Health equity and policy
Health equity and policy focuses on the scope and potential for public policies and programs to promote population health and health equity. Governments increasingly accept health promotion and reduction of disease through action on the determinants of health as a central and urgent goal of public policy.
Led by Professor Fran Baum, this area of research is based on a collaborative research approach aiming to produce policy relevant research.
Key areas of expertise
- Social determinants of health
- Health equity and policy
- Policy analysis
- Health in All Policies (HiAP)
- Health impact assessment
- Work and health
Current projects
The health impacts of transnational corporations
Project overview
Transnational corporations (TNC) are commercial determinants of health. Funding was obtained from the Rockefeller Foundation in 2016 to host an international meeting of academics, civil society and corporate representatives to develop the corporate health impact assessment (CHIA) framework. This framework has now been applied to a fast food TNC (McDonald’s in Australia), and an extractive industry TNC (Rio Tinto, in Australia and Southern Africa).
In 2016 a professionally facilitated citizen’s jury was held to obtain recommendations for government based on the findings of the McDonald’s health impact assessment. Interviews conducted for the McDonald’s and Rio Tinto projects were analysed to identify the various strategies and initiatives that were adopted by civil society advocates to challenge TNC products and practices that are detrimental to health. This analysis also highlighted the power disparity that exists between TNCs, which promote their financial interests, and civil society actors who promote improved public health and wellbeing.
- Transnational corporations and health: a research agenda https://journals.sagepub.com/doi/full/10.1177/0020731414568513?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
- Developing a corporate health impact assessment framework (CHIA) https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0164-x.
- A corporate health impact assessment of McDonald’s Australia https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0230-4
- A corporate health impact assessment of Rio Tinto in Australia and Southern Africa https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0453-2
- A citizen’s jury on the findings of the health impact assessment of McDonald’s Australia https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12769 .
- Civil society action against transnational corporations https://academic.oup.com/heapro/advance-article/doi/10.1093/heapro/daz088/5553724
Contact
Healthy South project
Funded by Health Translation SA through the Medical Research Future Fund (MRFF) Rapid Applied Research Translation Program 2019
The Healthy South project has conducted a rapid evaluation of health promotion and disease prevention structures and activities in southern Adelaide in order to determine the system building blocks required to make the south a health promoting region. The project has also developed a demographic profile of the southern metropolitan population which describes disease patterns and highlights the increasing non-communicable disease burden in South Australia and the persistent health inequities in the southern Adelaide region.
The Healthy South project is concerned with supporting healthy environments that lower people’s risk of developing chronic disease by addressing the societal and health service factors causing inequities. There is widespread agreement that the social determinants of health are the main drivers influencing how healthy a population is, and the southern region of Adelaide is no exception. While access to health care is critical to a person’s health outcomes, other significant factors identified in southern Adelaide include employment, education, housing, income, urban environments and social inclusion. A health promotion model seeks to address these underlying structures to prevent ill health.
To assist with the data collection and translation of the research findings this project brought together policy leaders from SA Health, Southern Adelaide Local Health Network (SALHN), urban planners, southern Adelaide local councils, NGOs and community members who are invested in reinvigorating health promotion leadership and coordination in southern Adelaide.
The research has identified what is required for health and wellbeing to flourish in southern Adelaide, including a vision that supports health promotion, and improved governance and leadership for health promotion. We propose a governance model - the ‘Southern Adelaide Health, Wellbeing, and Sustainability Hub’ and ten strategies that could be adopted or adapted to guide a Healthy South initiative.
Vision for the Future: the South in 2040 Hypothetical Panel
On the 29th of November 2019, the Southgate Institute hosted the Healthy South Summit to present research findings and facilitate discussion on how to strengthen and coordinate health promotion in the Southern region of Adelaide. The day concluded with a hypothetical panel "Vision for the Future: the South in 2040". The panel was facilitated by Professor Colin MacDougall, Southgate Institute. Panel members were asked to imagine that it was 2040 and the south of Adelaide had become the most healthy, equitable and sustainable region in the world, and to brainstorm ideas for how this happened, and what their organisation or sector did to improve health and equity. Ideas included a Treaty with Aboriginal and Torres Strait Islander people’s, investment in green manufacturing, investment in public schools, neighbourhood community hubs combining health services and health-promoting activities, the introduction of a job guarantee and a universal basic income, amongst many others.
