Understanding Australian policies on public health

The specific objectives of the workshop are:

• Develop theoretical understandings of why disease prevention and health promotion have a marginal position on the   political and policy agenda despite their importance in shaping population health.
• Stimulate in-depth discussion to identify key insights from social and political science theory into factors that shape the implementation of complex policy initiatives aiming to improve health and wellbeing equitably through action on the social determinants of health.
•Apply these insights to practical examples of the implementation of policy approaches designed to improve health (including the South Australian Health in All Policies initiative, national ‘Closing the Gap’ Policy Initiatives, the Tasmanian Food Policy, and the NSW Planning Review) to develop improved theoretical understanding of the processes of developing and implementing disease prevention and health promotion policy.
• Encourage debate between political scientists and public health social scientists with the aims of improving the application of theoretical perspectives to public health policy issues.

Background and rationale
There is strong, and growing, evidence documenting widening health inequities across the world. Widening gaps in health equity have led to repeated calls for innovative policy approaches that promote health and wellbeing, through action on the social and economic determinants of health to create conditions that are conducive to improved population health, wellbeing and equity (Baum, 2008). The European Union and the World Health Organisation have promoted a focus on the social determinants of health and health equity including through the global Commission on the Social Determinants of Health (on which Baum was a Commissioner). Despite recommendations from this Commission and a range of subsequent national and regional reports on the same topic, evidence indicates that most governments, including in Australia, do not prioritise policies to encourage action on social determinants. The European Union and the World Health Organisation have also promoted a ‘Health in All Policies’ (HiAP) approach which advocates for all sectors of government taking action designed to promote health, well-being and equity. This approach is being applied in South Australia and Tasmania. HiAP builds upon a long history of theory and conceptual development in the health promotion movement; such as the concepts of intersectoral action for health, healthy public policy and joined up government. All three of these concepts are underpinned by the idea that the health sector must work with other sectors, particularly within and across governments, to facilitate recognition of the impact that all sectors have on health, to advocate for improved health and to mediate between differing interests across sectors. The quest for better co-ordinated government policy nationally and locally is elusive, and only limited understanding exists about why it proves difficult to implement.

Despite the growing focus on the importance of policy on social determinants in the disease prevention and health promotion fields, government action has been slow to move away from a focus on direct attempts to change individual behaviour– a process described by Popay et al (2010) as “lifestyle drift”. Additionally available evidence, including the work of the Southgate Institute, suggests that, even when wider social determinants are a focus of public health policies, implementation is not easy and remains marginal to mainstream public sector activity.

It is rare for theoretical insights to be brought to bear on these issues (de Leeuw et al, 2014). After conducting a systematic review of the extent of policy analysis in health promotion literature, Embrett and Randall (2014) concluded, “Although policy analysis is neither sufficient or necessary for policy adoption it is reasonable to expect that without a firm understanding of the factors affecting the progression of a policy issue/problem onto the policy agenda and beyond it is highly unlikely that we will see any substantial increase in the adoption of healthy public policies”.

In order to fill this gap this workshop will examine the following questions:
• What are the processes that impede action on the social determinants of equity entering the public policy agenda? Examination of this will draw on a range of political theories including Kingdon’s agenda setting, Bacchi’s What’s the Problem Represented to Be and Considine’s policy networks.
• How can theoretical insights be applied to understand better the implementation of governance processes that cut across sectors with reference to practical policy examples from South Australia and Tasmania using theories such as Considine’s work on innovation, networks and leadership?
• Can learning from practical examples improve understanding of how health equity is interpreted and translated into policy action in Australia? Discussion of this will draw on the work of the Southgate scholars, Friel (ANU), Harris (UNSW) and Popay (UK) and applying this theory to policy examples including Federal policy on Indigenous health status, and road safety and Indigenous mortality from SA.
• How do diverse contemporary policy environments affect the implementation of health equity and social determinants of health policies? Exploration of this will draw on the work of Orchard and Miller (2014), Baum (2014, 2011) Friel (2009) and Schrecker and Smith (2014).

Workshop process
The workshop will be informed by a series of pre-prepared papers. These will be designed to provide theoretical insights on the policy issues of concern. The papers will be designed to stimulate linked discussion sessions which will develop the theoretical insights in the draft papers. These will subsequently be revised in light of the workshop discussion.

Participants
Participants will include leading and emerging scholars who study policy development and/or health promotion and disease prevention. It will also include public servants who are involved in the implementation of relevant public policy.

References
Baum, F. and J. Dwyer (2014). The accidental logic of health policy in Australia. Australian public policy: Progressive ideas in the neoliberal ascendency: 187-207.

Baum, F. and M. Fisher (2011). Are the national preventive health initiatives likely to reduce health inequities? Australian journal of primary health 17 (4): 320-326

Baum, F. (2008). The New Public Health. Adelaide, Oxford University Press.

de Leeuw, E., C. Clavier and E. Breton (2014). Health policy – why research it and how: health political science. Health Res Policy Syst 12 (1): 55 DOI: 10.1186/1478-4505-12-55.

Embrett, M. G. and G. E. Randall (2014). Social determinants of health and health equity policy research: exploring the use, misuse, and nonuse of policy analysis theory. Soc Sci Med 108: 147-155 DOI: 10.1016/j.socscimed.2014.03.004.

Friel, S. (2009). Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco, Australian National Preventative Health Taskforce.

Miller, C. and L. Orchard, Eds. (2014). Australian Public Policy: Progressive Ideas in the Neo-liberal Ascendency. Bristol, Policy Press.

Popay, J., M. Whitehead and D. J. Hunter (2010). Injustice is killing people on a large scale—but what is to be done about it? Journal of Public Health 32 (2): 148-149 DOI: 10.1093/pubmed/fdq029.

Smith, K. E., & Schrecker, T. (2014). Understanding health inequity and related policy responses: What insights can political and social theories offer? Paper presented at the World Congress of Political Science, Montreal.