3.1 Politics and governance: achieving the co-benefits
The logic of co-benefits has two compelling advantages relative to other ways of approaching intersectoral health action:
As health policy, the causal connections between health and health systems and other outcomes are important and make a convincing case for investments in health and health policies. It also allows for an increase in attunement to the other goals health policy can influence.
As health politics, it focuses conversations on win-win outcomes. This permits broader coalitional politics, rather than relying on the generally unproven ability of health advocates to mobilize another set of actors.
Delivering these goals, though, depends on politics governance: the institutions and organizations that make and implement decisions that can bring together or force apart organizations, sectors and people.
Achieving co-benefits puts a spotlight on politics and governance, in particular for the policy-focused approaches. How can health policymakers and health care leaders work with others to produce safe, healthy, equitable and sustainable cities and economies? How can they seek positive-sum, win-win solutions that build political coalitions to support a policy’s passage, implement it, and sustain it? Such win-win approaches enhance policymakers’ ability to build necessary supporting coalitions for policy (Reference Greer, Lynch and ReevesGreer et al., 2021b, Reference Greer, Lynch and Reeves2022a).
In the previous chapter, we have identified where the impact of the co-benefits is likely. In this chapter, we address the reasons why potential win-win solutions are precluded, ignored or adopted but not implemented or sustained. Administrative history is littered with more and less successful efforts to promote “joined up government” and other such goals (Reference BogdanorBogdanor, 2005). Here we show how we can build on these concepts to formulate and answer a set of important theoretical and practical questions.
How can evidence from research on co-benefits be most effectively used in different political situations and systems in order to develop policies that promote co-benefits?
What kinds of arguments and knowledge translation approaches work in different countries and political situations?
What governance approaches work in different situations to implement and sustain co-benefits approaches?
How should policies for co-benefits address the challenges of multi-level governance and the need for a whole of government or whole of society approach?
In health, a sector often known for its comparative isolation from the rest of government, efforts to integrate a broader logic into this argument are not new. A focus on co-benefits is an extension of longstanding research and practical experience in intersectoral policies, notably Health in All Policies (HiAP) in recent decades. The intuitions behind it are, of course, much older. Claiming that a single policy achieves multiple goals – has many co-benefits – is a persuasive tactic as old as politics. Creating or holding together a political coalition by winning supporters with different priorities is often necessary.
Governance is how societies make and implement decisions (Reference Greer, Vasev and JarmanGreer et al., 2019) – the formal and informal institutions that manage conflict and turn it into policy. This chapter introduces the two governance frameworks used throughout the case chapters to identify opportunities for action to achieve goals when political action is required.
3.2 Getting to a win-win: identifying practical co-benefits
Achieving co-benefits places the focus on politics and governance. Without them, the best-evidenced study or most persuasive model is unlikely to lead to real change. The study of political systems is rightfully a field in its own right. Everything is ultimately political, for the implications of even the most technical and scientific determinations and questions will be decided in the broad arena of politics and government (and to make something technical and scientific is to successfully constrain the scope of conflict over that topic).
This chapter presents two basic frameworks for identifying opportunities to make successful policies for co-benefits. One is for addressing the problem of change within government, in the framework commonly used by advocates of intersectoral policy. We adopt a framework from Edward C. Page that can clearly identify key dynamics and opportunities for the construction of cross-cutting policies, as well as the areas in which, under current circumstances, progress is likely to be limited and advocates might find themselves frustrated or defending their achievements against attack. This approach is essentially internal to government and the sectors involved.
The second approach to analysing politics and the possibility of action is grounded in the analysis of agenda-setting (Reference Greer, Kingdon, Agendas, Balla, Lodge and PageGreer, 2015; Reference Herweg, Zahariadis, Zohlnhöfer and WeibleHerweg, Zahariadis & Zöhlnhofer, 2023; Reference Jones, Peterson and PierceJones et al., 2016; Reference KingdonKingdon, 2003; Reference Zahariadis and SabatierZahariadis, 2019), which has been profitably applied to the area of intersectoral policy for health (Reference Leppo, Ollila and PeñaLeppo et al., 2013). Well known in health policy research, the multiple-streams framework focuses on the separate interests and development of political and policy debates as well as problems that can erupt unpredictably. The interplay of these three streams can produce a political agenda – which is not the same thing as legislation or government agreement, but is usually a precondition for any successful legislation.
