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

  • Kathryn Oliver

    Student thesis: Phd


    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
    Date of Award1 Aug 2013
    Original languageEnglish
    Awarding Institution
    • The University of Manchester
    SupervisorFrank De Vocht (Supervisor), Annemarie Money (Supervisor) & Martin Everett (Supervisor)


    • Knowledge utilisation
    • Evidence based policy
    • Health policy
    • Leadership
    • Social network analysis
    • Public health policy
    • Public health
    • Mixed methods

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