Health in All Policies in South Australia: what has supported early implementation?

Abstract

Health in All Policies (HiAP) is a policy development approach that facilitates intersectoral responses to addressing the social determinants of health and health equity whilst, at the same time, contributing to policy priorities across the various sectors of government. Given that different models of HiAP have been implemented in at least 16 countries, there is increasing interest in how its effectiveness can be optimized. Much of the existing literature on HiAP remains descriptive, however, and lacks critical, empirically informed analyses of the elements that support implementation. Furthermore, literature on HiAP, and intersectoral action more generally, provides little detail on the practical workings of policy collaborations. This paper contributes empirical findings from a multi-method study of HiAP implementation in South Australia (SA) between 2007 and 2013. It considers the views of public servants and presents analysis of elements that have supported, and impeded, implementation of HiAP in SA. We found that HiAP has been implemented in SA using a combination of interrelated elements. The operation of these elements has provided a strong foundation, which suggests the potential for HiAP to extend beyond being an isolated strategy, to form a more integrated and systemic mechanism of policy-making. We conclude with learnings from the SA experience of HiAP implementation to inform the ongoing development and implementation of HiAP in SA and internationally.

Hidden care: Revelations of a case‐note audit of physical health care in a community mental health service

“…), including optimizing the effectiveness of a ‘Health in All Policies’ (HiAP) approach (Delany et al . ).…”

The role of trust in joined‐up government activities: Experiences from Health in All Policies in South Australia

“…Establishing mutually beneficial goals early in HiAP collaborations has been shown to facilitate the engagement of collaborators from other sectors (Delany et al., ). Analysis of our data reveals that one of the reasons for this is that it provides a process for recognising a common purpose and for demonstrating how reciprocal benefit may be achieved for all sectors as a result of improving the health impacts of policies.…”

“…Furthermore, our analysis suggests that within the relationships that support joined‐up government initiatives, building and maintaining trust became part of the day‐to‐day work of those involved. Nurturing is particularly necessary when individuals working in collaborations experience the impacts of creeping managerialism (expressed through frequent reorganisation, cuts and a narrowing of core business; Lennefors, ) and where siloed departmental processes and accountability structures may conflict with collaborative aspirations (Delany et al., ). However, the data suggest that the trust that was ‘lost’ or not developed in the first place was not necessarily only influenced by interactions between individuals or collectives.…”

“…Incorporating a focus on population well‐being during the process of developing policy across sectors is intended to assist the Government to address the social determinants of health more effectively. HiAP is aligned with the strategic policy and legislative drivers of the SA Government, and is governed via a memorandum of understanding between the Health department and the Department of the Premier and Cabinet (Baum et al., ; Delany et al., ; Delany et al., ). To date, much of the work has been undertaken by groups of public servants who collaborate on specific projects.…”

“…By bringing together organisational and sociological perspectives on trust, the paper provides an integrated analysis of what facilitates and undermines trust at the individual, institutional and systems levels, as well as how trust influences joined‐up government relationships in the South Australian Health in All Policies (HiAP) initiative. Previous analysis of HiAP in South Australia has highlighted the importance of trust as a facilitator of relationships (Delany et al., ). This paper will deepen that analysis to explain what specific functions trust serves, and to describe how trust has been built, maintained and, in some instances, lost within HiAP collaborations to create policy that will support population well‐being.…”