A cross-disciplinary study on formulating child health policy with a focus on the social determinants of health – an Australian perspective

Author: Clare Phillips

Phillips, Clare, 2019 A cross-disciplinary study on formulating child health policy with a focus on the social determinants of health – an Australian perspective, Flinders University, College of Medicine and Public Health

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Background: There is a wide range of research that suggests policy action on the social determinants of health (SDH) is required to reduce child health inequities across the social gradient. However, there has been limited action in this area in Australia. Political will has been identified as a barrier to applying a SDH approach in policy, however, few public health scholars have conducted research which adopts a political science perspective to explore this issue. This thesis addresses this gap in the literature.

Methods: In this thesis, I conducted a critical interpretive review and synthesis of the public health and political science literature (study 1); document analysis of 17 strategic level child health policies across Australia, using an a priori coding framework specifically developed to assess the extent to which health departments address the social determinants of child health and health equity (study 2); and four policy case studies with 27 semi-structured interviews with policy actors directly involved in the development of Australian child health policy, using a range of political science theories and frameworks to guide design and analysis (study 3).

Findings: The findings from study 1 suggested that there was a relatively small amount of empirical research that adopted a political science perspective to explore this topic. I identified four theoretical constructs, namely politics, ideology, leadership and credibility, which together synthesised the literature in this cross-disciplinary field of research. The findings from study 2 showed that all Australian child health policies addressed health inequities to some extent, with the best examples being in Aboriginal or child protection policies, and whole of government policies with strong links to departments of health. However, there appeared to be limited action on the social determinants of child health within Australian health departments because while all policies acknowledged or audited the evidence on the SDH at the beginning of the policy, only 10% of strategies committed to action in this area. The findings from study 3 showed that the Australian child health policies which did most to apply a SDH approach in child health policy were supported by a cohesive policy network, including a range of leaders. In addition, in several cases the support of a guiding institution and/or community consultation were facilitators for policy change. The framing of the issues varied across cases, with early childhood development, health equity, and child rights being clear motivators for policy action in this area. Finally, throughout the policy formulation process, applying a SDH approach in Australian child health policy was constrained by neoliberal policy measures that preference individualised healthcare and/or behavioural strategies to improve child health.

Discussion: To better understand the circumstances that facilitated (or constrained) policy action on the social determinants of child health I further developed the four synthetic constructs identified in study 1, politics, ideology, leadership and credibility. I identified and discussed four policy formulation tactics that emerged through this thesis where policy actors constructed different storylines to ‘sell’ a SDH agenda to Australian health departments. The policy formulation tactics presented (and the associated storylines) were divided into four categories: extension, selective, adaptive and diversion. Drawing on the findings from across all three studies in this thesis, I presented a policy formulation model which illustrated how the four synthetic constructs, policy formulation tactics and storylines operated within the Australia child health policy environment. This thesis demonstrates the usefulness of cross-disciplinary research (public health and political science) in understanding the complex policy environment within which child health policy is formulated in Australia. In particular, the underlying assumptions, policy formulation tactics and constructed storylines offer a better understanding of what is required to gain legitimacy in Australian health departments for alternative health policy agendas such as the social determinants of child health.

Keywords: child health, youth health, health policy, public health, political science, politics, social determinants of health, health equity, policy case studies, agenda setting, policy development process, policy formulation, policy actors

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Medicine and Public Health
Supervisor: Professor Paul Ward