ORCID Profile
0000-0002-4649-4013
Current Organisation
UNSW Sydney
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Aboriginal and Torres Strait Islander Health | Public Health and Health Services not elsewhere classified | Public Policy | Public Health and Health Services
Aboriginal and Torres Strait Islander Health - Determinants of Health | Public Health (excl. Specific Population Health) not elsewhere classified | Social Structure and Health |
Publisher: Elsevier BV
Date: 10-2014
Publisher: AMPCo
Date: 05-2021
DOI: 10.5694/MJA2.51020
Abstract: CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping in iduals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide ex les of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.
Publisher: Informa UK Limited
Date: 03-2012
Publisher: MDPI AG
Date: 20-01-2015
Publisher: Centre for Health Equity Training, Research and Evaluation
Date: 11-2021
DOI: 10.53714/TWCQ8085
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.SOCSCIMED.2019.112594
Abstract: The purpose of this article is to investigate whether the neo-liberal goal of global economic competitiveness when included alongside image-inspired social goals such as liveability and environmental goals such as sustainability can lead to policies that impact positively on health and health equity. The paper presents an analysis of the content and intent of strategic planning and transport plans from two Australian state governments. The analysis was undertaken using a thematic document analysis of each plan and interviews with agents (n = 21) directly involved in the preparation of each document. Key strategic documents formulated under a neo-liberal hegemony simultaneously provided and reduced opportunities to promote and advance health. The policies viewed goals like liveability and sustainability as means of enhancing their cities' image in global competition for exogenous capital flows. Although liveability has many definitions, one definition was able to be used in one jurisdiction as an avenue to include a broad array of social determinants of health into urban planning policy. However, a productivity or a narrowly focussed image narrative can undermine the social determinants of health credentials of liveability. Overemphasising immediate city problems like road congestion as mechanisms to enhance global competitiveness can undermine necessary long-term strategies for city planning that are known to improve liveability and human health. Even where liveability is at the fore, there is a high risk of exacerbating spatial inequities through liveability investments for competitive advantage because they tend to flow to parts of cities with the greatest connections to the global economy, not those with the greatest social need. A neo-liberal-inspired competitive city paradigm provides opportunities for the advancement of health in urban development. However, when driven by the goals of productivity and/or liveability as image enhancement it can potentially exacerbate health inequities.
Publisher: Elsevier BV
Date: 11-2013
Publisher: Elsevier BV
Date: 09-2009
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.SOCSCIMED.2014.02.033
Abstract: The last decade has seen increased use of health impact assessment (HIA) to influence public policies developed outside the Health sector. HIA has developed as a structured, linear and technical process to incorporate health, broadly defined, into policy. This is potentially incongruent with complex, non-linear and tactical policy making which does not necessarily consider health. HIA research has however not incorporated existing public policy theory to explain practitioners' experiences with HIA and policy. This research, therefore, used public policy theory to explain HIA practitioners' experiences and investigate 'What is the fit between HIA and public policy?' Empirical findings from nine in-depth interviews with international HIA practitioners were re-analysed against public policy theory. We reviewed the HIA literature for inclusion of public policy theories then compared these for compatibility with our critical realist methodology and the empirical data. The theory 'Policy Cycles and Subsystems' (Howlett et al., 2009) was used to re-analyse the empirical data. HIAs for policy are necessarily both tactical and technical. Within policy subsystems using HIA to influence public policy requires tactically positioning health as a relevant public policy issue and, to facilitate this, institutional support for collaboration between Public Health and other sectors. HIA fits best within the often non-linear public policy cycle as a policy formulation instrument. HIA provides, tactically and technically, a space for practical reasoning to navigate facts, values and processes underlying the substantive and procedural dimensions of policy. Re-analysing empirical experiential data using existing public policy theory provided valuable explanations for future research, policy and practice concerning why and how HIA fits tactically and technically with the world of public policy development. The use of theory and empiricism opens up important possibilities for future research in the search for better explanations of complex practical problems.
