Volume 191 - Issue 10
Grasping the initiative in health policy research and reform
Authors: James Gillespie, Beverley Essue, Stephen R Leeder and Anne Marie T Thow
Med J Aust 2009; 191 (10): 528-529. || doi: 10.5694/j.1326-5377.2009.tb03303.x
Published online: 16 November 2009
Published online: 16 November 2009
The conference highlighted the need for new policy development using quantitative methods
The Fourth Emerging Health Policy Research Conference was held at the Menzies Centre for Health Policy, University of Sydney, on 19 August 2009. This national gathering of “new and emerging” policy researchers came as the Rudd government’s commissions and taskforces delivered their recommendations on improving Australian health.
The conference showcased a critical mass of diverse and innovative research projects that push the boundaries of traditional policy enquiry. Forty-two up-and-coming health policy researchers from Australia and New Zealand presented papers on an exciting range of topics within nine concurrent sessions. Researchers with expertise in the fields of medicine, anthropology, sociology, psychology, economics, nursing, history, law and political science exposed multiple disciplinary perspectives on critiquing and addressing current and future health policy problems.1
Hopes for substantial health reform around the world have been challenged by the global financial crisis. Professor John Wyn Owen (Chair of the Board of Governors, University of Wales Institute, Cardiff, and former Secretary of the Nuffield Trust, London), opened the conference with his keynote speech on the challenge to global health posed by macroeconomic emergencies. Health policy development requires an appreciation of the changing nature of capitalism and an assessment of the global health consequences of economic vulnerability. Although public awareness of the need for concerted action has never been higher, public health emergencies, from severe acute respiratory syndrome to swine flu, have weakened economies, lowering the resources that can be mobilised. Owen stressed the importance of the central discipline of health policy analysis — namely, understanding the context in which problems emerge, research is applied and political forces are mobilised. Christine Bennett (Chair, National Health and Hospitals Reform Commission, Canberra) also gave a spirited account of the principal recommendations of the National Health and Hospitals Reform Commission report.2
Major policy themes
Three major policy themes emerged in the remainder of the conference: improving chronic illness prevention and management, the intersections between health and other sectoral policy, and new policy instruments.
Improving chronic illness prevention and management
The desperate need for health systems and preventive health initiatives to combat the growing epidemic of chronic disease was raised in several presentations. For example, Renee Slade (Research Officer, Diabetes Unit, University of Sydney) described a capacity development process that is critical to improving the care and management of type 2 diabetes in the Pacific Islands and could provide a useful model for similar settings. Elizabeth Dunford (PhD candidate, George Institute for International Health, Sydney) demonstrated that, although action to reduce salt in Australian foods is being taken up by industry, full buy-in by the Australian government is necessary for widespread adoption of this initiative.
Intersections between health and other sectoral policy
The importance of developing cross-sectoral collaboration in developing and implementing policy to tackle challenging issues such as health equity and the social determinants of health also featured strongly in many presentations.
The analysis by Emma Webster (DrPH candidate, Discipline of Public Health, Flinders University, Adelaide) of women’s decision making around disbursement of the Baby Bonus payment suggests that an unintended consequence of this social policy has been to entrench social distinction, undermining its effectiveness as a public health intervention. Mandy Nielson (PhD candidate, School of Social Work and Human Services, University of Queensland, Brisbane) pointed to a silent epidemic of chronic pain — much of which has little or no identifiable pathology — and argued that multidisciplinary “biopsychosocial” models need to take the “social” element more seriously. The integration of commonly siloed sectors was pushed further in an analysis by Remo Ostini (Senior Research Officer, Faculty of Health Sciences, University of Queensland, Brisbane) of the implications of low health literacy for illness management, arguing for a national health literacy strategy. Such a strategy would require collaboration between the health, education, housing, employment and welfare sectors to gain any traction.
