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Despite the highest ranks on pandemic preparedness assessments European welfare states encounter great difficulty in responding effectively to the COVID-19 outbreak. In this article we compare the governance of COVID-19 response in 48 Eurasian countries and a selection of European and SARS (2003) exposed Asian countries during the first wave of the COVID-19 outbreak until 1 June 2020, using data from the COVID-19 Health System Response Monitor and the Oxford COVID-19 Government Response Tracker, recent scientific literature and policy documents.Pandemic preparedness during the first wave of COVID-19 evolved from specialist infectious disease control to a broad governance of population mitigation, which in at least half of Eurasian countries lacked appropriate authority and capacity. In the directly operational response in Asian countries, preparedness encompasses a whole of government approach, an engaged and active community and private actors. Preparedness requires and reflects both vertical and horizontal coordination as well as policies that fit with the political economy of a country and region.

Across many countries public health experts question to what extent are COVID-19 policies ‘evidence-based', driven by uncertainties and precautionary principle, and narrow disciplinary focus. The policy reflex in 2020 led to a State of Emergency in about half of the countries in the WHO Europe region and managing by decree without Parliamentary approval. Policy decision-making in many countries is persistently dominated by virologist medical expertise. Pandemic response organized by hierarchical, partisan or technical dominance has led to an overly dominant policy focus on curative services and disproportionate effects on vulnerable and minority groups. Now, after 1,5 years and even during electoral campaigns in many countries, the public lacks interest representation because of ‘Parliamentary paralysis': It has been suggested mainstream political parties do not want to question response policies for being associated with populist radical right, antivax and conspiracy theorists. However, policy mitigating and politically moderating options are available. Avoiding public litigation or electoral repercussions, rapid policy response can benefit from organizing quick consultations, rapid appraisals and fast feedback assessments. This will contribute substantially to the use, feasibility and acceptability of policies in society. Consequently, this may facilitate the actual implementation, organizational compliance and public adherence to regulations. In this workshop we aim to explore the needs, capacities and lessons learned so far by health policymakers themselves in the COVID-19 pandemic crisis, and draw implications for the public health community of scholars, professionals in support of policymaking. Rather than asking to what extent the policy responses have been evidence-based, we take the policymaker perspective and focus on the rapid exchanges and emerging processes of policy learning across different countries. There is evidence of policy learning across countries, but not so directly related to research evidence - how does learning take shape? Are public health experts and scientist trained to induce such learning? Three short presentations will share direct experiences with rapid pandemic response decision-making. A panel with politicians involved in pandemic decision-making will reflect on needs, capacities and conditions for well-informed and balanced pandemic response. Then the floor is opened for debate with the audience using Mentimeter and other facilities available for online interaction. The workshop ends with concrete recommendations for direct policy support by public health researchers, managers and professionals at regional, national and supranational levels. Key messages The COVID-19 pandemic has revealed the vulnerabilities in political and democratic systems under stress for decision-making with huge increases of socio-economic and health inequalities as a result. Learning from policymakers themselves will benefit the capacities of public health research and services to organise quick policy feedback preventing huge public health costs in the long run.

