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Principal Approaches to Policy Formation

Equality, Equity and Policy: Principal Approaches to Policy Formation

Health policies are formed through the complex inter-relationship of context, process and actors. Walt and Gibson (1994 in Buse et al, 2005) have proposed the health policy triangle as a way of systematically thinking about all the
different factors that may affect policy (Figure 1).

Figure 1: The Health Policy Triangle

Source Walt and Gilson, 1994 (in Buse et al, 2005)

Actors refer to individuals, organizations or the state, and their actions that affect health policy. All actors have their own interests and agendas. Examples of actors include individuals, international NGOs, national NGOs, pressure/interest groups, international organizations, bilateral agencies, funding organizations, private sector companies, and the media.

Context means systematic factors - political, economic, social or cultural, both national and international - which may have an effect of health policy. These include:

  • Situational factors- transient, impermanent conditions which can have an impact on policy (e.g wars, droughts)
  • Structural factors- relatively unchanging elements of society (e.g. the political system, type of economy, demographic features)
  • Cultural factors- religion, ethnicity, gender
  • International or exogenous factors- some policies require cooperation between national, regional or multilateral organizations

Content is the substance of a particular policy which details the subjects and topics covered.

Process is the way in which policies are initiated, developed or formulated, negotiated, communicated, implemented and evaluated.

Policy formation falls into the process corner of the framework above and is influenced by actors, content, and context. It is a process of negotiation and bargaining in order to satisfy various interests and build a coalition of support. Policy formation varies according to the nature of the policy and the organizational structure in which it is made (i.e. actors, content, and context) but often includes assembling information, developing arguments, developing
alternatives, and persuading others. Sometimes the process is rational - systematically weighing the pros and cons of various alternatives; and sometimes the process is incremental - an iterative decision making process without explicit goals (Anderson and Sotir Hussey, 2005).



  • Anderson g, Sotir Hussey P (2006). Influencing government policy. In: Pencheon D, Guest C, Melzer D, Muir Gray JA (eds) Oxford Handbook of Public Health. Oxford University Press.
  • Buse K, Mays N, Walt G (2005). Making Health Policy. Understanding Public Health Series Open University Press.
  • Walt G, Gibson L (1994). “Reforming the health sector in developing countries: The central role of policy analysis”. Health Policy and Planning,
    9: 353-70.

© Rebecca Steinbach 2009