Juggling Multiple Networks in Multiple Streams
arrangements to develop two distinctive subsets of policies for health : public health policy , and health care policy . In their very nature these two are qualitatively different from each other , which becomes obvious when we look at the policy elements each is supposed to address . Traditionally , healthcare policy deals with operations , access to services , individual patients , and resource allocations . Public health policy , on the other hand , is driven by notions of risk , populations , settings ( such as workplaces or schools ), and particular risk areas . It seems that , because of the diverging nature of the policy elements , policy development parameters that are deployed in one may be ineffective in another subset . Making policy for health , therefore , is certainly not a case of “ one size fits all ”; it needs to take into account the unique conditions of each policy domain .
In this paper we invite you to follow our investigative journey and reflect on the theoretical political science propositions that we used . We will need to use a few empirical approaches and findings , but our intent is to relate the development of our conceptual toolbox . This will lead to an admittedly praxisbased set of theoretical suggestions .
Policy Entrepreneurs Opening a Window
One theoretical perspective popularly applied to policy development issues in the health arena is Kingdon ’ s Multiple Streams Framework ( 1995 ) ( Figure 1 ). In its simplest narrative , this theory claims that there exist three continuously evolving streams around issues in society . For a complete reflection and meta-review see Jones et al . ( 2016 ).
Some of these issues become problems , and the nature of these problems is constantly massaged on and off agendas of those participants who feel engaged with the issue . Some of these participants are “ visible ,” that is , legitimate problem stream actors . They may include special interest groups , academics , and the media . Others are “ invisible ” and are called upon to provide ( or they volunteer ) their under-the-radar-services and capacities to contribute to problem framing . An invisible participant may be a lobbyist or a political staffer . Their “ invisibility ” relates not only to their legitimacy to act , but also to the formal role attributed to them . Visible and invisible participants similarly play roles in the other two streams , those of politics , and policies . An actor visible in one stream may well be invisible in another . In the politics stream the essential phenomenon is the raw nature of politics as determined by Lasswell ( 1936 ): Who gets what , when and how ? The dynamic nature of the politics stream is determined by a degree of seasonality ( terms of Parliament , electoral cycles , etc .), the political preferences of those in power and those in opposition , and the shifting sands of “ what ’ s hot and what ’ s not .” Finally , the policies stream is characterized by the evolution , existence and engagement of public policies in their social context . Some of these policies are only symbolic ( as , for instance , most public health mass media campaigns ), while some are truly redistributive in nature . ( Perceived ) incremental change to existing policy is often easier argued than radical policy shifts .
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