Elusive Implementation

An Ethnographic Study of Intersectoral Policymaking for Health

Ditte Heering Holt, Morten Hulvej Rod, Susanne Boch Waldorff, Tine Tjørnhøj-Thomsen

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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.
Original languageEnglish
Article number54
JournalBMC Health Services Research
Volume18
Number of pages12
ISSN1472-6963
DOIs
Publication statusPublished - 2018

Keywords

  • Intersectoral policymaking
  • Intersectoral collaboration
  • Health in all policies
  • Policy process
  • Implementation
  • Municipal health promotion
  • Local government

Cite this

Heering Holt, Ditte ; Rod, Morten Hulvej ; Waldorff, Susanne Boch ; Tjørnhøj-Thomsen, Tine. / Elusive Implementation : An Ethnographic Study of Intersectoral Policymaking for Health. In: BMC Health Services Research. 2018 ; Vol. 18.
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Elusive Implementation : An Ethnographic Study of Intersectoral Policymaking for Health. / Heering Holt, Ditte; Rod, Morten Hulvej; Waldorff, Susanne Boch; Tjørnhøj-Thomsen, Tine.

In: BMC Health Services Research, Vol. 18, 54, 2018.

Research output: Contribution to journalJournal articleResearchpeer-review

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