Juggling Multiple Networks in Multiple Streams
congruence between explanations and public policy responses suggests that public health arguments directed at addressing the social determinants of health have not become absorbed into bodies of lay knowledge .” No one owns health , and hence no one can be mobilized for its advocacy . We suggest that such a void of understanding necessarily leads to limited political expediency to address the issue . Also , the broad conceptualisation of ( social determinants of ) health is not a policy frame that resonates in the “ lay ” community . One of very few research efforts to consider what it would take to mobilize communities politically towards a more substantive social determinants policy effort has been undertaken by the Robert Wood Johnson Foundation , Carger , and Westen ( 2010 ). Over four years they systematically investigated frames and metaphors for health in the United States and found that there is a meaningful divide between language and rhetoric deployed by public health professionals and scholars on the one side , and what the US public ( across the Democratic-Republican spectrum ) feels on the other . Popular support for broad health policy seems absent , but can be framed meaningfully toward some degree of awareness and advocacy . The social determinants message needs to resonate at a deep metaphorical level . The framing of the “ health is created outside the healthcare sector ” issue appears difficult — at one level because the language that needs to be used generally eludes health practitioners and scholars ( de Leeuw 2016a ; 2016b ).
Recognising that we were facing a stagnant policy environment with a multitude of actors , we started our inquiry with a stakeholder analysis .
Stakeholder analysis is popular in organizational analysis , policy analysis and programme development ( Brugha and Varvasovszky 2000 ). Stakeholders may include individuals , organizations and different individuals within an organization , as well as networks of individuals and / or organizations . Stakeholder analysis is used as a tool to map the actors who have a stake in a policy , organization or programme and to describe the characteristics of these actors . For example , stakeholder analysis in policy-making is used to create support for policy decisions and commitment for the implementation of policy ( Provan and Milward 1995 ).
Our investigation into Dutch local government policy for health looked at the following characteristics of identified stakeholders : their ideas about local health policy , interests , collaboration with other actors in public health , influence and the contribution they made towards policy development . These attributes formed the principal constituents of the annual interviews with stakeholders ; they also structured our approach to participatory observation . Over 3 years , we monitored the change or stability of the characteristics of stakeholders . We were interested in knowing how these characteristics related to the policy development process and whether stakeholders engaged in entrepreneurial activities for policy change ( Hoeijmakers 2005 ). With a very small initial sample , we used “ snowball sampling ” to reach a stable research population ( Salganik and Heckathorn 2004 ) and subsequently one Delphi round to identify the most important stakeholders to the issue of “ broadly-defined-health ” policy making in the municipal cases under study .
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