Key points

• Rational models of planning and policy making underplay the contingent, ad hoc nature of these processes in practice.

• Policy making is a political process and only ever partially evidence-based.

• Understanding how policy is made can help you influence its development and implementation locally.

• Governments give policy on health services greater precedence over policy on public health although the latter has greater potential to improve population health.

Introduction

An understanding of how policy is made is an important means by which medical and public health practitioners can comprehend the services within which they work – and perhaps change them. The policy process is the means by which particular policies emerge and are pursued by governments and government agencies. There are many competing explanations of the policy process [1]. However, a simple and useful way of understanding how policy is made is as the consequence of the inter-relation of ‘actors’ (those people or organisations that populate the process), the wider context, the process by which policy is made and the content of the policy itself (i.e. what it is designed to achieve) [2] (Figure 16.1).