Intersectoral action on SDH and equity in Australian health policy

Abstract

Intersectoral action between public agencies across policy sectors, and between levels of government, is seen as essential for effective action by governments to address social determinants of health (SDH) and to reduce health inequities. The health sector has been identified as having a crucial stewardship role, to engage other policy sectors in action to address the impacts of their policies on health. This article reports on research to investigate intersectoral action on SDH and health inequities in Australian health policy. We gathered and individually analysed 266 policy documents, being all of the published, strategic health policies of the national Australian government and eight State/Territory governments, current at the time of sampling in late 2012-early 2013. Our analysis showed that strategies for intersectoral action were common in Australian health policy, but predominantly concerned with extending access to individualized medical or behavioural interventions to client groups in other policy sectors. Where intersectoral strategies did propose action on SDH (other than access to health-care), they were mostly limited to addressing proximal factors, rather than policy settings affecting the distribution of socioeconomic resources. There was little evidence of engagement between the health sector and those policy sectors most able to influence systemic socioeconomic inequalities in Australia.

Commissioning and equity in primary care in Australia: Views from Primary Health Networks

“…Fisher et al. () in a review of policy found that intersectoral policies primarily addressed health service access issues with little evidence of interdepartmental co‐operation and attempt to address structural inequities. Improving health service access is also a primary goal of the PHNs.…”

“…The provision of primary care is the province of private fee‐for‐service general practices that are primarily funded by the Federal government through Medicare rebates with an increasing out‐of‐pocket contribution and PHNs which plan but do not provide services (Department of Health and Ageing ). Local governments are a third level of government and provide very limited health services concerning vaccination and home care but may play an important role in addressing health inequity through addressing social determinants of health (Fisher et al., ).…”

System reform in the human services: what role can health promotion play?

“…It also involves them advocating for the needs of the most vulnerable to ameliorate health and social inequities. 2,16 It involves acknowledging the strong evidence that demonstrates the costeffectiveness of health promotion and prevention. 6,7 It involves celebrating the contribution that the health promotion profession plays, and can continue to play, in the human services landscape of this so-called 'lucky country'.…”

“…14,15 We also know that there are challenges associated with developing, implementing and evaluating action on the social determinants of health, 9,15 particularly those relating to effective intersectoral collaboration and system change. 9,11,15,16 But we also have much to celebrate. We have a rich network of health promotion researchers in Australia with experience in traversing multiple disciplines.…”

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

“…Despite the success of the South Australian HiAP model, it has not been adopted readily in other states and territories across Australia. Recent public health policy scholars have emphasised the importance of HiAP approaches, adaptive policies, intersectoral action and systems thinking to achieve action on SDH, but also questioned the extent to which current Australian approaches have been able to address structural health inequities . An over emphasis on individually focused, risk factor driven initiatives, has not helped in this regard .…”