ORCID Profile
0000-0003-3756-1146
Current Organisation
University of Adelaide
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Publisher: Elsevier BV
Date: 12-2013
Publisher: Wiley
Date: 12-07-2022
DOI: 10.1002/HPJA.517
Abstract: How health promotion is implemented varies and it is often not clear what activities are in place in a region. Understanding the extent of health promotion activities helps planning activities. This research involved a rapid audit of the types of health promotion activities in a suburban region of South Australia. This analysis was guided by the WHO Ottawa Charter's principles. To better understand population needs and which health promoting activities may help, an epidemiological, demographic and social determinants of health profile of southern Adelaide described disease patterns and health inequities. While there was evidence of a range of health promoting activities, most concerned in idual or behavioural services. A key finding was the small number of activities that the state health department and local health system were responsible for. Alongside local government, NGOs provided the bulk of health promotion activities. In addition, there were no overarching health promotion strategies or coordinating bodies to evaluate the activities. The epidemiological, demographic and social determinants of health profile found persistent health and social inequities. This rapid audit of health promotion in a region enabled a quick assessment of the current health promotion situation and provided evidence of gaps and areas where policy change should be advocated. SO WHAT?: The key findings distilled from this research were designed to inform policy priorities to shift health promotion in southern Adelaide onto a trajectory consistent with the Ottawa Charter and prevent further focus on in idualised behaviour change strategies known as 'lifestyle drift'.
Publisher: Cambridge University Press (CUP)
Date: 23-11-2023
DOI: 10.1017/S0047279421000726
Abstract: Early childhood education (ECE) and development is internationally recognised as important to child health and wellbeing and to enabling children to become healthy productive adults. This paper analyses Australian ECE policy current in 2019. It uses the institutional framework of ideas, actors and institutions to determine the extent to which ECE policy recognises and acts on social determinants of health and health equity. We found that the policies supported integrated approaches, intersectoral collaboration and partnerships with parents and families. Evidence was important in formulating the ideas underpinning ECE policy. ECE was widely recognised as a social determinant of health, and the impacts of other social determinants of health and health equity were acknowledged. The ECE policies tended to be future-focused and not respond to social determinants that influence children and their families in the present time. The policies lacked strategies to address social determinants, or to engage with other sectors for this purpose. While some policies focused on breaking the cycle of disadvantage, they did not explore potential policy responses to pathways from intergenerational disadvantage to reduce poverty. Despite this, Australian ECE policy has achieved significant coherence, with shared understandings of the purpose and benefits of ECE.
Publisher: Elsevier BV
Date: 06-0007
DOI: 10.1016/J.SOCSCIMED.2013.03.033
Abstract: The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure. Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long.
Publisher: Wiley
Date: 07-06-2023
DOI: 10.1002/HPJA.754
Abstract: Several national governments are showing interest in policies to promote wellbeing. One common strategy is to devise systems to measure indictors of wellbeing, presuming that governments act on what they measure. This article will argue instead that formation of multisectoral policies to promote psychological wellbeing requires a different kind of theoretical and evidentiary basis. The article integrates ideas from literature on wellbeing, health in all policies, political science, mental health promotion, and social determinants of health to make a case for place‐based policy as the central feature of multi‐sectoral policy for psychological wellbeing. I argue that the required theoretical foundation for policy action on psychological wellbeing lies with understanding certain basic functions of human social psychology including the role of stress arousal. I then draw on policy theory to propose three steps to translate this theoretical understanding of psychological wellbeing into practicable, multi‐sectoral policies. Step one is concerned with adopting a thoroughly revised conception of psychological wellbeing as a policy problem. Step two involves uptake of a theory of change in policy, grounded on recognition of essential social conditions required to promote psychological wellbeing. Proceeding from these, I will argue that a necessary (but not sufficient) third step is to implement place‐based strategies involving government‐community partnerships, to generate essential conditions for psychological wellbeing on a universal basis. Finally, I examine implications of the proposed approach for current theory and practice in mental health promotion policy. Place‐based policy is foundational for effective multi‐sectoral policy to promote psychological wellbeing. Governments aiming to promote psychological wellbeing should position place‐based policy at the centre of their strategies.
