The 'Scottish approach' refers to its distinctive way to make and implement policy. Its reputation suggests that it is relatively comfortable with local discretion and variations in policy outcomes. Yet, policymakers are subject to 'universal' processes -limited knowledge, attention and coordinative capacity, and high levels of ambiguity, discretion and complexity in policy processes -which already undermine central control and produce variation. If policy is a mix of deliberate and unintended outcomes, a focus on policy styles may exaggerate a government's ability to do things differently. We demonstrate these issues in two

Background: ‘Health in All Policies’ (HIAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the ‘social determinants’ of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HIAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HIAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HIAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HIAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HIAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HIAP expectations and policy outcomes. Theory-informed articles contribute to a HIAP playbook to close that gap or a programme theory to design and evaluate HIAP in new ways.   Conclusions: Few HIAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HIAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.

If ‘prevention is better than cure’, why isn’t policy more preventive? Policymakers only have the ability to pay attention to, and influence, a tiny proportion of their responsibilities, and they engage in a policymaking environment of which they have limited understanding and even less control. This simple insight helps explain the gap between stated policymaker expectations and actual policy outcomes. We use these insights to produce new empirical studies of ‘wicked’ problems with practical lessons. We find that both the UK and Scottish governments use a simple idiom—prevention is better than cure—to sell a package of profound changes to policy and policymaking. Taken at face value, this focus on ‘prevention’ policy seems like an idea ‘whose time has come’. Yet, ‘prevention’ is too ambiguous until governments give it meaning. No government has found a way to turn this vague aim into a set of detailed, consistent, and defendable policies. We examine what happens when governments make commitments without knowing how to deliver them. We compare their policymaking contexts, roles, and responsibilities, policy styles, language, commitments, and outcomes in several cross-cutting policy areas (including health, families, justice, and employability) to make sense of their respective experiences. We use multiple insights from policy theory to help research and analyse the results. The results help policymakers reflect on how to avoid a cycle of optimism and despair when trying to solve problems that their predecessors did not.

Background: ‘Health in All Policies’ (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the ‘social determinants’ of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways.   Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.

There is a broad consensus across European states and the EU that social and economic inequality is a problem that needs to be addressed. Yet inequality policy is notoriously complex and contested. This book approaches the issue from two linked perspectives. First, a focus on functional requirements highlights what policymakers think they need to deliver policy successfully, and the gap between their requirements and reality. We identify this gap in relation to the theory and practice of policy learning, and to multiple sectors, to show how it manifests in health, education, and gender equity policies. Second, a focus on territorial politics highlights how the problem is interpreted at different scales, subject to competing demands to take responsibility. This contestation and spread of responsibilities contributes to different policy approaches across spatial scales. We conclude that governments promote many separate equity initiatives, across territories and sectors, without knowing if they are complementary or contradictory. This outcome could reflect the fact that ambiguous policy problems and complex policymaking processes are beyond the full knowledge or control of governments. It could also be part of a strategy to make a rhetorically radical case while knowing that they will translate into safer policies. It allows them to replace debates on values, regarding whose definition of equity matters and which inequalities to tolerate, with more technical discussions of policy processes. Governments may be offering new perspectives on spatial justice or new ways to reduce political attention to inequalities.