child nutrition programs: the National School Lunch Program, the School Breakfast Program, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Summer Food Service Program, and the Child and Adult Care Food Program. The Healthy, Hunger-Free Kids Act allows USDA, for the first time in over 30 years, opportunity to make real reforms to the school lunch and breakfast programs by improving the critical nutrition and hunger safety net for millions of children.

School food issues are at the center of issues related to equality in our society. Americans live in a pluralistic society. For democracy to work, the interests of constituencies must be appropriately balanced. School food as a current issue is in a state of conflict regarding the balance between corporate interests and those of advocates for children’s health.  This paper will focus on one part of the overall program listed above the National School Lunch Program policy as it is evaluated through three different models for public policy analysis:  Punctuated-Equilibrium Theory (PET), Multiple Streams Model (MSM), and Advocacy Coalition Framework (ACF).

Theory, Model, Framework Examinations

Punctuated-Equilibrium Theory

Punctuated-Equilibrium Theory (PET) as defined by True, Jones, and Baumgartner (2007):

Punctuated-equilibrium theory seeks to explain a simple observation: political processes are generally characterized by stability and incrementalism, but occasionally they produce large-scale departures from the past. Stasis, rather than crisis, typically characterizes most policy areas, but crises do occur. Large-scale changes in public policies are constantly occurring in one area or another of American politics and policymaking as public understandings of existing problems change. Important governmental programs are sometimes altered dramatically, even if most of the time they continue as they did in the previous year. While both stability and change are important elements of the policy process, most policy models have been designed to explain, or at least have been most successful at explaining, either the stability or the change. Punctuated-equilibrium theory encompasses both.

The nutritional health of American children has changed during this century, improving dramatically in some ways, but not in others. In the early 1900s, the principal health problems among children were infectious diseases made worse by diets limited in calories and nutrients. As the economy improved, and as more was learned about nutritional needs, manufacturers fortified foods with key nutrients, the government started school feeding programs, and the results were a decline in nutrient deficiency conditions. That severe undernutrition has virtually disappeared among American children can be counted as one of the great public health achievements of the twentieth century. For the great majority of American children, the problem of not having enough food has been solved. Whether children are eating the right food, is another matter.

Unfortunately, the most important nutritional problem among children today is obesity — a consequence of eating too much food, rather than too little. Obesity rates are rising rapidly among children and adolescents, especially those who are African-American or Hispanic (DHHS, 2012). The health consequences also are rising: high levels of serum cholesterol, blood pressure, and “adult-onset” diabetes. This increase has occurred in response to complex societal, economic, demographic, and environmental changes that have reduced physical activity and promoted greater intake of foods high in calories but not necessarily high in nutrients.

“Several loosely related approaches in political science had previously noted that, although policy making often proceeds smoothly with marginal, or incremental accommodations, it also is regularly torn by lurches and significant departure from the incremental past (True, Jones and Baumgartner, 2007, p. 156).  This shift — from too little to too much food — has created a dilemma for the USDA and other agencies in federal and local governments.  Since its inception, the USDA has had two missions: to promote American agricultural products and to advise the public about how best to use those products. The school lunch program derived precisely from the congruence of the two missions. The government could use up surplus food commodities by passing them along to low-income children. As long as dietary advice was to eat more, the advice caused no conflict.

Once the problems shifted to chronic diseases, however, the congruence ended. Eat less means eating less of fat, saturated fat, cholesterol, sugar, and salt, which in turn means eating less of the principal food sources of those nutrients — meat, dairy, fried foods, soft drinks, and potato chips. USDA was then faced with the problem of continuing to promote use of such foods while asking the public to eat less of them — a dilemma that continues to the present day.  Merging True, Jones and Baumgartner’s (2007) observation that attention spans are limited in governments just as they are in people, we have a theory of decision making that is consistent with PET that is observable through this particular topic.

For the federal government to suggest that anyone eat less of any food does not bode well in our commercialized political camp.  It is assumed that a mere mention of “less” might hurt sales.  Please recall the great broccoli debacle of George HW Bush’s presidency where he declared “I do not like broccoli.  I’m President of the United States, and I’m not going to eat any more broccoli” (Dowd, 1990) which sent the United Fresh Produce Association into a tizzy of epic proportions over the possibility of lack of endorsement from the president.  This matters, because we vastly overproduce food in this country something that seems only to be known to analysts in the Economic Research Service via the USDA (Philipson, et al, 2004).  The average per capita supply of calories available from food produced in the U. S. — plus imports, less exports — is 3,900 per day for every man, woman, and child, more than twice what is needed on average. These are food availability figures and they cover food wasted, fed to pets, and fats used for frying, but they have gone up by 600 calories since 1970 and are more than sufficient to account for rising rates of obesity among adults and children (Nestle, 2010).