The Healthy Urban Neighbourhood Transition Tool (HUNTT)
The project also examined how the urban environment influences people’s health and specifically how to assess the health and liveability of individual neighbourhoods based on a range of social determinants and liveability indicators. The Healthy Urban Neighbourhood Transition Tool (HUNTT) has been created to carry out this assessment and is currently being trialled across a number of suburbs in metropolitan Adelaide.
Project team
Southgate Institute for Health Society and Equity, College of Medicine and Public Health, Flinders University:
- Dr Connie Musolino (Project Manager)
- Professor Fran Baum (Project Director)
- Dr Helen van Eyk
- Professor Colin MacDougall
- Dr Michael McGreevy
- Dr Toby Freeman
- Dr Matt Fisher
- Dr Joanne Flavel
- Dr Anna Roesler
- Professor Jonathan Craig, College of Medicine and Public Health & Co-Chair Healthy South Steering Committee (Co-Chair Advisory Committee)
Team members outside Flinders University:
- Carmel Williams, Health Determinants and Policy Prevention and Population Health Branch, Wellbeing SA
- Ms Maria Barredo, Aboriginal Family Clinic, Southern Adelaide Local Health Network
- Professor Paddy Phillips, Commission on Excellence and Innovation in Health, Dep for Health and Wellbeing (Co-Chair Advisory Committee)
- Professor Nicola Spurrier, Chief Public Health Officer, Health Regulation and Protection, SA Health (Co-Chair Advisory Committee)
Healthy South Steering Group Members:
- Department of Health and Wellbeing
- College of Medicine and Public Health, Flinders University
- Department of Planning, Transport and Infrastructure
- National Heart Foundation of Australia (SA Division)
- Local Government Association of SA
- City of Holdfast Bay
- Healthy Cities Onkaparinga
- City of Onkaparinga
- City of Marion
- City of Unley
- Baptist Care SA
- South Australian Council of Social Service
- Health Translation SA
- Adelaide and Mount Lofty Ranges Natural Resources Management Board
Australian government policy action on social determinants in health
Understanding how the policies of Australian governments can promote health through action on the social determinants of health and health equity
Funded by the Australian Research Council 2016-2019.
This project aims to increase understanding of how the policies of Australian governments in sectors other than health contribute to health and health equity. We will do this by examining how policy in the justice, urban planning, environment and industry sectors facilitates or obstructs action on social determinants of health and health equity (SDH/HE); including via their collaborative activity with other policy sectors. The research is intended to facilitate improved whole-of-government action to promote health and equity while still addressing other sector specific goals.
The specific aims of the research are to:
- advance knowledge of the extent to which Australian governments’ policies in the selected sectors at both Federal and State/Territory levels, recognise evidence and propose action on SDH/HE, in ways that are likely to improve health or reduce health inequities.
- identify opportunities for, and barriers to, improved action on SDH/HE within the policy positions of the selected sectors, including in relation to collaboration with other sectors.
- advance understanding of factors leading to incorporation of actions on SDH/HE in policy development, in each selected sector, and across sectors.
- understand how policy in each the selected sectors disposes them to action on social determinants to improve the health of Indigenous Australians.
- understand how political values and institutional norms shaping policy in the selected sectors affect prospects for improved cross-sectoral action, or whole-of-government action, on SDH/HE in Australia.
Each of the four sectors includes multiple departments, and we are defining our focus as follows:
- Justice – incorporating policy on Attorney General functions, courts, policing and corrections
- Urban Planning – incorporating policy on planning, infrastructure, transport and essential services
- Environment – incorporating policy on environmental protection, natural resources and land management
- Energy – incorporating policy on energy production, governance and distribution
The first stage of the research involves collecting and analysing all strategic policy documents from the four sectors. Two policies from each sector that demonstrate recognition of the SDH/HE will then be selected from each sector during the second phase of the research for further case study analysis. This will include interviews with those who developed each policy.
