Patrick Fafard

Beyond the usual suspects: using political science to enhance public health policy making

That public health policy and practice should be evidence based is a seemingly uncontroversial claim. Yet governments and citizens routinely reject the best available evidence and prefer policies that reflect other considerations and concerns. The most common explanations of this paradox emphasise scientific disagreement, the power of ‘politics’, or the belief that scientists and policymakers live in two separate communities that do not communicate. However, another explanation may lie in the limits of the very notion of evidence-based policy making. In fact, the social science discipline of political science offers a rich body of theory and empirical evidence to explain the apparent gap between evidence and policy. This essay introduces this literature with a particular emphasis on a recent book by Katherine Smith, Beyond evidence-based policy in public health: the interplay of ideas. As the title suggests, Smith argues that what matters for public health policy is less scientific evidence and much more a more complex set of ideas. Based on detailed case studies of UK tobacco and health inequality policy, Smith offers a richly textured alternative account of what matters for policy making. This excellent book is part of a small but growing body of political science research on public health policy that draws on contemporary theories of policy change and governance more generally. This essay provides a window on this research, describes some examples, but emphasises that public health scholars and practitioners too often retain a narrow if not naive view of the policy-making process.

Public Health Understandings of Policy and Power: Lessons from INSITE

Drug addiction is a major public health problem, one that is most acutely felt in major cities around the globe. Harm reduction and safe injection sites are an attempt to address this problem and are at the cutting edge of public health policy and practice. One of the most studied safe injection sites is INSITE located in Vancouver, British Columbia. Using INSITE as a case study, this paper argues that knowledge translation offers a limited framework for understanding the development of public health policy. This paper also argues that the experience of INSITE suggests that science and social justice, the meta-ideas that lie at the core of the public health enterprise, are an inadequate basis for a theory of public health policy making. However, on a more positive note, INSITE also shows the value of concepts drawn from the ways in which political science analyzes the policy process.

Taking power, politics, and policy problems seriously: the limits of knowledge translation for urban health research.

Knowledge Translation (KT) is a growing movement in clinical and health services research, aimed to help make research more relevant and to move research into practice and policy. This paper examines the conventional model of policy change presented in KT and assesses its applicability for increasing the impact of urban health research on urban health policy. In general, KT conceptualizes research utilization in terms of the technical implementation of scientific findings, on the part of individual decision-makers who can be “targeted” for a KT intervention, in a context that is absent of political interests. However, complex urban health problems and interventions infrequently resemble this single decision, single decision-maker model posited by KT. In order to clarify the conditions under which urban health research is more likely or not to have an influence on public policy development, we propose to supplement the conventional model with three concepts drawn from the social science: policy stages, policy networks, and a discourse analysis approach for theorizing power in policy-making.

Knowledge Translation and Social Epidemiology: Taking Power, Politics and Values Seriously

Although demand for evidence-based policies and programs to reduce population health inequities is intensifying, the influence of social epidemiology on public policy remains limited. In clinical and health services research domains, knowledge translation strategies have been developed to increase the impact of research evidence in policy making and practice. We review the applicability of these strategies for increasing the practical impact of social epidemiology research, drawing on the knowledge constitutive interests framework developed by Jurgen Habermas. We find that conventional knowledge translation characterizes policy change and the role of research in technical-instrumental terms that do not reflect the complex social, political and values-based dimensions of policy change and research use that come into play in relation to the reduction of health inequities. While conventional knowledge translation approaches may work in some cases, for social epidemiology to play a significant role in advancing social change, knowledge translation strategies that acknowledge and respond to the intersections of power, politics, values and science also need to be developed.

The Presence (or Lack Thereof) of a Federal Culture in Canada: The Views of Canadians

Canada may be among the oldest federations in the world but this says nothing about the strength of federalism in Canada. Based on the results of public opinion polling and roundtables with provincial government officials, this article argues that the political culture of federalism in Canada is quite weak. With the notable exception of Québec, Canadians in general and the provincial government officials who work on their behalf demonstrate little understanding of the basic logic of federalism or, when they do, are willing to trade off federalism values against concerns about efficiency, private goods, and meeting the needs of clients and consumers.

Closing the Deal: What Role for the Provinces in the Final Stages of the CETA Negotiations?

Why have the negotiations of a Comprehensive Economic and Trade Agreement (CETA) between Canada and the European Union taken so long? We argue that the delay is in good part the result of a weakly designed process for intergovernmental decision making: the role for provincial and territorial governments in international trade negotiations is still too limited and does not extend to final decisions about the text of any agreement. The limited role for provinces and the fact that there is no process that requires them to formally commit to an agreement leave open the real possibility that one or more provinces could choose not to fully implement any deal that is concluded. As a result, provinces possess negotiating leverage vis-à-vis Ottawa, thereby making it difficult for the federal government to agree to the trade-offs—which are of a geographical nature in CETA’s case—that are necessary for reaching a positive agreement.

Introduction—Knowledge Translation and Urban Health Equity: Advancing the Agenda

In 2011, an interdisciplinary symposium was organized in Toronto, Canada to investigate prevailing models of health policy change in the knowledge translation literature and to assess the applicability of these models for equity-focused urban health research. The papers resulting from the symposium have been published together, in the Journal of Urban Health, along with this introductory essay. This essay describes how the different papers grapple in different ways with how to understand and to bridge the gaps between urban health research and action. The breadth of perspectives reflected in the papers (e.g., social epidemiology, public health, political science, sociology, critical labor studies, and educational psychology) shed much light on core tensions in the relationship between KT and health equity. The first tension is whether the content of evidence or the context of decision making is the strong determinate of research impact in relation to health equity policy. The second tension is whether relationships between health equity researchers and decision makers are best viewed in terms of collaboration or of conflict. The third concerns the role that power plays in evidence-based policy making, when the issues at stake are not only empirical but also normative.

What Can Be Learned from Experience with Scientific Advisory Committees in the Field of International Environmental Politics

Abstract Scientific advisory committees (SACs) are a critically important part of global environmental policy. This commentary reviews the role of SACs in six global and regional environmental regimes, defined here as the set of rules, norms, and procedures that are developed by states and international organizations out of their common concerns and used to organize common activities. First, SACs play a critical role in putting issues on the political agenda and the creation of an overarching regime. Second, the effectiveness of a given SAC and the associated regime is highly variable. Third, there is also considerable variation in the extent to which the regime is driven by an overarching scientific consensus, for example, high in the case of climate change, lower in the case of whaling. Fourth, the role of science in a given regime is also a function of whether the problem being addressed is relatively benign or more malign, that is to say, marked by deep political disagreements (i.e., climate change). Finally, the cases examined here suggest that the institutional design of the SAC matters and can influence the overall effectiveness of the SAC and by extension, the regime, but it is seldom decisive.

Strange bedfellows: Federal systems and performance management

ABSTRACT This paper offers the first link between models of the measurement and management of performance and the dimensions of governance arrangements in federal systems. Four ideal type approaches to governance in federal systems are correlated against four ideal types of measuring and managing performance. The paper develops a model that will support empirical research examining reform trajectories where evolving systems of federalism require evolving systems to manage performance in joint arrangements between levels of government.

Systems Thinking as a Framework for Analyzing Commercial Determinants of Health

Policy Points: Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions. Context The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health communitys narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual‐level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. Methods Drawing on Donella Meadowss systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. Findings Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. Conclusions It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.