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Implementing health policy: lessons from the Scottish Well Mens policy initiative

1 Public Health Nutrition, University of Aberdeen, Aberdeen, Scotland;
2 Health and Social Care, University of Bournemouth, Bournemouth, England;
3 Public Health, University of Aberdeen, Aberdeen, Scotland;
4 Academic Primary Care, University of Aberdeen, Aberdeen, Scotland.

Special Issue: Addressing Chronic Disease Prevention and Tobacco Control in the Retail Environment

Background: Little is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men's Services (WMS) policy initiative as a ‘real world’ case study. The WMS were launched by the Scottish Government to address men's health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the ‘rational planning' principles health professionals are commonly encouraged to use for implementation purposes. Methods and materials: A mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc) the perspectives of national policy makers, and local health and social care professionals about the: (a) ‘policy problem’, (b) interventions intended to address the problem, and (c) anticipated policy outcomes. Results and conclusions: This analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.
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1. Nutbeam D. (1996) Achieving ‘best practice’ in health promotion: improving the fit between research and practice. Health Educ Res, 11: 317-326.    

2. Killoran A, & Kelly M. (2004) Towards an evidence-based approach to tackling health inequalities: The English experience. Health Educ J,;63: 7-14.

3. Perkins N, Smith K, Hunter DJ, Bambra C & joyce K. (2010) What counts is what works'? New Labour and partnerships in public health. Policy & Politic,s 38: 101-107.

4. Tones K & Green J. (2004) A systematic approach to health promotion planning. Chapter 4. In Health Promotion: Planning and Strategies, London: Sage Publications, 105-142.

5. Green LW & Kreuter MW. (1999) Health Promotion Planning: An Educational and Ecological Approach, 3rd ed. Boston: Mayfield.

6. Bartholomew LK, Parcel GS, Kok G & Gotteliob NH. (2006) Planning Health Promotion Programs, San Francisco: Jossey-Bass.

7. Sanderson, C, Haglund, BJA, Tillren, P, Svanstrom, L, Holm, L et al. (1996) Effect and stage models in community intervention programmes; and the development of the Model for Management of Intervention Programme Preparation (MMIPP). Health Promot Int, 11:143-156.    

8. Nutely S, Walter I, Davies HTO. (2007) Chapter 10 Drawing some conclusions on using evidence. In Using evidence, 1st ed. Bristol: Policy Press, 297-320.

9. Petticrew M, Platt S, McCollam A, Wilson S, Thomas S. (2008) "We're not short of people telling us what the problems are. We're short of people telling us what to do". An appraisal of public policy and mental health. BMC Public Health, 8 : 314. http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-314

10. Hill M. (2009) The Public Policy Process, Harlow: Pearson Longman.

11. Galt G. (1994) Health Policy: An Introduction to Process and Power, London : Zed Books.

12. Lipsky M. (1980) Street Level Bureaucracy: Dilemmas of the Individual in Public Services, 1st ed, New York: Russell Sage Foundation.

13. Pawson R, Greenhalgh T, Harvey G & Walshe K. (2005) Realist review--a new method of systematic review designed for complex policy interventions.[see comment]. J Health Services & Research Policy, 10 : 21-34.

14. Exworthy M, Berney L & Powell M. (2002) 'How great expectations in Westminster may be dashed locally: The local implementation of national policy on health inequalities. Policy & Politics, 30 : 79-96.

15. Alvarez-Rosete A & Mays N. (2008) Reconciling two conflicting tales of the English health policy process since 1997. Brit Politics, 3: 183-203.    

16. Sanderson I. (2004) Getting evidence into practice: Perspectives on rationality. Evaluation, 10 :366-379.

17. Carlisle S. (2001) Inequalities in health: Contested explanations, shifting discourses and ambiguous policies. Critical Public Health, 11 : 267-281.