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: Oxford University Press (OUP)
Date: 07-05-2016
Abstract: Intersectoral action between public agencies across policy sectors, and between levels of government, is seen as essential for effective action by governments to address social determinants of health (SDH) and to reduce health inequities. The health sector has been identified as having a crucial stewardship role, to engage other policy sectors in action to address the impacts of their policies on health. This article reports on research to investigate intersectoral action on SDH and health inequities in Australian health policy. We gathered and in idually analysed 266 policy documents, being all of the published, strategic health policies of the national Australian government and eight State/Territory governments, current at the time of s ling in late 2012-early 2013. Our analysis showed that strategies for intersectoral action were common in Australian health policy, but predominantly concerned with extending access to in idualized medical or behavioural interventions to client groups in other policy sectors. Where intersectoral strategies did propose action on SDH (other than access to health-care), they were mostly limited to addressing proximal factors, rather than policy settings affecting the distribution of socioeconomic resources. There was little evidence of engagement between the health sector and those policy sectors most able to influence systemic socioeconomic inequalities in Australia.
Publisher: Oxford University Press (OUP)
Date: 19-04-2018
Abstract: There is strong, and growing, evidence documenting health inequities across the world. However, most governments do not prioritize policies to encourage action on the social determinants of health and health equity. Furthermore, despite evidence concerning the benefits of joined-up, intersectoral policy to promote health and health equity, it is rare for such policy approaches to be applied systematically. To examine the usefulness of political and social science theory in understanding the reasons for this disjuncture between evidence and practice, researchers and public servants gathered in Adelaide for an Academy of the Social Sciences in Australia (ASSA) Workshop. This paper draws together the learnings that emerged from the Workshop, including key messages about the usefulness of various theories as well as insights drawn from policy practice. Discussions during the Workshop highlighted that applying multiple theories is particularly helpful in directing attention to, and understanding, the influence of all stages of the policy process from the construction and framing of policy problems, to the implementation of policy and evaluation of outcomes, including those outcomes that may be unintended. In addition, the Workshop emphasized the value of collaborations among public health researchers, political and social scientists and public servants to open up critical discussion about the intersections between theory, research evidence and practice. Such critique is vital to render visible the processes through which particular sources of knowledge may be privileged over others and to examine how political and bureaucratic environments shape policy proposals and implementation action.
Publisher: Australian Cities Research Network
Date: 2018
Publisher: Oxford University Press (OUP)
Date: 26-12-2021
Abstract: The provision of population-oriented, on-demand digital health services in many countries exemplifies the perceived utility of digital health services in supporting population health. Yet, limited knowledge exists regarding the equity of these services. Using mixed-method research, we recruited users of a health website and general practice patients to surveys (n = 441) and telephone interviews (n = 40). We contribute specific evidence investigating barriers to access, use and benefit from digital health services within an equity framework that incorporates social determinant factors, eHealth Literacy and trust. Our research highlights the foundational role of trust in predicting use, showcases which groups are unlikely to benefit from population-oriented digital health services, and proposes strategies to enhance the equity of these services. The theoretical framework we developed serves as a roadmap for future health promotion research and action by outlining the complex and interrelated pathways that can promote and threaten digital health equity.
Publisher: Wiley
Date: 04-2021
Abstract: Research suggests policy action on the social determinants of health (SDH) is required to reduce child health inequities (HE). However, there has been limited action in this area in Australia. Political will has been identified as a barrier but few public health scholars have conducted research which adopts a political science perspective to explore this issue. This study aims to address this gap in the literature. We conducted 27 semi‐structured interviews with policy actors involved in the development of four Australian child/youth health policies selected as relatively good practice in addressing the SDH and HE. Several political science theories guided the design of the study with the Shiffman and Smith framework predominantly used, and adapted, for analysis. The findings suggest policy development was supported by a cohesive policy network, including credible leaders. Framing of issues varied with early childhood development, health equity, and child rights being clear motivators for change. Policy actors used several tactics to navigate a neoliberal policy environment and promote a SDH agenda including adopting a credible framework consultation with children/youth establishing an institute outside of government engaging medical entrepreneurs and combining a Public Health and Wellbeing Act with a healthy cities approach.
