This article appears in the following Health Policy and Planning issue: Future directions for health policy analysis: a tribute to the work of Professor Gill Walt [View the issue table of contents]
Policy to tackle the social determinants of health: using conceptual models to understand the policy process
School of Management, Royal Holloway-University of London, Egham, Surrey, TW20 0EX, UK. E-mail: M.Exworthy{at}rhul.ac.uk
Like health equity, the social determinants of health (SDH) are becoming a key focus for policy-makers in many low and middle income countries. Yet despite accumulating evidence on the causes and manifestations of SDH, there is relatively little understanding about how public policy can address such complex and intractable issues. This paper aims to raise awareness of the ways in which the policy processes addressing SDH may be better described, understood and explained. It does so in three main sections. First, it summarizes the typical account of the policy-making process and then adapts this to the specific character of SDH. Second, it examines alternative models of the policy-making process, with a specific application of the ‘policy streams’ and ‘networks’ models to the SDH policy process. Third, methodological considerations of the preceding two sections are assessed with a view to informing future research strategies. The paper concludes that conceptual models can help policy-makers understand and intervene better, despite significant obstacles.
Key Words: Policy process, social determinants of health, health inequalities, research methodology
Accepted for publication 22 June 2008.