Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, South Australia.
BMJ Open. 2018 Oct 4;8(9):e025358. doi: 10.1136/bmjopen-2018-025358.
A well-established body of literature demonstrates that health and equity are strongly influenced by the consequences of governments' policy and resultant actions (or inactions) outside the health sector. Consequently, the United Nations, and its agency the WHO, have called for national leadership and whole-of-government action to understand and address the health impacts of policies in sectors. This research responds to that call by investigating how policymaking in four sectors-urban planning, justice, energy and environment-may influence the social determinants of health and health equity (SDH/HE).
The research design is informed by a critical qualitative approach. Three successive stages are included in the design. The first involves analysing all strategic policy documents and selected legislative documents from the four sectors (n=583). The document analysis is based on a coding framework developed to identify alignment between the documents and the SDH/HE. Two policies that demonstrate good practice in regard to SDH/HE will be selected from each sector during the second stage for embedded case study analysis (total n=8). This is intended to illuminate which factors have supported recognition and action on SDH/HE in the selected policies. The third stage involves progressive theoretical integration and development to understand political and institutional facilitators and barriers to action on SDH/HE, both within and between sectors.
The research will provide much needed evidence about how coherent whole-of-government action on SDH/HE can be advanced and contribute knowledge about how health-enhancing policy activity in the four sectors may be optimised. Learnings from the research will be shared via a project advisory group, policy briefings, academic papers, conference presentations and research symposia. Ethics approval has been secured for the embedded case studies, which involve research participants.
大量文献表明，健康和公平深受政府政策后果以及卫生部门以外的政府行动（或不作为）的影响。因此，联合国及其机构世卫组织呼吁国家领导层采取全政府行动，以了解和应对各部门政策对健康的影响。本研究通过调查城市规划、司法、能源和环境这四个部门的决策制定过程如何影响健康和公平的社会决定因素（SDH/HE），响应了这一号召。
研究设计受到批判性定性方法的启发。设计中包含三个连续阶段。第一阶段包括分析四个部门的所有战略政策文件和选定的立法文件（n=583）。文件分析基于一个编码框架，用于确定文件与 SDH/HE 的一致性。第二阶段将从每个部门中选择两份在 SDH/HE 方面具有良好实践的政策进行嵌入式案例研究分析（总 n=8）。这旨在阐明哪些因素支持了选定政策中对 SDH/HE 的认识和行动。第三阶段涉及渐进式理论整合和发展，以了解部门内部和部门之间在 SDH/HE 方面采取行动的政治和制度促进因素和障碍。
该研究将提供关于如何推进全政府协调一致地采取行动实现 SDH/HE 的急需证据，并为了解如何优化四个部门中促进健康的政策活动提供知识。研究结果将通过项目咨询小组、政策简报、学术论文、会议演讲和研究研讨会分享。已获得嵌入式案例研究的伦理批准，这些研究涉及研究参与者。