Publisher: Informa UK Limited
Date: 25-08-2010
Publisher: Maad Rayan Publishing Company
Date: 14-03-2022
Publisher: Elsevier BV
Date: 04-2018
Abstract: 1) To report outcomes from a citizens' jury examining regulatory responses to the health impacts of McDonald's Australia 2) To determine the value of using citizens' juries to develop policy recommendations based on the findings of health impact assessment of transnational corporations (TNCs). A citizens' jury engaged 15 randomly selected and demographically representative jurors from metropolitan Adelaide to deliberate on the findings of a Corporate Health Impact Assessment, and to decide on appropriate policy actions. Jurors unanimously called for government regulation to ensure that transnational fast food corporations pay taxes on profits in the country of income. A majority (two-thirds) also recommended government regulation to reduce fast food advertising, and improve standards of consumer information including a star-ratings system. A minority held the view that no further regulation is required of the corporate fast food industry in Australia. The jury's recommendations can help inform policy makers about the importance of ending the legal profit-shifting strategies by TNCs that affect taxation revenue. They also endorse regulating the fast food industry to provide healthier food, and employing forms of community education and awareness-raising. Implications for public health: Citizens' juries can play an important role in providing feedback and policy recommendations in response to the findings of a health impact assessment of transnational corporations.
Publisher: Cambridge University Press (CUP)
Date: 28-05-2018
DOI: 10.1017/S0047279418000338
Abstract: The paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development. The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition c aigning to ‘Close the Gap’ (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG c aign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda. Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.
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: Wiley
Date: 04-07-2014
Publisher: University of Western Ontario, Western Libraries
Date: 14-05-2021
DOI: 10.18584/IIPJ.2021.12.2.10208
Abstract: This article examines what kinds of policy reforms are required to reduce incarceration rates of Aboriginal and Torres Strait Islander people through a case study of policy in the Australian state of Victoria. This state provides a good ex le of a jurisdiction with policies focused upon, and developed in partnership with, Aboriginal communities in Victoria, but which despite this has steadily increasing incarceration rates of Indigenous people. The case study consisted of a qualitative analysis of two key justice sector policies focused upon the Indigenous community in Victoria and interviews with key justice sector staff. Case study results are analysed in terms of primary, secondary, and tertiary crime prevention the social determinants of Indigenous health and recommended actions from the Ottawa Charter for Health Promotion. Finally, recommendations are made for future justice sector policies and approaches that may help to reduce the high levels of incarceration of Aboriginal and Torres Strait Islander people.
Publisher: Wiley
Date: 04-2018
DOI: 10.1002/HPJA.48
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY16152
Abstract: Significant changes have occurred in Australia’s national primary healthcare (PHC) policy over the last decade, but little assessment has been made of implications for equity. This research aimed to identify key recent changes in national PHC policy and assess implications for equity of access to PHC. Academic literature was reviewed to identify issues affecting equity of access in national PHC policy, and grey literature was also reviewed to identify significant policy changes during 2005–16 with implications for equitable access. Equity implications of four areas of policy change, set against the existing Medicare system, were assessed. It was found that Medicare supports equitable access to general practice, but there is a risk of reduced equity under current policy settings. Four changes in PHC policy were selected as having particular implications for equity of access and these were assessed as follows: increased involvement of private health insurance presents risks for equity equity implications of new models of coordinated care are unclear and regional primary health organisations and current policy on Aboriginal and Torres Strait Islander health have potential equity benefits, but these will depend on further implementation.
Publisher: Springer Science and Business Media LLC
Date: 19-02-2019
Publisher: Oxford University Press (OUP)
Date: 26-01-2021
Abstract: Although rising rates of obesity are recognized as a major concern for Australian public health, debate on what (if any) responsive action should be undertaken is conceptually and normatively complex. It is shaped by erse values and interests different representations of the problem and many options for action by government, the private sector or in iduals. This paper presents research documenting arguments for and against implementing a sugar tax in Australia. It is based on semi-structured interviews with representatives from industry (n = 4), public health (n = 4), policy think tanks (n = 2) and document and media analyses. The research design was informed by framing and agenda setting theory with results reported under four main themes: framing economic impacts, framing equity, framing obesity and framing the ‘nanny state’ versus in idual liberty argument. We found that proposals for a sugar tax as part of policy responses to the issue of overweight and obesity in Australia are framed very differently by actors who either support or oppose it. A conclusion is that policy makers and public health advocates involved in policy debates on a sugar tax need to understand the role of problem and ‘solution’ framing, and develop positions based on protecting the public interest as a basic ethical responsibility of governments and public agencies.