In both cases, these are basic analytic frameworks for understanding which action is likely to be effective in improving the likelihood that proposals for achieving co-benefits do achieve their potential benefits. Notably, neither is a discussion of legislative adoption, a different topic that involves a wide range of institutional, partisan, economic and other factors studied by comparative politics. Nor is it a discussion of the policy design (governance of intersectoral action) and implementation after enactment. The chapter does not discuss the governance and implementation of the policies, a subject of considerable investigation and writing, which is discussed in the next chapter. Instead, the chapter focuses on two robust frameworks which can be useful in identifying opportunities to make coalitions and policies.
3.3 Salience and conflict: making policy in complex governments
Coordination is the “holy grail” of public administration (Reference Boin, Ansell and LodgeBoin et al., 2011; Reference PetersPeters, 2015) and the COVID-19 pandemic has clearly shown its importance (Reference Greer, Jarman and FalkenbachGreer et al., 2021a). Unfortunately, it is also a notoriously difficult political and administrative problem and an intractable concept for many researchers and policy thinkers. The basic problem is that the diversity of interests in any modern society means that government is pulled in many directions. While speaking of sectors or organizing around ministries and agencies gives some basic orientations to the conversation, a quick look at most health ministries shows how they often combine, or are combined with, quite diverse functions (Reference RoseRose, 1987). Furthermore, organizations and institutions have entrenched interests and ways of thinking. Even if there is an argument that they could do their jobs better were they to change approaches, the process of creating widespread acceptance and implementation of a change can be very prolonged and politically exhausting.
Consider health ministries (Reference BriatteBriatte, 2010; Reference GreerGreer, 2010; Reference MätzkeMätzke, 2010; Reference SheardSheard, 2010). Until the 1980s, most West European countries, Bismarck or Beveridge, folded health care into a ministry of labour or social security, packaging the delivery of health care with other areas of social insurance such as pensions and unemployment insurance. That gave health a certain kind of coherence, as a form of insurance against a social risk, but also made it hard for governments to treat health as a topic in its own right. As governments became increasingly engaged with health and health care management from the 1980s, they created freestanding health ministries along with arguments about what issues (youth? families? social care? sport?) should be packaged with and implicitly subordinated to the goals of health and health care.
Furthermore, a focus on intersectoral governance as a problem of public administration tends to direct our attention towards problems of administration when the greater challenges are often political. The recalcitrant ministry or sector will often reflect the interests of some well entrenched interest, party or faction rather than being mulish or inert. Analysts can go a long way by focusing on structural interests and politics of ministries and sectors such as transportation, health care, education or finance. However, those ministries’ actions often reflect deep political disagreement rather than a problem of bureaucratic politics. Just consider the resistance of health sectors to the austerity imposed in many European countries after the 2008 financial crisis – a failure of coordination in the eyes of many finance ministries and central banks but a laudable fight to maintain essential health services in the eyes of many in the health sector (Reference FierlbeckFierlbeck, 2021; Reference Greer and BrooksGreer & Brooks, 2020).
Hierarchy, meaning an attempt to subordinate one issue area to another, might look like a lasting solution. It is certainly a common one, with governments worldwide operating formal and informal hierarchies of departments and ministerial posts. That might be desirable, but it is unlikely to work if the underlying interests, political priorities and institutions do not support it. Instead, the solution will often lie in a more subtle politics of coalitions, identifying the particular mixtures of wins that will create a strong supportive coalition for enacting and implementing the policy. The creation of such a coalition will often depend on very specific policy compromises (for example, to do with who works or what kinds of companies provide a service) and sometimes side-deals in entirely separate areas, something generalist politicians and major interests will often do. Nonetheless, the basic social coalitions that can underpin a successful policy will often be explicable in terms of policies that unite their shared interests.
Many co-benefits can be attained by action within a single sector, ministry or organization. Improved school nutrition or reduced catastrophic health care costs can be achieved without intersectoral cooperation. They might not even require new resources if the money can be redeployed from elsewhere within the sector. This means, perhaps paradoxically, that some of the greatest co-benefits will come from sectoral, rather than intersectoral, actions. If reducing catastrophic health care costs is a route to reducing poverty and social risk, then a health care finance policy aimed at reducing it can receive support from across government. If better and more easily available school meals improve student health and education, that might be perfectly attainable within a normal education budget. Coordinating within a sector is by no means easy; it is easier to write about redeploying resources from elsewhere within the sector than to actually do it (consider the noteworthy failure of many efforts to redirect health care resources from hospitals into primary care and prevention).
