Health in All Policies (HiAP)

Does a Health in All Policies approach improve health, well-being and equity?

The Southgate Institute for Health, Society and Equity, in collaboration with SA Health and other South Australian, interstate and international investigators, is undertaking research to examine a policy initiative that is intended to stimulate inter-sectoral action to address social determinants of health. This research will examine the adoption and implementation of the policy initiative, which is called Health in All Policies (HiAP), to determine its effectiveness in motivating action across sectors to improve population health and health equity. This project is funded by the NHMRC until 2016.


Briefing paper:  Does a Health in All Policies approach improve health, wellbeing and equity in South Australia?

The Southgate Institute has developed a policy briefing paper to provide an overview of the findings of the 5 year NHMRC-funded research study into the adoption and implementation of Health in All Policies in South Australia.  The briefing includes key messages and recommendations from the project as well as details about the research activities undertaken and the Program Logic Model developed as part of the study.  The briefing paper can be found here (PDF 694KB) . 


Research Forum 2017

The final HiAP Symposium was held on Tuesday, 11 April 2017 with keynote address by Sir Michael Marmot. The symposium also included presentations and panel discussions between a number of key academics and public sector officers on the challenges, benefits and outcomes of intersectoral action for health equity, with particular focus on the Health in All Policies (HiAP) approach in SA.

This event was livestreamed and you can view the recording here.

Research Forum 2013

The first Research Forum for the NHMRC funded project ‘Does a Health in All Policies approach improve health, well-being and equity?’ was held on Tuesday 10th December 2013. This project is examining the adoption and implementation of a Health in All Policies (HiAP) approach in South Australia. The Forum was well attended by public servants, academics, students and staff from community based organisations. Read more

Research Overview

The social determinants of health are a key policy focus for governments seeking to improve population health and curb burgeoning health care budgets. Since 2008 the South Australian (SA) Government has developed and implemented a Health in All Policies (HiAP) approach to the development of healthy public policy. This research project is examining the adoption and implementation of a HiAP approach to determine its effectiveness. To do this the project is developing methodological and theoretical tools to meet the complex challenges of evaluating and better understanding complex policy processes. The project comprises both retrospective analysis of the development of the SA HiAP approach, and prospective, theory driven action research on the ongoing implementation of HiAP.

Research questions

  • To what extent is the SA HiAP approach an effective method of building healthy public policy in order to modify the determinants of population health, well-being and health equity?
  • To what extent does the application of policy agenda setting and implementation theory explain the strengths and weakness of the HiAP model as a means of bringing about action on the determinants of health, well-being and health equity across sectors of government?
  • How effective is the combination of a program logic and action research as a framework for determining the impact of a complex multi-sectoral policy initiative on population health?

Methodological Approach

This project is using mixed methods to collect and triangulate data across the spectrum of expected HiAP activity.

Stage 1: Building HiAP program theory

The first stage of the research involves using theory and local knowledge to document a program logic framework for HiAP. The underpinning theory will be developed and articulated by bringing together locally developed theory drawn from history, experience and intuition of key stakeholders and relevant academic literature.

Stage 2: Testing HiAP program theory: Examining HiAP in Action

The second stage involves testing and refinement of the theories developed in Stage 1 through an examination of HiAP processes in action. A sample of policy projects that HiAP has been involved in will be selected for assessment. Eight policy projects will be examined over the first two years of the study.

Methods for assessing each of the policy projects will comprise of workshops with key stakeholders, in-depth interviews and document analysis. Special attention will be paid to examining impacts on Indigenous health.

Stage 3: Developing Generalisable Knowledge

The third stage involves broader reflections of the findings of the project to consider:

  • potential improvements to HiAP processes;
  • what the findings contribute to knowledge about how policy can influence social determinants of health;
  • what the findings contribute to understanding about inter-sectoral action for health promotion, including in the area of Indigenous health; and
  • what the methods contribute to the field of health policy research.

Program Logic Model

A theory based program logic model has been developed and revised throughout the research project as an innovative mechanism to evaluate HiAP as a complex intersectoral policy process, and to assess its contributions to longer term outcomes.  The development and early application of the Program Logic Model is described in:  

Baum F, Lawless A, Delany T, MacDougall C, Williams C, Broderick D, Wildgoose D, Harris E, McDermott D, Kickbusch I, Popay J and Marmot M (2014) Evaluation of Health in All Policies:concept, theory and application, Health Promotion International, 29:1 DOI:10.1093/heapro/dau032 http://heapro.oxfordjournals.org/content/29/suppl_1/i130.full.pdf?keytype=ref&ijkey=RlXomXuKVFzKA2e

The 2016 version of the Program Logic Model can be viewed here (PDF 536KB) .

