## Introduction Public health professionals would not, for example, call for ‘individual will’ as a solution to obesity. Nor should we call for political will as a solution to policy problems. The objective of this paper is to renew interest in a political analysis of health policymaking with the aims of (i) illustrating how the political economy, party politics, interest groups and institutions obstruct or facilitate particular public health policies and outcomes, and (ii) creating awareness of how public health interest representation should also allow politicians to claim credit and to avoid blame or inconclusiveness. ## Box 1 Populism and public health - The populist radical right is nativist (believing that there is an ethnically united people with a territory, aka nationalism or ethnocentrism), authoritarian (believing in the value of obeying and valuing authority) and populist (preferring the 'common sense' of a united people to elite knowledge). - Populist politicians ‘infect’ regular party politics by showing the possible electoral rewards of adopting populist positions that might contradict evidence, norms or the law. This effect is visible in immigration policy in many countries, where mainstream parties adopted harsher policies as responses to populist radical right challengers. - The populist radical right therefore challenges the checks and balances of the political democratic system and the protections that exist for minorities. Once in office, there is a risk of ‘democratic backsliding’ when ‘elections happen but without a realistic chance of them leading to a transfer of power’.8 - [[Interesting Phrase]] Combined with a recent trend towards populist ‘[[welfare chauvinism]]’, populist policies could have very significant implications for unfair redistributive policies, unequal access to welfare benefits and increasing health inequalities.9  Whether they will, and how, depends on the political context that makes them more or less powerful and their agendas more or less practical. ## How evidence-based medicine led us away from what matters The world is too dominant on "knowledge-based medicine" in public health field. It might be well off for biomedical intervention, but for policy-making, it is not that simple. The root of this is Cartesian 'randomized clinical trial (RCT)' dubbed as Gold Standard of evidence generation. We must be aware that generating and using RCTs in biomedical research is already difficult, let alone society. [[Scientific knowledge generation does not automatically translate into (policy) solutions and practices]]. > The clinical world has struggled—and continues to struggle—with the need to develop simple, tools that would both explain and facilitate the movement of evidence into practice. [[Insights]] [[Interesting Phrase]] Apparent solution is [[Knowledge Translation (KT)]]: ‘...a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system’. However, it is also political because it may or may not serve the powerful elite. Moreover, the flip-side is also found: approached to empower the voiceless to affect policy decisions affecting their lives. ## Analysing public health politics: a basic toolkit [[Question]] Two core questions to ask of any political system that shape public health politics and policy: 1) what shapes the political options for public health? 2) what are the political techniques and the strategic landscape of the political systems in which these political options are played out? 1. what shapes the political options for public health? 1. [[Constitutional structure]]: the division of powers, the extent of regional and local autonomy, and the role of courts. Indonesia has decentralized governance. WHO has "command and control" approach to health emergencies. However, these approach is simply pointless if given to a country whose constitution lodges public health powers in the states rather than central governments (USA, Canada, Spain). 2. [[Local government is often overlooked variable part of social and health policy]]. Its role tend to be largest in areas of great relevance to public health as such social care, restaurant inspection, education and school health, and local built environment. The powers of a president, legislature or court, change, but at any given time they matter a great deal. 2. How the strategic landscape shapes politicians' actions? 1. Health policy writers have a strong tendency to assume that enlightened health policies depend on 'political will' that can overcome inertia and industry lobbying. 2. Will and framing are not the only variables predicting political success. Even successful framing can produce perverse results: [[a focus on inequalities in health directed policy attention not to the underlying social and economic inequalities, but rather to public health interventions that were never likely to reverse the inequalities of modern society. The result was failed health inequalities policies and a diversion from addressing real determinants of health inequalities]]. 3. Political scientists generally avoid such voluntarism and examine the components and circumstances of political will. Another topic is partisanship: political parties structure modern politics because they are the teams on which politicans compete for power, eg, policies such as tobacco control or global health aid are often adopted by parties in the hope that they will resonate with particular groups of voters. 4. [[Thinking politically (on the politics of politics)|If we start from understanding how given politicians think about credit, blame and traceability in a given political system then we will not be far from understanding them]] ## Conclusion and implications for public health education, research, political strategy [[We need to better understand the constitution, political system, institutions, and processes that mediate the success or failure of public health advocacy and policies. Without that, public health interventions are not likely to generate sustainable health impact]]. Therefore, we need: 1) A public health political science generating evidence on (i) the political options for public health appropriate to the characteristics of the constitutional order, the political economy and (ii) the political techniques and strategic landscapes of interest representation and partisanship. 2) A political action repertoire for politically informed public health practitioners working at the nexus of different policy sectors; disciplines; and science, practice and political arenas. Important to have understanding of party systems and interest groups, also teach professional skills such as effective lobbying, media engagement, social media and the mechanics of consultation (how and when governments solicit advice). [[Political strategis are always context dependent, but there are few points that apply in most systems: 1) respect political professionals, 2) make use of resources that are already available, 3) effective use of social media, organizing techniques, testifying before legislators and input into public consultations, 4) persistence]]