Whether they are earned income tax credits, cigarette sales taxes, Medicaid expansion, or firearm safety laws, state policies have an impact on population health. But figuring out the causal pathways is challenging and often indirect. For instance, increasing minimum wage policies may improve birth outcomes and reduce teenage pregnancy and smoking, but the underlying economic drivers of these changes are complex and may have unintended consequences.
Identifying the mechanisms through which policies change is critical for policymakers and researchers to understand how they can best drive positive community change. Existing policy change frameworks are distilled into three key elements or explanatory variables: institutions (processes, context); interests (actors, power); and ideas (content, evidence, values). More recent research has paid growing attention to networks as a policy change variable. Networks are empirically measurable sets of actors and their relationships and can be intentional governance or management structures with the capacity to act strategically (i.e., a HIV issue network).
Although previous research has shown that policy changes tend to correspond primarily with the preferences of citizens with high socio-economic status, the mechanisms through which this happens remain underexplored. This article takes a closer look at what factors might explain why political representatives’ opinions and policy output are more likely to reflect the preferences of advantaged groups than those of disadvantaged social groups. The analysis considers both the relative importance of these factors as well as their timing, in terms of when and how they lead to policy changes.
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