Creating Political Will for Action on Health Equity: Practical Lessons for Public Health Policy Actors

Document Type : Original Article

Authors

1 Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

2 Menzies Centre for Health Governance, School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia

3 Deceased March 19, 2020

4 Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia

Abstract

Background
Despite growing evidence on the social determinants of health and health equity, political action has not been commensurate. Little is known about how political will operates to enact pro-equity policies or not. This paper examines how political will for pro-health equity policies is created through analysis of public policy in multiple sectors.
 
Methods
Eight case studies were undertaken of Australian policies where action was either taken or proposed on health equity or where the policy seemed contrary to such action. Telephone or face-to-face interviews were conducted with 192 state and non-state participants. Analysis of the cases was done through thematic analysis and triangulated with document analysis.
 
Results
Our case studies covered: trade agreements, primary healthcare (PHC), work conditions, digital access, urban planning, social welfare and Indigenous health. The extent of political will for pro-equity policies depended on the strength of path dependency, electoral concerns, political philosophy, the strength of economic and biomedical framings, whether elite interests were threatened and the success or otherwise of civil society lobbying.
 
Conclusion
Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness; framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies. A shift in norms is required to stress equity and the right to health.

Keywords


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Articles in Press, Corrected Proof
Available Online from 05 December 2020
  • Receive Date: 28 April 2020
  • Revise Date: 11 November 2020
  • Accept Date: 14 November 2020