Week 6 – Theories of Public Policy and Health
1.) Signal, L. (1998). The Politics of Health Promotion: Insights from Political Theory. Health Promotion
International 13 :3, 257-263.
•Health promotion has developed over the past two decades and has been adopted by governments internationally.
oWHO defines health promotion as the process of enabling people to increase control over and to improve
•Signal examines the politics of health promotion using 3 political theories:
oPluralist interest group or Pluralism - (Micro-level)
Holds that public policy is developed according to the interests of a range of groups who compete
with each other in order to influence the policy process
Explains the influence of individuals and groups on the political process (state operates in a
democratic way meeting the needs of all its citizens)
The approach is concerned with identifying the interest groups in a policy arena, determining to
what extent these interest groups are organized, how well resourced they are and what strategies
they are adopting with regard to each other
Interest groups likely to be key in the development of health promotion, whether supporting or
restraining it are: public health professionals such as health promoters, health educators, public
health nurses and public health doctors.
•Whether collectively or individually, we all influence health promotion policy and
practice through our group.
The government & business groups represents another key set of interests
In analyzing the power of interest groups in health promotion it is important to examine how well
organized they are, what resources such as money, political skill and experience they command
and what strategies they are using to influence the political process.
Key strategies are: direct and continuous contact with politicians and bureaucrats, the
presentation of submissions, representation on advisory groups, and use of the media to
influence public opinion.
oNew institutionalism (Meso-level)
Holds that policy-making is determined by the institutions in which it occurs
The approach examines the impact of policy structures on policy process and outcome.
It focuses on such aspects of institutions as the organizational structure, the formal rules of
operations, the processes used and the ideas built into them
As a meso level theory- the new institutionalism focuses on the institutions such as advisory
boards to government, government departments and the institution of Parliament
Organizational structure is a key institutional influence – legislated or mandated functions of
institutions are powerful determinants of their work
•If an institution has a clear health promotion mandate – this provides considerable focus
for the institution’s work
•Institutional influence on public policy also include: rules, process and ideas of these
Macro-level theory, which allows us to situate health promotion within its broad political and
Builds on the work of Karl Marx – capitalist society characterized it as divided along class lines
between those members of society who own the means of production, the bourgeoisie and the
proletariat who are forced to sell their labour in order to survive.