Researching healthy land use policy making using realist methods

Purpose Realist methods in health research are increasingly used but there is very little knowledge about how to conduct realist research investigations into public policy. At the same time, despite the extensive evidence base... [ view full abstract ]

Purpose
Realist methods in health research are increasingly used but there is very little knowledge about how to conduct realist research investigations into public policy. At the same time, despite the extensive evidence base clarifying the built environment as a determinant of health, there is limited knowledge about how and why land use planning systems take on health concerns. This presentation provides methodological insights from a program of realist research investigating the inclusion of health across a land use planning system in New South Wales, Australia.
Methods
Data collection includes publicly available documentation and purposively sampled stakeholder interviews and focus groups across different cases of activities in the land use planning system. The (new institutionalist) units of analysis are ‘institutional’ structures (rules and mandates constraining and enabling actors), ‘actors’ (the stakeholders, organisations and networks involved), and ‘ideas’ (policy content).
Data analysis combines the empirical data with relevant theories from political science, sociology and political economy to develop propositions about ‘mechanisms’ and ‘conditions’ leading to the ‘outcome’ of health’s inclusion or non- inclusion.
Conclusions
The institutionalist units of analysis (ideas, actors, structures) is useful for designing data collection and initial analysis about mechanisms and conditions. For example, cases of environmental impact assessments of major infrastructure developments have shown health is principally included in assessments of risk (an idea as a ‘mechanism’) because of the culture of the health system (actors and structures forming ‘conditions’), which is necessary but insufficient to include the wide range of health issues (‘outcome’). Using different theories has helped to explain different aspects of policy making revealed by the empirical data. For example Kingdon’s focus on windows of opportunity complements Sabatier’s focus on networks and power, and the political economy approach interrogates facilitating or regulating health considerations within public and private capital investment in the built environment.