Determinants of health policy impact: a theoretical framework for policy analysis

SummaryThis paper addresses the role of policy and evidence in health promotion. The concept of von Wright’s “logic of events” is introduced and applied to health policy impact analysis.According to von Wright (1976), human action can be explained by a restricted number of determinants: wants, abilities, duties, and opportunities. The dynamics of action result from changes in opportunities (logic of events). Applied to the policymaking process, the present model explains personal wants as subordinated to political goals. Abilities of individual policy makers are part of organisational resources. Also, personal duties are subordinated to institutional obligations. Opportunities are mainly related to political context and public support. The present analysis suggests that policy determinants such as concrete goals, sufficient resources and public support may be crucial for achieving an intended behaviour change on the population level, while other policy determinants, e.g., personal commitment and organisational capacities, may especially relate to the policy implementation process. The paper concludes by indicating ways in which future research using this theoretical framework might contribute to health promotion practice for improved health outcomes across populations.

[1]  H. Grabowski,et al.  The impact of cost-effectiveness on public and private policies in health care: an international perspective. Introduction and overview. , 1997, Social science & medicine.

[2]  G. Lüschen,et al.  Determinants of health policy impact: comparative results of a European policymaker study , 2003, Sozial- und Präventivmedizin.

[3]  A. Giddens.  Central Problems in Social Theory: Action, Structure and Contradiction in Social Analysis , 1979 .

[4]  J. Springett,et al.  From Projects to Policy: ‘Healthy Cities’ As a Mechanism for Policy Change for Health? , 1997 .

[5]  E. de Leeuw,et al.  Health policy making: the Dutch experience. , 1995, Social science & medicine.

[6]  T. Davies,et al.  [Recommendations on cancer screening in the European Union]. , 2001, Bulletin du cancer.

[7]  Michael S. Goodstadt,et al.  Evaluation in health promotion : principles and perspectives , 2001 .

[8]  J. van der Zee,et al.  Health policy as a fuzzy concept: methodological problems encountered when evaluating health policy reforms in an international perspective. , 1997, Health policy.

[9]  I. White,et al.  National level promotion of physical activity: results from England's ACTIVE for LIFE campaign , 2001 .

[10]  Task Force on Community Preventive Services.  Recommendations to increase physical activity in communities. , 2002, American journal of preventive medicine.

[11]  Huey-tsyh Chen.  Theory-driven evaluations , 1990 .

[12]  G. Lüschen,et al.  Health Systems in the European Union: Diversity, Convergence, and Integration , 1995 .

[13]  N. Milio.  Promoting Health Through Public Policy , 1980 .

[14]  N. Milio.  Strategies for health-promoting policy: a study of four national case studies , 1988 .

[15]  Don Nutbeam,et al.  Evaluating Health Promotion—Progress, Problems and solutions , 1998 .

[16]  H. Wilensky,et al.  Social science and the public agenda: reflections on the relation of knowledge to policy in the United States and abroad. , 1997, Journal of health politics, policy and law.

[17]  J. Hammer,et al.  Ends and means in public health policy in developing countries. , 1995, Health policy.

[18]  A. Rütten.  The implementation of health promotion: a new structural perspective. , 1995, Social science & medicine.

[19]  R. Dahrendorf.  Homo Sociologicus: Ein Versuch zur Geschichte, Bedeutung und Kritik der Kategorie der sozialen Rolle , 1973 .

[20]  D. Prevention.  Ottawa charter for health promotion. , 1986, Canadian journal of public health = Revue canadienne de sante publique.

[21]  The Political Context of Social Inequalities and Health , 2001, International journal of health services : planning, administration, evaluation.

[22]  G. Lüschen,et al.  Self reported physical activity, public health, and perceived environment: results from a comparative European study , 2001, Journal of epidemiology and community health.

[23]  G. Esping‐Andersen,et al.  The Three Worlds of Welfare Capitalism , 1990 .

[24]  Alfred Rütten,et al.  Policy, competence and participation: empirical evidence for a multilevel health promotion model. , 2000 .

[25]  R. Tuomela,et al.  Essays on Explanation and Understanding , 1976 .

[26]  G. Lüschen,et al.  Self reported physical activity, public health, and perceived environment: results from a comparative , 2001 .

[27]  J. Coleman.  Foundations of Social Theory , 1990 .

[28]  A. Kellerman,et al.  The Constitution of Society : Outline of the Theory of Structuration , 2015 .

[29]  U. Reinhardt.  Making economic evaluations respectable. , 1997, Social science & medicine.

[30]  Mireille J. M. Broeders,et al.  Breast cancer screening programmes in 22 countries: current policies, administration and guidelines , 1998 .

[31]  M. Drummond,et al.  The role of economic evaluation in the pricing and reimbursement of medicines. , 1997, Health policy.

[32]  D. Mcqueen.  The search for theory in health behaviour and health promotion , 1996 .

[33]  Anne C. Haddix,et al.  Prevention effectiveness : a guide to decision analysis and economic evaluation , 1996 .

[34]  A. Rütten.  Evaluating healthy public policies in community and regional contexts. , 2001, WHO regional publications. European series.

[35]  S. Wilson.  Methods for the economic evaluation of health care programmes , 1987 .

[36]  Charles D. Elder,et al.  Participation in American Politics: The Dynamics of Agenda-Building , 1975 .

[37]  G. Lüschen.  On logic, methodology and practice of applied sociology , 1992 .

[38]  M. Stern.  In Care of the State: Health Care, Education, and Welfare in Europe and the USA in the Modern Era , 1990, History of Education Quarterly.

[39]  K. Dean.  Using theory to guide policy relevant health promotion research , 1996 .

[40]  N. Milio.  Priorities and strategies for promoting community-based prevention policies. , 1998, Journal of public health management and practice : JPHMP.

[41]  R. Brownson,et al.  Environmental and Policy Interventions to Control Tobacco Use and Prevent Cardiovascular Disease , 1995, Health education quarterly.

[42]  Fred C. Pampel,et al.  Age, Class, Politics, and the Welfare State , 1989 .

[43]  G. Lüschen,et al.  Health Promotion Policy in Europe: Rationality, Impact, and Evaluation , 1999 .