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Early childhood education (ECE) and development is internationally recognised as important to child health and wellbeing and to enabling children to become healthy productive adults. This paper analyses Australian ECE policy current in 2019. It uses the institutional framework of ideas, actors and institutions to determine the extent to which ECE policy recognises and acts on social determinants of health and health equity. We found that the policies supported integrated approaches, intersectoral collaboration and partnerships with parents and families. Evidence was important in formulating the ideas underpinning ECE policy. ECE was widely recognised as a social determinant of health, and the impacts of other social determinants of health and health equity were acknowledged. The ECE policies tended to be future-focused and not respond to social determinants that influence children and their families in the present time. The policies lacked strategies to address social determinants, or to engage with other sectors for this purpose. While some policies focused on breaking the cycle of disadvantage, they did not explore potential policy responses to pathways from intergenerational disadvantage to reduce poverty. Despite this, Australian ECE policy has achieved significant coherence, with shared understandings of the purpose and benefits of ECE. [ABSTRACT FROM AUTHOR]

Background: Studies show widespread widening of socioeconomic and health inequalities. Comprehensive primary health care has a focus on equity and to enact this requires more data on drivers of the increase in inequities. Hence, we examined trends in the distribution of income, wealth, employment and health in Australia. Methods: We analysed data from the Public Health Information Development Unit and Australian Bureau of Statistics. Inequalities were assessed using rate ratios and the slope index of inequality. Results: We found that the social gradient in health, income, wealth and labour force participation has steepened in Australia, and inequalities widened between the quintile living in the most disadvantaged areas and the quintile living in the least disadvantaged areas. Conclusion: Widening income, wealth and employment inequalities have been accompanied by increasing health inequalities, and have reinforced and amplified adverse health effects, leading to increased mortality inequality. Effective comprehensive primary health care needs to be informed by an understanding of structural factors driving economic and health inequities. Over recent decades, Australia has become more unequal in terms of income, wealth, employment, and health. We analysed publicly available Australian data and found that the social gradient in health, income, wealth and labour force participation have all steepened. This makes calls for comprehensive primary health care even more urgent as one strategy to address underlying structural factors driving these worsening inequities. [ABSTRACT FROM AUTHOR]

Adapting the AHPF to compel reporting on progress against indicators of health inequity would identify health equity and the collection of better data on inequities as a priority. 5 Griffiths K, Smith J. Measuring health disparities in Australia: Using data to drive health promotion solutions. Many Australian health data collections do not include information on socio-economic indicators or gather sufficient information on socio-economic position to estimate the social gradient in health and the distribution of social determinants that contribute to the gradient. Keywords: Population health EN Population health 388 391 4 05/04/22 20220501 NES 220501 Australia needs better data on health inequities to support building back fairer from the pandemic The coronavirus disease 2019 (COVID-19) pandemic has shone a light on longstanding inequities in societies.1 Yet, too often, these inequities are effectively invisible,1 and we can only know if we are tackling them if we can measure them. [Extracted from the article]

This article presents a case study of a project known as 'Designing Better Health Care in the South' that attempted to transform four separately incorporated health services in southern Adelaide into a single regional health service. The project's efforts are examined using Kotter's (1996) model of the preconditions for transformational change in organisations and the areas in which it met or failed to meet these preconditions are analysed, using results from an evaluation that was commenced during the course of the attempted reform. The article provides valuable insights into an attempted major change by four public sector health organisations and the facilitators and barriers to such change. It also examines the way in which forces beyond the control of individual public sector agencies can significantly impact on attempts to implement organisational change in response to an identified need. This case study offers a rare glimpse into the micro detail of health care reform processes that are so widespread in contemporary health services but which are rarely systematically evaluated.

Background: The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. Methods: A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. Results: The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP's success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion: The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory. [ABSTRACT FROM AUTHOR]

After publication of the article [1], it has been brought to our attention that Table 1 has been formatted poorly in the original version so that the columns are not aligned with their corresponding information. The correct version of the table is presented below. The original version of the article has now been revised. [ABSTRACT FROM AUTHOR]

This paper examines a case study of local health care reform in Australia that had as one of its aims the desire to increase the health promotion and partnership work of the region. The case study highlights the pressures contemporary health systems are facing and the challenge of re-orientating health services towards health promotion in this environment. Qualitative research, including interviews, focus groups, a staff survey and policy analysis were used to identify health system professionals' perceptions of the impact of health care reform. The case study portrays a complex system that is subject to frequent change but little reform. Our case study indicates that features of health systems that encourage collaborative partnerships are those where there is: an environment that encourages trust; a common purpose among the key players; a supportive external environment; practical projects to work on; organisational stability; commitment from staff throughout organisations; willingness to commit resources; evidence that change is likely to improve outcomes for users; and an organisational environment in which learning from past experience is encouraged. A number of constraints and tensions that work against introducing a greater emphasis on health promotion and collaboration within the system studied are discussed, including tensions between central funding bureaucracies and health care agencies and the reform fatigue and increasing cynicism among staff resulting from continuous change. The paper concludes that against the chaotic background of contemporary health service reform it is very. difficult to bring about genuine reform to achieve a shift to more emphasis on health promotion and partnerships. [ABSTRACT FROM AUTHOR]

Describes the contribution of a series of focus groups and a revised discussion paper to the evolution of health care reform in South Australia. Impact of health care reform on health care agencies; Reasons for the struggles of evaluators to evaluate health care reform programs; Relationships between bureaucracy and health care service providers.

Evaluators in the health sector struggle to develop effective mechanisms with which to evaluate healthcare reform programmes. Evaluation of these programmes is difficult because they are entangled in complex, inherently political processes and often shift away from their original aims and objectives as a result of policy changes within the health system. This article describes the evaluation of a healthcare reform process occurring in South Australia and discusses some of the methodological challenges encountered in evaluating a case study of continuous change with shifting policy objectives. It describes how the evaluators have attempted to address these challenges through a flexible and dynamic action-research approach. The article concludes by discussing the role of the evaluator, as intelligent observer, in reflecting on and documenting change in the highly political and complex field of healthcare reform. [ABSTRACT FROM AUTHOR]