Moreover, overproduction makes for a highly competitive food supply. People can only eat so much. So to sell more, as the graphic above (Wilson, 2012) shows, companies and lobbyist groups, must get us to eat their foods, not those of a competitor, or to in general eat more, thereby encouraging us to become obese (Nestle, 2010).

Enter Punctuated-Equilibrium Theory in the form of the Healthy, Hunger-Free Kids Act of 2010.  As the focus on the policy process via PET is on a dual foundation of political institutions and boundedly rational decision making (True, Jones and Baumgartner, 2007) and emphasis on issue definition and agenda setting, existing policies can be reformed, questioned or dismissed.  The perfect storm or as coined in PET as positive feedback equal slow steady buildup of small changes adding up to policy adjustment and major punctuation, in this case derived from 1) overfeeding/undernourishing children, 2) raise in obesity as epidemic proportion, 3) excess of food subsidies being passed through government agencies and landing on plates of children in public schools, 4) chronic disease increase in children under age of 18, 5) economics of scale resulting in higher pricing of higher nutrient dense foods, and cheaper processed higher volume produced foods, and let us not forget 6) no reform to policy in this area for OVER 30 YEARS, using PET we are able to show that through policy stasis, current agenda setting (Let’s Move!, 2012) and policy punctuation, policy change occurred via the Healthy, Hunger-Free Kids Act of 2010.  Furthermore, much like in Sabatier (2007b),

Baumgartner and Jones (1993) analyzed a number of U.S. policymaking cases over time and over a variety of issue areas, they found (1) that policymaking both makes leaps and undergoes periods of near stasis as issues emerge on and recede from the public agenda; (2) that this tendency toward punctuated equilibria is exacerbated by American political institutions; and (3) that policy images play a critical role in expanding issues beyond the control of the specialists and special interests that occupy what they termed “policy monopolies” (p. 157).

This is precisely what has happened with regard to the USDA and major food manufacturers as well as food lobbying organizations such as the National Dairy Council (NDC), The National Cattleman’s Beef Association (NCBA) and hundreds of others who have stake in the public school lunch programming as regulated through the USDA.  The USDA is a complex agency with multiple constituencies. Because of internal conflicts of interest, the agency cannot protect the integrity of the school meals program on its own. It is already clear, for example, that Congress believes that more competition is good for schools. If USDA wants to help children prevent obesity through healthier school lunches, it needs to be working with a much broader set of allies. USDA cannot tell children to eat less of any food, and the school meal programs still reflect the dual goals of their origin.

As described in Sabatier (2007b), while PET began with a long-term analysis of American national policymaking, its features have been frequently used in understanding public policymaking more generally. The theory focuses on the interaction of political institutions, interest mobilizations, and boundedly rational decisionmaking. And the dynamics of the interplay among institutions, interests, and attentiveness have been usefully applied to other advanced democracies as well as a variety of other policymaking venues (True, Jones, and Baumgartner, 2007, p. 158).  Indeed the stakes are very high. Food is a $1.3 trillion annual business, with the vast percentage of profits going to added-value products rather than basic commodities (Nestle, 2010). It pays to turn wheat into sugared breakfast cereals, or potatoes into chips. Farmers get only a small share — 18% or so — of the consumer’s food dollar, less for vegetables, fruits, and grains than for meat and dairy. Hence, there is a big incentive to marketers to make food products with cheap raw ingredients like fat and sugar. And they do, approximately 12,000 new products every year. There are now 320,000 foods on the market; the average large supermarket contains 40,000 to 60,000 food products, more than anyone could possibly need or want (CDC, 2012).

Lake, Jones, Baumgartner (2007, p. 157) assert “since agenda-setting theory always rested on such a decisionmaking foundation, punctuated-equilibrium theory simply extends current agenda-setting theories to deal with both policy stasis, or incrementalism, and policy punctuations.”  This level of overproduction has kept growth in the food industry stagnating for years at about a 1% growth rate, far lower than in comparable industries. Corporations need better growth rates than that to satisfy shareholders. To expand sales, food companies sell products overseas, or they can try to increase market share at home. With this understood, it is evident why marketers so relentlessly pursue children as potential sales targets: children seven to 12 years of age spend billions of their own money on snacks and beverages, and teenagers have billions more to spend on candy, soft drinks, ice cream, and fast food — precisely the types of foods that promote high caloric intakes (CDC, 2012). The influence of children on adult spending is even greater. Kids are said to influence one-third of total sales of candy and gum, and 20% to 30% of cold cereals, pizza, salty snacks, and soft drinks (CDC, 2012).  Parents want their kids to make independent choices whenever they can, and foods are perfect opportunities for such decision-making, which is just what marketers want.