It is often then harder when multiple sectors are involved, if nothing else because people within a different sector, however much they disagree, will often have a shared interest in avoiding intervention by outsiders. Understanding routes to effective action requires understanding the particular political system and government constraints involved. Fortunately, there are useful middle-range social scientific tools for this (Reference Greer, Fafard, de Leeuw and CassolaGreer, 2022; Reference Greer, Vasev and WismarGreer et al., 2017a, Reference 53Greer, Bekker and Azzopardi-Muscat2018). These can include understanding agenda-setting dynamics, which are useful for policy entrepreneurship and advocacy (Reference Greer, Kingdon, Agendas, Balla, Lodge and PageGreer, 2015; Reference KingdonKingdon, 2003; Reference Leppo, Ollila and PeñaLeppo et al., 2013; Reference Moran, Rein and GoodinPage, 2006) as well as understanding the particular institutional and political landscape of a given country.
In terms of identifying prospects for effective action, intersectoral or within a sector, Edward C. Page developed a simple four-cell that is very useful for understanding the prospects of a proposal for action, shown in Fig. 3.1 (Reference BogdanorPage, 2005). Two questions arise when considering a proposal for action: 1) Is the proposal contentious between one or more powerful actors? 2) Is the proposal salient to high level political generalists whose intervention can force a resolution to a dispute?
A high salience, low conflict problem has the highest potential of being resolved
In the abstract, the ideal situation for policy change is a high-salience, low-conflict policy. The second best is a low-conflict, low-salience area where patience can often achieve good outcomes. A high-conflict, low-salience issue has a bad prognosis since it is unlikely to attract the attention of more powerful actors who can decide an outcome. In contrast, a high-conflict, high-salience issue is likely to get a resolution because the top of government cannot avoid it. Note that both salience and conflict are partly rooted in the public administration and legal structures that preoccupy literature on intersectoral governance and HiAP. Still, both reflect broader politics which manifest in the creation, operation and leadership of different ministries and organizations.
The usefulness of this framework is twofold. Not only does it help to determine where a given proposal currently finds itself in terms of political importance and conflict, as previously mentioned, but it also helps us understand how the proposal can gain political importance while simultaneously becoming less conflictual. Thus, focusing on co-benefits has two potential rhetorical advantages in understanding and acting within this type of situation. First of all, it can increase the salience of the issue by offering more, or by documenting greater harms from a policy than were previously understood. For example, let’s consider the impact of catastrophic health care costs as a problem of both immiseration – poverty creation – and health access. There might be a bigger constituency to address them than if we only focus on health care access. Second, focusing on co-benefits also allows us to consider ways to redirect the conversation to reduce conflict. Identifying win-win solutions can release us from win-lose (or lose-lose) policy debates that have often gone on for a very long time and are often framed entirely within the constraints of very crude budgeting logic (Reference WhiteWhite, 2013). Win-win solutions are often attractive, in particular, to powerful generalist policymakers at the top, who are naturally reluctant to make tradeoffs.
3.3.1 Shaping the agenda and seizing opportunities
Almost all policy ideas seem to have been around for ever. What changes is how they are adapted to the moment by political entrepreneurs who support and advocate for them, and the mixture of policy problems and political calculations that lead to them being placed on the political agenda. This is the basic insight of the multiple-streams framework originally developed by John Kingdon, drawing on organizational studies.
The multiple streams framework is a theory of agenda-setting, not legislation (though in some systems with strong and unitary governments, the gap between being on the agenda and being adopted can be very small). It is about how a particular policy idea becomes something that is discussed and might be adopted. It focuses on three streams. The policy stream is where many health policy experts live. It is the discussion of policy problems and solutions. While there are many people interested in policy development and analysis, the key people involved are policy entrepreneurs who have the skills and networks, and dedicate the time, to promoting an idea and building a coalition of supporters who will validate it and aid its passage if it gets onto the agenda. Policy entrepreneurs are really a necessary condition for policies to matter. Still, they might be particularly important in the logic of co-benefits where being taken seriously across multiple policy fields requires energy and credibility in different areas that many experts will lack.