Publisher: Wiley
Date: 02-05-2021
Abstract: Indigenous peoples in Australia and similar colonised countries are subject to racism and systemic socioeconomic disadvantages, resulting in worse health outcomes compared to non‐Indigenous counterparts. Such inequities persist despite governments’ attempts to reduce them. Since 2008, Australian governments have committed to a national ‘Closing the Gap’ (CTG) to reduce inequities in health, education, and employment outcomes between Aboriginal and Torres Strait Islander peoples and other Australians, but with limited success. We applied policy theory and a cultural safety framework developed for the research to analyse stakeholder perceptions of CTG policy implementation between 2008 and 2019. We identified policy‐shaping ideas and policy incoherence in the environment surrounding CTG policy that obstructed culturally safe policy. Top‐down, prescriptive modes of implementation were also a barrier. However, Indigenous‐led policy partnerships and community‐controlled services in the health sector have met principles of cultural safety. Identifying these strengths and weaknesses points to ways in which implementation of CTG policies can be improved to achieve cultural safety and reduce Indigenous health inequities. These results may hold lessons for similar countries such as the United States, New Zealand, and Canada.
Publisher: Maad Rayan Publishing Company
Date: 04-08-2018
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: Wiley
Date: 19-11-2034
Publisher: Informa UK Limited
Date: 09-02-2019
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 08-2020
Publisher: SAGE Publications
Date: 12-2010
DOI: 10.3109/00048674.2010.509311
Abstract: Social determinants of health have come to greater prominence through the recent work of the WHO Commission on the Social Determinants of Health, and the Marmot Review of Health Inequalities in England. These reports also have significant implications for promotion of mental health in developed countries. In particular they reflect a growing research interest in the view that certain adverse social conditions may detrimentally affect mental or physical health by acting as chronic stressors. However, although the case for chronic arousal of stress systems as a risk factor for mental health is empirically well-founded, questions remain about how and why psychological exposure to certain kinds of proximal social conditions might contribute to such arousal. In this paper we argue that combining evidence and ideas from a number of disciplines, including public health research and psychiatry, presents an opportunity to understand the relationship better, and so inform complementary strategies in treatment, prevention and health promotion.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Cambridge University Press (CUP)
Date: 06-12-2022
DOI: 10.1017/S0047279421000866
Abstract: In the face of global epidemics of mental ill-health, the future of social policy lies with promotion of public wellbeing. This article aims to provide an explanatory rationale and methods for a fundamental shift in social policy away from a remedial focus on mental ill-health defined in terms of disease or aberrant behaviour and toward a focus on universal access to social conditions favourable to psychological wellbeing. The paper begins with prefacing argument about the urgent need for such a shift, noting the high rates of mental ill-health globally and the failure of current biomedical responses to reduce these. Building on recent theoretical work on public wellbeing and evidence on social determinants of mental health, the paper then proposes nine domains for social policy and broader public policy action, to create conditions supportive of wellbeing abilities. Finally, the paper presents several conceptual issues relating to the challenge of putting such action into practice and concludes that contemporary understanding of wellbeing offers a theory of change to shift social policy from mental illness to public wellbeing.
Publisher: Elsevier BV
Date: 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: Maad Rayan Publishing Company
Date: 23-11-2022
Abstract: Background: Universal health coverage (UHC) is central to current international debate on health policy. The primary healthcare (PHC) system is crucial to achieving UHC, in order to address the rising incidence of non-communicable diseases (NCDs) more effectively and equitably. In this paper, we examine the Australian case as a mature system of UHC and identify lessons for UHC policy to support equity of access to PHC and reduce NCDs. Methods: Our qualitative research used policy mapping and monitoring and 30 key informant interviews, and applied policy theory, to investigate the implementation of Australian PHC policy between 2008 and 2018. Results: Although the Australian PHC system does support equity of access to primary medical care, other ideational, actor-centred and structural features of policy detract from the capacities of the system to prevent and manage NCDs effectively, deliver equity of access according to need, and support equity in health outcomes. These features include a dominant focus on episodic primary medical care, which is a poor model of care for NCDs, and an inequitable distribution of these services. Also, a mixed system of public and private insurance coverage in PHC contributes to inequities in access and health outcomes, driving additional NCD demand into the health system. Conclusion: Countries aiming to achieve UHC to support health equity and reduce NCDs can learn from strengths and weaknesses in the Australian system. We recommend a range of ideational, actor-centred and structural features of UHC systems in PHC that will support effective action on NCDs, equity of access to care according to need, and equity in health outcomes across geographically and ethnically erse populations.