Research approach
Phase 1 (year 1-2): document analysis
Assessing policy orientation to SDH/HE in the selected policy sectors, across federal and state/territory governments. Identify examples of good practice on SDH/HE.
Phase 2 (year 2): case studies
Case studies of two policies identified as good practice on SDH/HE in each of the four sectors.
Phase 3 (year 3): theoretical integration
Application of policy theory to understand political or institutional facilitators or barriers to action on SDH/HE, within and between policy sectors.
Chief investigators
Prof Fran Baum, Southgate Institute, Flinders University
Prof Colin MacDougall, College of Medicine and Public Health, Flinders University
Dr Patrick Harris, Centre for Health Equity Training, Research and Evaluation, University of New South Wales
Prof Dora Marinova, Curtin University of Technology
Prof Dennis McDermott, Pro-Vice Chancellor, Indigenous, La Trobe University
Dr Matt Fisher, Southgate Institute, Flinders University
Partner investigators
Prof Margaret Whitehead, University of Liverpool
Prof Peter Sainsbury, South Western Sydney Local Health District
Ms Carmel Williams, SA Health
Associate Professor Lester Wright
Dr Anthea Krieg, Department of Communitites and Social Inclusion, SA Government
ARC Translation Forum, 26 June 2019 presentation
World Health Organization Collaborating Centre on Social, Political, and Commercial Determinants of Health Equity
In 2020, the Southgate Institute was designated as a World Health Organization Collaborating Centre, to foster global research and knowledge translation on the social, political and commercial determinants of health equity.
Centre for Research Excellence on the Social Determinants of Health Equity
The NHMRC Centre for Research Excellence on the Social Determinants of Health Equity (2015-2020) examines how government policies can work more effectively to address the social determinants of health, so as to improve health and reduce health inequities.
It includes policy case studies on the Northern Territory Emergency Response and the Closing the Gap strategy. The Lowitja Institute is a partner in the Centre.
Past projects
The Australian Health Inequities Program was an NHMRC-funded capacity building project addressing social and economic determinants of health. The project had two main aims:
- To build capacity in multidisciplinary population health work by increasing understanding of the complex social, economic and environmental factors contributing to health inequities.
- To improve policy, program and practice designed to reduce these inequities.
Key features of AHIP
- Building the capacity of individual researchers in the health inequities field to work in a multidisciplinary framework by employing a number of postdoctoral researchers and offering PhD scholarships in key areas of research.
- Creating a broad network of Australian researchers working in health related areas, bringing them together in forums and in national/international conferences on health inequities.
- Strengthening links with the international research community focused on health inequities in the UK, Canada, South Africa, the USA and Ireland.
- Close working relationships with the South Australian Department of Health and VicHealth and Department of Human Services in Victoria to improve policy responses to health inequities.
The researchers
The team assembled for the project had backgrounds in mainstream geography, housing and labour market economics as well as considerable experience in public health research. Researchers were from Flinders University and a researcher from Melbourne University.
AHIP projects
- Changing Patterns of Employment and Unemployment: Impacts on Physical and Mental Health and the Meditating Role of Social Capital - provided original insights into what aspects of employment help or harm health; and into what enables some people to escape the harm that others experience. This provided vital information to underpin policies designed to gain the benefits of a flexible workplace with minimum harm to workers.
- Location and Health - examined the differences in levels of social capital, mental and physical health between people living in four postcode areas with contrasting socio-economic status within metro-Adelaide. A central focus was with the impact that neighbourhoods characteristics have on the health and well-being of local communities.
- Mitsubishi - "Children's account of the closure of a car factory".
- VicLanes - A multilevel 3-year study funded by VicHealth - collected individual, household and environmental information from 4913 households in 50 areas across Melbourne to examine the relationships between the individual, household and environmental factors that impact on health.
- Australian Governments and Health Inequities - an analysis of key documents from each state/territory/federal health department to assess the extent to which documentary evidence suggests that each jurisdiction is aware of, and working to reduce, health inequities.
- Social capital and public policy - examined the way in which social capital theory is being used in public policies and programs to improve health and wellbeing in South Australia. It was concerned with the ways in which networking and trust between people in communities (what we call 'social capital') are developed through local, community-based initiatives.
