| Summary: | Health promotion research and practice reveal that goal setting and monitoring have
gained increased acceptance at international, national, provincial/state, regional and local levels
as a means to guide health planning, promote health-enhancing public policy, monitor reductions
in health inequities, set health priorities, facilitate resource allocation, support accountability in
health care, and track the health of populations. The global adoption of health goals as a strategy
for population health promotion has occurred even though few protocols or guidelines to support
the health goals development process have been published; and limited study has occurred on the
variation in approach to health goals planning, or on the complex, multiple forces that influence
the development process.
This is an exploratory and descriptive case study that endeavours to advance knowledge
about the process and contribution of health goals development as a strategy for population
health promotion. This study seeks to track the pathways to health goals in British Columbia
(BC) and to uncover influential factors in rendering the final version of health goals adopted by
the government of BC. Specifically, this study explores the forces that obstructed and facilitated
the formulation and articulation of health goals. It considers also implications of health goals
development for planning theory, research and health promotion planning. Data collection
consisted of twenty-three semi-structured interviews with key participants and systematic review
of BC source documents on health goals.
Data analysis uncovered nearly 100 factors that facilitated or obstructed the BC health
goals initiative, organized around three phases of health goals development. Key factors
influencing the premonitory phase included (a) government endorsement of health goals that
addressed the multiple influences on health, (b) expected benefits of health goals combined with
mounting concern about return on dollars invested in health, and (c) effective leadership by a
trusted champion of health goals. Key influencing factors in the formulation phase included (a)
the positioning of the health goals as a government-wide initiative versus a ministry-specific
initiative, (b) the "conditioning" of the health goals process through the use of pre-established
health goals and "orchestrated" consultation sessions, and (c) the make-up and degree of
autonomy of the health goals coordinating mechanism. The articulation phase of health goals
development revealed several influencing factors in relation to two chief issues that characterized
this phase: (a) the lack of specificity of the health goals, and (b) the variable portrayal of the
"health care system" as a priority area in the BC health goals.
This study also revealed several concessions and trade-offs that characterized the BC
health goals process. For example, the formulation of health goals that addressed the broader
health determinants yielded health goals without the capacity for measurement, (b) the
operational and bureaucratic autonomy of the health goals coordinating mechanism led to
feelings of alienation from the health goals process and product among some branches of the
Ministry of Health and some established health interests, and (c) the use of pre-determined health
goals and the delivery of educative sessions based on the determinants of health generated claims
of bias and a lack of trust and fairness in consultation processes and mechanisms.
|
|---|
