International Journal of Health Policy and Management

International Journal of Health Policy and Management

Threads or Tapestries? Realism, Pluralism, and Causal Explanation in Public Health Policy Research; A Response to Recent Commentaries

Articles in Press

Document Type : Correspondence

Authors
Patrick Harris 1
Evelyne De Leeuw 2
Candace Nykiforuk 3
1 International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia
2 École de Santé Publique de l’Université de Montréal, Montréal, QC, Canada
3 University of Alberta, Edmonton, AB, Canada
Keywords
Health
Policy
Methodology
Pragmatism
Realism

In our original paper exploring and explaining the generative mechanisms of financial strain and well-being we mapped a diverse landscape of (often assumed) cause and effect. In McIntyre and Mah’s response,1 the authors acknowledge “We are not the first to call for pragmatism in a moment of crisis and thus we offer our own same old, same old prescription.” Countering their argument, we contend that a regurgitation of known patterns does little to open policy black boxes.  ...(Read more...)

1.   McIntyre L, Mah CL. Generating “différance” or an ontology that is same old same old: Comment on “The generative mechanisms of financial strain and financial well-being: a critical realist analysis of ideology and difference.” Int J Health Policy Manag. 2024;13:8565. doi:10.34172/ijhpm.8565
2.     Howlett M, McConnell A, Perl A. Weaving the fabric of public policies: comparing and integrating contemporary frameworks for the study of policy processes. Journal of Comparative Policy Analysis: Research and Practice. 2016;18(3):273-289. doi:10.1080/13876988.2015.1082261
3.     Harris P. Building better public health policy knowledge: the case for pluralism. Int J Health Policy Manag. 2026;15:9659. doi:10.34172/ijhpm.9659
4.     Glenn NM, Yashadhana A, Jaques K, et al. The Generative Mechanisms of Financial Strain and Financial Well-Being: A Critical Realist Analysis of Ideology and Difference. Int J Health Policy Manag. 2023;12:6930. doi:10.34172/ijhpm.2022.6930
5.     Public Health Agency of Canada. Chief Public Health Officer of Canada's report on the state of public health in Canada 2025: Working Together to thrive: Well-being and public health. Government of Canada; 2025. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/working-together-thrive-well-being-public-health-2025/report.html.
6.     Devane D, Hamel C, Gartlehner G, et al. Key concepts in rapid reviews: an overview. J Clin Epidemiol. 2024;175:111518. doi:10.1016/j.jclinepi.2024.111518
7.     Nykiforuk CI, Belon AP, de Leeuw E, et al. A policy-ready public health guidebook of strategies and indicators to promote financial well-being and address financial strain in response to COVID-19. Prev Chronic Dis. 2023;20:E09. doi:10.5888/pcd20.220209
8.     de Leeuw E. Policy, theory, and evaluation: stop mixing the fruit salad; Comment on “Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia.” Int J Health Policy Manag. 2018;7(8):763-765. doi:10.15171/ijhpm.2018.35
9.     Sayer A. Method in Social Science: A Realist Approach. 2nd ed. London: Routledge; 2010. doi:10.4324/9780203850374
10. Archer MS. Realist Social Theory: The Morphogenetic Approach. Cambridge University Press; 1995.
11. Harris P. Methodology Matters. In: Illuminating Policy for Health: Insights From a Decade of Researching Urban and Regional Planning. Palgrave McMillan; 2022:7-61. doi.org/10.1007/978-3-031-13199-8
12. Greenhalgh T, Engebretsen E. The science-policy relationship in times of crisis: An urgent call for a pragmatist turn. Soc Sci Med. 2022;306:115140. doi:10.1016/j.socscimed.2022.115140
13. Harris P, Baum F, Friel S, et al. A glossary of theories for understanding power and policy for health equity. J Epidemiol Community Health. 2020;74(6):548-452. doi:10.1136/jech-2019-213692
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 13 September 2026

  • Received Date 19 August 2026
  • Revised Date 27 August 2026
  • Accepted Date 29 August 2026
  • First Published Date 13 September 2026
  • Published Date 13 September 2026