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

BMC Public Health

Research Article

Angela Lawless¹  Carmel Williams²  Helen van Eyk³  Fran Baum³  Toni Delany-Crowe³  Colin MacDougall⁴ 

[1] College of Nursing and Health Sciences, Flinders University, Adelaide, Australia;Health Determinants and Policy, Department for Health and Ageing, Adelaide, Australia;Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia;Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia;College of Medicine and Public Health, Flinders University, Adelaide, Australia;

关键词: Health in All Policies;    Institutional theory;    Intersectoral collaboration;    Social determinants of health;   

DOI  :  10.1186/s12889-017-4821-7

 received in 2017-02-07, accepted in 2017-10-04,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017