Publisher: MDPI AG
Date: 29-05-2022
Abstract: Background: Emerging evidence suggests that the COVID-19 pandemic is widening pre-pandemic health, social, and economic inequalities between refugees, migrants, and asylum seekers and the general population. This global scoping review examined the impact of the pandemic on community-based asylum seekers and undocumented migrants in high- and upper-middle-income countries. Methods: We conducted a systematic search of peer-reviewed articles in PubMed, Scopus, Web of Science, and ProQuest Central. We applied Katikireddi’s framework of understanding and addressing inequalities to examine the differential impact of the pandemic across exposure, vulnerability to infection, disease consequences, social consequences, effectiveness of control measures, and adverse consequences of control measures. Results: We included 32 articles in the review. The analysis showed that asylum seekers and undocumented migrants experienced greater exposure to the COVID-19 virus and higher infection rates. They also experienced differential social consequences in the form of job loss and lost and/or reduced work hours. The effectiveness of pandemic response measures on asylum seekers and undocumented migrants was also affected by pre-pandemic social and economic marginalisation, exclusion from pandemic-induced policy measures, lack of appropriate pandemic communication, and variable trust in governments and authority. Pandemic control measures had greater adverse consequences on asylum seekers and undocumented migrants than the general population, with the majority of studies included in this review reporting worsened mental health and social isolation conditions and reduced access to health care. Conclusions: Asylum seekers and undocumented migrants experienced a disproportionate impact of the COVID-19 pandemic across the six thematic areas of comparison. Policies that reduce exposure and vulnerability to the infection, grant equitable access to health and social care, and build capacities and resilience, are critical to enable asylum seekers and undocumented migrants to cope with and recover from pre-pandemic and pandemic-induced inequalities.
Publisher: Oxford University Press
Date: 29-11-2013
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.SOCSCIMED.2015.11.029
Abstract: Framing health as a relevant policy issue for other sectors is not well understood. A recent review of the New South Wales (Australia) land-use planning system resulted in the drafting of legislation with an internationally unprecedented focus on human health. We apply a political science approach to investigate the question 'how and to what extent were health and wider issues framed in submissions to the review?' We investigated a range of stakeholder submissions including health focussed agencies (n = 31), purposively identified key stakeholders with influence on the review (n = 24), and a random s le of other agencies and in iduals (n = 47). Using qualitative descriptive analysis we inductively coded for the term 'health' and sub-categories. We deductively coded for 'wider concerns' using a locally endorsed 'Healthy Urban Development Checklist'. Additional inductive analysis uncovered further 'wider concerns'. Health was explicitly identified as a relevant issue for planning policy only in submissions by health-focussed agencies. This framing concerned the new planning system promoting and protecting health as well as connecting health to wider planning concerns including economic issues, transport, public open space and, to a slightly lesser extent, environmental sustainability. Key stakeholder and other agency submissions focussed on these and other wider planning concerns but did not mention health in detail. Health agency submissions did not emphasise infrastructure, density or housing as explicitly as others. Framing health as a relevant policy issue has the potential to influence legislative change governing the business of other sectors. Without submissions from health agencies arguing the importance of having health as an objective in the proposed legislation it is unlikely health considerations would have gained prominence in the draft bill. The findings have implications for health agency engagement with legislative change processes and beyond in land use planning.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Maad Rayan Publishing Company
Date: 05-05-2018
Publisher: AMPCo
Date: 11-2014
DOI: 10.5694/MJA14.00743
Publisher: Elsevier BV
Date: 06-2020
DOI: 10.1016/J.HEALTHPOL.2018.11.013
Abstract: Infrastructure is a global multi-trillion dollar market presenting many opportunities and risks for sustainable development. This article aims to foster better conceptualisation of the connections and tensions between infrastructure policy and public health in the light of the Sustainable Development Goals, especially 'good health and wellbeing' (number 3) and 'industry, innovation and infrastructure' (number 9), based on findings from interviews with a purposive s le of senior practicing Australian infrastructure policy makers. We use an institutional framework to explore the ideas, actors, rules and mandates, and procedures underpinning the inclusion of health in infrastructure policy. Informants defined infrastructure as the construction and provision of services that facilitate economic, environmental and social outcomes. The tendency to default to infrastructure as essential for economic success has fundamental challenges for the SDGs, particularly the politically driven pursuit of 'mega-project' legacies, sector-specific siloed governance arrangements, and inadequate conceptualisations of costs and benefits. Public health and infrastructure policy are mutually re-enforcing given they both concern the public interest with implications for all 17 SDGs. Positioning health and wellbeing as fundamental societal outcomes from infrastructure decisions would go a long way to helping achieve the SDGs.
