1Regulatory Institutions Network, Australian National University, Canberra, ACT, Australia
2Centre for Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
3Maths and Science Institute, Australian National University, Canberra, ACT, Australia
Inequalities in the social determinants of health (SDH), which drive avoidable health disparities between different individuals or groups, is a major concern for a number of international organisations, including the World Health Organization (WHO). Despite this, the pathways to changing inequalities in the SDH remain elusive. The methodologies and concepts within system science are now viewed as important domains of knowledge, ideas and skills for tackling issues of inequality, which are increasingly understood as emergent properties of complex systems. In this paper, we introduce and expand the concept of adaptive policies to reduce inequalities in the distribution of the SDH. The concept of adaptive policy for health equity was developed through reviewing the literature on learning and adaptive policies. Using a series of illustrative examples from education and poverty alleviation, which have their basis in real world policies, we demonstrate how an adaptive policy approach is more suited to the management of the emergent properties of inequalities in the SDH than traditional policy approaches. This is because they are better placed to handle future uncertainties. Our intention is that these examples are illustrative, rather than prescriptive, and serve to create a conversation regarding appropriate adaptive policies for progressing policy action on the SDH.
Bambra C, Smith KE, Garthwaite K, Joyce KE, Hunter DJ. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. J Epidemiol Community Health. 2011;65:399-406. Doi:10.1136/jech.2010.111195
Black D. Inequalities in Health: The Black Report. London: Penguine; 1982.
Commission on Social Determinants of Health (CSDH). Closing the Gap in a Generation. Geneva: WHO; 2008.
Marmot M. Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalitites in England post-2010. London; 2010.
Carey G, Crammond B, Keast R. Creating change in government to address the social determinants of health: how can efforts be improved? BMC Public Health. 2014;14:1087 . Doi:10.1186/1471-2458-14-1087
Baum F, Lawless A, Williams C. Health in All Policies from International Ideas to Local Implementation: Policies, Systems and Organizations. In: Clavier C, de Leeuw E, eds. Health Promotion and the Policy Process. London: Oxford University Press; 2013:188–217.
Fisher M, Milos D, Baum F, Friel S. Social determinants in an Australian urban region: a “complexity” lens. Health Promot Int. 2014. Doi:10.1093/heapro/dau071
Lalonde M. A New Perspective on the Health of Canadians: A Working Document. Ottawa: Ministry of National Health and Welfare; 1974.
Mahamoud A, Roche B, Homer J. Modelling the social determinants of health and simulating short-term and long-term intervention impacts for the city of Toronto, Canada. Soc Sci Med. 2013;93:247-255. Doi:10.1016/j.socscimed.2012.06.036
Martin C, Sturmberg J. General practice - chaos, complexity and innovation. Med J Aust. 2005;183:106-109.
Jordon M, Lanham HJ, Anderson RA, McDaniel Jr RR. Implications of complex adaptive systems theory for interpreting research about health care organizations. J Eval Clin Pract. 2010;16:228-231. Doi:10.1111/j.1365-2753.2009.01359.x
Trochim WM, Cabrera DA, Milstein B, Gallagher RS, Leischow SJ. Practical challenges of systems thinking and modeling in public health. Am J Public Health. 2006;96:538.
Best A, Clark P, Leischow S, Trochim W. Greater than the sum of its parts. US Department of Health and Human Services; 2007.
Johnston LM, Matteson CL, Finegood DT. Systems science and obesity policy: a novel framework for analyzing and rethinking population-level planning. Am J Public Health. 2014;104(7):1270-1278. Doi:10.2105/AJPH.2014.301884
Vandenbroeck I, Goossens J, Clemens M. Foresight Tackling Obesities: Future Choices—Obesity System Atlas. UK: Foresight Study; 2007.
