Research themes

1. Problem identification and agenda setting

Making health equity a policy concern.

A question often raised in the health equity field is how to get issues of social justice, social determinants and health equity into the political and policy agendas?

Work Package 1 is concerned with the study of agenda setting – the stage of the policy process where some issues rise to the attention of policy-makers, whereas others are neglected or not considered at all.

Drawing on various policy theories, the aim of this work package is to examine the factors shaping attention or neglect of health equity in the policy agendas of multiple sectors. In doing so, the study will provide evidence on how to make health equity a political and policy priority in the future.

To do this, we will use four policy case studies. Two are examples where health equity has been prominent in policy goals (Medicare, Paid Parental Leave), and two are examples where health equity arguments appear to have had little influence (Northern Territory Intervention, Trans Pacific Partnership Agreement).

Using documentary evidence and key informant interviews with policy makers, academics and civil society groups, we will investigate the power of ideas, actors and institutions, and the formal and informal processes that are used to influence agendas.

2. Policy solutions / formulations

Formulating policy: understanding complex systems and policy coherence

The key question we are investigating in Work Package 2 is how do policies from different sectors interact and then potentially improve or worsen the social determinants of health and health inequities?

We will develop an innovative systems-science based method to explore this question.

The reason for this research is that policies that emerge from a narrow 'silo' approach may work initially to improve health but can be ineffective (even damaging) in the medium-to-long term, because they fail to account for the effects of policy interactions from other sectors.

There is increasing recognition that good policy requires the adoption of a complex systems perspective that accounts for such interactions. Taking a systems perspective also helps to avoid the policy trap of victim-blaming individuals rather than systems.

Two-phase research

The research will be done in two-phases:

1. We will build a theoretical systems-based analytical framework to understand how macroeconomic policies (trade and employment) interacts with daily living conditions (employment, access to health and social services), and how these interactions might improve or worsen people’s access to social, economic and cultural resources and power in ways that affect the health of different populations.
2. We will apply the systems framework to real life policy to identify the coherence or conflict between policies and how the social determinants of health are affected by local, state, national and global factors.

A key outcome will be a systems framework, which will provide greater clarity in the conceptualisation and communication of the links between policy action in these sectors and the impact on health equity.

3. Implementation

Effective implementation for health equity

Research in Work Package 3 is focused on understanding the implementation phase of the policy cycle: the processes of government policy being put into practice.

Implementation research asks: “What is happening?” in the implementation of policy; “Is it what is expected or desired?” and “Why is it happening as it is?” We will adopt this approach to conduct case studies on policy implementation in four policy case studies:

• National Broadband Network
• Land use planning in New South Wales
• Primary health care (PHC)
• ‘Closing the Gap’ (CTG) strategy

Each of these addresses social determinants of health and health equity in different ways. Thus, Work Package 3 aims to understand:

• How current processes of implementation in these four policy areas affect the social determinants of health and health equity; and
• How policy implementation – within and across different areas of policy –  could function more effectively  to address social determinants of health and contribute to health equity.

Why this research?

Research tells us the high-level goals for what a policy is ‘meant’ to achieve, or plans for how it is ‘meant’ to be implemented, do not always neatly follow in practice. Policy implementation is complex, influenced by political context, ideas, institutional arrangements and the actions of individuals or groups involved.

What is not yet well understood is how these various elements of policy implementation affect action (or inaction) on social determinants of health. This research is tackling that question. It is an important question to ask because we know that the social factors (determinants) that have significant impacts on population health and health equity are themselves strongly influenced by government policy.

Expected outcome

The expected outcome of our case studies is a more nuanced understanding of policy implementation processes, which can inform future policy and increase the chances of health equity being realised. This is particularly important in relation to the Closing the Gap strategy, as the failure to reduce Indigenous disadvantage has been an ongoing and long-term policy failure in Australia.

4. Evaluation of impact on health equity

Health equity impacts of public policy and action.

Policy-makers often raise the question: what is the evidence in terms of what works to reduce health inequities through action on the social determinants?

There is relatively little research that answers this question.

Work Package 4 aims to test the feasibility of different methodologies to evaluate the impact of multi-sectoral public policies on the social determinants of health and health equity outcomes.

We will do this by developing a health equity evaluation framework and methodologies.

Existing knowledge from the growing number of evaluation approaches for complex problems will inform the development of the framework, including program logic, equity focussed health impact assessment, systems science, realist evaluation and policy learning frameworks.

An important area which the work will address is the challenge of estimating health equity impacts when the policy interventions occur within complex interacting systems.

Work Package goals

• Assess international good practice on the evaluation of policy as it relates to the social determinants of health and health equity outcomes.
• Create a framework that expands existing conceptual thinking on health equity-focused policy evaluation.
• Develop a practical tool for the effective policy evaluation, including indicators for outcomes which best represent equity effects (both positive and negative) of policy processes, and methods to measure these effects.
• Apply the health equity evaluation framework to the four case studies adopted in Work Package 3 (Implementation).
• Synthesise lessons from the case studies for evaluation of health equity impacts of public policy in other policy domains.

Theme 1 - Macroeconomics and infrastructure

• Such policies shape the distribution of jobs, money and other material resources in society and therefore powerfully affect daily living conditions and health.
• Our research involves case studies from trade and investment (Trans-Pacific Partnership Agreement), employment (Australia’s paid parental leave scheme) and digital technology (implementation of Australia’s National Broadband Network) policy sectors.

Theme 2 - Land use and urban environments

• Over seventy percent of the Australian population and a majority of Indigenous Australians live in urban areas.
• The social, economic and physical make-up of urban environments therefore presents an important opportunity to improve health equity.
• Our research will use land-use planning legislation in New South Wales as a case study.