Multiple Streams Framework

As discussed above, the rate among overweight children in the United States has more than tripled in the last three decades.  Survey data from the National Health and Nutrition Examination Survey (2003 through 2006) estimated that 32% of children and adolescents had a body mass index (BMI) for age at or above the 85th percentile (Ogden, et al., 2008). Overweight status as a child is more than likely to continue into adulthood and increases the likelihood for a multitude of diseases in childhood and adulthood (Whitaker, et al., 1997; Edgeland, et al., 2004).  Adolescents with very high BMI have also been shown to have adult mortality rates up to 40% higher than those observed in adolescents with medium BMI (Edgeland, et al., 2004).

Hence, from the president down, obesity interventions and prevention have, consequently, become a major priority for policymakers, health care professionals, economists, and the general public.  Prior to 2003, several states and the federal government had enacted limited legislation aimed at reducing and preventing childhood obesity (Graaf, et al., 2012); however it was put on the national agenda for reform when President Obama appointed the Task Force on Childhood Obesity really that efforts were ramped across the scale from household to White House.  For the first time in over 30 years, reforms would be made to federal core child nutrition programs. With this large of a lens, including various levels of government and as this issue seems to be broad enough, the Multiple Streams Framework could be applied in a discussion of how policies are made by governments under strains of capacity and ambiguity (Zahariadis, 2003).

In the Multiple Streams Framework, the policy stream represents the ideas to which Kingdon (2001) referred (i.e., the policy alternatives and possible solutions to a problem). The political stream represents or addresses the overall mood, ideology, or attitudes of policymakers and the public. The problem stream discusses the issues that may require [governmental] action. These streams flow independently until a [policy] window or otherwise referred to as simply, window of opportunity (Kingdon, 1995) presents.  Such windows open when changes occur in the problem or political streams, perhaps because of new or additional/updated indicators, focusing current events which are watched closely publically, or distinct changes in political parties or ideology present.  Proposals from the policy stream that encompasses feasibility, possible acceptance and affordability then emerge through the policy window with the help of a policy entrepreneur. Such a person will invest his or her own resources to advocate a particular policy leading to its adoption (Zahariadis, 2007).

Policy Stream

Several events have drawn attention to overweight and obesity as public health problems. In 1998, the National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health released the Clinical Guidelines on the Identification, Evaluation, and Treatment of Obesity in Adults: Evidence Report. This report was the result of a thorough scientific review of the evidence related to the risks and treatment of overweight and obesity, and it provided evidence-based treatment guidelines for health care providers. In early 2000, the release of Healthy People 2010 identified overweight and obesity as major public health problems and set national objectives for reduction in their prevalence.

The National Nutrition Summit in May 2000 illuminated the impact of dietary and physical activity habits on achieving a healthy body weight and began a national dialogue on strategies for the prevention of overweight and obesity. Finally, a Surgeon General’s Listening Session, held in late 2000, and a related public comment period, generated many useful ideas for prevention and treatment strategies and helped forge and reinforce an important coalition of stakeholders. Participants in these events considered many prevention and treatment strategies, including such national priorities as ensuring daily physical education in schools, increasing research on the behavioral and environmental causes of obesity, and promoting breastfeeding.  Finally in 2001, David Satcher, M.D., Ph.D., Surgeon General of the United States, issued a plea to action.  The report, entitled “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” outlined strategies that communities can use in helping to address the problems (Thompson, 2001). Those options included requiring physical education at all school grades, providing more healthy food options on school campuses, and providing safe and accessible recreational facilities for residents of all ages.

“Overweight and obesity are among the most pressing new health challenges we face today,” HHS Secretary Tommy G. Thompson (2001) said. “Our modern environment has allowed these conditions to increase at alarming rates and become a growing health problem for our nation. By confronting these conditions, we have tremendous opportunities to prevent the unnecessary disease and disability they portend for our future.” “Overweight and obesity may soon cause as much preventable disease and death as cigarette smoking,” People tend to think of overweight and obesity as strictly a personal matter, but there is much that communities can and should do to address these problems (Thompson, 2001).

Approximately 300,000 U.S. deaths a year currently are associated with obesity and overweight (compared to more than 400,000 deaths a year associated with cigarette smoking). Over the course of ten years, the political climate aligned finally with direct correlations to an economic toll on American businesses for attention due to the direct and indirect costs attributed to overweight and obesity which amounted to $117 billion in the year 2000; the environment was ripe for change (CDC, 2012).

