Healthy public policy: A conceptual cognitive framework

Abstract

More than three decades ago, the report A New Perspective on the Health of Canadians (1974) highlighted the significance of other determinants than the healthcare system. The adoption of healthy public policy was identified in the Ottawa Charter (1986) as one of five strategies aiming to promote health. It must now be acknowledged that even if we have a better understanding of health determinants, the latter are not necessarily taken into consideration when developing public policies. The purpose of this paper is to help foster a better understanding of the healthy public policies by presenting a conceptual framework that is inspired by the Advocacy Coalition Framework developed by Sabatier and Jenkins-Smith (1999). On the one hand, this paper intends to show the relevance of the notion of subsystem of public policies in healthy public policy process. On the other, it aims to convince that it is necessary to channel the analysis around the decision-making process, the prospective evaluation of public policies and the knowledge transfer and appropriation process. Finally, the purpose of this paper is to contribute to the ongoing debate about the role of knowledge, values or beliefs in the formulation and adoption of public policies. After briefly summarizing the theoretical developments in studies on public policies, the logic and components of the ACF are introduced. The main criticisms regarding the ACF are then examined, followed by an introduction of the conceptual framework that is adapted to the reality of healthy public policies. The notions of the subsystem of public policy(ies), of process and of learning process are central to this framework.