Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

Document Type : Commentary


1 Wilfrid Laurier University, Waterloo, ON, Canada

2 Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada

3 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

4 Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada

5 Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

6 Faculty of Social Sciences, University of Tampere, Tampere, Finland

7 Finnish Institute of Occupational Health, Tampere, Finland


Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP.


Main Subjects

  1. Baum F, Delany-Crowe T, MacDougall C, Lawless A, van Eyk H, Williams C. Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors’ involvement. BMC Public Health. 2017;17(1):811. doi:10.1186/s12889-017-4821-7
  2. Lawless A, Baum F, Delany-Crowe T, et al. Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia. Int J Health Policy Manag. 2017. doi:10.15171/ijhpm.2017.121
  3. Muntaner C. Invited commentary: On the future of social epidemiology--a case for scientific realism. Am J Epidemiol. 2013;178(6):852-857. doi:10.1093/aje/kwt143
  4. Solar O, Irwin A. A Conceptual Framework for Action on the Social Determinants of Health: Discussion paper for the Commission on Social Determinants of Health. Geneva: World Health Organization; 2007.
  5. Giddens A. The constitution of Society: Outline of the Theory of Structuration. Berkeley: University of California Press; 1984.
  6. Howlett M RM, Perl A. Studying Public Policy: Policy Cycles and Policy Subsystems. Oxford: Oxford University Press; 2009.
  7. Kingdon J. Agendas, Alternatives and Public Policies. 2nd ed. Boston: Longman; 2011.
  8. Sabatier PA. An advocacy coalition framework of policy change and the role of policy-oriented learning therein. Policy Sci. 1988;21(2-3):129-168. doi:10.1007/bf00136406
  9. Freiler A, Muntaner C, Shankardass K, et al. Glossary for the implementation of Health in All Policies (HiAP). J Epidemiol Community Health. 2013;67(12):1068-1072. doi:10.1136/jech-2013-202731
  10. Oneka G, Vahid Shahidi F, Muntaner C, et al. A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP). J Epidemiol Community Health. 2017;71(8):835-838. doi:10.1136/jech-2017-208979
  11. Ghobarah HA, Huth P, Russett B. Comparative public health: the political economy of human misery and well-being. International Studies Quarterly. 2004;48:73-94.
  12. Kokkinen L, Muntaner C, O’Campo P, Freiler A, Oneka G, Shankardass K. Implementation of Health 2015 public health program in Finland: a welfare state in transition. Health Promot Int. 2017. doi:10.1093/heapro/dax081
  13. National Center for HIV/AIDS VH, STD, and TB Prevention. Program Operations: Guidelines for STD Prevention, Program Evaluation. Atlanta: Centers for Disease Control and Prevention; nd.
  14. Shankardass K, Renahy E, Muntaner C, O’Campo P. Strengthening the implementation of Health in All Policies: a methodology for realist explanatory case studies. Health Policy Plan. 2015;30(4):462-473. doi:10.1093/heapol/czu021
  15. Muntaner C, Lynch J. Income inequality, social cohesion, and class relations: a critique of Wilkinson’s neo-Durkheimian research program. Int J Health Serv. 1999;29(1):59-81.
  16. Shankardass K, Muntaner C, Kokkinen L, et al. The implementation of Health in All Policies initiatives: a systems framework for government action. Health Research Policy and Systems. In Press.
  17. Boulding KE. General systems theory-the skeleton of science. Manage Sci. 1956;2(3):197-208.
  18. Stroh DP. Systems Thinking For Social Change: A Practical Guide to Solving Complex Problems, Avoiding Unintended Consequences, and Achieving Lasting Results. White River Junction, VT: Chelsea Green Publishing; 2015.
  19. Von Bertalanffy L. An outline of general system theory. Br J Philos Sci. 1950;I(2):134-165.
  20. Better Evaluation. Developmental Evaluation.  Accessed January 20, 2017.
  21. Patton MQ. Developmental Evaluation. Applying Complexity Concepts to Enhance Innovation and Use. New York: Guilford Press; 2010.
  22. Dutton DJ, Forest PG, Kneebone RD, Zwicker JD. Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study. CMAJ. 2018;190(3):E66-E71. doi:10.1503/cmaj.170132
  23. Pinto AD, Molnar A, Shankardass K, O’Campo PJ, Bayoumi AM. Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia. BMC Public Health. 2015;15:171. doi:10.1186/s12889-015-1350-0
  24. Shankardass K, Solar O, Murphy K, Greaves L, O’Campo P. A scoping review of intersectoral action for health equity involving governments. Int J Public Health. 2012;57(1):25-33. doi:10.1007/s00038-011-0302-4
  25. World Health Organization. The Economics of Social Determinants of Health and Health Inequalities: A resource book. World Health Organization; 2013.
  • Receive Date: 31 January 2018
  • Revise Date: 06 March 2018
  • Accept Date: 07 March 2018
  • First Publish Date: 01 August 2018