Planetary health is the health of human civilization and the state of the natural systems on which it depends. (The Lancet commission on planetary health). Climate change puts planetary health under considerable strain. Climate health adaptation is defined as ‘designing, implementing, monitoring, and evaluating strategies, policies and programs to manage the risks of climate-relevant health outcomes' (WHO 2014). This workshop focuses on the perspective of governance, focusing on three basic coordination issues. Firstly, since climate health adaptation is a relatively new issue, it has not (yet) been organised into laws and regulations assigning clear responsibilities, capacities and resources. As a result, proponents turn to the judiciary for litigation of nation states' compliance with international agreements. Secondly, since climate problems manifest themselves across national borders and continents, there is a need for multilevel governance that requires both local community-based action as well as supranational agreements in resolutions and programs (= vertical coordination). Thirdly, since climate change affects many environmental and social health determinants, such as food systems, migration and water management, climate health adaptation requires a Whole of Society/HiAP approach. Necessary action extends far beyond the health system across different policy sectors, large and small businesses, civil society organisations as well as community initiatives (= horizontal coordination). As a result of these complexities, climate health adaptation rarely reaches the stage of actual policy implementation and goal achievement. This workshop aims to: explore existing literature on planetary health for issues, experiences and possible solutions to the governance and organisation of health adaptation to climate change; introduce principles, methods and institutional examples of multilateral and multilevel governance for planetary health; present examples of early arrangements and strategies for the vertical and horizontal coordination of climate health adaptation to climate change. (EU Green Deal program; Climate Pact; regional climate platforms; climate diplomacy). The workshop consists of three short presentations followed by an interactive panel discussion. After 30 minutes the floor is opened by means of a Mentimeter with which the audience can actively engage in the debate, as well as entering their questions, comments and suggestions through available facilities for interaction. The workshop will end with identifying the current and future necessary roles, responsibilities, capacities of the public health researchers, policymakers, and professionals for climate health diplomacy, network management, and setting up arrangements that offer stable rules for integrative action across different sectors, levels and borders. Key messages We can learn from policy sciences about how climate health adaptation can be organised by multilevel governance (vertical coordination) and Whole of Society governance (horizontal coordination). Working transdisciplinary, public health workers needs to develop skills for climate health diplomacy, network management, and setting up arrangements that offer stable rules for integrative action.

Background In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels. Methods Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models. Results PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses. Conclusions Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous. Trial registration This research was retrospectively registered at the Netherlands Trial Register (NL8108).

While the political and social determinants of health have become accepted among academic researchers, health inequalities in the health policy and political arenas are still predominantly addressed as outcomes of citizens' lifestyle and behavioural choices. The rise of populist radical parties across Western countries brings renewed urgency to communicating with elected leaders and policy makers about the importance of tackling the social (as well as behavioral and medical) determinants of health. Recent publications such as 'Health in Hard Times. Austerity and Health Inequalities' (Clare Bambra, 2019) and 'Health Equity in England: The Marmot Review 10 Years On' (Marmot et al, 2020) find that financial and economic policies in large part contribute to stagnating and even reversing population health trends in the UK and across Western countries. The underlying political system of decision-making needs to be clarified in order to effectively engage and exert influence. This workshop aims to strengthen countervailing power and competence in understanding the policy trajectories that effectively target the larger ambitions of economic and social welfare including reduced health inequalities. We provide participants with basic knowledge, methods and tools to carry out practice-based comparative analysis of public health politics and policies across different countries. The workshop consists of: A 20-minute mini-lecture by Julia Lynch, who will present key findings and the underlying methodology of her recent book Regimes of inequality: The political economy of health and wealth. This book systematically used historical institutionalist-methods and process tracing to compare the policies and politics aimed at reducing health inequalities in Finland, France and the UK from the 1990s to the present.A 15-minute panel reflection: The panel, consisting of Clare Bambra, Karien Stronks, and Holly Jarman, will relate this to their own key research and impact.A 25-minute plenary discussion of examples, questions and contributions to tackling inequalities in political and social determinants of health. Examples are labour market participation policies, progressive fiscal policies or policies resolving illiteracy or household financial debt. Key messages Health inequalities are a political choice. Learning by comparison increases capacity to improve policies on the social determinants of health as well as capacity to increase political influence.

