School of Social and Political Sciences - Theses
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ItemGrassroots to government: social policy reform & the social determinants of health in Australia( 2013)Public health is increasingly concerned with addressing the ‘social determinants of health’ (SDoH). These are social factors such as employment and housing that drive health outcomes. Despite widespread agreement that addressing SDoH is crucial, how to take action to address them is a critical challenge for public health. While inroads have been made in specific areas by giving concentrated attention on one social determinant (e.g. education), the pathways to more widespread change remain elusive. In Australia, in 2007 the Federal Government launched the Social Inclusion Agenda (SIA). The SIA is a broadscale ‘policy current’ designed to address social inequalities. The scale of the Agenda means that it has the potential to impact a wide range of SDoH, including education, housing, employment and social inequality. Change in these areas is understood to occur through ‘joined up’ action across government, and through greater collaboration between government and non-government actors. The SIA provides a rare opportunity to study the implementation of a policy that has the potential to impact a wide range of SDoH. Moreover, the mechanisms through which change is understood to occur under the SIA are consistent with recent debates in the SDoH field, where prominent advocates have called for coordinated action across government and between different sectors. Studying the implementation experiences of the SIA therefore provides important insights into the challenges and opportunities that exist for addressing the SDoH through broadscale ‘joined-up’ action. It also builds our knowledge of the contexts in which public health is increasingly pursuing change (e.g. within government). The aims of this research were: • To explore the implementation experiences of key social policy actors (government policymakers and non-government organisations) involved in the implementation of the Australian SIA. • From the implementation experiences of the SIA, identify potential opportunities for, and challenges to, the implementation of ‘policy currents’. In order to address these aims the study explored the implementation experiences of three different policy actors, who were collectively charged with implementing the SIA. Comparative case study analysis of two non-government organisations was undertaken using observational research and interviews (N=25), accompanied by semi-structured interviews with federal government policymakers (N=6). The study determined characteristics of the SIA and key social policy actors that shaped the spread and uptake of ‘social inclusion’ and examined how ‘experience’ and ‘context’ guided the implementation of the SIA. The research identified a number of critical limitations and challenges to broadscale ‘policy current’ approaches such as the SIA. In particular, the SIA struggled to overcome existing organisational histories, norms and values. Moreover, it established unrealistic expectations amongst implementers outside of government about the nature and speed of change that would occur. The interaction between these contexts and the implementation of the SIA indicates that more needs to be known about the social policy actors that SDoH interventions target (i.e. government policymakers and non-government organisations).