Society and Equity, Southgate Institute for Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
BMC Public Health. 2019 Jan 18;19(1):88. doi: 10.1186/s12889-019-6408-y.
This paper reports on a five-year study using a theory-based program logic evaluation, and supporting survey and interview data to examine the extent to which the activites of the South Australian Health in All Policies initiative can be linked to population health outcomes.
Mixed-methods data were collected between 2012 and 2016 in South Australia (144 semi-structured key informant interviews; two electronic surveys of public servants in 2013 (n = 435) and 2015 (n = 483); analysis of state government policy documents; and construction of a program logic model to shape assessment of the feasibility of attribution to population health outcomes).
Multiple actions on social determinants of health in a range of state government sectors were reported and most could be linked through a program logic model to making some contribution to future population health outcomes. Context strongly influences implementation; not all initiatives will be successful and experimentation is vital. Successful initiatives included HiAP influencing the urban planning department to be more concerned with the health impacts of planning decisions, and encouraging the environment department to be concerned with the health impacts of its work.
The theory-based program logic suggests that SA HiAP facilitated improved population health through working with multiple government departments. Public servants came to appreciate how their sectors impact on health. Program logic is a mechanism to evaluate complex public health interventions in a way that takes account of political and economic contexts. SA HiAP was mainly successful in avoiding lifestyle drift in strategy. The initiative encouraged a range of state government departments to tackle conditions of daily living. The broader underpinning factors dictating the distribution of power, money and resources were not addressed by HiAP. This reflects HiAP's use of a consensus model which was driven by (rather than drove) state priorities and sought 'win-win' strategies.
本研究报告通过基于理论的项目逻辑评估以及支持性调查和访谈数据，对南澳大利亚健康全政策倡议的活动与人群健康结果之间的关联程度进行了为期五年的研究。
2012 年至 2016 年期间在南澳大利亚州收集了混合方法数据（144 次半结构化关键知情人访谈；2013 年和 2015 年两次针对公务员的电子调查（n=435 和 n=483）；分析州政府政策文件；构建项目逻辑模型，以评估归因于人群健康结果的可行性）。
报告了多个针对卫生政策各领域社会决定因素的行动，并且通过项目逻辑模型，大多数行动都可以与未来人群健康结果的一些贡献联系起来。背景强烈影响实施；并非所有倡议都将取得成功，因此试验至关重要。成功的倡议包括健康全政策影响城市规划部门更加关注规划决策的健康影响，并鼓励环境部门关注其工作对健康的影响。
基于理论的项目逻辑表明，南澳大利亚健康全政策通过与多个政府部门合作，促进了人群健康的改善。公务员开始意识到他们所在部门对健康的影响。项目逻辑是一种评估复杂公共卫生干预措施的机制，考虑到政治和经济背景。南澳大利亚健康全政策主要成功地避免了战略上的生活方式转变。该倡议鼓励一系列州政府部门解决日常生活条件。决定权力、资金和资源分配的更广泛基础因素未被健康全政策所解决。这反映了健康全政策采用的共识模式，该模式由（而不是驱动）国家优先事项驱动，并寻求“双赢”策略。
