Metropolitan health policy development: barriers to implementation.

The complex health issues facing urban areas require effective public policy responses. Consistent with the call by the Institute of Medicine for local health policy development, a variety of groups within metropolitan areas have engaged in these efforts. This paper provides an exploratory analysis of a cross section of 25 health policy initiatives undertaken in Chicago from 1987 through 1994. Characteristics of these initiatives, their recommendations, and factors which served as barriers to implementation are identified. The barriers include: deficiencies in policy design, inadequate political support, organizational barriers, and resource constraints. Our findings are compared to other policy implementation research. Suggestions for improving the effectiveness of local policy development include: involving key individuals from the public and private sectors, maintaining a strategic perspective on achieving priority recommendations, including financial analysis and planning, developing an initial implementation plan, and securing political support.