Examining Policy Change in Greek Public Health, 1975-2003

Despite years of stasis, Greek health policy radically changed in 2003 producing the country’s first public health law. How and why did it happen? Employing Kingdon’s Multiple Streams Framework (MSF) to guide the collection and processing of data, the paper tackles the above question through a mixed-methods process-tracing approach analyzing primary and secondary sources as well as semi-structured interviews, focusing on the period 1975-2003. The framework views public policy change as the result of strategic actors taking advantage of windows of opportunity and coupling three independent streams (problems, policies and politics). But the case study adds two important elements to this argument. First, entrepreneurs not only track but also create policy windows. Second, political parties play an important role in framing the overall debate but they, too, are permeable to specific entrepreneurial strategies. In other words, parties matter, but less than what MSF hypothesizes. Third, entrepreneurs take advantage of the inherently fluid public policymaking context they operate in, by pressuring for the creation of transient formal procedures and interchanging roles, achieving better access, and understanding and strategic experience. In other words, under conditions of fluid institutional arrangements, successful entrepreneurs are more likely to engage in venue creation rather than venue shopping. The paper concludes with implications for the role of policy entrepreneurs in MSF explanations and theories of policy change in public health.