  

Jane Fitzgerald: student on HiAP project

Jane Fitzgerald is enrolled in a PhD and is undertaking full time research on the project. Jane holds degrees in Psychology and has worked as a mental health professional with children and families for 18 years. Jane is examining the impact of public policy on the wellbeing and mental health of communities, with a particular focus on examining how the links between policy activities and eventual health outcomes can be strengthened. Jane is interested in learning more about the Health in All Policies approach and about how it can be applied to improve mental health in South Australia. She can be contacted via email at fitz0225@flinders.edu.au.

Publications

  • New norms new policies: Did the Adelaide Thinkers in Residence scheme encourage new thinking about promoting well-being and Health in All Policies? 
    Baum F, Lawless A, MacDougall C, Delany T, McDermott D, Harris E, and Williams C, Social Science and Medicine 2015; doi: 10.1016/j.socscimed.2015.10.031 http://www.ncbi.nlm.nih.gov/pubmed/26520058
  • Delany, T., Lawless, A., Baum, F., Popay, J., Jones, L., McDermott, D., Harris, E., Broderick, D., and Marmot, M (2016) Health in All Policies in South Australia: what has supported early implementation?. Health Promotion International, 31 (4): 888-898. doi: 10.1093/heapro/dav084; https://academic.oup.com/heapro/article/31/4/888/2593482/Health-in-All-Policies-in-South-Australia-what-has
  • Technical Paper for World Health Organisation, written for the 8th Global Conference on Health Promotion, June 2013, Helsinki. Baum F, Lawless A, Delany T, MacDougall C, Williams C, Broderick D, Wildgoose D, Harris E, McDermott D, Kickbusch I, Popay J and Marmot M (2014) Evaluation of Health in All Policies: concept, theory and application, Health Promotion International, 29:1 DOI:10.1093/heapro/dau032 http://heapro.oxfordjournals.org/content/29/suppl_1/i130.full.pdf?keytype=ref&ijkey=RlXomXuKVFzKA2e
  • Delany T, Harris P, Williams C, Harris E, Baum F, Lawless A, Wildgoose D, Haigh F, MacDougall C, Broderick D and Kickbusch Ilona (2014) Health Impact Assessment in New South Wales & Health in All Policies in South Australia: differences, similarities, and connections, BMC Public Health, 14:699 DOI: 10.1186/1471-2458-14-699 http://www.biomedcentral.com/1471-2458/14/699
  • Creating a burden of evidence to consider the impact of Health in All Policies: A program logic approach, written for the International Political Science Association World Congress, July 2014, Montreal http://paperroom.ipsa.org/papers/paper_34806.pdf

Chief Investigators

Professor Fran Baum, AO

Southgate Institute for Health Society & Equity, Flinders University    

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Dr Elizabeth Harris, Centre for Primary Health Care and Equity, University of New South Wales    

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Professor Ilona Kickbusch, Graduate Institute of International and Development Studies, Geneva    

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Prof Colin MacDougall

College of Medicine and Public Health, Flinders University

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Professor Dennis McDermott, Poche Chair, Flinders Aboriginal Health Research Unit, Flinders University    

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Dr Angela Lawless,

College of Nursing and Health Sciences, Speech Pathology 

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Associate Investigators

  • Mr Danny Broderick, Torrens University, South Australia
  • Dr Kevin Buckett, SA Health, Government of South Australia
  • Professor Sir Michael Marmot, Research Department of Epidemiology and Public Health, University College London   
  • Ms Sandy Pitcher, Department of Environment, Water and Natural Resources, Government of South Australia
  • Professor Jennie Popay, Institute for Health Research, Lancaster University   
  • Mr Andrew Stanley, SA NT DataLink, University of South Australia     Profile
  • Ms Carmel Williams, SA Health, Government of South Australia
  • Ms Deborah Wildgoose, SA Health, Government of South Australia

Project Manager

  • Dr Helen van Eyk, Southgate Institute for Health Society & Equity, Flinders University Profile

Research Fellow

  • Dr Toni Delany-Crowe, Southgate Institute for Health Society & Equity, Flinders University Profile

Students

  • Jane Fitzgerald, Southgate Institute for Health Society & Equity, Flinders University