Swanson D, Barg S, Tyler S, et al. Seven tools for creating adaptive policies. Technol Forecast Soc Change. 2010;77:924-939. Doi:10.1016/j.techfore.2010.04.005
Walker WE, Rahman SA, Cave J. Adaptive policies, policy analysis, and policy-making. Eur J Oper Res. 2001;128:282-289. Doi:10.1016/s0377-2217(00)00071-0
Meadows D. Thinking in Systems. USA: Sustainability Institute; 1999.
Swanson D, Bhadwal S. Creating Adaptive Policies a Guide for Policymaking in an Uncertain World. Los Angeles: SAGE, IISD/International Institute for Sustainable Development, International Development Research Centre; 2009.
Boston J, Bradstock A, Eng D. Public Policy: Why Ethics Matters. Canberra: Australian National University Press; 2010.
Przeworski A. Capitalism and Social Democracy. Cambridge: Cambridge University Press; 1985.
Busenberg GJ. Learning in organizations and public policy. J Public Policy. 2001;21:173-189.
Dewey J. The Public and its Problems. New York: Holt and Company; 1927.
Rondinelli DA. Government decentralization in comparative perspective: theory and practice in developing countries. International Review of Administrative Sciences. 1981;47:133-145. Doi:10.1177/002085238004700205
Institute for Sustainable Development. Designing Policies in a World of Uncertainty, Change and Surprise. Ottawa: Institute for Sustainable Development; 2006.
Sabel C. Learning by Monitoring. In: Smelser E, Swedberg R, eds. Handbook of Economic Sociology. Princeton: Princeton University Press; 1995:135-165.
Dorf M, Sabel C. A constitution of democratic experimentalism. Columbia Law Rev. 1998;98:267–473. Doi:10.2307/1123411
Noonan K, Sabel CE, Simon W. Legal accountability in the service-based welfare state: lessons from child welfare reform. Law and society inquiry. 2009;34:523-568. Doi:10.1111/j.1747-4469.2009.01157.x
Kay A, Reid R. Sequences in health policy reform: reinforcement and reaction in universal health. Milan; 2013.
Food and Agriculture Organization (FAO). State of food insecurity in the world 2014: strengthening the enabling environment for food... security and nutrition. FAO; 2014.
Gwartney J. Economics: Private and Public Choice. Boston: Cengage Learning; 2014.
Carey G, Crammond B. A glossary of policy frameworks: the many forms of “universalism” and policy “targeting.” J Epidemiol Community Health. 2014. doi:10.1136/jech-2014-204311
Hurley J, Vaithianathan R, Crossley TF, Cobb-Clark DA. Parallel private health insurance in Australia: A cautionary tale and lessons for Canada. IZA Discussion Paper; 2002. Report No. 515.
Spicker P. Understanding particularism. Crit Soc Policy. 1994;13:5-20.
Thompson S, Hoggett P. Universalism, selectivism and particularism: towards a postmodern social policy. Crit Soc Policy. 1996;16:21-42.
Taylor-Gooby P. Postmodernism and social policy: a great leap backwards? J Soc Policy. 1994;23:385.
National Assessment Program – Literacy and Numeracy (NAPLAN). National Assessment Program Literacy and Numeracy Achievement in Reading, Persuasive Writing, Language Conventions and Numeracy. Canberra, ACT: Commonwealth Government of Australia; 2013.
Peske HG, Haycock K. Teaching Inequality: How Poor and Minority Students Are Shortchanged on Teacher Quality: A Report and Recommendations by the Education Trust. Education Trust. http://eric.ed.gov/?id=ED494820. Accessed November 24, 2014. Published 2006.
Shin JC. Impacts of performance-based accountability on institutional performance in the U.S. Higher Education. 2010;60:47-68.
Australia, Department of Education of Education and Workplace Relations, Gonski DM. Review of Funding for Schooling Final Report. Canberra: Department of Education, Employment and Workplace Relations; 2012.
Fleischmann M. The Fleischmann report on the quality, cost, and financing of elementary and secondary education in New York State. New York: New York State Commission on the Quality, Cost, and Financing of Elementary and Secondary Education; 1973.