18. Scottish Executive. (2005b). Funding boost for men's health. Retrieved 1st Nov 2015 from http://www.scotland.gov.uk/News/Releases/2003/10/4298

19. Douglas F, Amaya A, Greener J, Ludbrook A, Reid G, Robertson L & van Teijlingen, E. (2008) Evaluation of Well Men Health Service Pilots. Scottish Government Social Research. http://www.scotland.gov.uk/Publications/2008/04/01091641/0

20. Macintyre S. (2007) Briefing paper on health inequalities in Scotland. Scottish Government : Edinburgh.

21. Office of National Statistics. Life expectancy statistical bulletin - figures for Scotland. Available at: http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=8841&Pos=1&ColRank=1&Rank=272. Accessed June 9th, 2010.

22. Walsh D, Taulbut M & Hanlon P. (2009) The aftershock of deindustrialization--trends in mortality in Scotland and other parts of post-industrial Europe. Eur J Public Health, 1-7.

23. Hanlon P, Walsh C & Whyte B. (2006) Let Glasgow flourish: A comprehensive report on health and its determinants in Glasgow and West Central Scotland, Glasgow: Glasgow Centre for Population Health.

24. Lohan M. (2007) How might we understand men's' health better? Integrating explanations from critical studies on men and inequalities in health. Soc Sci Med, 65 : 493-504.

25. Payne S, Doyal L.(2010) Gender equity or gender inequality in health? Policy& Politics 38 : 171-175.

26. Hayes BC & Prior PM. (2003) Researching gender and health hare. In: Campling J, Ed Gender and Health Care in the United Kingdom: Exploring the Stereotypes. 1st ed. Basingstoke : Palgrave MacMillan.

27. Mansfield AK, Addis ME & Mahalik J. (2008) Why won't he go to the doctor? The psychology of help seeking. Int J Men's Health, 2 : 93-109.

28. Sharpe S. (2002) Attitudes and beliefs of men and their health. Men's Health J, 1 : 118-120.

29. Galdas PM, Cheater F & Marsahll P. (2005) Men and health help-seeking behaviour: Literature review. J Adv Nursing, 49 : 616-622.

30. Wilkins D. (2005) "Getting it sorted": Identifying and implementing practical solutions to men's health. J Men's Health and Gender, 2 : 13-16.

31. Robertson, LM, Douglas F, Ludbrook A, Reid G & van Teijlingen ER. (2008) What works with men? A systematic review of health promoting interventions targeting men. BMC Health Services Research 8 : 141 http://www.biomedcentral.com/1472-6963/8/141.

32. Scottish Government. Gender influences on health Accessed 24th November 2015. http://www.healthscotland.com/equalities/gender/health-issues.aspx

33. Carlisle S. (2010) Tackling inequalities and social inclusion through partnership and community engagement? A reality check for policy and practice aspirations for a Social Inclusion Partnerships in Scotland. Crit Public Health,1 : 117-127.

34. Macdonald JJ. (2006) Shifting paradigms: a social-determinants of health approach to solving problems in men's health policy and practice. MedJAustralia, 185 : 456-458.

35. Bird CE & Reiker PP. (1999) Genders matters: An integrated model for understanding men's and women's health. Soc Sci Med, 48 : 745-755.

36. Smith JA, Robertson S. (2008) Men's health promotion: a new frontier in Australia and the UK? Health Promot.Internation, 23 : 283-289.

37. Campbell M, Ballas D, Dorling D & Mitchell R. (2013) Mortality inequalities: Scotland versus England and Wales. Health & Place, 23 : 179-186.

38. Wilkinson R, Pickett KE. (2009) The Spirit Level: Why More Equal Societies Almost Always Do Better,1st ed, : London: Allen Lane.

39. Kawachi I, Kennedy BP. (2002) The Health of Nations: Why Inequalities is Harmful to Your Health, New York: New Press.

40. O'Brien R, Hunt K & Hart G. (2005) 'It's caveman stuff, but that is to a certain extent how guys still operate': Men's accounts of masculinity and help seeking. Soc Sci Med, 61 : 503-516.

41. Scottish Executive. Improving health in Scotland: The challenge. Retrieved 3rd September, 2005 from http://www.scotland.gov.uk/library5/health/ihis-00.htm 211 2005

42. Scottish Executive. Funding boost for men's health. Retrieved 3rd September, 2005 from http://www.scotland.gov.uk/News/Releases/2003/10/429. 2005

43. Scottish Executive. A partnership for a better Scotland: A partnership agreement. Retrieved 12th March, 2005 from http://www.scotland.gov.uk/library5/government/pfbs-00.asp. 2005

44. Scottish Executive. (2004) Evaluation of the Well Men Services Pilots: Research Specification. Edinburgh: Scottish Executive.

