An analysis of local government health policy against state priorities and a social determinants framework

Abstract

Objective: Victorian local governments are required to develop Municipal Public Health and Wellbeing Plans that incorporate state‐level health planning priorities and address the social determinants of health. This paper describes a novel method for evaluating councils' performance against these requirements. Methods: Deductive content analysis was used to categorise all actions in 14 local government MPHWPs against Victorian state priorities as well as against social determinants of health policy areas. Results: More than 1,000 actions were identified. However, fewer than half directly addressed a state priority, with many actions addressing policy areas known to be broader determinants of health. In particular, there was a marked focus on leisure and culture, and on building social cohesion through changes to living and working conditions. Conclusions: Councils are working beyond state priorities and there was a clear emphasis on addressing the diverse upstream ‘causes of the causes’ of health, rather than health promotion behaviour change programs. Implications: The approach for data analysis and presentation provides a useful method for rapid appraisal of health and wellbeing actions relative to councils', and the State's, responsibility and efficacy in public health.

‘Punching above their weight’: a qualitative examination of local governments’ organisational efficacy to improve the social determinants of health

“…But having done that, there was a feeling within LG that the opportunity cost attributable to not closely following the Action Areas was not significant enough to prevent them taking a more upstream approach than the State Plan put forward. Instead, this study supports previous work to suggest that LGs strongly adopt a social determinants approach in MPHWPs, 48 and feel that strategic or upstream actions are more efficient, equitable and economically beneficial than those that use health behaviourism. Despite having to work to the “relatively weak policy setting” 22 set by the State, 19 decisions to act upstream where possible were planners’ intentional response to the understanding that health and wellbeing are significantly socially determined and to a belief that LG was capable of ‘making a difference’.…”

“…In summary, the Act’s emphasis on social determinants, along with EfH, appear to have been more influential than was the 2011–2015 State Plan. It is noteworthy that despite the inconsistency between State and local plans, the approach taken by LG, described in recent research 48 and elaborated upon in the current research, is consistent with the role described for it by the WHO’s Commission on the Social Determinants of Health 8 . It is summarised in a modified version of the Action Areas from page 4 of the 2011–2015 State Health Plan 19 (Figure ).…”

“…Figure shows the original three Action Areas of the State Health Plan 19 and adds a fourth area, ‘Address social determinants’, which was absent from the original version. Also shown is the level of priority LG placed on each area according to this and previous 48 research. It shows that, more consistent with the Act than with the priorities of the State Health Plan, LG considered social determinants to be the highest priority and an area in which it could be efficacious 33,34 …”

“…More recently, an analysis of the actions in the 2013–2017 MPHWPs of the North and West Metropolitan Region of Melbourne (14 LGAs) was conducted for the way that state priorities and social determinants were addressed. It showed that councils were doing significant work beyond the explicitly defined priority areas of the State Plan, but that this was nevertheless an approach that was consistent with the WHO’s ambitions for LG in terms of addressing health’s social determinants 48 …”

Barriers and Enablers to Planning Initiatives for Active Living and Health

“…Nevertheless, until recently such an understanding has been relatively uncharted in the literature, especially at a local scale in an Australian setting (Browne et al, 2016;Lawless et al, 2017). In Australia, Lowe, Whitzman and Giles-Corti (2017) examine barriers and enablers to horizontally integrated health-promoting planning at the state government level in Victoria, with policy context, policy actors, policy processes and policy content given as relevant considerations.…”