To what extent can the activities of the South Australian Health in All Policies initiative be linked to population health outcomes using a program theory-based evaluation?

Abstract

BackgroundThis paper reports on a five-year study using a theory-based program logic evaluation, and supporting survey and interview data to examine the extent to which the activites of the South Australian Health in All Policies initiative can be linked to population health outcomes.MethodsMixed-methods data were collected between 2012 and 2016 in South Australia (144 semi-structured key informant interviews; two electronic surveys of public servants in 2013 (n = 435) and 2015 (n = 483); analysis of state government policy documents; and construction of a program logic model to shape assessment of the feasibility of attribution to population health outcomes).ResultsMultiple actions on social determinants of health in a range of state government sectors were reported and most could be linked through a program logic model to making some contribution to future population health outcomes. Context strongly influences implementation; not all initiatives will be successful and experimentation is vital. Successful initiatives included HiAP influencing the urban planning department to be more concerned with the health impacts of planning decisions, and encouraging the environment department to be concerned with the health impacts of its work.ConclusionsThe theory-based program logic suggests that SA HiAP facilitated improved population health through working with multiple government departments. Public servants came to appreciate how their sectors impact on health. Program logic is a mechanism to evaluate complex public health interventions in a way that takes account of political and economic contexts. SA HiAP was mainly successful in avoiding lifestyle drift in strategy. The initiative encouraged a range of state government departments to tackle conditions of daily living. The broader underpinning factors dictating the distribution of power, money and resources were not addressed by HiAP. This reflects HiAP’s use of a consensus model which was driven by (rather than drove) state priorities and sought ‘win-win’ strategies.

Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works

“…An increasing number of public health, and to a lesser extent human rights, scholars are adopting a CR position [e.g] [9, 22–25]. There is also now a large body work in the area of realist evaluation which is informed by a critical realist research paradigm [26], including examples in this journal [e.g] [27–29].…”

The role of trust in joined‐up government activities: Experiences from Health in All Policies in South Australia

“…For an overview of all findings, and of papers published to report on other themes from the broader project, see Baum et al. ().…”

“…Many other themes also emerged from the data at this point, including other interpersonal, structural and governance related facilitators and barriers of HiAP implementation, multiple factors that supported the dissemination of ideas about healthy public policy across SA Government, and understandings about how the broader context surrounding HiAP implementation supported and constrained its impact. For an overview of all findings, and of papers published to report on other themes from the broader project, see Baum et al (2019).…”

Recent Advances in Health Impact Assessment and Health in All Policies Implementation: Lessons from an International Convening in Barcelona

“…In South Australia, for example, the HiAP initiative between government departments aims to find win-win solutions to problems and to establish relationships built upon trust and which can use co-benefit approaches [ 17 ]. The evaluation of the project using a narrative theory of change indicated that its varied initiatives did, in all probability, lead to health gains [ 18 ].…”

“…In one city, for example, the urban planning and health departments identified shared goals related to bicycle infrastructure. The planning department’s goal to create a “vibrant” city converged with the health department’s goal of encouraging cycling for health benefits [ 18 ]. The HiAP initiative contributed to ensuring that the 30 year plan for the city contained multiple initiatives designed to promote health including increased walkability, improved public transport, and more livable suburbs [ 19 ].…”