Three main questions were raised at the IUHPE conference in June 2002 on "new dimensions in promoting health," with a particular focus on the process of policy change:
? How should people with an interest in promoting health across sectors approach the policy change process?
? What skills are needed to engage in the policy change process?
? How do we build collaborations across the policy arenas?
In short,the answer to all three of these questions is "politics." First, the policy change process needs to be approached through politics. Second,engagement in policy change requires political skills. And third, collaboration across policy arenas requires management of the political process.
A decade ago, in his election campaign for President of the United States, Bill Clinton made famous the slogan, "It?s the economy, stupid!" He plastered those words on the wall of his campaign headquarters in Little Rock, Arkansas, to remind him and his supporters that winning the election required a focus on economic promises.
But the policy change process is driven itself by politics. Indeed, more attention by Bill and Hillary Clinton to the politics of health care — from "it?s the economy, stupid," to "it ?s the politics, stupid!" — might have improved their chances of passing health reform in the United States in 1994.
The failure of the Clinton reform plan highlights the importance of the political process for promoting policy change, and the risks of underestimating political challenges. This article first reviews three political themes about the policy reform process, and then presents a systematic approach to the development of political strategies for reform, using examples of health policy.