Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia

Abstract

Background: The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. Methods: A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. Results: The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion: The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.

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

“…In our analysis of SA HiAP, as part of developing a program logic model for this research, we positioned intersectoral collaboration as a process goal that could contribute to the achievement of equity, and we recognised the importance of intersectoral collaboration in HiAP’s work to engage partner agencies to bring about changes in equity [ 42 , 65 ]. However, given the lack of attention to equity as a focus in these intersectoral collaborative processes, HiAP as it is currently implemented in SA is unlikely to bring about significant change in health equity.…”

“…Equity is a distal goal and so the work of SA HiAP could only show evidence of an equity impact over the coming decades, as predicted in the Program Logic Model developed for this research [ 65 ]. Realistically, HiAP was unlikely to improve equity in South Australia given the context of the adverse economic environment in which it was operating and the institutional constraints on its capacity to work on equity explicitly.…”

Intertwined Strands for Ecology in Planetary Health

“…This boundary crossing is particularly important when moving between and among scales and levels within global, through regional to local systems [64,66]. The deep governance and policy implications of this add to already recognized challenges of efforts toward Health in All Policies and Intersectoral Action for Health [67][68][69][70].…”

Ten years on from the World Health Organization Commission of Social Determinants of Health: Progress or procrastination?

“…There needs to be a shift in focus from what we know about SDH, to what we do about it. Whilst there have been some promising in‐roads between agenda setting and implementation to address SDH in Australia, further research examining this nexus, including institutional analyses, is required . The NHMRC Centre for Research Excellence on the Social Determinants of Health Equity has started to make a solid contribution in this regard.…”