European Policy Analysis Volume 2, Number 1, Spring 2016 | Page 197

European Policy Analysis

Kingdon’s Multiple Streams Framework
we discovered—through our direct
engagement with a range of policy
actors—that we could understand events
and couplings within and between
policy, politics, and problem streams
better by adopting a policy network
theoretical gaze. We contend that
further hybridization (adding even more
conceptual gazes) may establish an even
more fine-grained understanding of
health policy processes. In particular, we
would be interested in connecting and
contrasting policy rhetoric (e.g., Stone
2002) and framing theory (Schön and
Rein1995) with network mapping and
alternative specification perspectives.

First, however, we need to establish
the parameters for our particular health
policy perspective (de Leeuw, Clavier, and
Breton 2014). Health is created outside
the healthcare sector. The healthcare
sector aims to cure or mediate disease,
and is ill equipped to deal with the “causes
of the causes” of health and disease
(i.e., the social, economic, and political
determinants that create opportunities for
people to make—healthy—choices; see,
for instance, de Leeuw 2016a; 2016b). This
assertion has been made and validated
for over three decades now by scholars
(e.g., Blum 1974; Laframboise 1973;
Navarro 1986) and reputable national
and global forums (Lalonde 1974; World
Health Organization Commission on
Social Determinants of Health 2009).
A problem remains, though: if health is
not created by the sick care sector, why
should the sick care sector manage policy
development for health? It would make
much more sense if policy development
for health is managed across those socioeconomic realms where health is made.
Ideologically,
the
character

of true “policies for health” has been
established since the early 1980s. The
Declaration of Alma-Ata on Primary
HealthCare (International Conference
on Primary Healthcare 1978) and the
Ottawa Charter for Health Promotion
(World Health Organization, Canadian
Public Health Association, and Health
Canada 1986) recognized that broad and
integrated policies would support and
sustain the conditions for good health
across individuals, groups, communities,
and populations. Rhetorically, however,
this is a troubled area. Many concepts
are proposed and peddled, for example,
Healthy Public Policy, Health in All
Policy, and intersectoral policy (Peters et
al. 2014), with only nominal differences
in flavor or perspective. We would prefer
the simple designation “policy for health.”
Such policy consists of different subsets
of sector or issue driven policies, jointly
addressing the broad determinants of
health. Yet—it is useful to describe the
different flavors and perspectives, which
we will do next.

The notion of Healthy Public
Policy (thus, a subset of “policy for
health”) endeavors to explicitly introduce
health considerations in each of the
underlying policy sectors, building
momentum for change of all these policies
towards health development (Kickbusch
2010). Following Gusfield’s notions that
actors can own or disown social problems
(Gusfield 1981; 1989), health agencies
(ministries, public health services)
have assumed ownership of health as
a problem—and thus appropriating its
policy solution. However, this may be true
to a lesser extent for the much broader
Healthy Public Policy. In very operational
terms health agencies have been
charged through traditional governance

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