title: Who runs public health? A mixed-methods study combining qualitative and network analyses.
abstract: BACKGROUND
  Persistent health inequalities encourage researchers to identify new ways of understanding the policy process. Informal relationships are implicated in finding evidence and making decisions for public health policy (PHP), but few studies use specialized methods to identify key actors in the policy process.
  
  
  METHODS
  We combined network and qualitative data to identify the most influential individuals in PHP in a UK conurbation and describe their strategies to influence policy. Network data were collected by asking for nominations of powerful and influential people in PHP (n = 152, response rate 80%), and 23 semi-structured interviews were analysed using a framework approach.
  
  
  RESULTS
  The most influential PHP makers in this conurbation were mid-level managers in the National Health Service and local government, characterized by managerial skills: controlling policy processes through gate keeping key organizations, providing policy content and managing selected experts and executives to lead on policies. Public health professionals and academics are indirectly connected to policy via managers.
  
  
  CONCLUSIONS
  The most powerful individuals in public health are managers, not usually considered targets for research. As we show, they are highly influential through all stages of the policy process. This study shows the importance of understanding the daily activities of influential policy individuals.
authors.affiliation: Department of Innovation, Management and Policy, Manchester Business School, D38 Manchester Business School East, The University of Manchester, Booth Street East, Manchester, UK. kathryn.oliver@mbs.ac.uk
authors.forename: Kathryn
authors.initials: K
authors.lastname: Oliver
authors.forename: Frank
authors.initials: F
authors.lastname: de Vocht
authors.forename: Annemarie
authors.initials: A
authors.lastname: Money
authors.forename: Martin
authors.initials: M
authors.lastname: Everett
mesh_terms: D019058:Community Networks / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D011050:Policy Making; D011635:Public Health Administration / Q000379:methods; D036301:Qualitative Research; D006113:United Kingdom
keywords: decision-making; evidence-based policy; public health policy; social network analysis