Rigorously accounting for the role of social values in health systems: Guidance for health policy and systems researchers

Health systems are complex social systems and play an important role in reinforcing social values. This capacity to communicate social values is a product of systems complexity and, over time, social values become institutionalised in health systems. This means that social values are not only drivers of policy change, but also form part of the context in which policy processes unfold, and constrain change. However, in health policy and systems research, social values are often studied only as drivers of policy change. We present an analytical framework to guide analysts in accounting for values-based complexity in health systems change. Rigorously accounting for social values as both driving and constraining change requires recognising that policy processes unfold in complex social health systems; that social values comprise part of an ideational context that constrains actor choices; that this ideational context may change in important ways over time; and that past policy decisions embed values in social institutions, creating feedback loops that constrain change. The analytical framework centres moments of policy decision-making in their ideational context; emphasises the points of interaction between health systems, policy decisions and social values; and points the analyst towards the tangible contextual realities that shape the ideational context.