Policy Innovation for Health

Edited by Ilona Kickbusch , published by Springer NY . 2009 , 208 pages . Hardcover . ISBN 978-0-387-79875-2 . RRP $110.95 .

Reviewed by Vivian Lin

School of Public Health, La Trobe University, Victoria

Ilona Kickbusch has long been a thought leader and trend-setter in public health and health promotion. She was recently the Thinker-in-Residence in Adelaide who helped chart the South Australian Health-in-All-Policies approach. When a new book edited by Kickbusch is released, with a title that points to innovation, many will want to know what the latest cutting-edge thinking is.

Kickbusch introduces the book as the result of a two-year conversation (2006–08) between six authors. The mission was to map policy innovations in health governance in OECD countries. There are only six chapters – on policy innovations for health, innovation in monitoring of health and well-being, financing for health in all policies, health as a driving economic force, using network governance to integrate health in all policies at the local level, and citizen health information systems as knowledge-centred health innovation. It is unfortunate the only information about the lead author of each chapter is their current organisational location; there is no other information which might shed light on their background or experience that might help the reader place the author in context.

Each of the chapters can be a stand-alone paper. The first chapter, by Kickbusch, sets the scene. Then the chapters unfold as distinct contributions. They clearly emanate from different disciplinary perspectives, go through some basic literature and frameworks from the respective disciplines, before moving on to either application or case studies. Chapter 2 on monitoring health and well-being provides a useful table of summary indicators in use and proposes creating indicators that can point to “health expectancy gained through policy”. Chapter 3 reviews health sector financing strategies, considers the politics of why public health is the poor cousin in health system financing, and points to French public health and health care financing reform laws as a model of shifting from ‘spending’ to ‘investment’ as the paradigm for financing. Chapter 4 is a review of macroeconomics and health, in the context of the OECD discourse on the relationship between human capital investment and economic growth and productivity. Chapter 6 reviews a typology of networks and considers the concept of network governance, before suggesting how networks might be managed to achieve efficient integrated inter-organisational action. Chapter 7 starts with overview of notions of knowledge society and innovation, then moves to consider citizen-centred information systems (including moving from electronic health records to personal health information systems).

This is an advanced reader, rather than a book for the beginner. (The price certainly makes it somewhat out of reach). Despite the overview of basic concepts and frameworks in each chapter, the chapters are pitched at a well-versed professional and academic audience. The language used in the book has a certain European complexity about it and can be heavy going. A good native English speaker may have been useful to help transform it into more readily comprehensible text that would be suitable for a wider audience. At the same time, however, it wasn't clear that some of the chapters were offering much by the way of innovation. For instance, in reviewing the evidence on macroeconomics and health, chapter 4 did not offer new insights. On the other hand, I found Chapters 6 (network governance) and 7 (citizen health information systems) most useful, in part because they provided more concrete illustrations of the kind of paradigm shift they were arguing for.

The chapter that had me ruminating the longest was the opening one which posits that “we now live in a health society, which is characterised by two major social processes: the expansion of the territory of health and the expansion of the reflectivity of health” (p.3). While these major social processes may be aptly described, I wonder why we need the term ‘health society’. It seems to me that the notion of the good society binds many interests, and the pursuit of a good society may be better common ground than the pursuit of health. But perhaps I need to read it again, and again.