Southgate Institute for Health, Society and Equity, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, Australia.
BMJ Open. 2017 Dec 21;7(12):e017772. doi: 10.1136/bmjopen-2017-017772.
The development and implementation of multisectoral policy to improve health and reduce health inequities has been slow and uneven. Evidence is largely focused on the facts of health inequities rather than understanding the political and policy processes. This 5-year funded programme of research investigates how these processes could function more effectively to improve equitable population health.
The programme of work is organised in four work packages using four themes (macroeconomics and infrastructure, land use and urban environments, health systems and racism) related to the structural drivers shaping the distribution of power, money and resources and daily living conditions. Policy case studies will use publicly available documents (policy documents, published evaluations, media coverage) and interviews with informants (policy-makers, former politicians, civil society, private sector) (~25 per case). NVIVO software will be used to analyse the documents to see how 'social and health equity' is included and conceptualised. The interview data will include qualitative descriptive and theory-driven critical discourse analysis. Our quantitative methodological work assessing the impact of public policy on health equity is experimental that is in its infancy but promises to provide the type of evidence demanded by policy-makers.
Our programme is recognising the inherently political nature of the uptake, formulation and implementation of policy. The early stages of our work indicate its feasibility. Our work is aided by a Critical Policy Reference Group. Multiple ethics approvals have been obtained with the foundation approval from the Social and Behavioural Ethics Committee, Flinders University (Project No: 6786).The theoretical, methodological and policy engagement processes established will provide improved evidence for policy-makers who wish to reduce health inequities and inform a new generation of policy savvy knowledge on social determinants.
多部门政策的制定和实施以改善健康和减少健康不平等的进展缓慢且不均衡。证据主要集中在健康不平等的事实方面,而不是理解政治和政策进程。本为期五年的研究计划旨在调查这些进程如何更有效地发挥作用,以改善公平的人口健康。
该工作计划组织在四个工作包中,使用四个主题(宏观经济和基础设施、土地利用和城市环境、卫生系统和种族主义),这些主题与塑造权力、金钱和资源分配以及日常生活条件的结构驱动因素有关。政策案例研究将使用公开可用的文件(政策文件、已发布的评估、媒体报道)和对知情人(政策制定者、前政治家、民间社会、私营部门)的访谈(每个案例约 25 个)。将使用 NVIVO 软件分析文件,以了解“社会和健康公平”是如何被包括和概念化的。访谈数据将包括定性描述和理论驱动的批判性话语分析。我们评估公共政策对健康公平影响的定量方法工作是实验性的,处于起步阶段,但有望提供政策制定者所要求的证据类型。
我们的计划认识到政策的采用、制定和实施具有内在的政治性。我们工作的早期阶段表明其可行性。我们的工作得到了一个关键政策参考小组的帮助。已经获得了多项伦理批准,并得到了弗林德斯大学社会和行为伦理委员会的基础批准(项目编号:6786)。所建立的理论、方法和政策参与过程将为希望减少健康不平等的政策制定者提供更好的证据,并为社会决定因素方面的新一代有见识的政策知识提供信息。