Programmatic action in Chinese health policy—The making and design of “Healthy China 2030”

Abstract

The Programmatic Action Framework (PAF) is a powerful analytical perspective to advance our understanding of policy change by stressing the role of programmatic groups and how they promote their preferred policy programs. While the PAF has been applied successfully to European countries and the US, a considerable research gap remains regarding its explanatory power in other regions and political settings. To step into this research gap, we apply the PAF to authoritarian China through a qualitative case study of the making of “Healthy China 2030”, a national health policy program. We explore two research questions: firstly, to what extent can the PAF be operationalized in a nondemocracy to identify programmatic groups and evaluate policy design, and second, what are the limitations and challenges facing the application of the PAF to nondemocracies? Our empirical analysis shows that the design of this policy program involves actors from different policy areas, despite the top-down political structure. With regards to the transfer of PAF hypotheses, we show that the framework is a helpful lens to identify programmatic groups and to evaluate policy programs' potential for success based on coherence, responsiveness, and program fit. Meanwhile, the research process of our study revealed the challenges of applying policy process theories to China, including hard-to-reach political actors for data collection, lack of transparency regarding collaboration processes between actors, and a lack of publicly available program-related information.