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2018-025358
Abstract: A well-established body of literature demonstrates that health and equity are strongly influenced by the consequences of governments’ policy and resultant actions (or inactions) outside the health sector. Consequently, the United Nations, and its agency the WHO, have called for national leadership and whole-of-government action to understand and address the health impacts of policies in all sectors. This research responds to that call by investigating how policymaking in four sectors—urban planning, justice, energy and environment—may influence the social determinants of health and health equity (SDH/HE). The research design is informed by a critical qualitative approach. Three successive stages are included in the design. The first involves analysing all strategic policy documents and selected legislative documents from the four sectors (n=583). The document analysis is based on a coding framework developed to identify alignment between the documents and the SDH/HE. Two policies that demonstrate good practice in regard to SDH/HE will be selected from each sector during the second stage for embedded case study analysis (total n=8). This is intended to illuminate which factors have supported recognition and action on SDH/HE in the selected policies. The third stage involves progressive theoretical integration and development to understand political and institutional facilitators and barriers to action on SDH/HE, both within and between sectors. The research will provide much needed evidence about how coherent whole-of-government action on SDH/HE can be advanced and contribute knowledge about how health-enhancing policy activity in the four sectors may be optimised. Learnings from the research will be shared via a project advisory group, policy briefings, academic papers, conference presentations and research symposia. Ethics approval has been secured for the embedded case studies, which involve research participants.
Publisher: Bristol University Press
Date: 11-2022
DOI: 10.1332/174426421X16420923635594
Abstract: Insufficient progress has been made towards reducing health inequities, due in part to a lack of action on the root causes of health inequities. At present, there is a limited evidence base to guide policy decision making in this space. This paper proposes new principles for researchers to conduct health equity policy evaluation. Four key principles are presented: (1) where to evaluate – shifting from familiar to unfamiliar terrain (2) who to evaluate – shifting from structures of vulnerability to structures of privilege (3) what to evaluate – shifting from simple figures to complex constructs and (4) how to evaluate – shifting from ‘gold standard’ to more appropriate ‘fit-for-purpose’ designs. These four principles translate to modifying the policy domains investigated, the populations targeted, the indicators selected, and the methods employed during health equity policy evaluation. The development and implementation of these principles over a five-year programme of work is demonstrated through case studies which reflect the principles in practice. The principles are shared to encourage other researchers to develop evaluation designs of sufficient complexity that they can advance the contribution of health equity policy evaluation to structural policy reforms. As a result, policies and actions on the social determinants of health might be better oriented to achieve the redistribution of power and resources needed to address the root causes of health inequities.
Publisher: BMJ
Date: 04-2016
Publisher: BMJ
Date: 20-03-2020
Abstract: Progressing public policies that improve health equity requires understanding and addressing the creation, use and distribution of power. This glossary provides an overview of some of the most relevant conceptualisations of the dynamics of power in policy with implications for health equity. The aim is to provide an accessible overview of the different theories and perspectives behind power for public health focused policy researchers and advocates. The Glossary demonstrates how the broad literature on power in policy deepens understanding of the institutional dynamics that creates and maintains health inequities.
