Carmel Williams

Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors’ involvement

BackgroundThis 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.MethodsThe 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.ResultsThe 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 institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential.ConclusionsThe South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of government.

Human Rights Discourse in the Sustainable Development Agenda Avoids Obligations and Entitlements; Comment on 'Rights Language in the Sustainable Development Agenda: Has Right to Health Discourse and Norms Shaped Health Goals?'

Our commentary on Forman et al paper explores their thesis that right to health language can frame global health policy responses. We examined human rights discourse in the outcome documents from three 2015 United Nations (UN) summits and found rights-related terms are used in all three. However, a deeper examination of the discourse finds the documents do not convey the obligations and entitlements of human rights and international human rights law. The documents contain little that can be used to empower the participation of those already left behind and to hold States and the private sector to account for their human rights duties. This is especially worrying in a neoliberal era.

Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia

Background: 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. Methods: 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. Results: 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. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion: The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.

Using Health Rights to Design Aid-Funded Health Programs so They First do no Harm

This article reports on the development of a framework that guides aid-funded health programs to meet health rights obligations by focusing on health systems. The framework includes indicator-based tools that correspond to the three categories of rights obligations: respecting health rights by designing with a full understanding of the health system; fulfilling health rights by designing available, accessible, acceptable, and quality services; and protecting health rights by conducting a health systems impact assessment to ensure the health system is not weakened by program demands. The tools within this rights-based framework can assist the design of global health initiatives so that they work to strengthen health systems and meet rights obligations.

Maternal deaths and their impact on children in Papua New Guinea

In Papua New Guinea (PNG), with a population of just over seven million people, the life expectancy of men and women is 61.2 and 65.5 years, respectively.1 Estimates of the maternal mortality ratio range from 230/100,000 live births1 to 930/100,000,2 even in the same time periods. A 2013 study of the variances revised the estimate to 500/100,000 maternal deaths.3 These variances, and uncertainty about numbers of births, lead to estimates of between 800 and 2,500 women dying of maternal causes each year in PNG. Children also fare poorly; the Demographic and Health Survey in 20064 estimated that one in 13 children does not reach his or her fifth birthday.