New policy instruments
Developing effective strategies to allow researchers to better engage with and influence the policy process emerged as the final theme of the conference. For example, Mat Walton (PhD candidate and Research Fellow, Department of Public Health, University of Otago, Wellington, New Zealand) discussed his use of complexity theory to untangle the complex social systems that influence children’s nutrition and, in particular, how such findings could be applied to improve child nutrition policy in New Zealand. Gabriel Moore (Senior Project Officer, Sax Institute, Sydney) presented her proposal for a knowledge translation framework that integrates a pathway of interventions, including analysis of research need, development of policy–research partnerships, knowledge brokering, knowledge exchange and advocacy. Carol Holden (Chief Executive Officer, Andrology Australia, Monash University, Melbourne) looked at past failures to develop effective interventions in men’s health, identifying strength of stakeholder networks as the crucial variable and proposing a more strategic approach to health promotion.
Methodology underpinning health policy research
Much of the research presented was qualitative, reflecting interest in experiences of policy outcomes, broader factors influencing policy outcomes, and participatory policy development.
Qualitative methods — mainly interviews with stakeholders such as industry representatives, youth and members of the wider community — were used to assess experiences of policy implementation and effectiveness, as well as to directly inform new policy development. Another method employed was linguistic analysis. For example, Denise Fry (Project Officer, Health Promotion Service, Sydney South West Area Health Service), outlined an analysis of the keywords used in health promotion, showing how language can shape and frame policy issues. This helps to explain the persistence of behaviourist models in health promotion, which focus on individual motivation and exclude broader concepts of social determination. Qualitative methods are influential as a policy tool as long as the findings are interpreted in a way that is sensitive to current and emerging policy opportunities. This point was reinforced by Tanisha Jowsey (Research Officer, Serious and Continuing Illness Policy and Practice Study, Australian National University, Canberra) in her presentation on how to translate qualitative findings into practical, relevant and feasible policy options to improve chronic illness management.
The policy process was analysed to gain a better understanding of factors influencing policy uptake and implementation. For example, Kathy Flitcroft (Research Fellow, School of Public Health, University of Sydney) presented an analysis of the relative roles of research evidence and other factors in decision-making and implementation processes regarding bowel cancer screening. Similarly, qualitative methods such as ethnographic and historical research tools were used to analyse the broader context of health policy making and to investigate factors affecting policy implementation and equity issues, such as access to care.
Many of the evaluations of policy outcomes used mixed methods research, combining data on measurable outcomes with interview data reflecting stakeholder experiences. The conference also highlighted the need for new policy development using quantitative methods, such as epidemiological studies, economic analyses of cost-effectiveness, randomised controlled trials and carefully evaluated policy experiments. Natalie Plant (Research Officer, Menzies Centre for Health Policy, University of Sydney) presented on the development of a randomised controlled trial to compare patient management strategies in coordinating the hospital and community care of patients with serious and chronic illnesses.
The concluding speech was presented by Mary Ann O’Loughlin (Executive Councillor and Head of the Secretariat of the Council of Australian Governments [COAG] Reform Council), who described the COAG Health Reform Project, which has been largely forgotten amidst other more headline-grabbing commissions and reports. Recent COAG reforms will require annual report cards on the progress of state and territory governments and (in a break from the past) the federal government, measuring their progress in meeting targets on prevention, hospital and primary care reform, and Indigenous health. Australian policy researchers will have comprehensive data to compare the performance of governments and identify models to improve practice.
The Emerging Health Policy Research Conference was convened in response to concerns about the limited research culture in Australian health policy.3 The 2009 conference saw a doubling of papers and attendance compared with the previous year, so the future is looking a bit brighter.
Competing interests
None identified.
References
- Menzies Centre for Health Policy, University of Sydney. Emerging Health Policy Research Conference. 19 August 2009. http://www.ahpi.health.usyd.edu.au/events/past.php#ehpr09 (accessed Oct 2009).
- National Health and Hospitals Reform Commission. A healthier future for all Australians. Final report June 2009. Canberra: NHHRC, 2009. http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report (accessed Oct 2009).
- Smith-Merry J, Gillespie J, Leeder SR. A pathway to a stronger research culture in health policy. Aust New Zealand Health Policy 2007; 4: 19. 0_i1091868