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Pathways of undue influence in health policy-making: a main actor’s perspective
  1. Ildefonso Hernández-Aguado,
  2. Elisa Chilet-Rosell
  1. Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de Epidemiología y Salud Pública (CIBERESP), San Juan de Alicante, Spain
  1. Correspondence to Professor Ildefonso Hernández-Aguado, Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Ciber de Epidemiología y Salud Pública (CIBERESP), Carretera de Valencia s/n., 03550 San Juan de Alicante, Spain; ihernandez{at}


Background It is crucial to know the extent to which influences lead to policy capture—by which the policy-making process is shifted away from the public interest towards narrow private interests. Using the case study of Spain, our aim was to identify interactions between public administration, civil society and private companies that could influence health policies.

Methods 54 semistructured interviews with key actors related to health policy. The interviews were used to gather information on main policy actors as well as on direct and subtle influences that could modify health policies. The analysis identified and described, from the interviewed persons’ experiences, both the inappropriate influences exerted on the actors and those that they exerted.

Results Inappropriate influences were identified at all levels of administration and policy. They included actions for personal benefits, pressure for blocking health policies and pressure from high levels of government in favour of private corporations. The private sector played a significant role in these strategies through bribery, personal gifts, revolving doors, negative campaigns and by blocking unfavourable political positions or determining the knowledge agenda. The interviewees reported subtle forms of influence (social events, offers of technical support, invitations, etc) that contributed to the intellectual and cultural capture of health officials.

Conclusion The health policy decision-making processes in Spain are subject to influences by stakeholders that determine a degree of policy capture, which is avoidable. The private sector uses different strategies, from subtle influences to outright corruption, taking advantage in many cases of flexible legislation.

  • public health policy
  • qualitative research
  • decision making process

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  • Contributors IH-A conceived, designed and executed the study. Both EC-R and IH-A analysed the interviews, discussed the results and wrote the manuscript, which was reviewed and approved by both authors. IH-A is the guarantor for this study.

  • Funding This research was partially funded by the Ciber de Epidemiología y Salud Pública (CIBERESP) through a specific collaboration agreement with the Miguel Hernandez University of Elche for the promotion of research in epidemiology and public health.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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