Policy gaps in addressing social determinants of health for Australians with a disability

Compared to non-disabled people, Australians with a disability have poorer health and experience greater levels of socio-economic disadvantage e.g. unemployment, housing insecurity, and social exclusion. Reducing these inequities could significantly improve the health of Australians with a disability. However, in Australia there is a lack of knowledge on how to target health and social policies which address the social determinants of health for people with a disability in order to reduce social and economic disadvantage

Value choices in a mixed economy of care: How politics shapes the implementation of complex social policies

While social and public policy studies recognize the diversity of actors and processes occurring in the implementation of policy and the organization of public service delivery, analysis of the role of value pluralism in implementation remains underdeveloped. This article contributes to a more nuanced understanding of the relationship between value pluralism and organizational responses to value conflict by exploring the effect of politics on the value choices of senior public servants involved in the design and implementation of Australia's National Disability Insurance Scheme. Our analysis shows that politics may play an essential role in facilitating implementation of a complex social policy that contains a number of incommensurable values because successful politics allows these incommensurable values to co‐exist and adaption to take place, thereby avoiding organizational dysfunction.UNSW Human Ethics, Grant/Award Number:G16089

The place of community in a community organisation : negotiating relationships in the third sector

Community-based and non-government organisations are the subject of increasing academic debate. Although they are now understood to be an integral part of our social and political system as the third sector, separate from the government and market sectors' how these organisations will realise their critical potential and overcome practical and theoretical challenges is largely unexplored' This thesis draws on qualitative research conducted with workers at a hepatitis C community-based organisation - the Oliver Smith Council. The thesis provides an actororientated account of the complexities and challenges of working in the third sector as it stands between civil society and the state. It examines two interrelated concepts that are important for the positioning of the organisation: understandings of 'community' in the organisation, and experiences of spatialþ of the organisation. At the Oliver Smith Council the work and space of the organisation had become increasingly contested. Changes in size, location and internal policy had resulted in tensions and debates within the organisation with regard to how the Council would endeavour to continue to work with communþ, and what objectives, functions and roles are fundamental to the Council being a 'community-based' organisation in the third sector. Workers had a sense of shifting spaces of their organisation; many were concerned that the organisation was losing its grounding in civil society and the third sector and becoming too closely aligned with the state. In particular, workers were concerned that there was no longer a place for community within the walls of the organisation. These concerns manifested themselves in workers' concerns about how the Council worked with its community groups, and the types of organisational space it occupied. Through exploring the praxis of the Oliver Smith Council in this thesis,I examine how and why working in the third sector is complex and, attimes, difficult. I argue that the tensions and concerns experienced by Council workers relate to the organisation's, and the third sector,s, positioning between civil society and the state. In addition to enhancing our understanding of the third sector and its complexities, this thesis is also aimed at assisting workers at the Oliver Smith Council to make sense of the debates and tensions within their organisation.Thesis (MMSc) -- University of Adelaide, School of Population Health, 200

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

Inequities in the freedom to lead a flourishing and healthy life: time for a progressive social protections framework Comment on “Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy”

Evidence now shows that the key drivers of poor health are social factors, such as education, employment, housing and urban environments. Variations in these social factors—or the conditions in which we live our lives—have lead to a growth in health inequalities within and between countries. One of the key challenges facing those concerned with health equity is how to effect change across the broad policy areas that impact these social conditions, and create a robust ‘social protections framework’ to address and prevent health inequalities

Women’s experiences of accessing individualized disability supports: gender inequality and Australia’s National Disability Insurance Scheme

Background Care services in industrialized nations are increasingly moving towards individualized funding models, which aim to increase individuals’ flexibility, choice and control over their services and supports. Recent research suggests that such schemes have the potential to exacerbate inequalities, however none has explored gendered dimensions of inequality. The Australian National Disability Insurance Scheme (NDIS) is a major individualized funding reform, and has a female participation rate of only 37%, despite women and girls making up half of the disability population. Methods The objective of the study is to explore possible gendered barriers to applying for and receiving adequate support through the NDIS, and to suggest directions for future research. We report on semi-structured interviews with 30 women with disability and explore their experiences with the NDIS and their perspectives on challenges associated with being a woman seeking disability support in Australia. We analyse the results using thematic analysis. Results Most women in our sample reported differences between the experiences of men and women seeking disability support in Australia. Commonly reported gendered barriers to women being able to access the right supports for their disability involve a) confidence, negotiation and self-advocacy, b) gendered discrimination in diagnosis and the medical system, which has implications for disability support access, and c) support for and recognition of caring roles. Conclusions These results suggest that women are not receiving equitable treatment with regard to the NDIS, and that further research and policy reform are needed to ensure that women with disability are not further disadvantaged as a result of the move toward individualized funding models