The role of health education in the policy change process: Lessons from tobacco control

Abstract

The ‘new public health’ perspective urges a return to an agenda centred on the modification of the determinants of health, with a special emphasis on public policies. This enthusiasm for strategies focusing on the modification of policies may lead, however, to declining interest in health education interventions. The aim of the present analysis is to reflect on the role of health education in the process leading to the adoption of ‘Healthy Public Policies’ by drawing on theories from political science: Hall's Policy Paradigm approach and Sabatier and Jenkins-Smith's Advocacy Coalition Framework. Rejecting the traditional perspective that political actors’ choices and preferences are exclusively framed by an economic rationality, these two frameworks integrate the influence of ideas and values in the policy process. Applying these analytical frameworks to the case of tobacco control, we found that the policy change process is constrained by the worldview of a broad group of actors from the political and social spheres and that the dominant elite's worldview structures such a process. In addition, policies are derived from the ‘policy learning process’ and from events external to the policy domain. We conclude that health education through its health advocacy role and the sensitization of the public is a critical ingredient of the policy process. However, health educators should take part in the process not only by disseminating technical or scientific arguments but also by bringing forward arguments that take into account the fundamental values defended by the policy-makers and the public.

Keywords:

• Advocacy
• health education
• healthy public policy