Combining theory and data to understand how health was included and then excluded in a legislative reform of a land use planning system

Purpose Theory based evaluation is gaining currency to investigate complex problems. Realist evaluation is one approach where empirical data and theory combine to provide deeper explanations. Existing theory has not yet been... [ view full abstract ]

Purpose
Theory based evaluation is gaining currency to investigate complex problems. Realist evaluation is one approach where empirical data and theory combine to provide deeper explanations. Existing theory has not yet been used sufficiently to understand activities to influence public policy to improve health. This presentation reports findings from comprehensive reforms of the land use planning system in NSW, Australia, that led to the inclusion then exclusion of two (of 11) health objectives.
Methods
Primary data included nine purposively sampled stakeholder interviews and a focus group. Secondary data included Hansard recordings of parliamentary proceedings and freedom of information documents (emails, internal reports, minutes of meetings).
Three political science theories directly connected the data with explanations about agenda setting and policy change while retaining our institutionalist [1] analytic focus on structures (rules and mandates), ‘actors’ (people and networks), and ‘ideas’ (policy content): multiple streams approach (MSA) [2, 3]; advocacy coalition framework (ACF) [4]; and punctuated equilibrium theory (PET) [5, 6]. We also used political economy theory [7].
Conclusions
The theoretical analysis allowed explanation of the legislative review over time to be complex, incremental and non-linear, undergoing long periods of stasis, then openness to change, and then stasis (in terms of openness).
The explanatory detail provided by each provides subtly different explanations about why health became influential.
MSA suggests ‘healthy planning’ entrepreneurs used the reforms as a window of opportunity. ACF suggests health was successfully positioned due to struggles between different networks’ core beliefs but acceptance that health was positive. PET suggests positioning the health objectives rather than detail behind these did not challenge the limited information processing capacity of decision makers. Political economy suggests government was beholden to capital growth rather than balance or sustainability and this disconnect galvanised political opposition to the reforms and the opportunity for the health objectives.