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The paper by Guglielmin and colleagues1 examines the implementation of Health in All Policies (HiAP) in a local government context in Kuopio Finland. The authors use a realist explanatory case study design to explore what has supported... more
The paper by Guglielmin and colleagues1 examines the implementation of Health in All Policies (HiAP) in a local government context in Kuopio Finland. The authors use a realist explanatory case study design to explore what has supported HiAP implementation with a focus on two specific hypotheses on what leads to success: common goals and committed leadership and staff. The paper is well argued using appropriate methodology and their findings support the importance of the success factors tested by their two hypotheses. However, the narrowed focus on just two hypotheses underrepresents the complexity of implementing HiAP at any level of government, including local government. Given its local government focus, the paper would have been strengthened by referencing the lessons gained from the Healthy Cities movement. Local government is a critical setting for action to address health and health equity and there is great potential to continue research that adds to the knowledge base on how...
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Since the 2008 publication of the reports of the Commission on Social Determinants of Health and its nine knowledge networks, substantial research has been undertaken to document and describe health inequities. The COVID-19 pandemic has... more
Since the 2008 publication of the reports of the Commission on Social Determinants of Health and its nine knowledge networks, substantial research has been undertaken to document and describe health inequities. The COVID-19 pandemic has underscored the need for a deeper understanding of, and broader action on, the social determinants of health. Building on this unique and critical opportunity, the World Health Organization is steering a multi-country Initiative to reduce health inequities through an action-learning process in ‘Pathfinder’ countries. The Initiative aims to develop replicable and reliable models and practices that can be adopted by WHO offices and UN staff to address the social determinants of health to advance health equity. This paper provides an overview of the Initiative by describing its broad theory of change and work undertaken in three regions and six Pathfinder countries in its first year-and-a-half. Participants engaged in the Initiative describe results of ...
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The South Australian (SA) Health in All Policies (HiAP) initiative provides a framework and mandate for intersectoral policy work on the social determinants of health. Participation in decent and meaningful employment is a key social... more
The South Australian (SA) Health in All Policies (HiAP) initiative provides a framework and mandate for intersectoral policy work on the social determinants of health. Participation in decent and meaningful employment is a key social determinant of health, and is also an important strategy to promote ‘active ageing’ in the population. This paper reports on an intersectoral project undertaken by the Health In All Policies Unit and Country Health SA Local Health Network (CHSA LHN) in collaboration with Flinders University’s SA Community Health Research Unit and Southgate Institute for Health Society and Equity. The project Active Ageing and Employment in Regional South Australia aims to identify policy levers to increase the workforce retention and re-entry for rural people aged 45+. The project is designed to do this by building the capacity of the regional health workforce to address the social determinants of health in collaboration with agencies outside of the health system. The p...
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After publication of the article [1], it has been brought to our attention that Table 1 has been formatted poorly in the original version so that the columns are not aligned with their corresponding information. The correct version of the... more
After publication of the article [1], it has been brought to our attention that Table 1 has been formatted poorly in the original version so that the columns are not aligned with their corresponding information. The correct version of the table is presented below. The original version of the article has now been revised.
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Australia has a rapidly ageing population and this presents a range of opportunities and challenges, particularly in relation to service delivery, employment and rates of chronic disease. In South Australia (SA), one in six people are... more
Australia has a rapidly ageing population and this presents a range of opportunities and challenges, particularly in relation to service delivery, employment and rates of chronic disease. In South Australia (SA), one in six people are aged 65 years and older, with older people and those affected by chronic disease over-represented in regional areas.1,2 This presents two significant challenges to the workforce in regional areas:
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... more
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.
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The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation... more
The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. ...
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This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which... more
This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation. The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants. The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutiona...
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Health systems have long been criticised for focussing on curing rather than preventing disease. This paper examines to what extent the Adelaide Thinkers in Residence (ATiR) scheme contributed to the change in norms whereby promoting... more
Health systems have long been criticised for focussing on curing rather than preventing disease. This paper examines to what extent the Adelaide Thinkers in Residence (ATiR) scheme contributed to the change in norms whereby promoting well-being and a strategy to achieve this - Health in All Policies (HiAP) - was adopted by the South Australian (SA) State Government from 2007. The data presented in this paper are drawn from a five year (2012-2016) detailed mixed methods case study of the SA HiAP initiative which involved document analysis, interviews and workshops with public servants and political actors. We adapt the framework used by Finnemore and Sikkink (1998) which explains how norm changes can lead to political changes in international affairs. We also use Kingdon's concept of policy entrepreneurs to determine whether these ideas moved to an implementable initiative with the help of both a specific ATiR program on HiAP and the broader TiR scheme which promoted a series of innovations relevant to health. The process involved the ATiR reinforcing the work of local norm entrepreneurs with that of powerful external policy entrepreneurs, adapting the discourse about the value of prevention and promoting well-being so that it fitted with the dominant economic one. The powerful organisational platform of the ATiR, which was under the Department of the Premier and Cabinet and linked to the South Australian Strategic Plan (SASP) was used to advance these ideas. The case study offers important lessons for other jurisdictions on how to shift policy to encourage intersectoral approaches to health.
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In C Clavier and E deLeeuw (eds.) Health Promotion and the Policy Process: Practical and Critical Theories (pp. 188-217). Oxford: Oxford University Press.