The political stream is what politicians want to do, probably summarized most simply as the need to make a mark (remember: a politician can be intensely committed to a goal, but they can best advance that goal by being in office so that politicians will prioritize election and re-election above almost anything else). The question for politicians is how a policy idea can pass and its effects – will it reward a key constituency? Will voters see, appreciate and reward it? Will it be necessary for important issues such as business confidence, unemployment or the interest rate on government debt?
Finally, the problem stream is the set of issues widely acknowledged to need a response (problems are separate from conditions, which are tacitly understood to be unchangeable and tolerated). For example, the European political agenda since 2008 has featured an economic crisis, which triggered a debt crisis; a putative refugee crisis; Brexit; a vast global pandemic with associated disruptions; and a large-scale land war. Other problems, such as geopolitical competition, economic productivity and carbon neutrality, are constantly highlighted, including regular events such as unemployment reports and fires or floods. A successful politician tries to focus their participation in this issue effectively (even if that means being unobtrusive because it isn’t an issue that plays to their strengths). A successful policy entrepreneur explains how their policy contributes to solving at least one of these problems.
When the three streams come together, a policy gets on the agenda and politics can move remarkably quickly. Many of the whole of government responses to COVID-19 showed this. Co-benefits arguments might be especially well suited to getting onto the agenda since it is often easy and intellectually valid to show, for example, how health care systems can contribute to both carbon neutrality and response to disasters.
3.3.2 Credit and blame
It is almost axiomatic in political science that politicians seek to get credit for positive developments, whether or not they caused them, and avoid blame (Reference WeaverWeaver, 1986). An abundant literature in political science discusses these dynamics (Reference HinterleitnerHinterleitner, 2017, Reference Hinterleitner2020) and they are key mechanisms explaining influential findings in comparative health and social policies, such as the difficulty of retrenching welfare states (Reference 52Falkenbach, Bekker and GreerFalkenbach, Bekker & Greer, 2019; Reference PiersonPierson, 2001). The most attractive policies are easily “traceable” for voters, designed to clarify what politician or party was responsible for the new policy or investment. In the absence of traceability, when political, fiscal or institutional constraints mean that the party or politician cannot make a traceable policy, they will often resort to “position-taking”, in which they highlight their stances on major issues in lieu of being able to take creditworthy action. Traceability is also key to sustaining policies against the opposition because it clarifies which parties support and oppose a given policy. During the COVID-19 pandemic, all this behaviour was frequently on display, with heads of government centralizing government around themselves when there was credit to be had and decentralizing responsibility when blame was likely (Reference Greer, Rozenblum and FalkenbachGreer et al., 2022b), while parties unable to produce traceable, creditworthy results in health policy experimented with position-taking on issues such as masks, vaccines and China (Reference Falkenbach and GreerFalkenbach & Greer, 2020).
Attention to the politics of credit and blame can lead to a distinctive approach to policymaking, advocacy and research, which differs from some common approaches. It emphasizes opportunities for clearly traceable and, therefore, simple and robustly administered policies rather than complex systems of delegation or contracting. It emphasizes policies that make the wins clear to every coalition member. It de-emphasizes arguments that complexity, such as private sector contracting, can improve efficiency or individual choice because such policies reduce traceability. It also de-emphasizes some approaches from economics. Behavioural economics arguments that focus on nudging people into good behaviour might produce the desired result but almost by definition are not traceable, and thereby less likely to produce credit or cast blame on those who would undo them. It is hard to mobilize supporters to defend a policy that was specifically designed to go unnoticed. Arguments for pricing externalities do not just create concentrated losses among, often powerful, losers, but also create more blame than credit and are therefore less attractive. Put another way, carbon pricing might be an excellent policy but subsidies for green hospitals, with the attendant jobs and grand openings, generate more credit.
3.3.3 Win-wins, coalitions and enactment
In short, the political appeal of co-benefits logic is that it can create new coalitions which can make new kinds of progress and policy development. It can offer different perspectives on policy from, for example, HiAP or Healthy Cities, building on their insights as part of a more general approach that encompasses a fuller understanding of what health and health systems contribute across the board.
Coalitions are a powerful tool for analysing politics and policies, and a strong coalition that can support a policy can be strengthened by that policy and help support its implementation. Developing governance to do that is crucial, and the subject of the next chapter.
