How Can Policy Theory Help to Address the Expectations Gap in Preventive Public Health and ‘Health in All Policies’?

Abstract

AbstractThis chapter explores how to combine insights from public health and political science to explain and adapt to policymaking in preventive public health. First, it describes public health approaches to policy change, focusing on the social determinants of health and the need for high political commitment to health equity. Second, it suggests that, while governments often use the right language to describe public health aims, there is a major gap between commitment, policy, and policy outcomes. We draw on public policy theories to explain this gap, with reference to the ambiguity of preventive policy initiatives, exacerbated by policymaking complexity in which no actor or organisation has strong coordinative capacity. Third, it relates these insights to a qualitative systematic review of ‘Health in All Policies’ (HiAP) research. We compare two different ways to use policy theories for practical lessons: to improve the HiAP playbook and programme logic or to prompt critical reflection on policymaking dilemmas.