- Case Study of South Australia 's Social Inclusion Initiative - A report commissioned by the Social Exclusion Knowledge Network (SEKN) of the WHO's Commission on Social Determinants of Health to act as one of 14 background papers informing the SEKN's final report to the Commission.
For more information
For more information about the project, please contact us.
The Southgate Institute for Health, Society and Equity, in collaboration with SA Health and other South Australian, interstate and international investigators, undertood research to examine a policy initiative that is intended to stimulate inter-sectoral action to address social determinants of health. This research examined the adoption and implementation of the policy initiative, which is called Health in All Policies (HiAP), to determine its effectiveness in motivating action across sectors to improve population health and health equity. This project was funded by the NHMRC.
Research questions
- To what extent is the SA HiAP approach an effective method of building healthy public policy in order to modify the determinants of population health, well-being and health equity?
- To what extent does the application of policy agenda setting and implementation theory explain the strengths and weakness of the HiAP model as a means of bringing about action on the determinants of health, well-being and health equity across sectors of government?
- How effective is the combination of a program logic and action research as a framework for determining the impact of a complex multi-sectoral policy initiative on population health?
Neighbourhoods, communities, housing, and health was interdisciplinary in approach, crossing boundaries that included urban planning, housing studies, sociology and public health. Led by Associate Professor Kathy Arthurson, our focus was on cities and neighbourhoods and investigating the pathways by which characteristics of particular areas are interrelated with achieving health equity, community resilience and social inclusion.
The relocation tool kit: a guide for implementing relocation policies that enhance residents’ health and wellbeing and social inclusion (ARC Linkage)
Background: Over the five decades since its construction, the Carlton Public Housing Estate gained a negative reputation in an increasingly gentrified locality; yet, for its many residents, the estate was their long-term home and social nexus. The 11-year, phased plan, to redevelop the estate’s three sites (Lygon, Elgin and Keppel Street precincts) into a mixed private and public living space started in 2006 with the aim of: increasing housing capacity; improving safety; and integrating public housing with the wider community. This study collected the opinions and experiences of non-returning and returning residents to the Lygon precinct post redevelopment. We partnerned with VicHealth and Brotherhood of St Laurence for this project.
The project examined the way in which social capital theory is being used in public policies and programs to improve health and wellbeing in South Australia.
It focused on the ways in which networking and trust between people in communities (what we call ‘social capital’) are developed through local, community-based initiatives.
Public servants and how they intepret the concept of social capital and put their interpretations into practice were examined.
Our partners were the SA Department of Health, Arts SA and the City of Onkaparinga.
This longitudinal research project aimed to understand how the loss of employment arising from the closure of Mitsubishi at Lonsdale – a significant manufacturing plant – affected the well-being of workers and their families.
The research examined the processes of adjustment and change – health impacts, loss of job and possible loss of income – affecting workers and their families who were made redundant or accepted voluntary redundancy packages.
Our partners were Australian Housing and Urban Research Institute.
This research project examined uptake of evidence on social determinants of health and health inequities (SDH/HE) in Australian health policy. We examined uptake of evidence in all Australian governments’ strategic health policy documents current circa 2012-13. We also conducted eight case studies to examine the policy agenda setting process; interviewing policy actors involved in the development of eight policies that we had identified as good practice on addressing SDH/HE.
Our document analysis found that, while recognition of evidence on SDH/HE was very widespread in health policy, the strategies proposed were confined predominantly to medical care or individualised programs to encourage healthy behaviours. This process within policy of shifting the focus from SDH to individualised interventions is sometimes referred to as ‘lifestyle drift’.
Our case studies identified a range of factors influencing agenda setting processes, to get SDH into health policy in a meaningful way. The most successful policy in this regard was the National Aboriginal and Torres Strait Islander Health Plan. Here, Aboriginal and Torres Strait Islander non-government organisations in the health sector collaborated to shape the agenda setting process and insist on a partnership approach with government. In our assessment, the resultant document was the first in national Aboriginal and Torres Strait Islander health policy to fully take account of social determinants of Indigenous health and put culture at the centre.
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