Publisher: Wiley
Date: 04-2018
DOI: 10.1002/HPJA.48
Publisher: Centre for Health Equity Training, Research and Evaluation
Date: 18-11-2021
DOI: 10.53714/ANLR8512
Publisher: Informa UK Limited
Date: 10-2010
Publisher: BMJ
Date: 2012
Publisher: Oxford University Press (OUP)
Date: 05-09-2018
Abstract: Influencing healthy public policy through health advocacy remains challenging. This policy analysis research uses theories of agenda setting to understand how health came to be considered for specific mention in legislation arising from land-use planning system reform in New South Wales, Australia. This qualitative study follows critical realist methodology to conduct a policy analysis of the case. We collected data from purposively s led in-depth interviews (n = 9), a focus group and documentary analysis. We used three classic policy process (agenda setting) theories to develop an analytic framework for explaining the empirical data: Multiple Streams Punctuated Equilibrium Theory and Advocacy Coalition Framework. The reform process presented a window of opportunity that opened incrementally over a 2 year period. The opportunity was grasped by in idual policy entrepreneurs who subsequently formed a coalition of healthy planning advocates focused on strategically positioning 'health' as legislative objective for the new system. The actual point of influence seemed to appear suddenly when challenges to a perceived economic development agenda within the reforms peaked, and the health objective, see as non-threatening by all stakeholders, was taken up. Our analysis demonstrates how this particular point of influence followed sustained long-term activity by health advocates prior to and during the reform process. We demonstrate a theory-driven policy analysis of health advocacy efforts to influence an instance of major land-use planning reform. The application of multiple policy process theories enables deep understanding of what is required to effectively advocate for healthy public policy.
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 09-2018
Publisher: Oxford University Press (OUP)
Date: 05-05-2019
Abstract: Notwithstanding the historical benefits of coal in aiding human and economic development, the negative health and environmental impacts of coal extraction and processing are of increasing concern. Environmental impact assessments (EIAs) are a regulated policy mechanism that can be used to predict and consider the health impacts of mining projects to determine if consent is given. The ways in which health is considered within EIA is unclear. This research investigated ‘How and to what extent are health, well-being and equity issues considered in Environmental Impact Assessments (EIAs) of major coal mining projects in New South Wales, Australia’. To this end we developed and applied a comprehensive coding framework designed to interrogate the publicly available environmental impact statements (EISs) of three mines in New South Wales (NSW), Australia, for their inclusion of health, well-being and equity issues. Analysis of the three EISs demonstrates that: the possible impacts of each mine on health and well-being were narrowly and inadequately considered when health and well-being were considered there was a failure to assess the possible impacts specific to the particular mine and the communities potentially affected the cumulative impacts on human health of multiple mines in the same geographical area were almost completely ignored the discussions of intragenerational and intergenerational equity did not demonstrate a sound understanding of equity and, it is essential that governments’ requirements for the EIA include detailed analysis of the health, well-being, equity and cumulative impacts specific to the proposed mine and relevant communities.
Publisher: Informa UK Limited
Date: 22-03-2017
Publisher: Portico
Date: 2022
Publisher: Oxford University Press (OUP)
Date: 21-10-2022
DOI: 10.1093/OOIH/OUAC002
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 02-2012
Publisher: Maad Rayan Publishing Company
Date: 09-11-2021
Abstract: Background: Debate continues in public health on the roles of universal or targeted policies in providing equity of access to health-related goods or services, and thereby contributing to health equity. Research examining policy implementation can provide fresh insights on these issues. Methods: We synthesised findings across case studies of policy implementation in four policy areas of primary healthcare (PHC), telecommunications, Indigenous health and land use policy, which incorporated a variety of universal and targeted policy structures. We analysed findings according to three criteria of equity in access – availability, affordability and acceptability – and definitions of universal, proportionate-universal, targeted and residual policies, and devolved governance structures. Results: Our analysis showed that existing universal, proportionate-universal and targeted policies in an Australian context displayed strengths and weaknesses in addressing availability, affordability and acceptability dimensions of equity in access. Conclusion: While residualist policies are unfavourable to equity of access, other forms of targeting as well as universal and proportionate-universal structure have the potential to be combined in context-specific ways favourable to equity of access to health-related goods and services. To optimise benefits, policies should address equity of access in the three dimensions of availability, affordability and acceptability. Devolved governance structures have the potential to augment equity benefits of either universal or targeted policies.
