17 research outputs found
Re-orientation of health services towards health promotion: an Australian case study of aborted health service reform
To What Extent can the Activities of the South Australian Health in All Policies Initiative be Linked to Population Health Outcomes Using a Program Theory-Based Evaluation
This paper reports on a five-year study using a theory-based program logic evaluation, and supportingsurvey and interview data to examine the extent to which the activites of the South Australian Health in All Policiesinitiative can be linked to population health outcomes
How do advisory groups contribute to healthy public policy research?
Objectives: This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research.
Methods: Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers’ critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken.
Results: PAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers’ need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified.
Conclusions: The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs’ role and how they can increase research translation into policy
Power, Process and Context in Theory Based Evaluation of Policy Implementation: A Response to Recent Commentaries
Health in All Policies in South Australia-Did It Promote and Enact an Equity Perspective?
© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Mobilising cross-sectoral action is helpful in addressing the range of social determinants that contribute to health inequities. The South Australian Health in All Policies (SA HiAP) approach was implemented from 2007 to stimulate cross-sector policy activity to address the social determinants of health to improve population wellbeing and reduce health inequities. This paper presents selected findings from a five year multi-methods research study of the SA HiAP approach and draws on data collected during interviews, observation, case studies, and document analysis. The analysis shows that SA HiAP had dual goals of facilitating joined-up government for co-benefits (process focus); and addressing social determinants of health and inequities through cross-sectoral policy activity (outcomes focus). Government agencies readily understood HiAP as providing tools for improving the process of intersectoral policy development, while the more distal outcome-focused intent of improving equity was not well understood and gained less traction. While some early rhetorical support existed for progressing an equity agenda through SA HiAP, subsequent economic pressures resulted in the government narrowing its priorities to economic goals. The paper concludes that SA HiAP’s initial intentions to address equity were only partially enacted and little was done to reduce inequities. Emerging opportunities in SA, and internationally, including the UN Sustainable Development Goals, may revive interest in addressing equity
Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia
Abstract
Background: The importance of evaluating policy processes to achieve health equity is well recognised but such
evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian
Health in All Policies (HiAP) initiative.
Methods: A framework of the theorised components and relationships of the HiAP initiative was produced to guide
evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research
partnership and drew on social and political science theory and relevant policy literature.
Results: The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and
was informed by a number of social and political science theories. The framework provides a basis for exploring the
interactions between framework components and how they shape policy-making and public policy. It also enables an
assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for
predicting the impacts of resulting policies.
Conclusion: The use of a program theory-based evaluation framework developed through a consultative process
and informed by social and political science theory has accommodated the complexity of public policy-making. The
framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal
outcomes through the explicit articulation of the underpinning program theory
'Desiging better health care in the South': a case study of unsuccessful transformational change in public sector health service reform
108 COWLEY RD, OXFORD, ENGLAND, OXON, OX4
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Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors’ involvement
Abstract Background This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation. Methods The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants. Results The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential. Conclusions The South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of government
Correction to: Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors’ involvement
Abstract After publication of the article [1], it has been brought to our attention that Table 1 has been formatted poorly in the original version so that the columns are not aligned with their corresponding information. The correct version of the table is presented below. The original version of the article has now been revised
Explaining health inequalities in Australia: the contribution of income, wealth and employment.
BACKGROUND: Studies show widespread widening of socioeconomic and health inequalities. Comprehensive primary health care has a focus on equity and to enact this requires more data on drivers of the increase in inequities. Hence, we examined trends in the distribution of income, wealth, employment and health in Australia. METHODS: We analysed data from the Public Health Information Development Unit and Australian Bureau of Statistics. Inequalities were assessed using rate ratios and the slope index of inequality. RESULTS: We found that the social gradient in health, income, wealth and labour force participation has steepened in Australia, and inequalities widened between the quintile living in the most disadvantaged areas and the quintile living in the least disadvantaged areas. CONCLUSION: Widening income, wealth and employment inequalities have been accompanied by increasing health inequalities, and have reinforced and amplified adverse health effects, leading to increased mortality inequality. Effective comprehensive primary health care needs to be informed by an understanding of structural factors driving economic and health inequities