Ideas, Policy Learning and Policy Change: The Determinants-of-Health Synthesis in Canada and the United Kingdom

Over the past several decades, researchers have developed a vast body of knowledge about the social determinants of health. Drawing on scholarship about the role of ideas in policymaking, I developed a conceptual framework to identify institutional innovations or policy changes in Canada and the United Kingdom which may have come about, at least in part, because of the determinants-of-health synthesis and to determine the role that these ideas played in the politics associated with these developments. Elite interviews and reviews of primary and secondary sources suggested that the policy-relevant ideas embodied in the determinants-of-health synthesis played strategic, rather than instrumental, roles in any institutional innovation or policy change. The greater number of policy-making bodies in Canada's federal governance structure and the different relationships between the governing party and the groups with whom these ideas were associated at the time they were introduced to the political arena may explain why the cases in which these ideas did play a role were all drawn from Canada. Discordance between these ideas and specialized bureaucratic structures suggests that institutional innovations may provide (in the short run) the most likely role for these ideas and (in the long run) the most influential role.