The Hidden Players in Public Health Policy (according to research)

by Jon Scaccia February 14, 2025

Public health policies don’t implement themselves. Behind every law, regulation, or guideline, there’s a network of decision-makers—policy developers, implementers, disseminators, influencers, and enforcers. But who exactly are these people? And how can researchers engage them effectively to ensure policies actually improve health outcomes?

A recent study introduces a structured, five-step methodology for identifying and engaging policy actors. Using the Family First Prevention Services Act (FFPSA) as a case study, researchers developed a taxonomy to clarify who shapes policy at different levels and phases of implementation. This approach could revolutionize how public health professionals work with policymakers to turn research into action.

Why Does This Matter?

Policies, particularly large-scale “Big P” policies (like state and federal laws), can profoundly impact public health. However, their success hinges on the individuals responsible for rolling them out. Engaging the right people early can help ensure that evidence-based interventions are adopted and sustained.

Traditionally, implementation science has focused more on “little p” policies—organizational guidelines, hospital procedures, or local programs. But understanding the broader policymaking landscape is crucial for creating lasting change. This study provides a roadmap for researchers to navigate that complex space.

The Five-Step Method to Identify Policy Actors

The study lays out a structured way to identify key policy actors and their roles in policy implementation:

1. Clarify the Policy Implementation Phase(s): Determine whether the policy is in the exploration, preparation, implementation, or sustainment phase. Each phase has different actors and priorities.
2. Identify the Policy “Room(s)”: Find out where key policy decisions happen—formal settings like legislative sessions or informal spaces like email threads and hallway conversations.
3. Identify and Characterize Organizations in the Room: Understand which institutions (government agencies, nonprofits, advocacy groups) are shaping the policy landscape.
4. Identify and Characterize Policy Actors: Pinpoint individuals within those organizations and categorize their roles—are they developers, disseminators, implementers, influencers, or enforcers?
5. Summarize and Compare “Rooms” to Inform Engagement: Analyze the composition of different policymaking spaces to see which voices are overrepresented, missing, or crucial for effective implementation.

Case Study: The Family First Prevention Services Act (FFPSA)

To test this framework, the researchers applied it to FFPSA, a federal policy aimed at reducing child maltreatment and out-of-home placements. The law required states to develop five-year prevention plans, but it wasn’t immediately clear who the key decision-makers were in each state.

By systematically searching public documents, websites, and reports, the researchers identified policy actors involved in FFPSA implementation. Their findings revealed that decision-making rooms varied widely by state, with different stakeholders influencing adoption and execution.

This process not only mapped out policy actors but also highlighted potential gaps—like the absence of community-based organizations in some states’ planning processes. By using this method, researchers and advocates can better understand power dynamics and tailor their engagement strategies accordingly.

What’s Next?

This methodology is a game-changer for public health and policy researchers. By systematically identifying policy actors and decision-making spaces, it becomes easier to:

• Build research-policy partnerships that translate evidence into action.
• Ensure diverse stakeholder representation in policy discussions.
• Develop targeted implementation strategies that account for real-world political and organizational dynamics.

Future research should explore how this method applies in different policy contexts—beyond child welfare, into areas like opioid prevention, mental health services, and climate policy. Additionally, refining techniques like social network analysis could further clarify relationships between policy actors and their influence on health outcomes.

Join the Conversation

What do you think about this approach? Have you encountered challenges in engaging policymakers for implementation research? Who do you think is often missing from the “room” in public health decision-making? Share your thoughts in the comments or on social media!

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