Background The political system is an important influencing factor for population health but is often neglected in the public health literature. This scoping review uses insights from political science to explore the possible public health consequences of the rise of populist radical right (PRR) parties in Europe, with welfare state policy as a proxy. The aim is to generate hypotheses about the relationship between the PRR, political systems and public health. Methods A literature search on PubMed, ScienceDirect and Google Scholar resulted in 110 original research articles addressing 1) the relationship between the political system and welfare state policy/population health outcomes or 2) the relationship between PRR parties and welfare state policy/population health outcomes in Europe. Results The influence of political parties on population health seems to be mediated by welfare state policies. Early symptoms point towards possible negative effects of the PRR on public health, by taking a welfare chauvinist position. Despite limited literature, there are preliminary indications that the effect of PRR parties on health and welfare policy depends on vote-seeking or office-seeking strategies and may be mediated by the political system in which they act. Compromises with coalition partners, electoral institutions and the type of healthcare system can either restrain or exacerbate the effects of the PRR policy agenda. EU laws and regulations can to some extent restrict the nativist policy agenda of PRR parties. Conclusions The relationship between the PRR and welfare state policy seems to be mediated by the political system, meaning that the public health consequences will differ by country. Considering the increased popularity of populist parties in Europe and the possibly harmful consequences for public health, there is a need for further research on the link between the PRR and public health.

Public health research aims to change the world, or at least contribute to the development of healthier and more equitable societies. However, the availability of health information does not inherently lead to its increased use in policy and decision-making. Significant gap remains between the knowledge of public health researchers and the actions taken by decision-makers. Various tools and mechanisms can help to increase the use of scientific evidence in policy development by making policymakers appreciate, understand and incorporate such scientific information into policy decisions. As part of this process, it is crucial that researchers and public health practitioners acquire the ability to translate their knowledge and become skilled on communicating the evidence effectively. To this aim, we will present firstly a WHO approach for that on the basis of EVIPNet Europe. Member countries have benefited of EVIPNet Europe’s capacity building efforts, its training workshops, coaching and mentoring schemes, leading to increased knowledge and skills in view of identifying, accessing, appraising, synthesizing and communicating the best available evidence. The presentation will focus on the ways to trigger tangible changes at policy and legislative levels. The second presentation will give more specific information about the process of real-life applications. Main question will be “How to advocate scientific evidence to decision-makers in the frame of evidence-informed policy-making?”. The presentation will help the participants to analyze to whom they are targeting, what their interests are and how to communicate scientific information to a decision-maker effectively. Last but not least, common challenges of evidence-informed policy-making process in health care and ways to tackle them will be presented. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science. The workshop will engage participants interactively and leave time for answering their questions at the end. Key messages Public health professionals can influence health policies, if they learn strategies in communicating scientific evidence to decision-makers effectively. Providing correct skills to researchers when communicating about and advocating for the scientific evidence with policymakers will enhance the impact of evidence on policy making.

Background As coordination issues arise in an increasingly complex health domain with a growing number of stakeholders involved in health initiatives, WHO proposed a transformation towards a Whole of Society approach. However, this abstract approach lacks practical guidelines to tackle these issues. In domains such as the environmental policy sector, similar transformations were established by applying governance strategies. This study aims to answer, which conditions and arrangements are found in the governance literature for the coordination and evaluation of the transformation of health towards a Whole of Society approach? Methods A systematic search was conducted by combining ’governance’, with adjectives as ’collaborative’, ’adaptive’, ’experimentalist’ and ’reflexive’ in order to target relevant governance theories in JStor, Web of Science, EBSCO and Google Scholar. Based on inclusion criteria two reviewers independently selected articles following PRISMA. Results Analysis of 56 articles showed that transformation should be coordinated by stimulating favourable conditions such as learning and experimenting in networks that cut across traditional boundaries. These conditions and methods can be divided into three categories. First, establish collaborations with government as equal partner by making the inclusion and decision-making process open and transparent. Second, stimulating innovation by engaging local initiatives, and supporting learning, experimentation, reflection and adaptation. Third, ensuring the sustainability of innovation by enabling institutional change. Conclusions To coordinate and evaluate the transformation of health towards a Whole of Society approach, conditions may consist of a combination of collaboration, innovation and institutional change. Key messages To bring together the fragmented resources for public health, we present emerging conditions for the coordination of a Whole of Society approach as transformative governance strategy. The transformative capacity of governance can be found in the combination of the theories as adjectives: collaborative, adaptive, experimentalist and reflexive.