Political Stream

Childhood obesity and nutrition has been on the radar for many years.  The political battles over what children eat and drink are crucial to the nation’s health.  Tripling the rate in childhood obesity in the last three decades pretty much insures that diabetes, heart disease and other illness in decades to come. America is one of the fattest nations on Earth, and the Institute of Medicine (IOM), the health group of the National Academy of Sciences, in a 2006 report requested by Congress, said junk food marketing contributes to an epidemic of childhood obesity that continues to rise.

This report builds on the IOM’s 2005 report, Preventing Childhood Obesity: Health in the Balance (Koplan, 2005), which was a congressionally mandated study that provided a guide outlining deliberate actions for many stakeholders–including government, industry, media, communities, schools, and families—in an attempt to rally said groups and respond to the growing obesity epidemic in children and youth.

The follow up reports to be released by the IOM would contain entirely more urgent language in 2010 and 2012 the titles to these volumes respectively were:  Accelerating Progress in Obesity Prevention and Speeding Progress Against Obesity Crisis.  Reports issued on this topic by the IOM could be sourced back to 1997 as researchers began formal notification of pending health woes as a result of nutrition, weight and disease in youth and adults.   This news was punctuated and brought from the researchers to the streets with numerous documentaries in the last 20 years; however, it hit a critical mass in 2011-2012 via mainstream media ironically with HBO’s Emmy-winning production and free live streaming events on YouTube via a project called Weight of the Nation: America’s Obesity Crisis a collaborative between IOM, Centers for Disease Control (CDC), National Institutes of Health (NIH), a private insurance company (Kaiser Permanente) and a private foundation (Michael & Susan Dell Foundation).  “It will take many individuals and organizations at all levels, public and private, to tackle the obesity crisis, one of the most serious threats to our nation’s health,” said IOM President Harvey V. Fineberg (Koplan, 2005).  This collaborative alone essentially leapfrogs over government control by enlisting private-public-government partnership to inform and educate stakeholders on the now termed “obesity epidemic.”

Problem Stream

As illustrated in the diagram below, in 1990, among states participating in the Behavioral Risk Factor Surveillance System, ten states had a prevalence of obesity less than 10% and no state had prevalence equal to or greater than 15%.  By 2000, no state had a prevalence of obesity less than 10%, 23 states had prevalence between 20–24%, and no state had prevalence equal to or greater than 25%. In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence equal to or greater than 25%; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence equal to or greater than 30% (Center for Disease Control, 2006, 2008, and 2010; Mokdad, A. et al, 1999, 2001, and 2003).

WORKING ON CHART FOR WP

Sabatier’s (1988) original version of ACF focused on two paths to change.  The first path is external subsystem events defined as policy core attribute shifts.  The second path: policy-oriented learning defined as intended paths that result from experience or new information that are relevant to policy objectives (Sabatier and Jenkins-Smith, 1999).  In 2007, two additional paths were added in a revision by Sabatier and Weible to include the third path of internal subsystem events occurring to highlight failures in current practices and the final path considering alternative dispute resolution or agreements involving two or more coalitions.

Policy Window and Policy Entrepreneur

As a result of these changes in the political and problem streams, a temporary policy window opened, providing the opportunity for comprehensive policy changes to combat childhood obesity. As the Let’s Move! Campaign and Healthy, Hunger-Free Kids Act were the last pieces of the window of opportunity opening in regard to obesity as an identified national topic of interest, a direct result of First Lady Michelle Obama’s political action platform, we will for purposes of this paper consider her as the policy entrepreneur as she has more perceived power in this scenario as a result of her status.  Secondary and tertiary entrepreneurs are present, multiple and overlapping surrounding this topic ranging from public, to elected officials, policymakers, private and public citizens as well as lobbyists.  Kingdon (1995) asserted that although generation of policy alternatives may be incremental, as was the case for the Healthy, Hunger-Free Kids Act, agenda change is nonincremental and occurs when a combination of the three streams opens a policy window as illustrated above.  The Multiple Streams Framework incorporates the important and frequently frustrating role of luck, or chance, in the process (Zahariadis, 2007). Policy windows are short, include random players, and are almost always unpredictable in nature. Recognition of professionals in understanding the policy environment, previous research, actors and prior policy is critical in engaging with the appropriate moment of time when the three streams converge and the opportunity window opens in order to act swiftly (Zahariadis, 2007). Kingdon’s Multiple Streams Framework continues to be a useful model for understanding many cases of health/wellness policy reform, particularly comprehensive change such as Healthy, Hunger-Free Kids Act of 2010 to be examined.

