To what extent do Australian child and youth health, and education wellbeing policies, address the social determinants of health and health equity?: a policy analysis study

Development and implementation of Australian State, territory, and national policy on the health and wellbeing of adolescents and young adults: An exploration of policy actor perspectives using the Consolidated Framework for Implementation Research

OBJECTIVES

Government policies that support the health and wellbeing of young people (aged 10 to 25) can have important individual and societal impacts. The aim of this study was to explore policy actor perspectives on the development and implementation of Australian government policies focussed on the health and wellbeing of young people.

METHODS

We utilised a qualitative research design consisting of semi-structured interviews with policy actors with experience working with Australian youth health policies. Our interview guide and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We interviewed 19 participants from various national, state, and territory bodies.

RESULTS

Several specific barriers and facilitators to policy development and implementation were identified using the Consolidated Framework for Implementation Research. Key policy development barriers were limited available resources (e.g. staffing and funding) and low relative priority within health and political systems. Key policy implementation barriers were limited available resources, limited policy compatibility with health services, cosmopolitanism issues related to interagency collaboration, and a lack of policy evaluation. Meaningful engagement of young people could also be improved.

CONCLUSIONS

Although Australian youth health policies are perceived as evidence-based and comprehensively developed, the ability to promote implementation remains stalled.

IMPLICATIONS FOR PUBLIC HEALTH

The development of policy implementation plans, monitoring and evaluation mechanisms, funding and resources, and a strong commitment to removing barriers to working across multiple departments and systems is required to improve outcomes for young people.

Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders

BACKGROUND

With their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus.

METHODS

We conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke's reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework.

RESULTS

Local governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO's.

CONCLUSIONS

Local governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government's capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.

"Ngany Kamam, I Speak Truly": First-Person Accounts of Aboriginal Youth Voices in Mental Health Service Reform

Aboriginal young people are experts in their own experience and are best placed to identify the solutions to their mental health and wellbeing needs. Given that Aboriginal young people experience high rates of mental health concerns and are less likely than non-Indigenous young people to access mental health services, co-design and evaluation of appropriate mental health care is a priority. Increasing Aboriginal young people's participation in mental health service reform is key to ensuring services are culturally secure, relevant and accessible. This paper presents first-person accounts from three Aboriginal young people who worked alongside their Elders and in a positive and constructive partnership with mainstream mental health services on a three-year participatory action research project in Perth, Western Australia, in Whadjuk Nyoongar boodja (Country). The young people recount their experiences as participants and co-researchers on a systems change mental health research project and share their views on the importance of privileging Aboriginal youth voices. Their accounts highlight that Aboriginal young people's participation and leadership must be understood through a decolonising lens and that working in genuine partnership with the community is key to increasing their contact and engagement with mental health care and improving mental health and wellbeing outcomes.