Background Do political parties matter to health? Do they affect population health either directly, or through welfare states’ social policies and the eligibility, affordability and quality of health systems? And if they do, how? These are crucial questions if we are to understand health politics or shape public health policy, particularly given the changing landscape of both political parties, party dominance in the executive, and the possibly mediating influence of the legislature. Methods This review using a systematic approach examines 107 peer-reviewed articles and books published after 1978 about high-income countries asking the overarching question: Do political parties matter to health and the welfare state? Results As the literature relating parties to health directly was surprisingly thin, the welfare state was used as a ‘proxy’ variable. An overwhelming majority of the literature sample suggests that Left parties are inclined to expand the welfare state and avoid cutting benefits if possible, while the Right does not expand and tends to reduce benefits. There is an inflection in the 1980s when Left parties shift from expansion to maintaining the status quo. Conclusions Considering current health trends in the form of measles outbreaks, the “Deaths of Despair”, the return of presumed eradicated infectious diseases and the declining health expectancy rates in some Western countries as well as the rise of PRR parties in office we question the current partisanship thesis that political parties matter less and less.

In this presentation, information about common challenges of evidence-informed policy-making process in health care and ways to tackle them will be given to the participants. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science.

Contains fulltext : 178380.pdf (Publisher’s version ) (Open Access) If public health is the field that diagnoses and strives to cure social ills, then understanding political causes and cures for health problems should be an intrinsic part of the field. In this article, we argue that there is no support for the simple and common, implicit model of politics in which scientific evidence plus political will produces healthy policies. Efforts to improve the translation of evidence into policy such as knowledge transfer work only under certain circumstances. These circumstances are frequently political, and to be understood through systematic inquiry into basic features of the political economy such as institutions, partisanship and the organization of labour markets. 10 oktober 2017 4 p.

While much research utilisation literature shows an increasing emphasis on the added value of structural partnerships, which should facilitate prolonged interactions between researchers, policy makers and professionals, the question of how such collaborative structures develop over time and what consequences that has in terms of collaboration is usually neglected. This paper offers an empirical analysis of a Dutch partnership format developed over a period of four years, based on two interview rounds conducted between 2007 and 2010, supplemented with document analysis and a focus group. It focuses on changing challenges and dilemmas in different development stages and outlines which strategies are used.

textabstractPublic health policies and services are increasingly scrutinized for their quality and accountability and 'evidence-based' ways of working are becoming more important in most public sector activities. In the Netherlands this led to the development of academic collaborative centers (ACCs) for public health: formal, long-term collaborations between municipal health services, university departments and other stakeholders. In this paper we argue that discussing issues of research uptake or research utilization in terms of 'gaps' that need to be 'bridged' is unproductive when analyzing structural collaborations or partnerships between researchers, policy-makers and practitioners. Within collaborative settings such as the ACCs, the clear distinction between what counts as 'science' and what counts as 'policy' is only one side of the story. We use the notions of 'boundary organization' and 'front stage and back stage settings' to analyze a case study of a collaborative project conducted within one of the ACCs.

Many authors in public health identify gaps between science, policy, and professional practice and seek to solve the problems by facilitating interactions between policymakers and researchers by creating partnership structures. Little empirical research indicates how these interactions contribute to use of research by policymakers, and under which conditions. We provide empirical information by analysing one project in an innovative partnership structure in the Netherlands. We show that although a partnership structure might facilitate interactions, it does not automatically render these interactions meaningful. To balance potential conflicts, careful issue management on a formal and informal level is needed. Partnership designs aiming to facilitate interactions between researchers and policymakers should pay attention to the role of knowledge brokers, expectations of science and policy actors, and the ways in which different perspectives can be helped to converge.

