New norms new policies: Did the Adelaide Thinkers in Residence scheme encourage new thinking about promoting well-being and Health in All Policies?

doi:10.1016/j.socscimed.2015.10.031

Social Science & Medicine

Volume 147, December 2015, Pages 1-9

https://doi.org/10.1016/j.socscimed.2015.10.031 Get rights and content

Highlights

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Thinker in Residence (ATiR) scheme operated in South Australia between 2003 & 2013.
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The ATiR scheme contributed to a change in policy norms.
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It challenged medical power, positing health promotion as economically beneficial.
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ATiR is a model for breaking down policy silos that impede health promotion.

Abstract

Health systems have long been criticised for focussing on curing rather than preventing disease. This paper examines to what extent the Adelaide Thinkers in Residence (ATiR) scheme contributed to the change in norms whereby promoting well-being and a strategy to achieve this - Health in All Policies (HiAP) - was adopted by the South Australian (SA) State Government from 2007. The data presented in this paper are drawn from a five year (2012–2016) detailed mixed methods case study of the SA HiAP initiative which involved document analysis, interviews and workshops with public servants and political actors. We adapt the framework used by Finnemore and Sikkink (1998) which explains how norm changes can lead to political changes in international affairs. We also use Kingdon's concept of policy entrepreneurs to determine whether these ideas moved to an implementable initiative with the help of both a specific ATiR program on HiAP and the broader TiR scheme which promoted a series of innovations relevant to health. The process involved the ATiR reinforcing the work of local norm entrepreneurs with that of powerful external policy entrepreneurs, adapting the discourse about the value of prevention and promoting well-being so that it fitted with the dominant economic one. The powerful organisational platform of the ATiR, which was under the Department of the Premier and Cabinet and linked to the South Australian Strategic Plan (SASP) was used to advance these ideas. The case study offers important lessons for other jurisdictions on how to shift policy to encourage intersectoral approaches to health.

Introduction

Health systems are a sector of government in which organised medicine has a particularly strong hold on power and influences what does and does not get on to the policy agenda (Lewis, 2005, Blaxter, 2010, Alford, 1975). Public health activists have long bemoaned the fact that the health sector overwhelmingly focuses its efforts and resources on treating the sick rather than on keeping people well in the first place (Baum, 2015, Wilkinson and Marmot, 2003, CSDH, 2008). Thus a major challenge for health sectors is to focus on disease prevention and health promotion; a change that the World Health Organization, 1978, World Health Organization, 1986, World Health Organization, 1988, World Health Organization, 2010 has long advocated. There is also increasing recognition that working for healthier societies and communities must involve improving the overall co-ordination of government so that complex and “wicked” (Rittel and Webber, 1973, Exworthy and Hunter, 2011) health and social problems can be tackled. A recent attempt to co-ordinate government action has been the Health in All Policies (HiAP) initiative. HiAP is promoted by the World Health Organisation and the European Union to encourage action on the social determinants of health (CSDH, 2008) in sectors outside health. HiAP examines the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity (World Health Organization, 2013). The health sector needs to understand and engage with multiple sectors to bring about action on the social determinants in ways that support their core business and existing priorities, and that take their capacities into account (Delany et al., 2014, Kalegaonkar and Brown, 2000, Mannheimer et al., 2007). Comparatively little is known about how to challenge the dominant paradigms in health in order to get a HiAP approach on the political and bureaucratic agenda. This paper asks whether the “Adelaide Thinkers in Residence” (ATiR) scheme in South Australia (SA) influenced broader norms that in turn influenced the health policy agenda by providing greater policy support for co-ordinated, across government responses that focused on prevention and wellness promotion. As part of this analysis we use a case study of the ATiR and examine if it created the authority, structures and processes to move Health in All Policies (implemented from 2007) from an idea to a norm institutionalised in policy-making processes.

Section snippets

Background

Whilst governments seek short-term policy payoffs to meet the demands of electoral cycles, disease prevention and health promotion pay dividends in the longer term (Baum et al., 2014). In the health sector, the power of curative interests means public health advocates need to take every opportunity to advance their case, including framing ideas that will shape broader norms across government in support of health promotion. Furthermore, if the broader norms change across government, it will be

Methods

The data presented in this paper are drawn from a five year (2012–2016) detailed mixed methods case study of the SA HiAP initiative which used interviews, workshops and document analysis.

Findings

The ATiR was introduced by an incoming Australian Labor Party (ALP) Premier, who noted that:

… wouldn't it be fantastic if … we could actually bring people in from around the world, or around Australia or locally, who would advise us – would come for a minimum of three months and would advise us on the most important pressing issues that confront a government, to give us interestingly a different lens – … I said ‘they have to be – I don't want it to be bureaucratic. I don't want it to be a

Discussion and conclusions

Our study has analysed data from documents, interviews and evaluation workshops to propose a number of ways in which the ATiR scheme enabled a great acceptance of and focus on prevention and promotion agenda in South Australia. The Health in All Policies case study has allowed a detailed consideration of the process. ATiR was explicitly designed to remove silos and the barriers to innovation across government sectors that prevent the adoption of upstream policies in the health sector and in

Acknowledgements

We acknowledge the input of all other Chief and Associate Investigators who have contributed to the design of this research; Ilona Kickbusch, Michael Marmot, Kevin Buckett, Danny Broderick, Sandy Pitcher, Jennie Popay, Andrew Stanley and Deborah Wildgoose.

The views expressed in this paper do not necessarily reflect those of the South Australian Government.

This work was supported by the National Health and Medical Research Council (grant number 1027561). The authors declare no conflicts of

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View full text

New norms new policies: Did the Adelaide Thinkers in Residence scheme encourage new thinking about promoting well-being and Health in All Policies?

Highlights

Abstract

Introduction

Section snippets

Background

Methods

Findings

Discussion and conclusions

Acknowledgements

Health Care Politics: Ideological and Interest Group Barriers to Reform

The New Public Health

The accidental logic of health policy in Australia

Evaluation of Health in All Policies: concept, theory and application

Health Promot. Int.

Health

Global Institutions and Development: Framing the World?

Public Policy: A Critical Approach

Policy interventions and networks

Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health

Policy implementation: Implications for evaluation

New Dir. Eval.

Health impact assessment in New South Wales & Health in All Policies in South Australia: differences, similarities and connections

BMC Public Health

Managing stakeholder involvement in decision making: a comparative analysis of six interactive processes in the Netherlands

J. Public Adm. Res. Theory

The Challenge of joined-up government in tackling health inequalities

Int. J. Public Adm.

Qualitative Analysis: Practice and Innovation

International norm dynamics and political change

Int. Organ.

International norm dynamics and the “End of Poverty”: understanding the millennium development goals

Glob. Gov. A Rev. Multilater Int. Organ.

Health in All Policies: The South Australian Approach

Ideology, power, and the structure of policy networks

Policy Stud. J.