Time for balloons again: Evaluating power, influence and evidence-use in public health policy: a social network analysis

Posted on April 3, 2013


Time for balloons again:



Another PhD student finished her thesis, submitted it, completed the viva, made some changes, re-submitted, and can now officially call herself a Doctor of Philosophy (yes Free-Public-Health-Poster-AOOP-450the whole examination process here in the UK is very much a dragged out affair. Personally I prefer the Dutch system…).

Anyhow, this was a very interesting PhD. It all had to do with public health, but more specifically with evaluating of power and influence in public health policy making, hubs, authorities, and the use of scientific evidence in this process. Kathryn made use of qualitative methods and social network analysis. All very intriguing, but also, to stay within a British context, not  entirely my cup of tea…

Her PhD was introduced to “the world” in the first publication, entitled The Human Factor: Re-organisations in public health policy (Oliver, Everett, Verma & de Vocht. Health Policy 2012; 106(1): 97-103) (link), which turned out to be a timely piece of work in light of the current government’s idea on how to…how do i put this delicately…sell the NHS to anyone and everyone.

As I normally do on this blog, and hopefully for your interest, please hereby the abstract of Kathryn’s thesis. The peer-reviewed papers are, of course, on their ways and in various stages from conception to publication:

566Evaluating power, influence and evidence-use in public health policy: a social network analysis

Kathryn A Oliver. 

(2012) PhD thesis, University of Manchester


Introduction: Persistent health inequalities are the focus for much public health policy activity. Understanding the policy response to public health problems, the role of evidence, and the roles and strategies of different actors may help explain this persistence. Research suggests that policy actors often access knowledge through interpersonal relations, but current perspectives in the literature do not analyse relational aspects of finding evidence and influencing policy. Identifying powerful and influential actors (in terms of personal characteristics, strategies, and network properties) offers a method of exploring the policy process and evidence use.

Methods: Network data were gathered from a public health policy community in a large urban area in the UK (n = 152, response rate 80%), collecting relational data on perceived power, influence, and sources of evidence about public health policy. Hubs and Authorities analyses were used to identify powerful and influential actors, to test whether powerful and influential actors were also sources of information; and betweenness and Gould-Fernandez brokerage were used to explore the importance of structural position in policy networks.
These data were analysed in conjunction with qualitative data from semi-structured interviews (n = 24) carried out with a purposive subsample of network actors. Characteristics of powerful and influential actors, the use of evidence in the policy process, and roles and strategies used to influence policy were analysed using a framework approach, and combined with network data.
Results: The most influential actors were mid-level managers in the NHS and local authorities, and to a lesser extent, public health professionals. These actors occupied advantageous positions within the networks, and used strategies (ranging from providing policy content, to finding evidence, to presenting policy options to decision-makers) to influence the policy process. Powerful actors were also sources of information for one another, but providing information did not predict power. Experts, academics and professionals in public health were represented in the networks, but were usually more peripheral and played fewer roles in the policy process. This study presents empirical evidence to support the suggestion that recognition of network structure assists individuals to be influential, and proposes a framework to categorise their activities.
Conclusions: In order to influence policy, actors need good relationships with other influential actors, and the skills to exploit these relationships. The relational approach is useful for both identifying powerful and influential people (potential evidence-users) and for exploring how evidence and information reaches them. Identifying powerful and influential actors and describing their strategies for influencing policy provides a new focus for researchers in evidence-based policy, and for those wishing to influence policy. For academics and researchers, this study demonstrates the importance of directly creating ties with decision-makers.


Posted in: Public Health