The call for ‘evidence-based health policy’ in the Netherlands has to date been accommodated by the consensual policy tradition in this country and by the institutionalised arrangements for research funding, researcher career development and research accountability systems. The aim of this paper is to describe and explain from a sociological perspective how these arrangements for two-way research–policy interactions enable the co-production of ‘useable knowledge’ for ‘doable problems’ in health policy making. We conclude that many arrangements function as boundary objects that allow for mediation between research and policy. This mediation occurs via both frontstage and backstage processes. The backstage processes are an essential precondition for the co-production of acceptable evidence, policy advice and policy in the frontstage. However, as a result of the increasing emphasis on evidence-based policy, and an accompanying instrumentalisation of research use in the policy process, some of the characteristic, and until now productive, elements of the Dutch system are threatened.

Een belangrijke uitdaging in de publieke gezondheidszorg is het coordineren van onderzoek, beleid, en praktijk. Het ZonMw programma Academische Werkplaatsen Publieke Gezondheid is erop gericht om deze coordinatie te verbeteren, om op die manier enerzijds het onderzoek binnen de gezondheidszorgsector lokaal relevant te maken, en anderzijds het beleid en de praktijk binnen de publieke gezondheidszorg meer op wetenschappelijk bewijs te stoelen. De negen Academische Werkplaatsen die inmiddels zijn opgestart, hebben verschillende (maar ook overlappende) thema’s, zoals Gezondheidsbevordering, Jeugdgezondheidszorg en Infectieziekten. Het instituut Beleid en Management Gezondheidszorg analyseert in opdracht van ZonMw de wijze waarop aan de interactie tussen wetenschap, beleid en praktijk binnen de Werkplaatsen wordt vormgegeven. De Academische Werkplaatsen worden in dit onderzoek geconceptualiseerd als grensorganisaties: organisaties die verschillende ‘sociale werelden’ coordineren en tegelijkertijd verantwoording naar iedere wereld blijven afleggen. Dit artikel beschrijft de eerste resultaten van het onderzoek. De organisatiestructuren, instrumenten, ervaren opbrengsten en genoemde randvoorwaarden van de Werkplaatsen worden vergeleken. Op basis van deze bevindingen worden de interessante spanningen en aandachtspunten in kaart gebracht die in een aantal verdiepende case studies nader worden onderzocht.

Binnen de openbare gezondheidszorg speelt de notie van op ’evidence’ gebaseerd beleid een steeds grotere rol. In dit artikel worden de rol en de betekenis van de VTV beschreven als kennisinstrument voor (overheids)beleid. Vanuit een wetenschapssociologische benadering is onderzocht op welke wijze de VTV zich positioneert als kennisinstrument binnen het gezondheidsbeleid. In hoeverre kunnen we hier spreken van ‘evidence-based policy’ en wat voor vorm neemt dat dan aan? De VTV fungeert, zoals blijkt uit onze analyse, als consensusplatform voor wetenschappelijke kennis waarbij steeds de juiste balans tussen wetenschap en beleid gezocht moet worden. De VTV heeft daarvoor een infrastructuur in het leven geroepen die de participatie van zowel wetenschappers als beleidsmakers in het proces van totstandkoming van de VTV coordineert, zonder dat beiden in elkaars vaarwater terechtkomen. De VTV manifesteert zich frontstage als een wetenschappelijk gefundeerd kennisinstrument met een duidelijke rol binnen het beleidsproces van de overheid. Anderzijds vergt deze rol backstage veel informeel overleg en onderhandeling tussen verschillende actoren uit alle lagen van de overheid en het centrum VTV in het VTV proces. De opzet van de VTV maakt deze twee posities mogelijk. De huidige ontwikkelingen binnen het zorgstelsel vereisen een grotere rol voor lagere overheden, provincies en gemeenten in het zorgdragen voor een goed functionerende openbare gezondheidszorg. Regionale en lokale overheden hebben daarvoor instrumenten nodig die vaak nog niet zijn ontwikkeld. De manier waarop de VTV vorm geeft aan haar gezaghebbende rol binnen het evidence based gezondheidsbeleid van de centrale overheid kan als ’good practice’ dienen voor de verdere ontwikkeling van beleidsinstrumenten voor lokale en regionale overheden, bijvoorbeeld bij het opzetten van lokale VTV’s. De belangrijkste les is dat bruikbare kennis alleen tot stand kan komen in de interactie tussen beleidsmakers en experts. Daarvoor vormen backstage coordinatie van informele contacten tussen experts en beleidsmaker een noodzakelijke voorwaarde voor evidence based gezondheidsbeleid.