3.4 Governance: overcoming challenges of implementation and sustainability
Implementation is famously one of the most theoretically and empirically challenging topics in social sciences. It is not for want of attention by researchers in fields as diverse as public administration, political science, economics, change management, organizational behaviour and psychology. There are powerful reasons why something that has been decided might be ignored at the level where it must be implemented – from habit to complexity to inadequate resources to poor communications to interest group resistance to corruption to well founded disagreement with the policy. It appears that, for all the effort, there is no one good theory of implementation or how it works which can be adopted across different contexts (a sign of this is the burgeoning new field of implementation science).
A second question is how to sustain, or entrench, a policy over time. Sustainability is a second question of great interest to political science researchers but often receives less attention in public health and health policy literatures (Reference Greer and LillvisGreer & Lillvis, 2014). Put simply, most officials, ministers and governments are not in position long enough to assume that even the policies they implement will be sustained. New officials, ministers and governments will have their own agendas, might be actively hostile to their predecessor’s activities, and are often unlikely to invest too much energy in the previous agenda. Interest groups and others who lost out on the original decision and resisted implementation will have additional opportunities to undermine the policy. We can see this in some of the most dramatic policies the EU has adopted in the twenty-first century as well as endless examples in government.
There is a variety of solutions that governments can adopt in trying to address the sustainability problem and entrench their programmes. They include entrenching them in legislation or even constitutional law, the effectiveness of which varies with political institutions. The more difficult it is to legislate, the more value politicians will see in legislation since the difficulty of legislating will deter or defeat successors who do not value the policy. They also can include mandatory requirements of various sorts, which expand the scope of conflict and thereby make it harder for governments to renege on commitments. This can mean, for example, mandatory submission of reports on progress to the legislature, publication of regular and relevant data, and public consultation processes which allow allies in civil society to follow policy closely and argue for continued policy implementation. They include public visibility and “traceability” of benefits, allowing voters to know who, and what policy, is responsible for something good they received. They can also include the legal system’s use, for example, in the form of rights of action that can be enforced through lawsuits. This is partly achieved through simple policy design, which makes it clear where benefits and co-benefits come from.
Progress and sustainability require governance, which is the set of processes by which decisions are made and implemented (Reference Greer, Wismar, Figueras, Greer, Wismar and FiguerasGreer et al., 2016, Reference Greer, Vasev and Jarman2019). To some extent governance in a country is usually a given; there are legal, bureaucratic, political, cultural and other limits to how much any particular policy area or programme is likely to diverge from how things are generally done in a country. But governance is constantly changing, being reshaped by political and institutional evolution as well as the policies themselves, whose organization changes “the way things are done” for the future.
The TAPIC framework (Box 3.1) is a useful analytical tool for identifying problems in governance (Reference Greer, Wismar and FiguerasGreer, Wismar & Figueras, 2015). The framework first determines whether a problem can be attributed to governance (as against, for example, inadequate resources) and then identifies the particular governance problem: transparency, accountability, participation, integrity and policy capacity.
Transparency means that institutions inform the public and other actors of both upcoming decisions and decisions that have been made, and of the process by and grounds on which decisions are being made.
Accountability means that an actor must give an account of its actions, with consequences if the action and explanation are inadequate.
Participation means that affected parties have an opportunity to provide input to relevant deliberations without fear of retribution.
Integrity means that the processes of representation, decisionmaking, employment and enforcement should be clearly specified. Individuals and organizations should have a clear allocation of roles and responsibilities.
Policy capacity refers to the ability to develop policy that is aligned with resources in pursuit of goals.
If we assume that the case for a particular programme with co-benefits has been made, then the question is what mechanisms will promote the necessary level of intersectoral governance. Longer discussions can be found in Reference Greer, Wismar, Figueras, Greer, Wismar and FiguerasGreer, Wismar and Figueras (2016), and especially Reference Lillvis, Greer, Greer, Wismar and FiguerasLillvis and Greer (2016) and Reference 54McQueen, Wismar, Lin, McQueen, Wismar and LinMcQueen and colleagues (2012). Table 3.1 is a schematic presentation of the below described approaches, drawing on and expanding the more structural (organizational and budgetary) approach developed in earlier work (Reference McQueen, Wismar and LinMcQueen et al., 2012).