Publisher: Elsevier BV
Date: 2020
Publisher: SAGE Publications
Date: 19-05-2021
Abstract: In Australia, incarceration rates have steadily increased since the 1980s, providing an imperative for crime prevention. We explored the extent to which Australian justice sector policies were aimed at preventing crime, using a framework for “primary, secondary and tertiary” crime prevention. We analyzed policies and legislation ( n = 141) across Australian jurisdictions (a census was undertaken from May to September 2016, with policies spanning from 1900 to 2022). We found a strong focus on tertiary crime prevention, with reci ism rather than root causes of crime problematised. We also found little focus on primary crime prevention, despite some high-level cross sectoral strategies designed to prevent crime. In this paper, we will use the framework of Bacchi’s “what’s the problem?” approach, considering levels of crime prevention, social determinants of health, and discourses surrounding crime. We discuss policy implications and make suggestions for policy reform and accountability mechanisms to reduce crime and incarceration.
Publisher: Oxford University Press (OUP)
Date: 08-08-2016
Abstract: Area-based strategies have been widely employed in efforts to improve population health and take action on social determinants of health (SDH) and health inequities, including in urban areas where many of the social, economic and environmental factors converge to influence health. Increasingly, these factors are recognized as being part of a complex system, where population health outcomes are shaped by multiple, interacting factors operating at different levels of social organization. This article reports on research to assess the extent to which an alliance of health and human service networks is able to promote action on SDH within an Australian urban region, using a complex systems frame. We found that such an alliance was able to promote some effective action which takes into account complex interactions between social factors affecting health, but also identified significant potential barriers to other forms of desired action identified by alliance members. We found that a complex systems lens was useful in assessing a collaborative intervention to address SDH within an urban region.
Publisher: Oxford University Press (OUP)
Date: 22-08-2020
Abstract: Transnational corporations (TNCs) shape population health both positively and negatively through their national and international social, political and economic power and influence and are a vital commercial determinant of health. In idual and group advocacy and activism in response to corporate products, practices or policy influences can mediate negative health impacts. This paper discusses the unequal power relations existing between TNCs that promote their own financial interests, and activists and advocates who support population and environmental health by challenging corporate power. It draws on interview data from 19 respondents who informed 2 health impact assessments conducted on TNCs 1 from the fast food industry, and 1 from the extractive industries sector. It reveals the types of strategies that civil society organizations (CSOs) have used to encourage TNCs to act in more health promoting ways. It discusses the extent to which these strategies have been effective, and how TNCs have used their power to respond to civil society action. The paper highlights the rewards, and the very real challenges faced by CSOs trying to change TNC practices related to health, within a neoliberal policy environment. It aims to provide evidence for socially oriented actors to inform their advocacy for changes in public policy or corporate practices that can contribute to improving population health and equity and tackling commercial determinants of health.
Publisher: Bristol University Press
Date: 11-2014
DOI: 10.1332/174426414X14170264741073
Abstract: Despite abundant evidence on social determinants of health (SDH) and health inequities, effective uptake of the evidence in health policies of high-income countries has been limited. Health policies might acknowledge evidence on SDH but still direct most strategies towards biomedical and behavioural interventions. This article reports on a framework developed for qualitative analysis of health policy documents to assess how and to what extent policies address health inequities and SDH outside health care services. This framework provides an effective way to interrogate health policies on key points raised in recent literature about the translation of evidence on SDH into policy.
