Policy-as-discourse - an additional theory that makes for a more comprehensive glossary

Sara E Shaw, Senior Lecturer in Health Policy Research,

Other Contributors:

December 13, 2012

Dear Editor

In their recent paper, Smith and Katikireddi (2012) provide a useful outline of theories for understanding policymaking. The article is aimed at public health practitioners and researchers who are seeking to shape policy. It rightly encourages them to draw on relevant theory to more productively guide their interactions with, and potential influence on, relevant policy. This is a timely and welcome message. However, authors have failed to include an important shift in political science and policy studies that is highly relevant to the process of shaping public health policy.

Approaches to thinking about policy come from three epistemological frameworks (Shaw 2010). Firstly, a rationalist framework that conceives of policymaking in terms of clear 'stages' that actors simply feed evidence into. Secondly a political rationalist framework that recognises the way that ideas, values, interests and actors interact in a more complex, non- linear way to shape policy. Thirdly a policy-as-discourse framework that recognises that language and social interaction shape policy. Authors focus briefly on the first, largely on the second and not at all on the third. Whilst this perhaps reflects the dominance of rationalist thinking about policy, by not acknowledging policy-as-discourse authors fail to provide the glossary that they claim to provide.

A policy-as-discourse approach has relevance for those seeking to shape health policy because, amongst other things, it acknowledges that social problems are identified and addressed through the activities of different interest groups (clinicians, managers, patients and so on). By drawing attention to the language and arguments used by groups, such an approach encourages public health practitioners and researchers to consider how policy problems are framed, by who and why. It also encourages them to consider their own language and how they might productively use it to challenge public health policies and open up possibilities for social change.

We encourage those interested in shaping policy to consider, not only the theories outlined by Smith and Katikireddi, but also policy-as- discourse. Such theory reflects a wider 'linguistic and argumentative turn' in the social and political sciences (Fischer and Forester 1996), which has been very influential in some areas of social policy, but has yet to filter through into health policy. Doing so will not only provide additional insight into what are often complex areas of policy (e.g. health inequalities), but also ensure a more comprehensive theoretical landscape from which public health practitioners and researchers can select appropriately.


Fisher F and Forester J (1996) The Argumentative Turn in Policy Analysis and Planning. Durham/London, Duke University Press.

Shaw SE (2010) Reaching the parts that other theories and methods can't reach: How and why a policy-as-discourse approach can inform health- related policy. Health 14(2) 196-212

Smith KE and Katikireddi SV (2012) A glossary of theories for understanding policymaking. JECH Online First doi:10.1136/jech-2012- 200990.

Conflict of Interest:

None declared

Conflict of Interest

None declared