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. 2018 Jan 30;18(1):54.
doi: 10.1186/s12913-018-2864-9.

Elusive implementation: an ethnographic study of intersectoral policymaking for health

Ditte Heering Holt  1 , Morten Hulvej Rod  2 , Susanne Boch Waldorff  3 , Tine Tjørnhøj-Thomsen  4
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Elusive implementation: an ethnographic study of intersectoral policymaking for health

Ditte Heering Holt et al. BMC Health Serv Res. .

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.

Keywords: Health in all policies; Implementation; Intersectoral collaboration; Intersectoral policymaking; Local government; Municipal health promotion; Policy process.

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Conflict of interest statement

Ethics approval and consent to participate

According to the National Committee on Health Research Ethics in Denmark formal ethics approval is not required because no human biological material was sampled. The study was carried out in accordance with current Danish rules of ethics and legislature and has been approved by the Danish Data Protection Agency, 23rd May 2013, record number 2013-41-1960.

A written agreement outlining the aim and extent of the research was signed by the involved parties. Oral permission was always obtained to record meetings and interviews during the fieldwork.

Consent for publication

Not applicable.

Competing interests

The authors declare they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Organization of the intersectoral process adapted from a visualization produced by PHO
See this image and copyright information in PMC

References

    1. Christiansen NS, Pedersen CH, Holt DH, Holmberg T, Christensen AI, Rod MH. Kortlægning. Kommunernes arbejde med implementering af Sundhedsstyrelsens forebyggelsespakker. Midtvejsrapport. 2014. Copenhagen: Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark; 2014.
    1. Knudsen M, Møller J, Jacobsen PØ. Rapport om ledelse og organisering af den kommunale sundhedsindsats. Copenhagen: Master of Health Management, CBS, Center for ledelsesudvikling, Kommunernes Landsforening og Efficiens; 2010.
    1. Exworthy M, Hunter DJ. The challenge of joined-up government in tackling health inequalities. International Journal of Public Administration. 2011;34(4):201–212. doi: 10.1080/01900692.2011.551749. - DOI
    1. Baum F, Lawless A, Williams C. Health in all policies from international ideas to local implementation: policies, systems, and organizations. In: Clavier C, de Leeuw E, editors. Health promotion and the policy process. Oxford: Oxford University Press; 2013. pp. 188–217.
    1. World Health Organization . The Ottawa charter for health promotion. Ottawa: World Health Organization; 1986.

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