Publisher: Informa UK Limited
Date: 22-06-2020
Publisher: Elsevier BV
Date: 12-2020
Publisher: University of Western Ontario, Western Libraries
Date: 21-05-2019
DOI: 10.18584/IIPJ.2019.10.2.4
Abstract: Despite evidence showing the importance of social determinants of Indigenous health and Indigenous rights for health and equity, they are not always recognised within policy. This scoping review identified research on public policy and Indigenous health through a systematic search. Key themes identified included the impact of ongoing colonisation the central role of government in realising rights and the difficulties associated with the provision of mainstream services for Indigenous Peoples, including tokenism towards Indigenous issues and the legacy of past policies of assimilation. Our approach to problem representation was guided by Bacchi (2009). Findings from the review show social determinants of Indigenous health and Indigenous rights may be acknowledged in policy rhetoric, but they are not always a priority for action within policy implementation.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2019
DOI: 10.1186/S12889-019-7626-Z
Abstract: Wellbeing is seen as a matter of concern for governments and public policy. However, current theories on wellbeing are not well placed to inform this concern, because they fail to take account of and explain evidence on social determinants of mental health. This article proposes a new theory of public wellbeing which does takes account of such evidence, by explaining the role of stress within three basic functions of social cognition. Building on this description, the article then proposes that wellbeing consists in seven basic abilities, which are always developed and exercised (or not) through constant processes of interaction between in idual and environment. The article explains why contemporary theories on wellbeing are poorly placed to inform public policy for wellbeing. It also positions the proposed theory in relation to evidence on social determinants of health (SDH) and the associated public policy agenda. It is argued the proposed theory of wellbeing extends on and challenges the SDH policy agenda in relation to the normative target of policy proposals, factors identified as determinants, impacts of determinants on populations, and proposals for political and social change. Improved theory on public wellbeing can inform policy for wellbeing because it explains the contingent nature of wellbeing within contemporary social environments, and extends understanding of social determinants of wellbeing.
Publisher: BMJ
Date: 02-01-2014
Abstract: This paper offers lessons to in-coming health ministers on how they can act to reduce inequities and take action on social determinants. It draws on an interview study of twenty former Australian State, Territory and Federal health ministers about the extent to which they were able to do these things during their tenure. In order to take effective health equity action the health ministers advised: ensure evidence is used to develop a strong party policy platform for health equity install policy entrepreneurs for health equity and social determinants in the health ministry build popular constituencies through processes of deliberative democracy establish context appropriate cross-department mechanisms to co-ordinate action on social determinants and be elected in the context of a political party which values social justice and redistribution.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2017
Publisher: Springer Science and Business Media LLC
Date: 15-06-2016
Publisher: Wiley
Date: 08-2018
DOI: 10.1002/AJS4.45
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/PY11041
Abstract: This paper examines commitments to address health inequities within current (2008–11) Australian government initiatives on health promotion and chronic disease prevention. Specifically, the paper considers: the Council of Australian Governments’ ‘National partnership agreement on preventive health’ the National Preventative Health Taskforce report, ‘Australia: the healthiest country by 2020’ and the Australian Government’s response to the taskforce report, ‘Taking preventative action’. Arising from these is the recent establishment of the Australian National Preventive Health Agency. Together, these measures represent a substantial public investment in health promotion and disease prevention. The present paper finds that these initiatives clearly acknowledge significantly worse health outcomes for those subject to social or economic disadvantage, and contain measures aimed to improve health outcomes among Indigenous people and those in low socioeconomic status communities. However, we argue that, as a whole, these initiatives have (thus far) largely missed an opportunity to develop a whole of government approach to health promotion able to address upstream social determinants of health and health inequities in Australia. In particular, they are limited by a primary focus on in idual health behaviours as risk factors for chronic disease, with too little attention on the wider socioeconomic and cultural factors that drive behaviours, and so disease outcomes, in populations.
Publisher: Oxford University Press (OUP)
Date: 22-02-2020
Abstract: The concept of cultural safety (CS) has been developed as a critical perspective on healthcare provided to Indigenous service users in neo-colonial countries such as New Zealand, Australia and Canada. Unlike other frameworks for culturally competent healthcare, a CS approach recognizes impacts of colonization and power inequalities on Indigenous peoples and asks how these may manifest in healthcare settings. It has been argued that CS thinking is suited to critical analysis of public policy, but there has been limited work in this direction. Drawing on literature on CS in Australian healthcare, we defined a CS framework consisting of five concepts: reflexivity, dialogue, reducing power differences, decolonization and regardful care. Our research examined whether and in what terms this framework could be adapted as a tool for critical analysis of Australian public policy as it affects Aboriginal and Torres Strait Islander peoples. We used a collaborative inquiry process combining perspectives of an Aboriginal researcher and a non-Indigenous researcher. We developed a thematic analysis framework to examine how the five concepts might be reflected in contemporary writings on policy by leading Aboriginal or Torres Strait Islander thinkers. We found the framework is applicable as a tool for policy analysis bringing together key concerns raised by Aboriginal and Torres Strait Islander leaders and critical concepts such as sovereignty and interface thinking. We concluded the framework is likely to be a useful tool for critical, systemic thinking about public policy as it affects Indigenous peoples and for specifying areas where performance can be improved to achieve culturally safe policy.