Publisher: Maad Rayan Publishing Company
Date: 10-05-2018
Publisher: Wiley
Date: 05-10-2015
Publisher: Wiley
Date: 19-11-2034
Publisher: Elsevier BV
Date: 08-2021
Publisher: Informa UK Limited
Date: 30-07-2021
Publisher: Maad Rayan Publishing Company
Date: 05-12-2020
Abstract: Background: Despite growing evidence on the social determinants of health and health equity, political action has not been commensurate. Little is known about how political will operates to enact pro-equity policies or not. This paper examines how political will for pro-health equity policies is created through analysis of public policy in multiple sectors. Methods: Eight case studies were undertaken of Australian policies where action was either taken or proposed on health equity or where the policy seemed contrary to such action. Telephone or face-to-face interviews were conducted with 192 state and non-state participants. Analysis of the cases was done through thematic analysis and triangulated with document analysis. Results: Our case studies covered: trade agreements, primary healthcare (PHC), work conditions, digital access, urban planning, social welfare and Indigenous health. The extent of political will for pro-equity policies depended on the strength of path dependency, electoral concerns, political philosophy, the strength of economic and biomedical framings, whether elite interests were threatened and the success or otherwise of civil society lobbying. Conclusion: Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies. A shift in norms is required to stress equity and the right to health.
Publisher: Elsevier BV
Date: 07-2011
Publisher: BMJ
Date: 07-2015
Publisher: Elsevier BV
Date: 04-2017
Abstract: To examine the awareness and perceptions of local government staff about the social determinants of health (SDoH) and health inequity and use of these ideas to shape policy and practice. 96 staff at 17 councils in South Australia or New South Wales responded to questions in a pilot online survey concerning: sources of knowledge about, familiarity with the evidence on, attitudes towards, and uses of ideas about the social determinants of health. Eight of 68 SA councils and 16 of 152 NSW councils were randomly selected stratified by state and metropolitan status. Differences between states and metropolitan/non-metropolitan status were explored. The majority of respondents (88.4%) reported some familiarity with ideas about the broad determinants of health and 90% agreed that the impact of policy action on health determinants should be considered in all major government policy and planning initiatives. Research articles, government rofessional reports, and professional contacts were rated as important sources of knowledge about the social determinants of health. Resources need to be dedicated to systematic research on practical implementation of interventions on social determinants of health inequities and towards providing staff with more practical information about interventions and tools to evaluate those interventions. The findings suggest there is support for action addressing the social determinants of health in local government. The findings extend similar research regarding SDoH and government in NZ and Canada to Australian local government.
Publisher: BMJ
Date: 18-08-2022
Abstract: As the COVID-19 pandemic took hold in 2020, Chief Medical Officers (CMOs) entered the public spotlight like never before. Amidst this increased visibility, the role is deeply contested. Much of the disagreement concerns whether CMOs should act independently of the government: while some argue CMOs should act as independent voices who work to shape government policy to protect public health, others stress that CMOs are civil servants whose job is to support the government. The scope and ersity of debates about the CMO role can be explained by its inherently contradictory nature, which requires incumbents to balance their commitments as physicians with their mandates as civil servants who advise and speak on the government's behalf. The long-haul COVID-19 pandemic has further tested the CMO role and has shone light on its varying remits and expectations across different jurisdictions, institutions and contexts. It is perhaps unsurprising, then, that calls to amend the CMO role have emerged in some jurisdictions during the pandemic. However, any discussions about changing the CMO role need a stronger understanding of how different institutional and in idual approaches impact what incumbents feel able to do, say and achieve. Based on an ongoing comparative analysis of the position across five countries with Westminster-style political systems, we provide an overview of the CMO role, explain its prominence in a pandemic, examine some debates surrounding the role and discuss a few unanswered empirical questions before describing our ongoing study in greater detail.
Publisher: Springer International Publishing
Date: 2022
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080509
Abstract: A prospective health impact assessment (HIA) was conducted to identify potential health impacts arising from the planned redevelopment of Liverpool Hospital, a major teaching hospital in New South Wales, Australia. A multidisciplinary team of health professionals oversaw the HIA and a core project team led by population health practitioners conducted the HIA using a structured, stepwise process. Methods used to gather data for the identification of impacts were a literature review, development of a population profile and consultation with stakeholders. A range of positive and negative health impacts were identified and an assessment matrix was used to prioritise the health impacts and develop recommendations for the proponents of the redevelopment plan.The HIA added value to the planning process for the hospital redevelopment, increasing capacity to conduct future HIAs.
