Salvador Tortajada
Fundacion Para La Investigacion Del Hospital Universitario La Fe De La Comunidad Valenciana

The definition of what is a Health Policy may be difficult since it depends on the profile and the experience of who defines it. In the framework of the CrowdHEALTH project, we mainly follow and broaden general definitions by Buse and Smith [Buse et al. 2012, Smith et al. 2009] and we base our definition on the policy analysis triangle model proposed by Walt and Gilson in 1994 [Walt & Wilson, 1994]. In the CrowdHEALTH project we extend this well-known triangle model that includes the concepts of the context, the content, and the process and that also involves the actors. We propose two add two new concepts to this model. Firstly, we propose to take into account a measure of the evolution of a Public Health Policy (PHP) by incorporating Key Performance Indicators (KPIs). Secondly, we suggest including a differentiation between active actors and passive actors that we call stakeholders.

In the resulting definition, the context of a policy defines why the policy is needed and refers to those cultural, structural, situational and/or international factors that may have a relevant effect on PHPs.The content of a PHP defines whatspecific issues are being the focuses of the policy, such as how to improve access to the healthcare system, how to increase efficient use of hospital resources, or how to promote a better lifestyle among others. The process of policy making can be seen as a methodology since it defines how the policy is brought forward and implemented. The active actors are individuals, groups, or organizations that are relevant decision-makers and/or who are interested in monitoring the effect and evolution of the policies that have been created or modified, while the stakeholders are any individual, citizen, group, or organization whose health status may be affected by the defined PHPs but who do not take any decision. However, it is worth mentioning that stakeholders and actors may not be disjoint sets, since a citizen can be promoting policies, hence having the role of an actor, and at the same time being affected by the PHP, hence having the role of a stakeholder. Finally, KPIs are measures of performance that are of utmost importance to enhance decision-making and to monitor and track evolution of the public health policies that have been implemented to assess whento continue with the same policies, apply corrective measures, or even to partially or completely redefine the content of the PHPs. KPIs should be based on standards and are determined through scientific evidence or through the consensus of experts, when evidence is unavailable, to provide feedback to key actors about the results being achieved and to use this information to improve PHPs. These concepts are illustrated in the figure of the attached file, where the initial triangle model has become a health policy star model.

To summarize, we consider a PHP to be the decisions taken within a context by those responsible in the public sector, following a methodology, that covers a set of actions (or inactions) that affect a group of public and private actorsof the health care system, such as citizens, patient associations, insurance companies, or healthcare professionals, in order to achieve specific health care goals that are measured by specific Key Performance Indicators.


  • Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353–70.
  • Buse K, Mays N, Walt G, Gilson L. Making Health Policy (Understanding Public Health). Second. London: Open University Press; 2012. 236 p.
  • Smith PC, Mossialos E, Papanicolas I, Leatherman S. Performance Measurement for Health System Improvement. Experiences, Challenges and Prospects. Smith PC, Mossialos E, Papanicolas I, Leatherman S, editors. Cambridge University Press; 2009.