Investment Decisions on Physical Activity Promotion: A Locality Case Study in Complex Public Health Policy Making

The role of 'best investment' methodology in shaping priorities in many health policy areas is becoming increasingly prominent. Whilst this has traditionally been seen as a technocratic exercise, the social and political context of such practices and the constructed nature of decisions are now considered significant. In this context, this article reports on a longitudinal case study of such a process that sought to identify 'best investments' in public health interventions related to promoting physical activity. Drawing on a series of conceptual resources, we describe and reflect upon the complex and invested elements that contributed to the grounded decision-making process. In conclusion we suggest the need to adopt a multifaceted and nuanced approach to resource investment decision making, including: deploying a range of appraisal assessment resources; maintaining a long-term processual perspective; involving a variety of stakeholders; accepting and embracing fallibility; and accommodating theoretical and empirical evidence-based principles.