Publisher: Wiley
Date: 19-09-2022
DOI: 10.1002/HPJA.540
Abstract: We sought to examine barriers to access to, use of, and benefits from digital health services in an area of socioeconomic disadvantage of Adelaide, Australia. We conducted waiting room surveys in two hospital diabetes clinics and one hospital antenatal clinic in South Australia, and follow‐up telephone interviews with 20 patients. We examined the extent of access to, use of and benefits from digital health services, and what barriers people encountered. We undertook mixed methods, with quantitative descriptive analysis and qualitative analysis. Thirty‐seven diabetes clinic patients (54% response rate) and 99 antenatal clinic patients (33% response rate) participated. Sixty‐two percent of the patients with diabetes and 27% of antenatal clinic patients had never used digital health services. Seventeen percent of patients with diabetes and 30% of antenatal clinic patients were hesitant users, and 22% of patients with diabetes and 44% of antenatal clinic patients were confident users. Barriers included struggling to afford the technology or to stay connected and a lack of trust in online health information. Potential benefits included feeling more empowered and complementing face‐to‐face care. There are socioeconomic barriers to access, use of, and ability to benefit from digital health strategies that mean not everyone will be able to benefit from digital health services. As COVID‐19 accelerates the shift towards digital health services, people experiencing socioeconomic disadvantage may be excluded. If barriers to access and use are not addressed, they will exacerbate already increasing health inequities.
Publisher: Wiley
Date: 02-2014
Abstract: Increasing rates of chronic conditions have resulted in governments targeting health behaviour such as smoking, eating high-fat diets, or physical inactivity known to increase risk for these conditions. In the process, many have become preoccupied with disease prevention policies focused excessively and narrowly on behavioural health-promotion strategies. These aim to improve health status by persuading in iduals to change their health behaviour. At the same time, health promotion policy often fails to incorporate an understanding of the social determinants of health, which recognises that health behaviour itself is greatly influenced by peoples' environmental, socioeconomic and cultural settings, and that chronic diseases and health behaviour such as smoking are more prevalent among the socially or economically disadvantaged. We identify several reasons why behavioural forms of health promotion are inadequate for addressing social inequities in health and point to a dilemma that, despite these inadequacies and increasing evidence of the social determinants of health, behavioural approaches and policies have strong appeal to governments. In conclusion, the article promotes strategies addressing social determinants that are likely to reduce health inequities. The article also concludes that evidence alone will not result in health policies aimed at equity and that political values and will, and the pressure of civil society are also crucial.
Publisher: Oxford University Press (OUP)
Date: 11-11-2022
Abstract: Globally health promotion has remained marginalized while biomedical health systems have maintained and even increased their dominance. During 2019–2021 we drew on the local and historical knowledge of actors from multiple sectors through semi-structured interviews and focus groups, to assess the implications of the withdrawal of the state from health promotion in a suburban region of South Australia. Institutional theory enabled in-depth analysis of the ideas, actors, and institutional forces at play in the institutional field, and how these elements come together to maintain the dominance of medicine. We found that the ideas, actors and institutional forces supporting health promotion in the study region have weakened and fragmented. This has happened as biomedicine has increased its dominance in the region’s health system, mirroring international trends. The results point to a withdrawal of state and federal governments from health promotion, which has led to severe gaps in leadership and governance, and locally, to a decline in capacity and resources. The state health department reallocated resources to focus on in idual behavioural change rather than more structural factors affecting health. While some activities aimed at the social determinants of health or community development strategies remained, these had minimal institutional support. The establishment of a state government wellbeing agency in 2020 prompted an exploration to determine whether the agency and the international wellbeing movement presents an opportunity for a revival of more comprehensive health promotion.
