Elusive implementation: an ethnographic study of intersectoral policymaking for health
Abstract Background For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities i...
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doaj-c2bc43bc5a9f43328c6a1c3864342ba12020-11-25T01:38:35ZengBMCBMC Health Services Research1472-69632018-01-0118111210.1186/s12913-018-2864-9Elusive implementation: an ethnographic study of intersectoral policymaking for healthDitte Heering Holt0Morten Hulvej Rod1Susanne Boch Waldorff2Tine Tjørnhøj-Thomsen3University of Southern Denmark, National Institute of Public HealthMetropolitan University College, National Research Centre for Disadvantaged Children and Young PeopleCopenhagen Business School, Department of OrganizationUniversity of Southern Denmark, National Institute of Public HealthAbstract Background For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling. Methods On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts. Results By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action. Conclusion We argue that the ‘myth’ of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.http://link.springer.com/article/10.1186/s12913-018-2864-9Intersectoral policymakingIntersectoral collaborationHealth in all policiesPolicy processImplementationMunicipal health promotion |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ditte Heering Holt Morten Hulvej Rod Susanne Boch Waldorff Tine Tjørnhøj-Thomsen |
spellingShingle |
Ditte Heering Holt Morten Hulvej Rod Susanne Boch Waldorff Tine Tjørnhøj-Thomsen Elusive implementation: an ethnographic study of intersectoral policymaking for health BMC Health Services Research Intersectoral policymaking Intersectoral collaboration Health in all policies Policy process Implementation Municipal health promotion |
author_facet |
Ditte Heering Holt Morten Hulvej Rod Susanne Boch Waldorff Tine Tjørnhøj-Thomsen |
author_sort |
Ditte Heering Holt |
title |
Elusive implementation: an ethnographic study of intersectoral policymaking for health |
title_short |
Elusive implementation: an ethnographic study of intersectoral policymaking for health |
title_full |
Elusive implementation: an ethnographic study of intersectoral policymaking for health |
title_fullStr |
Elusive implementation: an ethnographic study of intersectoral policymaking for health |
title_full_unstemmed |
Elusive implementation: an ethnographic study of intersectoral policymaking for health |
title_sort |
elusive implementation: an ethnographic study of intersectoral policymaking for health |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2018-01-01 |
description |
Abstract Background For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling. Methods On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts. Results By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action. Conclusion We argue that the ‘myth’ of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health. |
topic |
Intersectoral policymaking Intersectoral collaboration Health in all policies Policy process Implementation Municipal health promotion |
url |
http://link.springer.com/article/10.1186/s12913-018-2864-9 |
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