3.4.1 Plans
One of the conceptually simplest ways to implement co-benefits is to start with a plan. A plan chooses some coherent goals and identifies the resources and actions needed to achieve them – for example, the changes to health financing and access and surrounding social provision that would be required to reduce the contribution of ill health to poverty, or the changes to the actions of health sector employers needed to remove discrimination. A plan can be a necessary requirement for action, and the planning process can also be a valuable way of connecting organizations and identifying resources and possibilities. Still, it will only work if it has consistent political support, some attention to the interests of the involved actors and, ideally, both high salience and low conflict.
3.4.2 Indicators and Targets
Gathering data is an important part of identifying, let alone addressing, a problem. A large part of the SDGs programme involves finding and improving indicators that let countries, their citizens and the world view their progress and challenges. The SDG indicators enterprise can be critiqued, as is to be expected of something so complex and global, but it is nonetheless ambitious and important. Indicators are measures of particular broader phenomena, such as infant mortality or employment discrimination, and are often constructed in subtle ways from other, more basic data (for example, infant mortality statistics rest on a foundation of birth and death statistics that required decades of political argument to establish in even rich countries). We can use indicators to identify broad issues, ideally unobtrusive ones that are less likely to be gamed. An indicator is not a target: as soon as an indicator becomes a target, it ceases to be an indicator (Reference CampbellCampbell, 1979; Reference Goodhart and GoodhartGoodhart, 1984). That is because the more important a measure, the more likely it is to be manipulated – the dark side of the saying that “what’s measured is what’s managed”. Thus, the SDGs are goals but the indicators are less likely to be gamed because of their sheer profusion.
One way to proceed might be to focus on developing and using a mixture of robust and, if possible, unobtrusive measures (Reference 55Webb, Campbell and SchwartzWebb et al., 1999) from multiple areas to understand progress towards overarching goals such as the SDGs. Another is to use the SDGs as leverage to broaden goals, targets and indicators taken into account in policy.
3.4.3 Budgets
Budgets set and reflect organizations’ priorities, and budgeting tools are therefore a key instrument used by policymakers to direct activity towards co-benefits. There is a well established public financial management literature and approach which starts with a conceptual description of the budgeting process framed in stages, namely planning (determining the relationship between goals and expenditures), budgeting (mapping available resources onto specific budget lines) and monitoring (ensuring that budgeted funds are spent in the most appropriate way). Each stage has more subdivisions, but they broadly map how governments and other organizations budget and identify opportunities to improve practice.
In this context, budgeting techniques for intersectoral action include: pooled budget; shared accountability, goals and outcomes; or coordinated budgeting (often informally, in the manner of ministerial linkages, discussed below). It is important to underscore that in budgeting, as well as any other activity, evaluation and monitoring are crucial and need to be built into the policy design from the start. Otherwise, it will be difficult to tell what, if anything, was achieved.
3.4.4 Organizations
Reorganization and organization are another key tool used to achieve intersectoral action and effects. There are many ways to reshape government organizations, and many limitations on the effects (Reference GreerGreer, 2010; Reference MätzkeMätzke, 2011). These can include (Reference Greer, Wismar, Figueras, Greer, Wismar and FiguerasGreer, Wismar & Figueras, 2016; Reference McQueen, Wismar and LinMcQueen et al., 2012): ministerial linkages (such as small teams of cabinet ministers), specific ministers (for example, for public health or equity), special parliamentary committees to raise awareness and keep government accountable, interdepartmental committees and units, mergers (for example, of health and sport or justice and equity), or specific efforts to engage the public and stakeholders such as industry. In each of these cases, it is crucial to understand the context and formulate a goal relevant to the salience, importance and goals of the different actors. When there is agreement on a goal, but no agreement on the best methods of achieving it, and a highly unattractive alternative to achieving the goal, for example, it is relatively easy for organizations to work together (low conflict-high salience) (Reference Sabel and ZeitlinSabel & Zeitlin, 2007, Reference Sabel and Zeitlin2010), but in other cases a more hierarchical approach might be more useful.
3.4.5 People
Policy analysts and public administration students, focused on developing policies that will be resilient to future incompetent or weak staff, often downplay the importance of people. Politicians and policymakers, by contrast, often adhere to the idea that “personnel is policy” – that appointing the right people can be a far more effective strategy than changing structures or budgeting rules. That is because people can lead – set agendas and priorities within and around their organization – while also using their discretion to advance the agenda through decisions about programmes, research, staffing, pilots, evaluations and budgetary proposals. Networks of people with shared convictions can be extremely effective, as a great deal of research has shown, and advocates of co-benefits can ensure that interested politicians will have access to capable staff who understand the issues.
