This paper examines the opportunities and barriers that the South Australian Health in all Policies (SA HiAP) approach encountered when seeking to establish a whole-of-government response to promoting healthy weight.
The paper draws on data collected during 31 semi-structured interviews, analysis of 113 documents, and a program logic model developed via workshops to show the causal links between strategies and anticipated outcomes.
A South Australian Government target to increase healthy weight was supported by SA HiAP to develop a cross-government response. Our analysis shows what supported and hindered implementation. A combination of economic and systemic framing, in conjunction with a co-benefits approach, facilitated intersectoral engagement. The program logic shows how implementation can be expected to contribute to a population with healthy weight.
The HiAP approach achieved some success in encouraging a range of government departments to contribute to a healthy weight target. However, a comprehensive approach requires national regulation to address the commercial determinants of health and underlying causes of population obesity in addition to cross-government action to promote population healthy weight through regional government action.
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Australian Bureau of Statistics (2019) National Health Survey: first results 2017–2018 (cat. no. 4364.0.55.001). https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Overweight%20and%20obesity~90#. Accessed 11 July 2019
Australian Institute of Health and Welfare (2017) A picture of overweight and obesity in Australia 2017. Cat. no. PHE 216. AIHW, Canberra
Baker P, Gill T, Friel S, Carey G, Kay A (2017) Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study. Soc Sci Med 177:141–149. https://doi.org/10.1016/j.socscimed.2017.01.047
Baum F, Lawless A, MacDougall C, Delany T, McDermott D, Harris E, Williams C (2015) New norms new policies: did the Adelaide Thinkers in Residence scheme encourage new thinking about promoting well-being and Health in All Policies? Soc Sci Med 147:1–9. https://doi.org/10.1016/j.socscimed.2015.10.031
Baum F, Delany-Crowe T, MacDougall C, Lawless A, van Eyk H, Williams C (2017) Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors’ involvement. BMC Public Health. https://doi.org/10.1186/s12889-017-4821-7
Baum F, Delany-Crowe T, MacDougall C, van Eyk H, Lawless A, Williams C, Marmot M (2019) 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? BMC Public Health. https://doi.org/10.1186/s12889-019-6408-y
Buse K, Tanaka S, Hawkes S (2017) Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Glob Health 13:34. https://doi.org/10.1186/s12992-017-0255-3
Chaufan C, Yeh J, Ross L, Fox P (2015) You can’t walk or bike yourself out of the health effects of poverty: active school transport, child obesity, and blind spots in the public health literature. Crit Public Health 25:32–47. https://doi.org/10.1080/09581596.2014.920078
Duckett S, Swerissen H, Wiltshire T (2016) A sugary drinks tax: recovering the community costs of obesity. Grattan Institute, Melbourne
Ezzy D (2002) Qualitative analysis—practice and innovation. Allen and Unwin, Sydney
Friel S, Chopra M, Satcher D (2007) Unequal weight: equity oriented policy responses to the global obesity epidemic. BMJ 335:1241–1243. https://doi.org/10.1136/bmj.39377.622882.47
Government of South Australia (2007) South Australia’s Strategic Plan 2007. Government of South Australia, Adelaide
Government of South Australia (2011a) Eat well be active strategy for South Australia 2011–2016. Department of Health, Public Health and Clinical Systems Division, Adelaide
Government of South Australia (2011b) South Australia’s Strategic Plan 2011. Government of South Australia, Adelaide
Hastings G (2012) Why corporate power is a public health priority. BMJ 345:e5124. https://doi.org/10.1136/bmj.e5124
Holt DH (2018) Rethinking the theory of change for Health in All Policies: comment on “Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups”. Int J Health Policy Manag. https://doi.org/10.15171/ijhpm.2018.96
Huse O, Hettiarachchi J, Gearon E, Nichols M, Allender S, Peeters A (2018) Obesity in Australia. Obes Res Clin Pract 12:29–39. https://doi.org/10.1016/j.orcp.2017.10.002
Khayatzadeh-Mahani A, Ruckert A, Labonté R (2018) Obesity prevention: co-framing for intersectoral ‘buy-in’. Crit Public Health 28:4–11. https://doi.org/10.1080/09581596.2017.1282604
Kingdon J (2011) Agendas, alternatives and public policies, 2nd edn. Longman, Boston
Knai C, Petticrew M, Mays N, Capewell S, Cassidy R, Cummins S, Eastmure E, Fafard P, Hawkins B, Jensen JD, Katikireddi SV, Mwatsama M, Orford J, Weishaar H (2018) Systems thinking as a framework for analyzing commercial determinants of health. Milbank Q 96:472–498. https://doi.org/10.1111/1468-0009.12339
Lawless A, Baum F, Delany-Crowe T, MacDougall C, Williams C, McDermott D, van Eyk H (2018) Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia. Int J Health Policy Manag 7(6):510–521. https://doi.org/10.15171/ijhpm.2017.121
Leppo K (2008) Health in All Policies: perspectives from Europe. Public Health Bull S Aust 5:6–8
