Opening up possibilities for health in all policies : An action research study to understand local level policy practice and its development

Wilding, Helen and Giga, Sabir and Limmer, Mark (2021) Opening up possibilities for health in all policies : An action research study to understand local level policy practice and its development. PhD thesis, Lancaster University.

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Abstract

Local government in England has a role in leading health improvement which includes making progress towards health in all policies. International research has focused on identifying the strategies and tactics being taken by local government as part of a health in all policies approach. However, there is little research evidence behind these actions and recent literature critiques the assumptions underpinning the dominant approach. This thesis is positioned within the scholarly field of health political science which seeks to draw on different branches of political science to understand the determinants of health and public policy. It argues that developing policy practice could be a possible area of action for those seeking to achieve local level health in all policies. Therefore, it set out to understand the practice enacted by those who are professionally engaged in local level policy as a form of employment, the influences on that practice and how it does, or could, develop. The research presented has an action research orientation with three concurrent, interrelated streams of action that focus on understanding professional practice and its development, engaging with archival data and conducting fieldwork. In doing so, it contributes to health political science by drawing attention to the value of the previously neglected field of policy work studies. It also provides methodological insights for those studying professional practice, developing researcher-practitioner partnerships and engaging with non-health literature in this interdisciplinary field. The study finds that policy practice is constituted of a number of sub-practices (research, collaboration, public participation, public affairs and development) and two diffuse practices (documenting and interacting). Dynamic distal and proximal conditions, as well as the background of the individual practitioner, influence which sub-practices dominate and how they are enacted, at both a point in time and over time. Of all the influences identified, policy capacity – the local authority’s ability to marshal the necessary internal and external resources to support local policy processes – is particularly influential to the quality of policy practice and any practice development efforts. Developing policy practice requires local government to create the time and the space to pay attention to coordinating and strengthening policy capacity, including enabling practitioners to develop relationships with each other and initiate practitioner-led improvements. The findings have implications to the achievement of local level health in all policies in England. The specialist public health workforce needs to work with other policy practitioners to advocate for, and implement, a multi-sectoral approach to coordinating policy capacity and developing policy practice.