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.PUHE.2014.01.006
Abstract: Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA). A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions. Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration. This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted.
Publisher: Elsevier BV
Date: 02-2012
Publisher: Elsevier BV
Date: 2018
Publisher: Informa UK Limited
Date: 22-06-2020
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.HEALTHPOL.2019.08.011
Abstract: Homelessness has serious consequences for the health of people experiencing homelessness, and presents a challenge to the provision of quality care by health services. Policymaking to address homelessness, as with other social determinants of health (SDH), is complicated by issues of complex causation, intersectoral working and the dominance of biomedicine within health policy. This paper investigates how policies addressing homelessness have been explored using formal policy process theories (PPT). It also examines how health (as an actor and an idea) has intersected with the issue of homelessness reaching policy agendas and in policy implementation. A systematised search of academic databases for peer-reviewed literature from 1986 to 2018 identified six studies of homelessness policy change from Australia, Canada, France and the United States. PPT were able to articulate the interplay of actors, ideas and structures in homelessness policymaking. When the health sector was involved, it tended to be in terms of healthcare service utilisation rather than a broader public health framework emphasising structural social determinants of homelessness. Tensions between differing the priorities of local homelessness actors and a biomedical evidence-based policy paradigm were noted. Future policy action on homelessness requires new models of intersectoral governance that account for the complexity of health determinants, a health workforce enabled to engage with the SDH, and meaningful inclusion of those with lived and living experience of homelessness in policy formulation.
Publisher: Springer Science and Business Media LLC
Date: 2011
Publisher: Oxford University Press
Date: 25-03-2020
DOI: 10.1093/OBO/9780199756797-0196
Abstract: Healthy public policy (HPP) became an important idea in the 1980s. The concept can be traced primarily to Nancy Milio, who produced a now hard-to-find book, Promoting Health through Public Policy (Philadelphia: Davis, 1981), and was subsequently cemented in the WHO’s Ottawa Charter for Health Promotion as a strategy to use in promoting, protecting, and maintaining the health of populations. HPP is not, however, a modern phenomenon. Historically HPP was embedded in the 16th-century Poor Laws and passed through to 19th- and early-20th-century public health activity and legislation. Across this history is the recognition that improving public health requires addressing the social and economic (and environmental) conditions created by public policy. It follows, as explained by many, that public health practice is inherently political. This bibliography introduces the large literature that falls under the broad pantheon of HPP. Definitions, as this bibliography will show, do matter. Central is the often underrealized truth that “healthy public policy” fundamentally concerns how public policy influences the health of populations. This, in turn, necessitates that HPP practice is interdisciplinary. For knowledge, this means much of the theory and evidence underpinning HPP is to be found in other disciplines that have public policy at their core, political science being the most obvious (public administration another). It is through HPP that societies in general and public health researchers and practitioners in particular seek to create social and economic and environmental conditions for whole populations. Attention thus moves “upstream” to policies and institutions rather than “downstream” to behaviors or health services. Not all healthy public policy is generated with the intention to influence population health directly. Nor are all public policies that impact on the health of populations generated by the health sector, although many are. A core goal of HPP is reducing inequities in health. These inequities are what the 2008 WHO Commission on the Social Determinants of Health named as a “toxic mix of poor social policies, unfair economic arrangements and bad politics.” Just as policy actors are responsible for policies that have created inequalities, so too are they responsible for developing and implementing policies in that overcome the unfair and unjust distribution of the resources necessary for good health and well-being. Public policies are formed through “contests for power” between the various actors involved in policy-making in part because they are value-laden. The choices actors make are influenced by powerful structures and ideas that are not always explicit. HPP, therefore, can never be “atheoretical” just as it cannot be orced from a normative position (what is believed “should” happen) concerned with changing political conditions for the betterment of the health of the population in general and disadvantaged in particular. In recent years there has been some confusion (see Oxford Bibliographies article Health in All Policies) whether HiAP replaces HPP as a concept and method. This article errs on the side of history by suggesting HiAP, with intersectoral action, is one recent strategy to achieve HPP.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Springer International Publishing
