Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Scope
2.2. Research Setting
2.3. Data Collection
2.3.1. Semi-Structured Interviews
2.3.2. Documents
2.4. Data Analysis
Causal Loop Diagrams (CLD)
2.5. Data Reporting
2.6. Ethics Approval
3. Results
3.1. Advocacy Coalition Framework Analysis
3.1.1. External Subsystem Events
“It [the emphasis of the need for the policy] was all around the National Partnership Agreement and we had a mandate and money to do something…and we had targets [that] we had to meet from the Commonwealth so there was an imperative for us to do something.”(Senior Policy Maker 1)
“There were some incredibly tight timeframes around getting something up and running because KGFYL was ceasing so there was, from a department and ministerial perspective, there was a risk in having any great length of delay in going from the KGFYL”(Policy Maker 1)
3.1.2. Coalition Opportunity Structures
“…What we foresaw before we engaged [a stakeholder organisation] was that they could see the Achievement Program as competition and we didn’t want that to be the case…we wanted to engage them right from the beginning to talk about how we weren’t trying to be in competition with what they were doing”(Policy Maker 4)
3.2. Action Arenas and Patterns of Interaction (Institutional Analysis and Development Framework)
“So the network and the distribution of power; that original steering group really only had two representatives from the Department of Health and about eight from Department of Education, so we deliberately sought to shift some of that power to Education as a strategy to engage them, to give them a little bit more power and control over the direction to inform it right from the beginning.”(Policy Maker 2)
3.3. Institutional Rules and Procedures
3.3.1. Advocacy Coalitions
3.3.2. Belief Systems
3.4. Core Beliefs
“So certainly from Worksafe’s point of view, something that came through very strongly was that anything in this [policy] space could only be voluntary.”(Policy Maker 1)
3.5. Policy Beliefs
“I do also think that the Secretary at the time understood that agenda—understood the prevention agenda and was also highly supportive of it.”(Senior Policy Maker 2)
“…We were under a Liberal government, so we kept emphasising that the state has signed up to this, we have to do it, the money’s coming. [So that there was] no opportunity to shut this down, because we didn’t know what the Liberals would think. As it turned out we had a wonderful Minister who totally understood public health so it wasn’t really an issue but you just never know because sometimes the values don’t align.”(Senior Policy Maker 1)
Policy Brokers
“[A Senior Public Health Advisor] did a lot of the heavy lifting with a lot of those individual groups, which was not always straightforward. There was a bit of push back, [but] they were, in the end, actually very supportive [of the Achievement Program].”(Senior Policy Maker 2)
3.6. Multiple Streams Theory Analysis
3.6.1. Problem Stream
3.6.2. Politics Stream
3.7. Political Interests
“[The AP] delivered lots of good things for them [the Minister for Health], because there were lots of good news stories lots of photo ops [opportunities], lots of chances to go out and meet and greet.”(Senior Policy Maker 1)
“…The political cycle always has a role…so at that stage [with the change in government] you are usually looking for something new…we couldn’t have [KGFYL] anymore.”(Senior Policy Maker 2)
“We were very fortunate with the factions within the government. When we were developing the AP, the Health Minister also had a good relationship with the Early Childhood Minister so there was a connection which helped.”(Senior Policy Maker 1)
Policy Stream
“…It is not a high cost initiative and, given the reach, it was a reasonably easy thing I think for the government to agree to…”(Policy Director 1)
“I would say the complication we had was working out the delivery, [with] the DHHS not being a delivery body. The decisions around, who do we fund to do this? I think that’s where some of the…well, kind of turf conflict [between public health organisations who seek funding to implement the health promotion programs] came out a little bit.”(Policy Maker 1)
3.8. Framing
“[When one of the policy entrepreneurs] spoke to the Secretary about this approach, [they] would be talking about that the hospital system has quality measures, [and that] we are trying to do the same thing for prevention. So it was about creating the match between where [the Secretary] wanted to go and what this might deliver for [them].”(Senior Policy Maker 2)
“…It was about really articulating how the Achievement Program would help them [early childcare settings] meet the National Quality Standards that they had to meet and how it could support that for schools. It was about trying to line up the process and then demonstrate to schools how the quality improvement process that they went through with the Achievement Program was no different to the process that they were required to do otherwise by Department of Education. For workplaces, it was about demonstrating more the business case to them around the benefits, but these were all factors that enabled us to get the right kind of support to support its development.”(Policy Maker 2)
3.8.1. Policy Windows and Entrepreneurs
“…I give [one particular policy entrepreneur] an enormous credit for a lot because [they] really did drive it. [They] were a tough taskmaster but a pretty strong captain of the ship…that strong leadership [was] right up front.”(Senior Policy Maker 2)
3.8.2. The Achievement Program Policy System
4. Discussion
4.1. Stakeholder Resistance
4.2. Beliefs
4.3. Framing
4.4. Institutional Factors
4.5. Complexity of the Policy Process
- Explicitly consider the policy implementation requirements (e.g., feasibility issues) at an early stage of the policy development process in order to identify potential risks of policy adoption and inform the development of risk management strategies (e.g., reframing policy solutions, consultations and negotiations strategies);
- Advocate the establishment of organisation structures that support collaboration and open, transparent policy development processes to assist in creating fairer opportunities for a broad range of external stakeholders to contribute to policy development. This is particularly important given the increasingly noted efforts of the food industry to influence policy makers, and the privileged access to decision makers that they often enjoy [81,82];
- Alter policy framing to align with broader government objectives, dominant belief systems and to minimise political risk (e.g., resistance from stakeholders).
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Clarke, B.; Swinburn, B.; Sacks, G. Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia. Int. J. Environ. Res. Public Health 2018, 15, 2393. https://doi.org/10.3390/ijerph15112393
Clarke B, Swinburn B, Sacks G. Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia. International Journal of Environmental Research and Public Health. 2018; 15(11):2393. https://doi.org/10.3390/ijerph15112393
Chicago/Turabian StyleClarke, Brydie, Boyd Swinburn, and Gary Sacks. 2018. "Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia" International Journal of Environmental Research and Public Health 15, no. 11: 2393. https://doi.org/10.3390/ijerph15112393