Abstract
Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies.
Highlights
Population health has evolved as a dominant epidemiological approach that encapsulates principles of both public health and health promotion, and aims to improve the health of the entire population by reducing health inequities between population groups.[1,2] In essence, the population health approach extends the traditional definition of health to include one’s capacity to be able to pursue one’s goals, to acquire skills and education, and to grow.[1]
As Gagnon et al articulate, the implementation of population health policies is further complicated by political realities, institutional structures, and analytical challenges.[11]
Our article does not review the entire policy change literature, we believe that our focus on policy entrepreneurs, ideas, and institutions offers major insights into how population health scholars and practitioners could better navigate and impact the policy process
Summary
Population health has evolved as a dominant epidemiological approach that encapsulates principles of both public health and health promotion, and aims to improve the health of the entire population by reducing health inequities between population groups.[1,2] In essence, the population health approach extends the traditional definition of health (ie, absence of disease) to include one’s capacity to be able to pursue one’s goals, to acquire skills and education, and to grow.[1]. Formal political institutions and bureaucratic rules shape political decision-making systems and the role of various policy actors, such as policy entrepreneurs.[43] Second, existing policy legacies create their own constituencies and vested interests, which tend to support the policy status quo.[44] At the same time, instead of creating self-reinforcing mechanisms, changing demographic and economic circumstances can generate self-undermining mechanisms that reduce support for them over time as they become increasingly ineffective or expensive.[45] In federal or decentralized political systems such as the United States, both decision-making systems and existing policy legacies can vary greatly from one state or even one municipality to the next.[46] This is why the analysis of policy change should take into account how territorially-embedded institutions can shape opportunities for, and obstacles to, policy change This means that the analysis of policy change at the sub-national level should adopt a comparative lens to grasp key institutional differences among states, regions, or municipalities. This scenario creates the need for both overarching advocacy groups, as well as issue specific (eg, smoking) leaders to act as policy entrepreneurs
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