בריאות הציבור מן האמצע החוצה: תפקידם הייחודי של שחקני אמצע בקידום מדיניות

Collaboration in public health faces numerous obstacles. Programs implemented across and impacted by diverse environments offer opportunities to learn how professionals in the field address these obstacles in real-time. We used the socio-technical analytical approach “from the middle out,” to elucidate the significance of middle actors – stakeholders between policymakers at the “top”and the public at the “bottom”. Through participant observation in the forums where the National Program to Promote Active, Healthy Lifestyle in Israel was formed, interviews with 30 stakeholders, and document analysis, we examined three aspects of influence from the middle out: (1) directions of influence,(up, down, and sideways); (2) modes of influence (facilitation, mediation, and aggregation); (3) mechanisms of influence (strengthening agency and capacity to act). We conclude that integrating the middle out approach can contribute to the understanding and pursuit of policies, innovation and collaboration to foster sustainability and improve public health.