Harris Patrick, Kent Jennifer, Sainsbury Peter, Marie-Thow Anne, Baum Fran, Friel Sharon, McCue Peter
Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Level 6 The Hub, Charles Perkins Centre D17, Camperdown, NSW, Australia.
Urban and Regional Planning, Faculty of Architecture, Design and Planning, The University of Sydney, Australia.
Health Promot Int. 2018 Dec 1;33(6):1090-1100. doi: 10.1093/heapro/dax055.
Influencing healthy public policy through health advocacy remains challenging. This policy analysis research uses theories of agenda setting to understand how health came to be considered for specific mention in legislation arising from land-use planning system reform in New South Wales, Australia. This qualitative study follows critical realist methodology to conduct a policy analysis of the case. We collected data from purposively sampled in-depth interviews (n = 9), a focus group and documentary analysis. We used three classic policy process (agenda setting) theories to develop an analytic framework for explaining the empirical data: Multiple Streams; Punctuated Equilibrium Theory and Advocacy Coalition Framework. The reform process presented a window of opportunity that opened incrementally over a 2 year period. The opportunity was grasped by individual policy entrepreneurs who subsequently formed a coalition of healthy planning advocates focused on strategically positioning 'health' as legislative objective for the new system. The actual point of influence seemed to appear suddenly when challenges to a perceived economic development agenda within the reforms peaked, and the health objective, see as non-threatening by all stakeholders, was taken up. Our analysis demonstrates how this particular point of influence followed sustained long-term activity by health advocates prior to and during the reform process. We demonstrate a theory-driven policy analysis of health advocacy efforts to influence an instance of major land-use planning reform. The application of multiple policy process theories enables deep understanding of what is required to effectively advocate for healthy public policy.
通过健康宣传影响健康的公共政策仍然具有挑战性。这项政策分析研究运用议程设置理论，来理解在澳大利亚新南威尔士州土地利用规划系统改革产生的立法中，健康是如何被考虑特别提及的。这项定性研究遵循批判实在论方法对该案例进行政策分析。我们通过有目的抽样的深度访谈（n = 9）、焦点小组和文献分析收集数据。我们运用三种经典的政策过程（议程设置）理论来构建一个分析框架，以解释实证数据：多源流理论、间断均衡理论和倡导联盟框架。改革过程呈现出一个机会窗口，在两年时间里逐步打开。这个机会被个别政策企业家抓住，他们随后组建了一个健康规划倡导者联盟，专注于将“健康”战略性地定位为新系统的立法目标。当改革中对一个被认为的经济发展议程的挑战达到顶峰，且健康目标被所有利益相关者视为无威胁时，实际的影响点似乎突然出现并被采纳。我们的分析表明，这个特定的影响点是如何在改革过程之前和期间，由健康倡导者持续进行长期活动之后出现的。我们展示了一个理论驱动的政策分析，即健康宣传努力对一次重大土地利用规划改革实例的影响。多种政策过程理论的应用能够深入理解有效倡导健康公共政策所需的条件。
