Understanding what really drives 'healthy' public policy: the human systems coherence framework
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University of New South Wales (UNSW), Sydney, Australia
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A1833
Background and Objective: Public policies and projects usually have multiple and potentially conflicting goals, some of which are unstated. This means that the explicit use of health-related language is an unreliable indicator of the actual priority accorded to health. The objective of this research was to develop a framework that could be applied to existing or proposed policies and projects, to assess the priority and coherence of health relative to other goals and factors.   Methods: The framework was developed iteratively. Its application involves coding and analysing policy and project documents based on their boundary judgements (sources of motivation, control, expertise, and legitimacy), their core policy content (goals, instruments, and settings), and their strategic content (diagnoses, approach, and actions). The Resultsing data is then assessed for coherence within and across policies and projects. The framework was validated by applying it to the redevelopment of a large public housing estate in Sydney, Australia.   Results: Looking for coherence proves a strong entry point for policy assessment. Assessing the coherence of variables within individual policy and project documents clarifies their underlying rationale, which can then be compared to their stated goals. In the case study project, this revealed a superficial commitment to health, accompanied by a constraining focus on instrumental and financial outcomes. A comparison of variables across different policies and projects revealed the same pattern, providing evidence that the case study is representative of a broader value base and approach to public policy and administration at this time.   Conclusions: The Human Systems Coherence Framework is a useful tool for disentangling explicit and implicit policy and project goals, and assessing the priority and coherence of health relative to other policy factors. It can be applied to any area of public policy and administration where health is or should be a priority (i.e., all areas). 
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