Department of Nutrition and Dietetics, Monash University, Notting Hill, Vic., Australia.
Baker Heart and Diabetes Institute, Melbourne, Vic., Australia.
Health Promot J Austr. 2019 Apr;30(2):276-280. doi: 10.1002/hpja.45. Epub 2018 Mar 25.
Whole-of-setting initiatives have been recommended as an equitable approach to health promotion. However, there has been little analysis of differences in uptake of such approaches according to indicators of socioeconomic position. In Victoria, Australia, the Achievement Program is a state government health promotion initiative that uses a whole-of-setting approach in early childhood services, schools and workplaces. We conducted an exploratory comparison of uptake of and progression through the programme by schools and early childhood services in one local area, according to area-level socioeconomic position.
Approximately 3 years after programme initiation, we linked data on the progress of 89 early childhood services and 67 primary schools to an area-level index of relative socioeconomic disadvantage. We compared uptake of and progression through the programme by setting (service or school) and quartiles of socioeconomic position.
About 89% of early childhood services and 70% of primary schools had registered for the programme, with 18% and 15%, respectively, attaining the goal of completing the final stage. A greater proportion of settings in areas in the most disadvantaged quartile had registered for the programme and completed the final stage of the programme, compared with settings in areas in the least disadvantaged quartile. However, variation by socioeconomic position was not linear across quartiles.
The Achievement Program did not appear to be inequitable in its uptake. Research into uptake in other local areas and outcomes achieved would be beneficial. SO WHAT?: This demonstrates that whole-of-setting approaches can potentially be an equity-enhancing approach to health promotion.
整体环境倡议被推荐为促进健康的公平方法。然而，根据社会经济地位的指标，对于这种方法的采用差异，几乎没有分析。在澳大利亚维多利亚州，成就计划是一项州政府的健康促进倡议，它在幼儿服务、学校和工作场所采用了整体环境方法。我们根据区域社会经济地位，对一个地方的学校和幼儿服务机构对该计划的采用和进展情况进行了探索性比较。
在计划启动大约 3 年后，我们将 89 家幼儿服务机构和 67 所小学的进展数据与相对社会经济劣势的区域水平指数相关联。我们比较了环境（服务或学校）和社会经济地位四分位数对计划的采用和进展情况。
大约 89%的幼儿服务机构和 70%的小学已经注册了该计划，分别有 18%和 15%达到完成最后阶段的目标。与最不贫困四分之一区域的环境相比，处于最贫困四分之一区域的环境中，注册该计划并完成该计划最后阶段的比例更高。然而，社会经济地位的差异在四分位数之间并不是线性的。
成就计划在采用方面似乎没有不公平。对其他地方的采用情况和所取得的成果进行研究将是有益的。
这表明，整体环境方法可能是一种增强健康促进公平性的方法。
