The politics and analytics of health policy.

Introduction Let us start with an example of health policy analysis in action. Within that category of countries loosely known as ‘the West’, quite basic differences exist in attitudes to health policy and also actual health policy. Comparing the US with mainland Europe and indeed Canada, for example, one perceives a difference in attitude on the part of the majority towards collectivism and individualism in access to, provision of and financing of healthcare. The explanation for policy and system differences— for example, between the US healthcare system(s) and the various NHSs of the UK countries (England, Scotland, Wales and Northern Ireland)—is commonly framed in terms of ‘ideology’ but there are also ‘institutional’ explanations (1). Additionally, however, popular attitudes or ‘values’ may be taken as autonomous ‘inputs’ into the explanation (e.g. ‘American values prevent the enactment of an NHS’) or, at least in part, derived from or influenced by institutional reality. If, for example, there is no chance of a bill to establish an NHS or a comprehensive system of public health insurance passing in Washington, then reformers over time trim not only their legislative ambitions, but also their very way of thinking about the issue. In this case, what we might be observing is the interplay of ideas and institutions (2): ideas about what is possible are influenced over time, and that can—over an even longer period of time—lead to those ideas coalescing into an ‘ideology’ of what is desirable (i.e. politics as the art of the possible, where the practitioners eventually internalise the possible as the (most) desirable state-of-affairs). Institutions shape ideology. And conversely, ideology can shape institutions: approaches to change (e.g. incremental versus comprehensive; marginal versus radical) can affect how politicians and other actors behave within political institutions, and whether they accept the standard-operating procedures or challenge them. Policy analysis may be descriptive and analytical (positive as opposed to normative, in the language of economics)—what policy do we see, and why? Alternatively it may be normative —what policy do we wish to see and how can we get it? In a separate but related vein, health policy for some will tend to be studied with overtones of ‘positivism’ (which I will define here as seeking patterns in data without necessarily explaining them at the level of human perception and action), whereas for others it will involve a rich range of ‘policy studies’ involving things like who holds power, what the structures are, which condition Calum R. Paton1* Editorial http://ijhpm.com Int J Health Policy Manag 2014, 2(3), 105–107