There is clearly a need to improve the use of more robust Policy theory on Health Policy analysis. Powell and Mannion in an editorial on the relationship between Health Policy analysis and the wider field of public Policy theory note, as others have done before, the limited application of Policy theory in Health Policy analysis. However, they also highlight that within the Health Policy analysis arena new models have emerged which have wider use within Policy analysis such as the Health Policy triangle. While Powell and Mannion suggest that Health Policy analysis can take one of two paths I argue that we should be developing more integrated frameworks of Health Policy Processes, governance and systems which would involve the use of robust public Policy theories and models.

Models of the Health Policy Process have largely developed in isolation from political studies more widely. Of the models which Powell and Mannion’s editorial considers, a stages model of the Policy Process offers a framework for combining these specifically Health-focused models with empirical findings and more general explanatory models of the Policy Process drawn from other political studies. This commentary uses a stages model to assemble a bricolage which combines some of these components. That identifies a further research task and suggests ways of revealing in more life-like ways the politics involved in the Health Policy Process: that is, how that Process channels wider, often conflicting, non-Health interests, actors, policies, conflicts, ideologies and sources of power from outside the Health system into Health Policy formation, and introduces non-rationality.

Powell and Manion present an important review of reviews about Health and Policy research. They zero in on theories of the Policy Process as the most likely to unearth what is really going on in Health Policy. Here I contend that their analysis insufficiently attends to institutions. Powell and Manion situate ‘institutions’ (with ‘Ideas’ and ‘Interests’) as a ‘Health Policy Process models’ that ‘tend to’ list factors rather than connect them. Rather, I show how there is a rich history of considering institutions in the political science literature that is under considered by Powell and Manion. By necessity for a Public Health audience I quickly pull back the covers on ‘rigour’ and ‘causation’ to demonstrate what is ‘fit for purpose’ in rigorous institution focussed Policy analysis. I conclude by arguing how institutionally focussed public Health Policy analysis is vital for understanding and addressing heath inequities. That focus necessitates research that provides better, explicit, conceptualisations of power in Health Policy: especially drawing out the roles played by structure and agency. I offer some recent examples.

Powell and Mannion suggest that ‘Health Policy Process’ research should draw more lessons from ‘the wider Policy Process literature.’ While Health research could continue with sector specific models, the wider literature is ‘conceptually stronger.’ In that context, I clarify how and why Health researchers should use Policy theories. I describe a review of the use of Policy theories in public Health research to show that many researchers use them to not only understand Policy-making but also influence Policy and Policy-making. Most Policy theories are not designed for that purpose, but it is still possible to produce practical lessons. I outline the issues that arise when repurposing theory-informed insights, such as that Policy change takes a long time, and the scale of Policy-making is potentially overwhelming. I then highlight the valuable role of theories in raising dilemmas in relation to modes of governance and evidence production.

Powell and Mannion’s review of reviews maps the landscape of Health Policy research, showing a number of problematic and longstanding features. This commentary focuses on the extent to which Health parochialism is good for the scientific development of the literature, the extent to which a “tournament of theories” actually develops our understanding of Health Policy Process, and, finally, whether circumscribed theories of the Policy Process might be missing some of the most important and useful findings of broader comparative politics, which focus on the ways policies create politics over time. It concludes that Health parochialism and focus on a circumscribed Policy Process is not likely to be helpful because it distracts attention from the ways in which coalitions and institutions over time shape politics and Policy, a finding explored by scholars of many sectors whose findings should influence Health Policy research.

This commentary reflects upon the article along three broad lines. It reflects on the theoretical choices and omissions, particularly highlighting why it is important to adapt the multiple streams framework (MSF) when applying it in a socio-political context like Vietnam’s. The commentary also reflects upon the analytical threads tackled by Ha et al; for instance, it highlights the opportunities offered by, and raises questions about the centrality of the Policy Entrepreneur in getting the Policy onto the political agenda and in pushing it through. The commentary also dwells on the implications of the article for development aid policies and practices. Throughout, the commentary signposts possible themes for Ha et al to consider for further analysis, and more generally, for future research using Kingdon’s multiple streams theory.