Advocacy Coalition FrameworkQuestions in policy involving learning, belief, policy change, and the role of scientific and technical information in policymaking “operate in complex, interdependent political environments where hundreds of participants interact in the context of nested institutional arrangements, uneven power relations, and uncertain scientific and technical information about problems and alternatives” (Weible, Sabatier, and McQueen, 2009, p. 121).  The results are a complexity that requires a matter of simplification in order to enact any real change or policy implementation.  A particular policy framework that was specifically developed to conquer such variables is the Advocacy Coalition Framework (ACF).  ACF was developed by Sabatier and Jenkins-Smith in 1988 in a response to what they saw as limitations in policy process literature.  The first limitation was their interpretation of the stages heuristic as an inadequate causal theory of the policy process (Sabatier and Jenkins-Smith, 1993).  The second was in response to top-down and bottom-up approaches to implementation research and need for system-based theories in policymaking (Sabatier, 1987).  The last was the lack of theory and research on the role of scientific and technical information in the policy process (Jenkins-Smith, 1990; Sabatier, 1988).  ACF was created as a system-based model that allows for both top-down and bottom-up approaches to studies but puts technical info, science in key place in its goals (Sabatier, 2007a).

Within the ACF framework policy formation and change is a function of competing advocacy coalitions within a policy subsystem. A policy subsystem consists of “actors from public and private organizations who are actively concerned with a policy problem” (Sabatier, 1988, p. 131). The actors within a policy subsystem are grouped into a number of advocacy coalitions that consist of individuals who share a particular belief system for example, a set of basic values, causal assumptions, and problem perceptions and who show a coordinated and deliberate degree of activity over time (Sabatier, 1988). Advocacy coalitions attempt to realize a set of shared policy beliefs ‘by influencing the behavior of multiple government situations over time’ (Sabatier and Jenkins-Smith, 1993a, p. 212) it considers a set of corresponding beliefs to be the most significant factor bringing and holding coalitions together.

While the overarching model of ACF considers policy change as the result of the learning process among and across coalitions, it stops there.  ACF focuses exclusively on the structure of the advocacy coalitions without accounting for how actors within certain policy belief systems develop, maintain or make lasting action within the coalitions.  Advocacy Coalition Framework has been known to be used to map structures of learning and knowledge while evolving or being accompanied by other models, theories or frameworks to describe policymaking as a holistic process.  The ACF predicts that stakeholder beliefs and behavior are embedded within informal networks and that policymaking is structured, in part, by the networks among important policy participants. Likewise the framework assumes that policy participants strive to translate components of their belief systems into actual policy before their opponents can do the same.

In order to have any prospect of success, they must seek allies, share resources, and develop complementary strategies (Sabatier, 2007b).  Although some applications of the ACF merely identify the competing sides of a political debate, the purpose of the ACF is much broader: to explain belief change and policy change over long periods. Sabatier and Weible (2007) reinforce the four paths to major policy change within the ACF:

(1) policy-oriented learning:  “relatively enduring alternations of thought or behavioral intentions that result from experience and/or new information and that are concerned with the attainment or revision of policy objectives” (Sabatier and Jenkins-Smith, 1999, p. 123).  Sabatier believes that changes in deep and policy core beliefs are resistant to new information but over time, change can evolve with appropriate resources, information, and time (Sabatier and Jenkins-Smith, 1993b).

(2) external shocks:  significant perturbations include changes in socioeconomic conditions, regime change, outputs form others subsystems, or disaster (Sabatier, 2007). These shifts agendas, focus, attract or detract attention which can flip the majority and minority actors or coalitions within the policy system affecting change.

(3) internal shocks:  Sabatier and Weible (2007) describe these as changes within the policy subsystem and can lead to major policy change.  Internal shocks confirm policy core beliefs in the minority advocacy and increase doubt within the dominant coalition .  These shocks directly question policy core belief of the dominant policy coalition.

(4) negotiated agreements:  In collaboration with the literature on alternative dispute resolution (ADR) (Carpenter and Kennedy, 1988) involving perceptual filters and distrust in creating conflict that reverberates through a policy system, agreements are negotiated fairly using certain “prescriptions” (Sabatier and Weible, 2007) to arrive at a solution for policy control or change.

In the case of the Healthy, Hunger-Free Kids Act of 2010 using the Sabatier framework, the actual model as developed is complete as an illustration of the mobility and complexity of the interwoven relationships devised in the policymaking or change process.  Illustrated below please find an example of this policychange as it might have been from the old policy to the new Healthy, Hunger-Free Kids Act of 2010 prior to its enactment.

Conclusion