45. Leishman, J. (2008) Around the world with men's health and women's health organisations: Healthy Scottish men? J Men's Health, 2 : 133-134.

46. W.K. Kellogg Foundation. (2004). Logic model development guide, Available at http://www.wkkf.org/resource-directory/resource/2006/02/wk-kellogg-foundation-logic-model-development-guide.

47. National Cancer Institute. (2005) Theory at a glance: A guide for health promotion practice.;05-3896. Available athttp://www.sneb.org/2014/Theory%20at%20a%20Glance.pdf

48. Naidoo J & Wills J (2009) Health Promotion; Foundations for Practice. 3rd ed, Balliere Tindall : Royal College of Nursing.

49. Jayasinghe S. (2011) Conceptualising population health: from mechanistic thinking to complexity science. Emerg Themes Epidemiol, 8 :1-7.

50. Hill PS. (2000) Planning and change: a Cambodian public health case study. Soc Sci Med, 51 : 1711-1722.

51. MacDonald MA & Green LW. (2001) Reconciling concept and context: the dilemma of implementation in school-based health promotion. Health Edu& Behav, 28 : 749-768.

52. Royal Society for Public Health. A planning guide: health inequalities and the voluntary and community sector. Available at: http://www.healthscotland.com/topics/settings/community-voluntary/oa.aspx. Accessed 15th June, 2014.

53. Moore N. (2007) (Re)Using Qualitative data? Sociological Research Online Accessed: 7th September, 2009.

54. Strauss A, Corbin J. (1998) Basics of qualitative research: Techniques and procedures for developing grounded theory, Thousand Oaks : Sage.

55. Ritchie J & Lewis J. (2003) Qualitative Research Practice. 1st ed, London : Sage.

56. Craig P, Hanlon P & Morrison J. (2008) Can primary care reduce inequalities in mental health? Public Health (e-supplement), 1-5.

57. Elston J, Fulop N. (2002) Perceptions of partnership. A documentary analysis of Health Improvement Programmes. Public Health, 116 : 207-213.

58. Denzin NK, Lincoln YS. (1998) Methods of analysing and interpreting qualitative materials. In: Denzin NK, Lincoln YS, Eds Collecting and Interpreting Qualitative Material, s London : Sage, 35-45.

59. Chun YH & Rainey HG. (2005) Goal ambiguity in U.S. federal agencies. J Public Administration Research & Theory, 15 : 1-30.

60. Lee JW, Rainey GH & Chun YH. (2009) Of politics and purpose: Political salience and goal ambiguity of US federal agencies. Public Administration, 87 : 457-484.

61. Pandey SK & Wright BE. (2006) Connecting the dots in public management: Political environment, organisational goal ambiguity, and the public manager's role ambiguity. J of Public Administration Research& Theory, 16 : 511-532.

62. Feldman MS. (1989) Order Without Design: Information Production and Policy Making. Stanford: California: Stanford University Press..

63. Oliver TR. (2006) The politics of public health policy. Annu Rev Public Health, 27 : 195-233.

64. Gordon D, Graham L, Robinson M & Taulbut M. (2010) Dimensions of Diversity: Population differences and health improvement opportunities, Edinburgh : NHS Health Scotland.

65. Cabinet Office. (2007) Fairness and Freedom: The Final Report of the Inequalities Review. Available at http://webarchive.nationalarchives.gov.uk/20100807034701/http:/archive.cabinetoffice.gov.uk/equalitiesreview/upload/assets/www.theequalitiesreview.org.uk/equality_review.pdf

66. Godin G, Gagnon H, Alary M, Levy JL & Otis J. (2007) The degree of planning; an indicator fo the potential success of health education programs. Promotion & Education, XIV : 138-142.

67. De Leeuw E. (1993) Health policy, epidemiology and power: the interest web. Health Promotion International, 8 : 49-52.