Date: 2022
Publisher: Maad Rayan Publishing Company
Date: 03-06-2018
Publisher: Elsevier BV
Date: 08-2017
Publisher: SAGE Publications
Date: 11-09-2021
DOI: 10.1177/17579759211034418
Abstract: If health promotion as a field of change for human and ecological health is to maintain its urgency, it needs to continue building its policy credentials. This paper charts the development of policy as a concern for IUHE/IUHPE (International Union for Health Education/International Union for Health Promotion and Education) from the mid-1970s when ‘health education policies’ were prominent issues, to the launch of Healthy Public Policy (in the 1980s) and Health in All Policy (in the 2000s). We argue that solid conceptual and theoretical foundations exist to frame and develop the relevance and connectedness of health promotion more prominently. We start off with a brief introduction into (health) political science, and then illustrate the urgency of the argument with three case studies. The first takes a critical realist perspective on ‘closing the gap’ in Australian Indigenous populations. With recent evidence it demonstrates that the core of the policymaking process needs to re-align itself with an Indigenous narrative. The second case study reviews the politics of healthy urban planning and health equity in cities. Taking a critical theory institutionalist view, the case describes how the political and narrative parallels between urban theory and health equity have gone underexplored. With an explicit gaze to connect the two, the field could become a large and influential driver of enhanced health promotion and public health policy. The third case describes the languages, policy frames, and distinctions, in four urban/health paradigms. It shows that unconscious policy and practice bias exists in policy priorities and processes. We conclude with observations and recommendations on the role of health promotion as a conceptual realm and field of activity. We show that all health promoters should be aware of the political nature of their enterprise. Tools and analyses exist to help further action.
Publisher: The Sax Institute
Date: 2021
DOI: 10.17061/PHRP3122108
Publisher: Informa UK Limited
Date: 09-06-2023
Publisher: Elsevier BV
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 09-07-2014
Publisher: Centre for Health Equity Training, Research and Evaluation
Date: 18-11-2021
DOI: 10.53714/AJYL5121
Publisher: Maad Rayan Publishing Company
Date: 07-08-2023
Abstract: Powell and Manion present an important review of reviews about health and policy research. They zero in on theories of the policy process as the most likely to unearth what is really going on in health policy. Here I contend that their analysis insufficiently attends to institutions. Powell and Manion situate ‘institutions’ (with ‘Ideas’ and ‘Interests’) as a ‘health policy process models’ that ‘tend to’ list factors rather than connect them. Rather, I show how there is a rich history of considering institutions in the political science literature that is under considered by Powell and Manion. By necessity for a Public Health audience I quickly pull back the covers on ‘rigour’ and ‘causation’ to demonstrate what is ‘fit for purpose’ in rigorous institution focussed policy analysis. I conclude by arguing how institutionally focussed public health policy analysis is vital for understanding and addressing heath inequities. That focus necessitates research that provides better, explicit, conceptualisations of power in health policy: especially drawing out the roles played by structure and agency. I offer some recent ex les.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Wiley
Date: 05-2015
DOI: 10.1002/APP5.89
Publisher: Oxford University Press (OUP)
Date: 23-06-2020
Abstract: Rapid urbanization requires health promotion practitioners to understand and engage with strategic city planning. This policy analysis research investigated how and why health was taken up into strategic land use planning in Sydney, Australia, between 2013 and 2018. This qualitative study develops two case studies of consecutive instances of strategic planning in Sydney. Data collection was done via in-depth stakeholder interviews (n = 11) and documentary analysis. Data collection and analysis revolved around core categories underpinning policy institutions (actors, structures, ideas, governance and power) to develop an explanatory narrative of the progress of ‘health’ in policy discourse over the study period. The two strategic planning efforts shifted in policy discourse. In the earlier plan, ‘healthy built environments’ was positioned as a strategic direction, but without a mandate for action the emphasis was lost in an economic growth agenda. The second effort shifted that agenda to ecological sustainability, a core aspect of which was ‘Liveability’, having greater potential for health promotion. However, ‘health’ remained underdeveloped as a core driver for city planning remaining without an institutional mandate. Instead, infrastructure coordination was the defining strategic city problem and this paradigm defaulted to emphasizing ‘health precincts’ rather than positioning health as core for the city. This research demonstrates the utility in institutional analysis to understanding positioning health promotion in city planning. Despite potential shifts in policy discourse and a more sophisticated approach to planning holistically, the challenge remains of embedding health within the institutional mandates driving city planning.
