Crawford Gemma, Trebeck Katherine
Collaboration for Evidence, Research and Impact in Public Health, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
Writer-At-Large, Edinburgh Futures Institute, University of Edinburgh, Edinburgh, UK.
Health Promot J Austr. 2025 Jul;36(3):e70050. doi: 10.1002/hpja.70050.
This commentary examines a critical paradox in contemporary policymaking that hinders effective action for health equity. On one hand, certain policymakers fixate on economic growth measured by GDP as the solution to societal challenges (putting all their eggs in one basket). Simultaneously, other policymakers acknowledge but ultimately avoid addressing how the economic system fundamentally drives health inequalities (dancing around the elephant in the room). This results in perpetuating a focus on downstream interventions rather than disrupting health's structural and economic determinants. While notable exceptions exist, sustained examples of upstream economic intervention remain scarce. Health promotion practitioners are positioned to challenge this paradox through their core competencies in policy influence, systems thinking, partnership building, and community mobilisation. By supporting policymakers to address power and wealth inequalities that underpin health disparities, health promotion practitioners can help move beyond approaches focused primarily on individual behaviour change. This commentary calls for creative collaborations, new language for conceptualising wellbeing economies, and broader public support to expand what is deemed politically possible in addressing economic causes of health inequalities.
本评论审视了当代政策制定中一个阻碍实现健康公平有效行动的关键悖论。一方面,某些政策制定者将以国内生产总值衡量的经济增长视为解决社会挑战的办法(孤注一掷)。与此同时,其他政策制定者虽然认识到但最终却回避探讨经济体系如何从根本上导致健康不平等问题(对房间里的大象视而不见)。这导致持续关注下游干预措施,而非打破健康的结构和经济决定因素。虽然存在显著的例外情况,但上游经济干预的持续实例仍然很少。健康促进从业者有能力通过其在政策影响、系统思维、伙伴关系建设和社区动员方面的核心能力来挑战这一悖论。通过支持政策制定者解决造成健康差距的权力和财富不平等问题,健康促进从业者可以帮助超越主要关注个人行为改变的方法。本评论呼吁开展创造性合作,采用新的语言来概念化福祉经济,并获得更广泛的公众支持,以扩大在解决健康不平等的经济成因方面被认为在政治上可行的范围。