68. Marks L. (2006) An evidence base for tackling inequalities in health: Distraction or necessity? Critical Public Health, 16 : 16-17.

69. Smith KE. (2007) Health inequalities in Scotland and England: the contrasting journeys of ideas from research into policy. Soc Sci Med, 64 : 1438-1449.

70. Aronowitz R. (2008) Framing disease: An underappreciated mechanism for the social patterning of disease. Soc Sci Med, 67 : 1-9.

71. Nutbeam D. 1998) Evaluating health promotion - progress, problems and solutions. Health Promot.Int, 13 :27-44.

72. Raphael D. (2008) Getting serious about the social determinants of health: new directions for public health workers. Promotion & Education, 15 : 15-20.

73. Chan CC. (2009) Choosing health, constrained choices. Global Health Promotion, 16 : 54-57.

74. Green J. (2014) What kind of research does public health need? Critical Public Health, 24 : 249-252.

75. Hanlon P, McEwen J, Carey L, Gilmour H, Tannahill C, Tannahill A, et al. (1995) Health checks and coronary risk: further evidence from a randomised controlled trial. BMJ, 311 : 1609-1613.

76. Fitzpatrick M. (2001) The Tyranny of Health, London : Routledge.

77. Popay J, Whitehead M & Hunter DJ. (2010) Injustice is killing people on a large scale--but what is to be done about it? J Public Health, 2 : 148-149.

78. Baum F. (2011) From Norm to Eric: avoiding lifestyle drift in Australian health policy. Aust N Z J Public Health,35 : 404-406.

79. Baum F & Fisher M. (2014) Why behavioural health promotion endures despite its failure to reduce health inequities. Sociol Health Illn, 36 : 213-225.

80. Kim SH, Willis LA. (2007) Talking about Obesity: News Framing of Who is Responsible for Causing and Fixing the Problem.J Health Communication,;12 : 359-376.

81. King D. (2007) Foresight report on obesity. Lancet, 70 : 1754.

82. Friedli L. (2012) ‘What we've tried, hasn't worked': the politics of assets-based public health 1. Critical Public Health, 12 :1-15.

83. Mitzenberg H. (1994) The Rise and Fall of Strategic Planning, Harlow Essex: Prentice Hall.

84. Brassolotto J, Raphael D, Baldeo N. (2013) Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: A qualitative inquiry. Critical Public Health, 24 : 321-336.

85. Chambers D & Thompson S. (2009) Empowerment and its application in health promotion in acute care settings: nurses' perceptions. J Adv Nursing, 65 : 130-138.

86. Starfield B, Hyde J, Health I. (2008) The concept of prevention: a good idea gone astray? J Epidemiology & Community Health, 62 : 580-583.

87. NHS Health Scotland. Logic Models. 28th April 2010; Available at: http://www.healthscotland.com/understanding/planning/logic-models.aspx. Accessed June 8th, 2010.

88. NHS Health Scotland. Outcome focussed approaches. Available at: http://www.healthscotland.com/topics/settings/community-voluntary/oa.aspx. Accessed 15th June, 2014.

89. Buse K, Mays N & Walt G. (2005) Making Health Policy, Maidenhead: Open University Press.

90. Rittel HW & Webber M. (1973) Dilemmas in a General Theory of Planning. Policy Sciences, 4 : 155-169.

91. Rod MH, Ingholt L, Bang Sørensen B, Tjørnhøj-Thomsen T. (2013) The spirit of the intervention: reflections on social effectiveness in public health intervention research. Critical Public Health , 24 : 296-307.

92. Cohn S, Clinch M, Bunn C & Stronge P. (2013) Entangled complexity: why complex interventions are just not complicated enough. J Health Serv Res Policy, 18 : 40-43.

93. Mackenbach JP. (2012) From deep-fried Mars bars to neoliberal political attacks: explaining the Scottish mortality disadvantage. Eur J Public Health, 22 : 751-751.

94. Marmot M. (2012) Health equity: the challenge. Aust N Z J Public Health, 36 : 513-514.

95. Bambara C, Fox D & Scott-Samuel A. (2005) Towards a politics of health. Health Promot.Internation, 20 : 187-193.

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