Creating change in government to address the social determinants of health: how can efforts be improved?

Background - The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government. Methods - In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives. - We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. Results - We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design. Conclusion - Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next

Public space in Vancouver\u27s downtown

This study examines whether evidence exists of people and processes changing the regulation of public space in Vancouver’s downtown between 2003 and 2009, with particular attention paid to the Downtown Eastside. What role, if any, can be attributed to Olympics’ preparations? My central argument focuses on how legislation restricting panhandling, loitering and sleeping/camping impacts the most vulnerable citizens, which, in Vancouver, may relocate people from the downtown core into the Downtown Eastside. I compare Vancouver’s by-laws with other Canadian cities to understand Vancouver in a Canadian context. Finally, I examine policy decisions of three regulators of public space: the City of Vancouver, Business Improvement Associations and the Vancouver Police Department. I conclude that, while the regulation of public space has changed, the Olympics simply play the role of catalyst rather than instigator. Individual political priorities are much more pertinent to the regulation of public space than are the Games themselves