Contains fulltext : 163359.pdf (Publisher’s version ) (Closed access) BACKGROUND: The National Prevention Program ‘Everything is Health' (EiH) 2014–2016) has adopted a ‘Whole of Society' (WoS) approach by engaging societal and business organisations as well as public authorities and services to pledge their commitment ‘to the realisation of the EiH goals by conducting specific focused activities'. Our two-year evaluation focuses on the governance and organisational conditions for the coherence, spread, consolidation and accountability of health promotion activities in the pledges, and the functioning of the EiH arrangements. METHODS: Three research stages consist of (1) a literature study and exploratory interviews of similar programs such as the UK Responsibility Deal, and the Dutch Corporate Social Responsibility program; (2) a qualitative monitoring of the Program Office and a selection of pledges; and (3) a responsive evaluation among and between program officers and pledgeholders in the EiH Platform. RESULTS: We consider EiH to be a governance experiment sharing responsibilities for health among public and private actors while developing a sustainable social order. One condition is to build an infrastructure for sharing knowledge, experience and feedback for peer review in an advanced pledgeholder community of practice. Another condition is to discourage non-compliance. There will be no sustainable health impact without such a consolidating infrastructure. Evaluating such a complex, ambiguous and uncertain approach requires a careful interaction between evaluators and program officers, pledgeholders and stakeholders. The EiH Platform can serve as a joint evaluative infrastructure. CONCLUSIONS: Evaluating the EiH program as a governance experiment is a necessary precondition to organising health impact. Building a consolidating infrastructure for a sustainable order of responsibilities and health impact takes time, effort and risk. Evaluation design can set an example of an infrastructure for sustainable health impact.

Like any policy-relevant research, HIA faces the risk of not being used by decisions-makers. This article addresses the questions: “How do policy decisions come about?” and “How does this affect HIA?” Current literature in political-administrative sciences identifies three ways for decision-making: rational, incremental and mixed model. These models define the relationship between the policy process at stake and the HIA. In incremental or mixed model decision-making, use of HIA evidence by policy-makers is heavily dependent on their values in the context, which may result in conceptual utilization or may extend to strategic utilization. In rational decision-making, HIA provides information independent from the context, which results in instrumental utilization. HIA practitioners need to optimise utilization and produce an appropriate HIA by mapping the policy process. They can do this by asking the questions ‘What? How? Who? and What context? and by maintaining continuous communication with the decision-makers. An appropriate HIA is policy-, time- and place-specific: reflecting the decision-making of the policy at stake. Furthermore, HIA concerns two policy fields with two different contexts and, in some cases, two different decision-making models. The administrative requirements for an appropriate HIA need further exploration.

Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science of sociology and knowledge management. This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model ‘City & Environment’ that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIA was part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decision-making behaviour. Appropriate cognitive and social strategies are needed to avoid ‘negative learning’ in those the HIA seeks to influence.

Hoe treffend is de titel ‘Buiten de gebaande paden’1 van een advies, waarmee de RVZ, de Onderwijsraad en de Raad voor het Openbaar Bestuur het goede voorbeeld geven. Vanuit bestuurskundig oogpunt maakt het advies de ambities en de daarbij horende systeemvoorwaarden en verwachtingen ten aanzien van de betrokken partijen zichtbaar. De daadwerkelijke realisering van intersectoraal gezondheidsbeleid vergt echter meer dan in het advies wordt uitgewerkt.