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Baum F, McGreevy MP, MacDougall CM, Henley M. Energy as a Social and Commercial Determinant of Health: A Qualitative Study of Australian Policy. Int J Health Policy Manag 2022; 12:7193. [PMID: 37579461 PMCID: PMC10125081 DOI: 10.34172/ijhpm.2022.7193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/06/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND This paper considers energy as a social and commercial determinant of health. Stable access to clean and sustainable energy is integral for human wellbeing yet public health rarely considers its importance. METHODS Using NVivo qualitative analysis software we analysed all Australian federal, state and territory strategic energy policies covering varying periods between 2016-2030. We defined strategic policy as including the goals, objectives and strategies of the department regarding a specific area of policy responsibility. This criterion excluded documents such as operational guidelines. 36 energy-related policies were analyzed. RESULTS While the nature of energy supply is crucial to determining the impact of human and environmental health, our analysis showed that health and wellbeing are only rarely considered in policy. We developed a conceptual framework to guide our work linking energy policy with health. Australia's continued reliance on fossil fuels evident in the policies poses health risks, especially as climate change threatens physical and mental health. Yet health considerations were mainly absent from the policies. However, some jurisdictions (South Australia and the Australian Capital Territory [ACT]) had policies encouraging a fast move to renewables. Energy pricing was a key focus in each jurisdiction and had become highly politicalized in the past decade. Little attention was paid to equity considerations in the policies. CONCLUSION Energy policy would be more health promoting if public health perspectives were considered during its development. On the basis of our policy analysis and literature review we conclude with recommendations for healthy energy policy.
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Affiliation(s)
- Fran Baum
- Stretton Institute, University of Adelaide, Adelaide, SA, Australia
| | - Michael P. McGreevy
- Department of Industrial Systems Engineering and Management, National University of Singapore, Singapore, Singapore
| | - Colin M. MacDougall
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Ssennyonjo A, Ssengooba F, Criel B, Titeca K, Van Belle S. 'Writing budgets for meetings and teas?': a multitheoretical analysis of intragovernmental coordination for multisectoral action for health in Uganda. BMJ Glob Health 2022; 7:bmjgh-2021-007990. [PMID: 35197251 PMCID: PMC8867254 DOI: 10.1136/bmjgh-2021-007990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Coordination across policy domains and among government agencies is considered critical for addressing complex challenges such as inequities, urbanisation and climate change. However, the factors influencing coordination among government entities in low-income and middle-income countries are not well known. Although theory building is well suited to explain complex social phenomena, theory-based health policy and systems studies are limited. This paper examined the factors influencing coordination among government entities at the central government level in Uganda. Methods This theory-based case study used a qualitative approach. Primary data were collected through 26 national-level key informant interviews supplemented with a review of 6 national strategic and policy documents. Data were analysed abductively using a multitheoretical framework combining the transaction cost economics theory, principal–agent theory, resource dependence theory and political economy perspective. Results Complex and dynamic interactions among different factors, both internal and external to the government, were found. Interdependencies, coordination costs, non-aligned interests, and institutional and ideational aspects were crucial factors. The power dynamics within the bureaucratic structures and the agency of the coordinated entities influence the effectiveness of coordination efforts. New public management principles promoted in the 1990s by donor institutional strengthening projects (characterised by agencification and setting up of independent agencies to circumvent ineffective big line ministries) created further fragmentation within the government. The donors and international agendas were occasionally supportive but sometimes counterintuitive to national coordination efforts. Conclusion The multitheoretical framework derives a deep analysis of the factors that influence organisational decision-making to coordinate with others or not. Achieving intragovernmental coordination requires more time and resources to guide the software aspects of institutional change—articulating a shared vision on coordination across government. Shaping incentives to align interests, managing coordination costs and navigating historical-institutional contexts are critical. Countervailing political actions and power dynamics should be judiciously navigated.
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Affiliation(s)
- Aloysius Ssennyonjo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda .,Institute of Development Policy, University of Antwerp, Antwerp, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristof Titeca
- Institute of Development Policy, University of Antwerp, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Dominello A, Howell M, Craig JC, Scholes-Robertson N, Guha C, Sinka V, Jesudason S, Wong G, Ladhani M, Tong A. Equity in national policies for Australians with kidney disease. Aust N Z J Public Health 2021; 45:370-375. [PMID: 33818846 DOI: 10.1111/1753-6405.13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe how the Australian Government Department of Health policies address equity in the management of chronic kidney disease (CKD). METHODS We searched the websites of the Australian Government Department of Health, Kidney Health Australia, Australian Indigenous HealthInfoNet and the National Rural Health Alliance for policies using the search terms: kidney, renal and chronic. RESULTS We included 24 policies that addressed groups of people that experience health inequities: 23 addressed Aboriginal and Torres Strait Islander peoples, 18 rural/remote communities, 12 low socioeconomic status groups, six culturally and linguistically diverse communities and four addressed gender disparities. The scope of the policies ranged from broad national frameworks to subsidised access to health services and medicines. Only two policies explicitly addressed equity for patients with CKD. CONCLUSION CKD outcomes are highly variable across population groups yet Australian Government policies that address access to and the experience of care are limited in both number and their attention to equity issues. Implications for public health: In Australia, some groups of people with CKD have a substantially higher risk of mortality and morbidity than the general CKD population. We advocate for the development and implementation of policies to attain equity for people with CKD.
