Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
Centre for Primary Health Care and Equity, Level 3, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia.
Int J Environ Res Public Health. 2017 Oct 25;14(11):1288. doi: 10.3390/ijerph14111288.
Mobilising cross-sectoral action is helpful in addressing the range of social determinants that contribute to health inequities. The South Australian Health in All Policies (SA HiAP) approach was implemented from 2007 to stimulate cross-sector policy activity to address the social determinants of health to improve population wellbeing and reduce health inequities. This paper presents selected findings from a five year multi-methods research study of the SA HiAP approach and draws on data collected during interviews, observation, case studies, and document analysis. The analysis shows that SA HiAP had dual goals of facilitating joined-up government for co-benefits (process focus); and addressing social determinants of health and inequities through cross-sectoral policy activity (outcomes focus). Government agencies readily understood HiAP as providing tools for improving the process of intersectoral policy development, while the more distal outcome-focused intent of improving equity was not well understood and gained less traction. While some early rhetorical support existed for progressing an equity agenda through SA HiAP, subsequent economic pressures resulted in the government narrowing its priorities to economic goals. The paper concludes that SA HiAP's initial intentions to address equity were only partially enacted and little was done to reduce inequities. Emerging opportunities in SA, and internationally, including the UN Sustainable Development Goals, may revive interest in addressing equity.
动员跨部门行动有助于解决导致健康不平等的一系列社会决定因素。南澳大利亚州的全政策健康方法（SA HiAP）从 2007 年开始实施，以激发跨部门政策活动，解决健康的社会决定因素，提高人口福利，减少健康不平等。本文介绍了对 SA HiAP 方法进行的为期五年的多方法研究的部分研究结果，并借鉴了在访谈、观察、案例研究和文件分析中收集的数据。分析表明，SA HiAP 有两个目标：促进政府协同工作以实现共同效益（注重过程）；通过跨部门政策活动解决健康和不平等的社会决定因素（注重结果）。政府机构很容易理解 HiAP 为改善部门间政策制定过程提供了工具，而通过 SA HiAP 推进公平议程的更遥远的注重结果的意图则理解得不够，也没有得到太多关注。尽管最初对通过 SA HiAP 推进公平议程有一些口头支持，但随后的经济压力导致政府将重点缩小到经济目标上。本文的结论是，SA HiAP 最初解决公平问题的意图只是部分实施的，减少不平等的工作做得很少。南澳大利亚州和国际上出现的新机会，包括联合国可持续发展目标，可能会重新引起人们对解决公平问题的兴趣。
