Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders

Abstract

Background With their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus. Methods We conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke’s reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework. Results Local governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO’s. Conclusions Local governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government’s capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.

Políticas públicas en salud en Perú: Responsabilidad social para la atención de patologías congénitas

“…Liu et al, ( 2023) mencionan que las políticas públicas en salud desempeñan un papel crucial en la promoción del bienestar y la equidad en una sociedad. Tal planteamiento es reforzado por Schultz et al, (2023) quienes consideran que estas políticas abarcan una amplia gama de áreas, desde la prevención y el control de enfermedades hasta la accesibilidad a servicios médicos de calidad, que por extensión se entiende que estas políticas buscan garantizar que todos los ciudadanos tengan igualdad de oportunidades para acceder a atención médica, medicamentos y servicios preventivos. Lilly et al, (2023) precisan que las políticas públicas en salud se tienen que centrar en la educación sanitaria y en la promoción de estilos de vida saludables.…”

Intersectoral Partnerships Between Local Governments and Health Organisations in High-Income Contexts: A Scoping Review

“… 8 , 9 Recent research has focussed on the consideration of [health] equity in local government policies and programs. 10 There is some literature 1 , 11 , 12 on the understanding and adoption of health as a concept in local government. 10 In some jurisdictions local government (municipalities) have become responsible by law for health promotion and prevention.…”

“… 10 There is some literature 1 , 11 , 12 on the understanding and adoption of health as a concept in local government. 10 In some jurisdictions local government (municipalities) have become responsible by law for health promotion and prevention. Those municipalities have been investigated for their capability to implement activities to improve health and health equity, including establishing intersectoral collaboration.…”