Determinants of health policy impact: comparative results of a European policymaker study.
OBJECTIVE
This article will use a new theoretical framework for the analysis of health policy impact introduced by Rütten et al. (2003). In particular, it will report on a comparative European study of policymakers' perception and evaluation of specific determinants of the policy impact, both in terms of output (implemented measures) and outcome (health behaviour change). Policy determinants investigated are goals, resources, obligations and opportunities as related to the policymaking process.


METHODS
Theory is applied to a comparative analysis of prevention and health promotion policy in Belgium, Finland, Germany. The Netherlands, Spain and Switzerland. The study is MED2-part of a project that has developed a Methodology for the Analysis of the Rationality and Effectiveness of Prevention and Health Promotion Strategies (MAREPS) within the EU-BIO-program. A mail survey of 719 policymakers on the executive and administrative level selected by a focused sample procedure was conducted. This survey used policymakers' experience and evaluative expertise to analyse determinants of policy output and outcome.


RESULTS
Regression analyses reveal differential predictive power of policy goals, resources, obligations, as well as of political, organisational and public opportunities. For instance, whereas resources, concreteness of goals, and public opportunities have significant importance for health outcome of policy, obligations and organisational opportunities significantly predict policy output.


CONCLUSIONS
Results are discussed in terms of rationality and effectiveness of health policy. They indicate that six sensitising constructs derived from the theoretical framework represent equivalent structures across nations. They comprise a validated instrument that can be used for further comparative health policy research.
Rütten
Alfred
A
Friedrich-Alexander-University of Erlangen-Nuremberg, Institute for Sport Sciences, Gebbertstr. 123b, D-91058 Erlangen. alfred.ruetten@sport.uni-erlangen.de
Lüschen
Günther
G
von Lengerke
Thomas
T
Abel
Thomas
T
Kannas
Lasse
L
Rodríguez Diaz
Josep A
JA
Vinck
Jan
J
van der Zee
Jouke
J
D005060:Europe; D019983:Guideline Adherence; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration*; D006306:Health Surveys; D006801:Humans; D009937:Organizational Objectives; D011050:Policy Making; D011057:Politics; D011795:Surveys and Questionnaires; D014944:World Health Organization