Health Policy Analysis Requires Attending to Institutions; Comment on “Modelling the Health Policy Process: One Size Fits All or Horses for Courses?”

Document Type : Commentary

Author

Centre for Health Equity, Training, Research & Evaluation (CHETRE), Part of the UNSW Sydney Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool, NSW, Australia

Abstract

Powell and Manion present an important review of reviews about health and policy research. They zero in on theories of the policy process as the most likely to unearth what is really going on in health policy. Here I contend that their analysis insufficiently attends to institutions. Powell and Manion situate ‘institutions’ (with ‘Ideas’ and ‘Interests’) as a ‘health policy process models’ that ‘tend to’ list factors rather than connect them. Rather, I show how there is a rich history of considering institutions in the political science literature that is under considered by Powell and Manion. By necessity for a Public Health audience I quickly pull back the covers on ‘rigour’ and ‘causation’ to demonstrate what is ‘fit for purpose’ in rigorous institution focussed policy analysis. I conclude by arguing how institutionally focussed public health policy analysis is vital for understanding and addressing heath inequities. That focus necessitates research that provides better, explicit, conceptualisations of power in health policy: especially drawing out the roles played by structure and agency. I offer some recent examples.

Keywords

References

  1. Powell M, Mannion R. Modelling the health policy process: one size fits all or horses for courses? Int J Health Policy Manag. 2023;12:7580. doi:34172/ijhpm.2022.7580
  2. Weible CM, Sabatier P. Theories of the Policy Process. Routledge; 2018.
  3. Howlett M, Ramesh M, Perl A. Studying Public Policy: Policy Cycles and Policy Subsystems. 3rd ed. Canada: Oxford University Press; 2009.
  4. North DC. Five propositions about institutional change. In: Knight J, Sened I, eds. Explaining Social Institutions. The University of Michigan Press; 1995. p. 116-131.
  5. March JG, Olsen JP. The new institutionalism: organizational factors in political life. Am Polit Sci Rev. 1983;78(3):734-749. doi:2307/1961840
  6. Hall PA, Taylor RC. Political science and the three new institutionalisms. Polit Stud. 1996;44(5):936-957. doi:1111/j.1467-9248.1996.tb00343.x
  7. Hall PA. Governing the Economy: The Politics of State Intervention in Britain and France. New York: Oxford University Press; 1986.
  8. Harris P. Illuminating policy for health: insights from a decade of researching urban and regional planning. In: Evelyne de Leeuw PF, ed. Health Political Science. Palgrave Macmillan; 2022.
  9. Peters BG. Institutional Theory in Political Science: The New Institutionalism. 4th ed. Edward Elgar Publishing; 2019.
  10. Weiss CH. The interface between evaluation and public policy. Evaluation. 1999;5(4):468-486. doi:1177/135638909900500408
  11. Real-Dato J. Mechanisms of policy change: a proposal for a synthetic explanatory framework. J Comp Policy Anal Res Pract. 2009;11(1):117-143. doi:1080/13876980802648268
  12. van der Heijden J, Kuhlmann J, Lindquist E, Wellstead A. Have policy process scholars embraced causal mechanisms? A review of five popular frameworks. Public Policy Adm. 2021;36(2):163-186. doi:1177/0952076718814894
  13. John P. Is there life after policy streams, advocacy coalitions, and punctuations: using evolutionary theory to explain policy change? Policy Stud J. 2003;31(4):481-498. doi:1111/1541-0072.00039
  14. Cairney P. Standing on the shoulders of giants: how do we combine the insights of multiple theories in public policy studies? Policy Stud J. 2013;41(1):1-21. doi:1111/psj.12000
  15. Harris P, Baum F, Friel S, Mackean T, Schram A, Townsend B. A glossary of theories for understanding power and policy for health equity. J Epidemiol Community Health. 2020;74(6):548-552. doi:1136/jech-2019-213692
  16. Friel S, Townsend B, Fisher M, Harris P, Freeman T, Baum F. Power and the people's health. Soc Sci Med. 2021;282:114173. doi:1016/j.socscimed.2021.114173
  17. Schram A, Townsend B, Mackean T, et al. Promoting action on structural drivers of health inequity: principles for policy evaluation. Evid Policy. 2022;18(4):761-775. doi:1332/174426421x16420923635594

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History

  • Receive Date: 24 April 2023
  • Revise Date: 24 July 2023
  • Accept Date: 24 July 2023
  • First Publish Date: 25 July 2023

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