Beyond policy analysis: the raw politics behind opposition to healthy public policy

Despite evidence that public policy that equitably distributes the prerequisites/social determinants of health (PrH/SDH) is a worthy goal, progress in achieving such healthy public policy (HPP) has been uneven. This has especially been the case in nations where the business sector dominates the making of public policy. In response, various models of the policy process have been developed to create what Kickbusch calls a health political science to correct this situation. In this article I examine an aspect of health political science that is frequently neglected: the raw politics of power and influence. Using Canada as an example, I argue that aspects of HPP related to the distribution of key PrH/SDH are embedded within issues of power, influence, and competing interests such that key sectors of society oppose and are successful in blocking such HPP. By identifying these opponents and understanding why and how they block HPP, these barriers can be surmounted. These efforts to identify opponents of HPP that provide an equitable distribution of the PrH/SDH will be especially necessary where a nation's political economy is dominated by the business and corporate sector.