Field of Dreams: Strengthening Health Policy Scholarship in Canada

This background paper was prepared to inform discussion at CHEPA's Health Policy Symposium Field of Dreams: Strengthening Health Policy Scholarship in Canada on November 2, 2007. We reflect on the characteristics of Canada's health policy community in relation to the larger and more mature international health policy community: its contributions, opportunities and constraints for growing into a well institutionalized Canadian academic field. Sources consulted in preparing this document include: - Approximately 60 U.S. and Canadian graduate health policy course syllabi gathered between May and September 2007 - An inventory of over 40 active Canadian health policy research centres (university and non-university-based) - An investigation of the Canadian Institutes of Health Research (CIHR) researcher database to characterize the community of researchers who identify 'health policy' as an area of expertise - A Web of Science analysis of health policy journals, publications and citations between 1990 and 2006 - A selective review of Canadian health reform documents Characterizing the Field The terms 'health policy' and 'health policy analysis' often interchangeably refer to scholarship concerned with policy in the health sector. Clear, agreed upon definitions of either term are hard to find, and each has its drawbacks. 'Health policy analysis', often associated with research to inform health policy making, disregards some of the most important and interesting contributions to knowledge that arise from the analysis of policy. 'Health policy' is the favoured alternative, but unfortunately conflated with the very thing which is studied (health policies themselves and policy making). The field might be also be characterized by its exemplary and seminal literature, in search of its 'canon'. An examination of 35 Canadian and U.S. health policy course syllabi reveal a diverse array of teaching resources including texts, journal articles and grey literature with minimal overlap across courses. The over 40 assigned core texts comprise a mix of general policy and politics, health policy and politics, and content-specific texts. Descriptive and evaluative peer reviewed journal articles are drawn from 250 different journals though 20 core general medical and health policy journals are sources for 70% of these articles. Two texts -- Deborah Stone's Policy Paradox and Malcolm Taylor's Health Insurance and Canadian Public Policy – along with the final report of the Commission on the Future of Health Care in Canada and Hutchison, Abelson and Lavis' 2001 Health Affairs analysis of Canadian primary care reform are the most frequently assigned teaching resources. Health Policy Scholars The Canadian health policy community originated from a small group of disciplinary and interdisciplinary scholars based in a handful of research centres across the country. These academics applied training and expertise in primarily public health and epidemiology, economics, sociology and political science to address emerging health services problems. Today, this community has grown to include at least 30 university based health policy research centres specializing in population- and content-specific issues and is expanding its frontiers to include additional disciplines, fields and sub-fields such as management, law, history, geography, nursing. In the past, Canadian health policy educators tended to cluster in Faculties of Health Sciences but are now more evenly distributed across Faculties of Social Sciences, Law and in Schools of Business