Suchergebnisse

AbstractThe confluence of social and health inequities and global environmental degradation shines a light on fundamental ruptures in society. A systems view of humanity reminds us that this status quo is not static, and that the shifting political and economic sands provide an important window of opportunity to collectively change the system towards the public good, such that communities are able to live with good health, dignity and in an environmentally sustainable way. To enable this, global policy, and in particular global health policy must break out of the policy silos and refocus in a systems way. If the system is to adapt, an ambitious vision for the system is needed that is different to the status quo. No one regulatory model that can improve complex societal problems, rather we must use a plurality of approaches. Reorienting the system to achieve positive outcomes depends on reimagining the purpose of structural regulatory powers, and the releasing the agency of networks of concerned actors. In a hyper‐connected world there are many partners to help create systems of hope.

AbstractThe consumption of harmful commodities drives the noncommunicable disease (NCD) epidemic globally and in Pacific small island developing states. Multisectoral committees are commonly chosen avenues to facilitate policy coherence across government sectors in regulating the commercial determinants of health (CDoH), but these committees often fail to function as intended. This paper aims to explore the institutional conditions that enable or constrain multisectoral committees in facilitating policy coherence for tobacco control in Fiji and Vanuatu. An exploratory, qualitative research design was applied, incorporating a two‐case study design with within‐case analysis and cross‐case synthesis. Data collection consisted of 70 in‐depth interviews in 2018 and 2019. Data collection and analysis were informed by an analytical framework drawn from the institutional collective action framework. The results show that the current amount of authority behind the investigated multisectoral committees in Fiji and Vanuatu is inadequate to meaningfully bring stakeholders together for an issue with high complexity. Moreover, multisectoral discussions on tobacco control have a high risk to break down, as the collaboration may generate unwanted impacts to one or more actors and the net benefits are perceived to be low. The authority behind multisectoral committees might be strengthened by the chairmanship of a cross‐sectoral, high‐level government official and the allocation of more resources for managing intersectoral engagement. Divergent preferences might be brought closer together by showcasing the socioeconomic costs of NCDs and policies affecting the availability, affordability, accessibility, and desirability of tobacco and raising awareness about CDoH in nonhealth sectors.

AbstractMultisectoral governance has been recognized to be vital to regulate harmful commodity industries, yet countries struggle with reaching policy coherence due to government agencies' conflicting mandates and industry interference. Limited empirical evidence is available on how interests, ideas, and institutions intersect and influence multisectoral governance in low‐ and middle‐income countries, particularly in Pacific small island developing states (PSIDS), often exploited by vested industry interests and whose non‐communicable disease crisis commands urgent action to regulate harmful commodities. This study assessed the ways interests, ideas, and institutions intersect and shape multisectoral tobacco governance in PSIDS. Interviewee data collected in Fiji and Vanuatu show that the idea of individual responsibility, the limited recognition of commercial determinants of health, the centralization of authority, and the vulnerabilities of small island developing states, (including small population, land, economy, geographic isolation, and status as a developing economy), prevent these states from achieving policy coherence in multisectoral tobacco governance.

AbstractIndigenous peoples in Australia and similar colonised countries are subject to racism and systemic socioeconomic disadvantages, resulting in worse health outcomes compared to non‐Indigenous counterparts. Such inequities persist despite governments' attempts to reduce them. Since 2008, Australian governments have committed to a national 'Closing the Gap' (CTG) to reduce inequities in health, education, and employment outcomes between Aboriginal and Torres Strait Islander peoples and other Australians, but with limited success. We applied policy theory and a cultural safety framework developed for the research to analyse stakeholder perceptions of CTG policy implementation between 2008 and 2019. We identified policy‐shaping ideas and policy incoherence in the environment surrounding CTG policy that obstructed culturally safe policy. Top‐down, prescriptive modes of implementation were also a barrier. However, Indigenous‐led policy partnerships and community‐controlled services in the health sector have met principles of cultural safety. Identifying these strengths and weaknesses points to ways in which implementation of CTG policies can be improved to achieve cultural safety and reduce Indigenous health inequities. These results may hold lessons for similar countries such as the United States, New Zealand, and Canada.

AbstractHealth in All Policies is an approach that seeks to strengthen public policy‐making across health and other sectors in order to achieve the most favourable health impacts. There is currently interest in understanding how Health in All Policies is applied in different contexts; whether it makes a difference to policy practices, health outcomes and health equity; and what is required to equip the different sectors to work effectively to improve the health equity impacts of their policies. This article presents findings from a review of domestic policies and practices of Health in All Policies in countries across the World Health Organization Western Pacific Region. The findings illustrate that there is a strong foundation for action, particularly given prior intersectoral action and the important convening point that issues like non‐communicable diseases and transport provide for Health in All Policies within the Western Pacific Region. However, the consideration of health equity in Health in All Policies needs more explicit attention. This knowledge can be used for building capacity within the health sector and other sectors to undertake sustainable and effective intersectoral collaboration for improved health equity.

AbstractDeindustrialisation and the closure of automotive manufacturing can differentially affect the socioeconomic prospects of workers and their communities, and contribute to social and health inequity. We used Bacchi's problematisation approach to examine the South Australian (SA) Labor government's policy responses to the General Motors Holden (GMH) Elizabeth plant closure announcement. We focused on the way that these policy responses framed the 'problem' of this major economic shock, particularly the extent to which potential social and health equity consequences were addressed. We found a narrow focus on economic strategies, neglecting the compounding impact of poverty in Playford, which may exacerbate health inequity. The community effects from the GMH closure remain uncertain and may be delayed for several years. SA requires better integrated social and economic policies to minimise social and health inequalities, as the consequences of the car manufacturing loss are realised.