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Table 1 Summary of key findings from published papers

From: 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?

Paper published from the research Key findings
Evaluation of Health in All Policies: concept, theory and application [8] - Developed through a consultative process and informed by social and political science theory, program logic can accommodate the complexity of public policy-making.
Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia [12] - Program logic and its underlying theory of change provide a framework within which attribution of health outcomes can be made through a predictive chain-of-logic approach.
- The program logic framework provides a basis to explore interactions between the framework’s components and how they shape policy-making and public policy.
- Using a program logic framework allowed for assessment of HiAP’s success in integrating health and equity considerations in policies and laid the foundations for predicting the impacts of resulting policies.
Creating a burden of evidence to consider the impact of Health in All Policies: A program logic approach [42] - A case study of a HiAP project undertaken with Education Department staff to increase parental engagement in child literacy is used to show how the research built a ‘burden of evidence’ that supports logically coherent chains of relationships between HiAP activities and intended outcomes, which have been explained through a program logic model.
Health in All Policies in South Australia: what has supported early implementation? [22] - Implementation of the SA HiAP approach was supported by dedicated staff and adequate financial resources; a central mandate that created an authorising environment and supported the entry of HiAP staff into other government departments; alignment of HiAP with government core business and strategic priorities; and establishment and maintenance of trust in, and credibility of, the HiAP approach and staff.
- Relationship development and maintenance was central, and a focus on co-benefits supported development of these relationships.
- Dominance of siloed government structures and decision making and narrow definitions of core business threaten HiAP success and reduce its acceptance.
Ideas, actors and institutions: Lessons from South Australian Health in All Policies on what encourages other sectors’ involvement [20] - Wide acceptance among participants of role of social determinants in shaping health and of importance of action to promote health in all participating government agencies.
- The existence of a HiAP Unit helped gain support from other sectors.
- Other sectors became involved in HiAP because of the presence of a supportive, knowledgeable policy network of public servants, a clear political mandate, a move from a short term project focus to institutionalisation through new public health legislation, and finding a fit between HiAP ideas and the dominant economic paradigm of government.
- Policy entrepreneurs and champions played a critical role in supporting and disseminating understanding of healthy public policy and social determinants of health.
Health in All Policies in South Australia—Did It Promote and Enact an Equity Perspective? [21] - The SA HiAP approach had dual goals of facilitating joined-up government for co-benefits, and addressing social determinants of health and inequities through cross-sectoral policy activity.
- Government agencies understood HiAP as a catalyst for collaboration, and as providing tools for improving intersectoral policy development, but did not understand HiAP’s equity goal, which gained little traction.
- Where equity is not seen as core government business, it can be viewed by agencies as optional and can struggle to achieve prioritisation against competing political agendas.
- HiAP’s co-benefits approach has been central to the SA HiAP approach and brought significant benefits to participants from other sectors. The goal of establishing and maintaining relationships for co-benefits was privileged over equity outcomes, so that equity became practically invisible in HiAP activity.
- HiAP’s initial intentions to address equity were only partially enacted and little was done to reduce inequities.
Understanding Australian policies on public health using social and political science theories: reflections from an Academy of the Social Sciences in Australia Workshop [43] - Most governments do not prioritise action on social determinants of health and health equity.
- Applying multiple theories is helpful in directing attention to, and understanding, the influences of the different stages of the policy process. The application of theory promises to be most effective when it is multidisciplinary and blends and applies insights from a number of different theories.
- There is value in collaboration between public health researchers, political and social scientists and public servants to open up critical discussion about the intersections between theory, research evidence and practice.
- Critique is vital to make visible the processes through which some sources of knowledge may be privileged over others, and to examine how political and bureaucratic environments shape policy proposals and implementation.
Health Impact Assessment in New South Wales & Health in All Policies in South Australia: differences, similarities, and connections [23] - Health impact assessment (HIA) and HiAP approaches have similar overall intents to facilitate engagement of other sectors to consider the health implications of their policies.
- Key differences are in underpinning principles, technical processes and tactical strategies, which appear to stem largely from organisational positioning of the work and the extent of links to government systems.
- Alignment of the HiAP approach with government systems increases its likelihood of influence in the policy cycle but political priorities and government sensitivities can limit the scope of HiAP work. Implementation of the HIA approach from outside government gives greater freedom to collaborate with different partners and assess priorities without the constraint of government priorities. However, greater distance may also reduce the potential impact on government policy.
New norms new policies: Did the Adelaide Thinkers in Residence scheme encourage new thinking about promoting wellbeing and Health in All Policies? [44] - The Adelaide Thinker in Residence scheme was an innovative program to encourage a more flexible, responsive and adaptable SA public sector, through expert international Thinkers introducing new strategic ideas to address complex problems. It highlighted the need for intersectoral collaboration and a mutually reinforcing agenda across government to advance a social determinants approach.
- As external entrepreneurs, the Thinkers built on the work of local entrepreneur networks to advance their policy agendas, including presenting prevention as important to economic goals.
- The scheme enhanced commitment to public health and health promotion, and highlighted the importance of investing in disease prevention and health promotion, including through addressing social determinants outside the health sector.
- By strengthening and recasting norms and establishing a stronger and more extensive policy network, a tipping point was reached for the adoption of new norms within the bureaucracy. Intersectoral networks were mobilised, and the issue of health was expanded to one of economics and governance, thus increasing likelihood of institutionalisation.
- A HiAP approach was proposed through this scheme, with health reframed as an economic concern. HiAP was directly linked to the government’s broader political priorities, which supported its implementation in SA.
  1. Abbreviations: HiAP Health in All Policies, HIA Health impact assessment, SA South Australia