McCann W (2012) Review of non-hospital based services: a Report by Warren McCann, Internal Consultant, Office of Public Employment and Review to the Hon John Hill MP, Minister for Health and Ageing. Office of Public Employment and Review, Government of South Australia, Adelaide
McKee M, Stuckler D (2016) Current models of investor state dispute settlement are bad for health: the European Union could offer an alternative comment on “The Trans-Pacific Partnership: Is it everything we feared for health?”. Int J Health Policy Manag 6:177–179. https://doi.org/10.15171/ijhpm.2016.116
Newman L, Ludford I, Williams C, Herriot M (2014) Applying Health in All Policies to obesity in South Australia. Health Promot Int. https://doi.org/10.1093/heapro/dau064
Norman J, Kelly B, Boyland E, McMahon A-T (2016) The impact of marketing and advertising on food behaviours: evaluating the evidence for a causal relationship. Curr Nutr Rep 5:139–149. https://doi.org/10.1007/s13668-016-0166-6
Otero G (2018) The neoliberal diet: healthy profits, unhealthy people. University of Texas Press, Austin
Roberto CA, Swinburn B, Hawkes C, Huang TTK, Costa SA, Ashe M, Zwicker L, Cawley JH, Brownell KD (2015) Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet 385:2400–2409. https://doi.org/10.1016/S0140-6736(14)61744-X
Rodgers A, Woodward A, Swinburn B, Dietz WH (2018) Prevalence trends tell us what did not precipitate the US obesity epidemic. Lancet Public Health 3:e162–e163. https://doi.org/10.1016/S2468-2667(18)30021-5
Rodriguez L, George JR, McDonald B (2017) An inconvenient truth: why evidence-based policies on obesity are failing Māori, Pasifika and the Anglo working class. Kōtuitui N Z J Soc Sci Online 12:192–204. https://doi.org/10.1080/1177083x.2017.1363059
Rushton S, Williams OD (2012) Frames, paradigms and power: global health policy-making under neoliberalism. Global Soc 26:147–167. https://doi.org/10.1080/13600826.2012.656266
South Australian Nutrition Network (2018) Select Committee into the Obesity Epidemic in Australia, Submission 98
Swinburn B, Egger G, Raza F (1999) Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med 29:563–570. https://doi.org/10.1006/pmed.1999.0585
Townshend T, Lake A (2017) Obesogenic environments: current evidence of the built and food environments. Perspect Public Health 137:38–44. https://doi.org/10.1177/1757913916679860
UK Government Office for Science (2007) Tackling obesities: future choices—modelling future trends in obesity and their impact on health. Foresight Programme, Government Office for Science, London
van Eyk H, Harris E, Baum F, Delany-Crowe T, Lawless A, MacDougall C (2017) Health in All Policies in South Australia—did it promote and enact an equity perspective? Int J Environ Res Public Health 14(11):1288. https://doi.org/10.3390/ijerph14111288
Williams C, Galicki C (2017) Health in All Policies in South Australia: lessons from 10 years of practice. In: Lin V, Kickbusch I (eds) Progressing the sustainable development goals through Health in All Policies: case studies from around the world. Government of South Australia and World Health Organization, Adelaide, pp 25–42
World Health Organization (2015) 68th World Health Assembly: Contributing to social and economic development: sustainable action across sectors to improve health and health equity (follow-up of the 8th Global Conference on Health Promotion) (A68/17)—Annexe: Draft framework for country action across sectors for health and health equity
World Health Organization (2017) Shanghai declaration on promoting health in the 2030 Agenda for Sustainable Development. Health Promot Int 32:7–8. https://doi.org/10.1093/heapro/daw103
World Health Organization (2018) Obesity and overweight. http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 16 Oct 2018
We acknowledge the input of all Chief and Associate Investigators who have contributed to the design of this research: Angela Lawless, Colin MacDougall, Jennie Popay, Elizabeth Harris, Dennis McDermott, Danny Broderick, Ilona Kickbusch, Michael Marmot, Kevin Buckett, Sandy Pitcher, Andrew Stanley, Carmel Williams 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 Australian National Health and Medical Research Council (Grant No. 1027561).
Conflict of interest
The authors declare they have no conflict of interest.
Research involving human participants
The research was conducted according to the guidelines in the Declaration of Helsinki and all data collection activities involving human subjects received prior approval by the Flinders University Social and Behavioural Research Ethics Committee (Project number 5518) and the SA Health Research Ethics Committee (Reference number HREC/12/SAH/74).
Informed consent was obtained from all individual participants involved in the study prior to interview, including consent to record and transcribe their interview. Interviewees were also offered the opportunity to review and revise the transcripts of their interviews.
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van Eyk, H., Baum, F. & Delany-Crowe, T. Creating a whole-of-government approach to promoting healthy weight: What can Health in All Policies contribute?. Int J Public Health 64, 1159–1172 (2019). https://doi.org/10.1007/s00038-019-01302-4
- Health in All Policies
- Intersectoral action
- Healthy public policy
- Determinants of health
- Healthy weight