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: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12992-019-0509-3
Abstract: Sustainable management of the natural environment is essential. Continued environmental degradation will lead to worsened health outcomes in countries and across generations. The Sustainable Development Goals (SDGs) provide a framework for viewing the preservation of natural environments and the promotion of health, well-being and health equity as interconnected pursuits. Within the SDG framework the goals of promoting environmental sustainability and human health are unified through attention to the social determinants of health and health equity (SDH/HE). This paper presents findings from a document analysis of all Australian environment sector policies and selected legislation to examine whether and how current approaches support progress toward achieving SDG goals on water, climate change, and marine ecosystems (Goals 6, 13 and 14), and to consider implications for health and health equity. Consideration of a broad range of SDH/HE was evident in the analysed documents. Related collaborations between environment and health sectors were identified, but the bulk of proposed actions on SDH/HE were initiated by the environment sector as part of its core business. Strengths of Australian policy in regard to SDGs 6, 13 and 14 are reflected in recognition of the effects of climate change, a strong cohesive approach to marine park protection, and recognition of the need to protect existing water and sanitation systems from future threats. However, climate change strategies focus predominately on resilience, adaptation and heat related health effects, rather than on more comprehensive mitigation policies. The findings emphasise the importance of strengthened cross-sectoral action to address both the drivers and effects of environmental degradation. A lack of policy coherence between jurisdictions was also evident in several areas, compounded by inadequate national guidance, where vague strategies and non-specific devolution of responsibilities are likely to compromise coordination and accountability. Evidence on planetary health recognises the interconnectedness of environmental and human health and, as such, suggests that ineffective management of climate change and water pose serious risks to both the natural environment and human well-being. To address these risks more effectively, and to achieve the SDGs, our findings indicate that cross-jurisdiction policy coherence and national coordination must be improved. In addition, more action to address global inequities is required, along with more comprehensive approaches to climate change mitigation.
Publisher: Oxford University Press (OUP)
Date: 24-09-2021
Abstract: Governments in Australia and internationally show growing interest in wellbeing as a policy goal however, such interests raise questions about the theories or definitions of wellbeing they will apply. Choices about how wellbeing is defined for policy purposes are likely to delimit the strategies applied. Wholly in idualized conceptualizations of wellbeing may lead to policy focused narrowly on ‘improving’ in iduals rather than on creating favourable social conditions. Also, Indigenous theories of wellbeing may have much to offer policy for public wellbeing, but little research has examined whether this potential is considered in contemporary health policy. We report on research examining Indigenous and non-Indigenous theories of wellbeing in a representative s le of current Australian health policy documents. We examine what theories or definitions of wellbeing are present, whether policies recognize social determinants of health if ‘lifestyle drift’ is present how Indigenous and non-Indigenous theories of wellbeing are positioned and whether policies propose strategies consistent with their definitions of wellbeing. We discuss implications of current approaches for effective policy to promote Indigenous and non-Indigenous wellbeing.
Publisher: Maad Rayan Publishing Company
Date: 13-03-2023
Publisher: Maad Rayan Publishing Company
Date: 06-02-2018
Publisher: Cambridge University Press (CUP)
Date: 07-01-2016
DOI: 10.1017/S0047279415000756
Abstract: Evidence on social determinants of health and health equity (SDH/HE) is abundant but often not translated into effective policy action by governments. Governments’ health policies have continued to privilege medical care and in idualised behaviour-change strategies. In the light of these limitations, the 2008 Commission on the Social Determinants of Health called on health agencies to adopt a stewardship role to take action themselves and engage other government sectors in addressing SDH/HE. This article reports on research using analysis of health policy documents – published by nine Australian national or regional governments – to examine the extent to which the Australian health sector has taken up such a role. We found policies across all jurisdictions commonly recognised evidence on SDH/HE and expressed goals to improve health equity. However, these goals were predominantly operationalised in health care and other in idualised strategies. Relatively few strategies addressed SDH/HE outside of access to health care, and often they were limited in scope. National policies on Aboriginal health did most to systemically address SDH/HE. We used Kingdon's (2011) multiple streams theory to examine how problems, policies and politics combine to enable, partially allow, or prevent action on SDH/HE in Australian health policy.
No related grants have been discovered for Matthew Fisher.