Creating change in government to address the social determinants of
health: how can efforts be improved?
Background
The evidence base for the impact of social determinants of health has been
strengthened considerably in the last decade. Increasingly, the public
health field is using this as a foundation for arguments and actions to
change government policies. The Health in All Policies (HiAP) approach,
alongside recommendations from the 2010 Marmot Review into health
inequalities in the UK (which we refer to as the 'Fairness Agenda'), go
beyond advocating for the redesign of individual policies, to shaping the
government structures and processes that facilitate the implementation of
these policies. In doing so, public health is drawing on recent trends in
public policy towards 'joined up government', where greater integration is
sought between government departments, agencies and actors outside of
government.
Methods
In this paper we provide a meta-synthesis of the empirical public policy
research into joined up government, drawing out characteristics associated
with successful joined up initiatives.
We use this thematic synthesis as a basis for comparing and contrasting
emerging public health interventions concerned with joined-up action
across government.
Results
We find that HiAP and the Fairness Agenda exhibit some of the
characteristics associated with successful joined up initiatives, however
they also utilise 'change instruments' that have been found to be
ineffective. Moreover, we find that - like many joined up initiatives -
there is room for improvement in the alignment between the goals of the
interventions and their design.
Conclusion
Drawing on public policy studies, we recommend a number of strategies to
increase the efficacy of current interventions. More broadly, we argue
that up-stream interventions need to be 'fit-for-purpose', and cannot be
replicated from one context to the next.



http://www.biomedcentral.com/1471-2458/14/1087/abstract

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