Health in All Policies in South Australia-Did It Promote and Enact an Equity Perspective?

Helen van Eyk,Colin MacDougall,Angela Lawless,Fran Baum,Elizabeth Harris,Toni Delany-Crowe

doi:10.3390/ijerph14111288

Abstract

Mobilising cross-sectoral action is helpful in addressing the range of social determinants that contribute to health inequities. The South Australian Health in All Policies (SA HiAP) approach was implemented from 2007 to stimulate cross-sector policy activity to address the social determinants of health to improve population wellbeing and reduce health inequities. This paper presents selected findings from a five year multi-methods research study of the SA HiAP approach and draws on data collected during interviews, observation, case studies, and document analysis. The analysis shows that SA HiAP had dual goals of facilitating joined-up government for co-benefits (process focus); and addressing social determinants of health and inequities through cross-sectoral policy activity (outcomes focus). Government agencies readily understood HiAP as providing tools for improving the process of intersectoral policy development, while the more distal outcome-focused intent of improving equity was not well understood and gained less traction. While some early rhetorical support existed for progressing an equity agenda through SA HiAP, subsequent economic pressures resulted in the government narrowing its priorities to economic goals. The paper concludes that SA HiAP’s initial intentions to address equity were only partially enacted and little was done to reduce inequities. Emerging opportunities in SA, and internationally, including the UN Sustainable Development Goals, may revive interest in addressing equity.

Highlights

Addressing the social determinants of health through intersectoral action is important in improving health equity [1] because progress depends upon health promoting policy decisions being made within sectors outside of health departments [2]
We present a series of research case studies of Health in All Policies (HiAP) activity, considering the extent to which each of these has focused on equity
We present interview data to show how equity has been understood and problematised by policy actors involved with HiAP, and how they understand the positioning of equity in regard to the business of government agencies, including within the context of competing political agendas, and we consider the implications of a co-benefits approach for an explicit focus on equity

Summary

Introduction

Addressing the social determinants of health through intersectoral action is important in improving health equity [1] because progress depends upon health promoting policy decisions being made within sectors outside of health departments [2]. Public policies are the key levers used by governments to address fundamental social issues such as equity and inequity. Health in All Policies (HiAP) is an approach to forming intersectoral relationships and developing intersectoral policies across government to address the social determinants of health and equity [3,4,5]. Achieving equity in health is often cited as a core aim of HiAP [2,6]. Res. Public Health 2017, 14, 1288; doi:10.3390/ijerph14111288 www.mdpi.com/journal/ijerph

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Conclusion