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To assess the social capital profile of a known disadvantaged area a large cross-sectional survey was undertaken. The social capital profile of this area was compared to data from the whole of the state. The overall health status of the... more
To assess the social capital profile of a known disadvantaged area a large cross-sectional survey was undertaken. The social capital profile of this area was compared to data from the whole of the state. The overall health status of the disadvantaged area was assessed in relation to a wide variety of social capital related variables. Univariate and multivariate analysis were undertaken. In the univariate analysis many statistically significant differences were found between the respondents in the disadvantaged area and the state estimates including overall health status, perceived attributes of the neighbourhood, levels of trust, community involvement and social activities. In the multivariate analysis very few variables were found to be statistically significantly associated with poorer health status. The variables that jointly predicted poorer health status in the disadvantaged area were older age, lower income, low sport participation, non-seeking help from neighbours and non-att...
Research Interests: Decision Making, Government, Social Capital, Community Health, Health, and 12 morePublic Health, Health Policy, Community Involvement, Healthcare, State Estimation, Multivariate Analysis, Scientific, Educational, Statistical Significance, Health Status, Cross Section, and Public health systems and services research
Health in All Policies (HiAP) has been promoted as a means of embedding concern for health impacts in the policy-making process. In South Australia, specific structures and processes to achieve this have been developed and tested. The... more
Health in All Policies (HiAP) has been promoted as a means of embedding concern for health impacts in the policy-making process. In South Australia, specific structures and processes to achieve this have been developed and tested. The HiAP approach is designed to engage policy officers and managers in all sectors of government. South Australia, one of six Australian states, which operates under a system of cabinet government. There are 15 government departments. The primary mechanism of the South Australian HiAP approach is the health lens analysis (HLA) - an intersectoral, partnership process drawing on public health research methods. It has been applied to three separate public policy issues: water security, digital technology and migration. Evaluation findings to date suggest that the HLAs have resulted in the following: increased understanding by policy-makers of the impact of their work on health outcomes; changes in policy direction; development and dissemination of policy-rel...
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Public policy strategies impact on population health by acting on the effectiveness, availability and distribution of the social determinants of health. Reducing obesity and promoting healthy weight is a key focus of governments, health... more
Public policy strategies impact on population health by acting on the effectiveness, availability and distribution of the social determinants of health. Reducing obesity and promoting healthy weight is a key focus of governments, health promoters and researchers, and can benefit from a systems approach with 'upstream' policy action beyond the health sector. Although the literature identifies many areas for hypothetical non-health policy action, and in particular relating to food and activity environments, few have identified practical, politically viable and relatively cost-free processes by which non-health sectors would want to commit to such action. This article details how the Government of South Australia used the Health in All Policies (HiAP) approach in the SA HiAP Healthy Weight Project. It mapped the core business and policy directions of 44 state departments against research on 'what works' to address obesity. Negotiations then developed high-level policy c...
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In C Clavier and E deLeeuw (eds.) Health Promotion and the Policy Process: Practical and Critical Theories (pp. 188-217). Oxford: Oxford University Press.
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BACKGROUND: To assess the social capital profile of a known disadvantaged area a large cross-sectional survey was undertaken. The social capital profile of this area was compared to data from the whole of the state. The overall health... more
BACKGROUND: To assess the social capital profile of a known disadvantaged area a large cross-sectional survey was undertaken. The social capital profile of this area was compared to data from the whole of the state. The overall health status of the disadvantaged area was assessed in relation to a wide variety of social capital related variables. Univariate and multivariate analysis were undertaken. RESULTS: In the univariate analysis many statistically significant differences were found between the respondents in the disadvantaged area and the state estimates including overall health status, perceived attributes of the neighbourhood, levels of trust, community involvement and social activities. In the multivariate analysis very few variables were found to be statistically significantly associated with poorer health status. The variables that jointly predicted poorer health status in the disadvantaged area were older age, lower income, low sport participation, non-seeking help from n...
Research Interests: Decision Making, Government, Social Capital, Community Health, Health, and 12 morePublic Health, Health Policy, Community Involvement, Healthcare, State Estimation, Multivariate Analysis, Scientific, Educational, Statistical Significance, Health Status, Cross Section, and Public health systems and services research
Significant improvements in population health are likely to arise when the social determinants ofhealth are addressed. This creates a challenge for health systems, as the policy levers to influence the determinants largely lie outside of... more
Significant improvements in population health are likely to arise when the social determinants ofhealth are addressed. This creates a challenge for health systems, as the policy levers to influence the determinants largely lie outside of their direct control. Health agencies have been attempting to develop responses that affect these policy levers with mixed success. Success often requires particular conditions or "windows of opportunity" to be present before even small systemic change can be made. The government of South Australia has developed a practical, policy-oriented response to address the determinants of health--Health in All Policies--and has been successfully working across government for the past five years, using a policy learning process to implement this approach. This article will focus on how the South Australian Health in All Policies initiative started and the conditions that enabled South Australia to establish a centralized governance structure, harness a group of cross-sector policy entrepreneurs, and conduct health lens projects across a range of policy issues. The authors will comment on the nature of these conditions and their relevance for other governments struggling to reduce the burden of chronic disease and growing health budgets by addressing the social determinants of health.
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The health lens is a key feature of the Health in All Policies (HiAP) approach adopted in South Australia (SA). The application of a health lens aims to identify key interactions and synergies between South Australia's Strategic Plan... more
The health lens is a key feature of the Health in All Policies (HiAP) approach adopted in South Australia (SA). The application of a health lens aims to identify key interactions and synergies between South Australia's Strategic Plan (SASP) targets, policies and strategies ...