Publisher: American Chemical Society (ACS)
Date: 25-08-2020
Publisher: Oxford University Press (OUP)
Date: 10-2023
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.HEALTHPLACE.2021.102711
Abstract: 'City Deals' are new governance instruments for urban development. Vast evidence exists on the relationship between urban factors and health equity, but little research applies a health equity lens to urban policy-making. This paper does precisely that for the Western Sydney City Deal (WSCD) in Australia. We conducted a critical discourse analysis of publicly available documents and interviews with the WSCD's main architects, applying insights from relevant theories. We find 'pro-growth' discourse to encourage economic investment dominates any references to disadvantage. Interviewees maintained the WSCDs fundamental purpose is to rebalance urban investment toward the historically disadvantaged West. However, the WSCD makes limited reference to health and none to equity. Institutionalised governance practices that favour private investments in infrastructure remain the dominant force behind the WSCD. We document how a shift to 'place-based' infrastructure has promise for equity but struggles to overcome institutionalised approaches to urban investments.
Publisher: Maad Rayan Publishing Company
Date: 13-03-2023
Publisher: Centre for Health Equity Training, Research and Evaluation
Date: 18-01-2022
DOI: 10.53714/NWIF3767
Publisher: Elsevier BV
Date: 07-2011
Publisher: Elsevier BV
Date: 07-2011
Publisher: Maad Rayan Publishing Company
Date: 06-12-2022
Abstract: Background: Rapid, strategic action is required to mitigate the negative and unequal impact of the coronavirus disease 2019 (COVID-19) pandemic on the financial well-being (FWB) of global populations. Personal financial strain (FS) worsened most significantly among systematically excluded groups. Targeted government- and community-led initiatives are needed to address these inequities. The purpose of this applied research was to identify what works for whom, under what conditions, and why in relation to community and government initiatives that promote personal and household FWB and/or address FS in high income economies. Methods: We employed a critical realist analysis to literature that reported on FWB/FS initiatives in high income countries. This included initiatives introduced in response to the pandemic as well as those that began prior to the pandemic. We included sources based on a rapid review. We coded academic, published literature (n=39) and practice-based (n=36) reports abductively to uncover generative mechanisms – ie, underlying, foundational factors related to community or government initiatives that either constrained and/or enabled FWB and FS. Results: We identified two generative mechanisms: (1) neoliberal ideology and (2) social equity ideology. A third mechanism, social location (eg, characteristics of identity, location of residence), cut across the two ideologies and demonstrated for whom the initiatives worked (or did not) in what circumstances. Neoliberal ideology (ie, in idual responsibility) dominated initiative designs, which limited the positive impact on FS. This was particularly true for people who occupied systematically excluded social locations (eg, low-income young mothers). Social equity-based initiatives were less common within the literature, yet mostly had a positive impact on FWB and produced equitable outcomes. Conclusion: Equity-centric initiatives are required to improve FWB and reduce FS among systemically excluded and marginalized groups. These findings are of relevance now as nations strive for financial recovery in the face of the ongoing global pandemic.
Publisher: Informa UK Limited
Date: 16-02-2015
Publisher: Elsevier BV
Date: 08-2022
Publisher: Maad Rayan Publishing Company
Date: 06-02-2018
Publisher: Springer International Publishing
Date: 2022
Start Date: 2023
End Date: 2028
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2018
Funder: Australian Research Council
View Funded ActivityStart Date: 2015
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2015
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2021
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2020
End Date: 2020
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2021
End Date: 2022
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 05-2016
End Date: 06-2019
Amount: $699,500.00
Funder: Australian Research Council
View Funded Activity