The implication is that time-honoured techniques of developing skills, awareness and training in managers, policymakers, analysts and staff should not be neglected, and investment in training them in the policy analysis and evaluation techniques for intersectoral governance can be richly rewarded. Furthermore, encouraging cross-sectoral professional networks (which go by many names in the social sciences (Reference Greer, Löblová, Laible and GreerGreer & Löblová, 2020; Reference LöblováLöblová, 2018) means that it is possible for an engaged politician or senior policymaker to find a group of potential allies who can inform policy and carry out the work. A minister with no policy capacity – which means capable people – will quickly find the limits of political will (Reference Greer, Wismar, Figueras, Greer, Wismar and FiguerasGreer et al., 2016).
3.4.6 Accountability
One of the key problems of implementation and, especially, sustainability, is accountability. Ministers leave, prime ministers leave and governments leave. Agendas change – over the last decade, European political agendas have bounced from one crisis to another (climate change, economic crisis, refugee “crisis”, COVID-19 and now the Russian invasion of Ukraine). How do strategic policymakers ensure that there will be accountability for delivering outcomes after they have gone?
One technique is to act, while in office, to strengthen outside accountability for those goals (Reference Greer and LillvisGreer & Lillvis, 2014). Thus, for example, legislating mandatory reports to the legislature and public on progress; creating oversight and watchdog agencies and evaluators that can report on failure; mandating the collection and public release of relevant data; joining international collaborations that require benchmarking and data reporting; and even requiring particular public reports are all ways to enhance accountability by making it easier for civil society, the media, researchers, politicians and legislators to know when a government is faltering and put pressure on it (Reference Greer, Vasev and WismarGreer et al., 2017b). Even if subsequent governments try to reverse these mechanisms by defunding activists or interfering with data collection, as they often will (Reference Rocco, Rich and KlasaRocco et al., 2021), that creates new opportunities to call them to account. Finally, the courts can be used to create accountability by creating a right of action – the ability for somebody to file suit against the government or other public agencies if they fail to take broader co-benefits into account. This is a tool governments are often hesitant to deploy, but it can be powerful.
3.4.7 Summary
Table 3.1 shows the different options in what is inevitably an incomplete list of options. It shows some of the commonly used tools of intersectoral action and the purposes to which they are put.
The chapters in this book use this framework to categorize different mechanisms. While the list is necessarily always incomplete, it can contribute to understanding what worked and what kinds of options exist if we are to institutionalize intersectoral governance that attains co-benefits.
3.5 Conclusion
Governance and politics in the abstract are not always interesting or productive topics, but figuring out the political coalitions’ governance arrangements that will create and sustain intersectoral co-benefits is complex and vitally important. How do the law and organization of each sector contribute to or impede intersectoral action? What policy tools might help to change that?
In particular, intersectoral action faces the twin challenges of implementation and sustainability. Implementation challenges receive much of the attention in policy debates and literature, since it is clear that many statements of intersectoral good intentions, like many policies of all kind, do not turn into real changes. There are many ways policymakers approach the implementation problem, as shown in Table 3.1, which can include budget, procedural and other changes to the way policy is made, substantive plans and targets, and appointments of key people.
But politicians and policymakers also must focus on the sustainability of their approaches. Enactment of a policy creates new challenges and might give opponents new opportunities to delay or reverse changes, while also creating the possibility of policy that can win supporters as it is implemented. Policymakers meet the sustainability challenge by identifying ways to entrench intersectorality through techniques as different as reporting to the legislature, creating legal rights, and developing internal review processes within government. Entrenching policy is urgent because otherwise bureaucratic entropy combines with political opposition to undermine that policy. It is also a kind of political thinking, because it involves anticipating potential supporters who can defend and extend the policy once the ministers are long out of office, and identifying ways to empower them.
Governance for co-benefits, in particular, is often going to be about supporting coalitions of different interests which can support each other even after a government decides it is time to go back to basics (for example, not focusing on win-win solutions and instead focusing on a few targets), changes ideological orientation, or simply loses interest. Fortunately, the vocabulary and range of international experience means that there is a great deal of writing and thought in this area, and it shows the importance of creating and entrenching coalitions. That, of course, is best done with a win-win approach.
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