Abstract
Models of interest group politics can help public health professionals (PHPs) to identify potential allies and establish mechanisms of sustainable political influence. This article focusses on a particular model, known as the Advocacy Coalition Framework (ACF), and its explanations of coalition behaviour, the role of scientific information and the ways in which coalitions can bring about policy change. The analysis illustrates the relevance of the ACF for public health by drawing on examples from the recent policy debate on direct-to-consumer advertising of prescription drugs (DTCA-PD) in the European Union (EU). It explores the strengths and weaknesses of the ACF in explaining why ‘control’ of particular governmental units was key to the anti-DTCA coalition success, how the evidence base was used strategically and why the pro-DTCA coalition ultimately failed in bringing about major policy change. The article aims to equip PHPs with a tool which can be used to understand and engage with the policy process. Moreover, in offering a more nuanced view of this process, a case is made for moving beyond traditional, linear conceptions of the policy process and engaging in further research which uses political science concepts to inform the study and practice of public health. The article concludes with a set of recommendations for practitioners and researchers, emphasizing the value of political science for the former and the need for the latter to reflect on the accessibility of policy studies for PHPs.
Highlights
An understanding of interest groups and the coalitions that they form is vital to successful engagement in health policy processes
This article focusses on a particular model, known as the Advocacy Coalition Framework (ACF), and its explanations of coalition behaviour, the role of scientific information and the ways in which coalitions can bring about policy change
The analysis illustrates the relevance of the ACF for public health by drawing on examples from the recent policy debate on direct-to-consumer advertising of prescription drugs (DTCA-PD) in the European Union (EU)
Summary
An understanding of interest groups and the coalitions that they form is vital to successful engagement in health policy processes. The benefits of this, the pro-DTCA coalition argued, would be to educate consumers, improve doctor-patient dialogue and identify previously undiagnosed illnesses.[4] Their efforts were challenged and eventually defeated by an opposing coalition, made up of actors concerned by evidence that DTCA-PD ‘medicalizes’ non-essential health issues and increases demand for drugs,[5,6,7] as well as suggestions that ‘targeting of patients may be a prime objective’ of industry actors.[8] The legislative proposal to weaken the DTCA-PD ban was withdrawn by the European Commission in 2014, having failed to gain agreement among EU policy-makers, and the debate has since shifted to one of ‘health literacy’ and broader information provision.[3]
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