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