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Affiliation(s)
- Amanda Dominello
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Martin Howell
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, South Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Chandana Guha
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Maleeka Ladhani
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales.,Sydney School of Public Health, The University of Sydney, New South Wales
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van Eyk H, Friel S, Sainsbury P, Boyd-Caine T, Harris P, MacDougall C, Delany-Crowe T, Musolino C, Baum F. How do advisory groups contribute to healthy public policy research? Int J Public Health 2020; 65:1581-1591. [PMID: 33057731 DOI: 10.1007/s00038-020-01504-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research. METHODS Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers' critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken. RESULTS PAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers' need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified. CONCLUSIONS The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs' role and how they can increase research translation into policy.
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Affiliation(s)
- Helen van Eyk
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia.
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Peter Sainsbury
- Sydney Medical School, University of Notre Dame, Sydney, NSW, Australia
| | | | - Patrick Harris
- Centre for Health Equity Training, Research and Evaluation (CHETRE). University of New South Wales Australia Research Centre for Primary Health Care and Equity. Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool Hospital, Sydney, NSW, Australia
| | - Colin MacDougall
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toni Delany-Crowe
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Connie Musolino
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
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Lesch M, McCambridge J. Reconceptualising the study of alcohol policy decision-making: the contribution of political science. ADDICTION RESEARCH & THEORY 2020; 29:427-435. [PMID: 34566546 PMCID: PMC8460360 DOI: 10.1080/16066359.2020.1773445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 05/28/2023]
Abstract
In this article, we demonstrate the applicability of a 3-I (interests, institutions, and ideas) framework to alcohol policy research. The analysis uses literature from political science research to provide a core theoretical framework. To help illustrate the argument, we draw on relevant examples from alcohol policy in the UK as well as initial findings from an ongoing research study on minimum-unit pricing in Wales. The Welsh case study provides an opportunity to examine the value of the framework in generating testable hypotheses in alcohol policy research. We find that several interrelated factors promoted policy change in Wales, including the government's power to legislate on matters of public health (institutionally), a relatively weak alcohol industry (a key interest group), and a public health community with specific policy arguments on why and how to tackle alcohol-related harms (ideas). Our analysis has important implications for public health research and evidence-based policymaking. It suggests that the uptake of new ideas depends on the existing configuration of interests, institutions and ideas. This analysis provides alcohol policy researchers with a portable framework for analysing the policy context.
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Affiliation(s)
- Matthew Lesch
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
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Delany-Crowe T, Marinova D, Fisher M, McGreevy M, Baum F. Australian policies on water management and climate change: are they supporting the sustainable development goals and improved health and well-being? Global Health 2019; 15:68. [PMID: 31847858 PMCID: PMC6918614 DOI: 10.1186/s12992-019-0509-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/21/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sustainable management of the natural environment is essential. Continued environmental degradation will lead to worsened health outcomes in countries and across generations. The Sustainable Development Goals (SDGs) provide a framework for viewing the preservation of natural environments and the promotion of health, well-being and health equity as interconnected pursuits. Within the SDG framework the goals of promoting environmental sustainability and human health are unified through attention to the social determinants of health and health equity (SDH/HE). This paper presents findings from a document analysis of all Australian environment sector policies and selected legislation to examine whether and how current approaches support progress toward achieving SDG goals on water, climate change, and marine ecosystems (Goals 6, 13 and 14), and to consider implications for health and health equity. RESULTS Consideration of a broad range of SDH/HE was evident in the analysed documents. Related collaborations between environment and health sectors were identified, but the bulk of proposed actions on SDH/HE were initiated by the environment sector as part of its core business. Strengths of Australian policy in regard to SDGs 6, 13 and 14 are reflected in recognition of the effects of climate change, a strong cohesive approach to marine park protection, and recognition of the need to protect existing water and sanitation systems from future threats. However, climate change strategies focus predominately on resilience, adaptation and heat related health effects, rather than on more comprehensive mitigation policies. The findings emphasise the importance of strengthened cross-sectoral action to address both the drivers and effects of environmental degradation. A lack of policy coherence between jurisdictions was also evident in several areas, compounded by inadequate national guidance, where vague strategies and non-specific devolution of responsibilities are likely to compromise coordination and accountability. CONCLUSIONS Evidence on planetary health recognises the interconnectedness of environmental and human health and, as such, suggests that ineffective management of climate change and water pose serious risks to both the natural environment and human well-being. To address these risks more effectively, and to achieve the SDGs, our findings indicate that cross-jurisdiction policy coherence and national coordination must be improved. In addition, more action to address global inequities is required, along with more comprehensive approaches to climate change mitigation.
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Affiliation(s)
- Toni Delany-Crowe
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia.
| | - Dora Marinova
- Sustainability Policy Institute, Curtin University, Adelaide, Australia
| | - Matt Fisher
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Michael McGreevy
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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McGreevy M, Harris P, Delany-Crowe T, Fisher M, Sainsbury P, Baum F. Can health and health equity be advanced by urban planning strategies designed to advance global competitiveness? Lessons from two Australian case studies. Soc Sci Med 2019; 242:112594. [DOI: 10.1016/j.socscimed.2019.112594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/01/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022]
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