Public health researchers are increasingly concerned with achieving 'upstream' change to achieve ... more Public health researchers are increasingly concerned with achieving 'upstream' change to achieve reductions in the global burden of disease and health inequalities. Consequently, understanding policy and how to change it has become a central goal of public health. Yet conceptualisation of what constitutes policy and where it can be found is very limited within this field. Our glossary demonstrates that policy is many headed. It is located in a vast array of documents, discussions dialogues and actions which can be captured variously by formal and informal forms of documentation and observation. Effectively understanding policy and its relevance for public health requires an awareness of the full range of places and contexts in which policy work happens and policy documents are produced.
Understanding and modifying the influence of structural factors on health is one of the core aims... more Understanding and modifying the influence of structural factors on health is one of the core aims of contemporary public health. The currently dominant account in public health treats structure as being synonymous with indicators of social status such as income, education or occupation level. The unequal distribution of these indicators is further treated as the 'fundamental cause' of health inequalities. In this paper we build an account of structure which is grounded in social theory and responsive to the empirical evidence on health inequalities. We start with Bourdieu's model of habitus which positions social structures more proximally to the individual and redraws the hierarchy of up-, mid-and downstream influences. Bourdieu's theory does not adequately account for the role of public health interventions in changing attitudes and behaviours and it is particularly ill-suited to explaining the considerable reductions in smoking prevalence seen in industrialised countries. For these reasons we supplement habitus with Foucault's notion of governmentality. Structural influences on health behaviour are understood to combine equally with the myriad individual concerns of daily life. Describing some structures as being 'fundamental causes' owing to their distant position from the individual leads to misunderstanding the crucially important roles of all levels of structure.
Because of the complex aetiology of modern obesity patterns, isolated therapeutic or public healt... more Because of the complex aetiology of modern obesity patterns, isolated therapeutic or public health measures will not solve the obesity problem. Consumers must be made aware of the ways in which the food industry influences their food purchases. Government needs to prioritise health ahead of industrial productivity and increased consumption. An obesity intervention wish list is presented as a suggested reform package: > prohibit all forms of marketing of energy-dense, nutrient-poor foods; introduce measures such as kilojoule caps, prohibition of bundling, and greater uniformity in packaging design to make energy-dense, nutrient-poor foods less enticing and less amenable to bulk purchase; redesign supermarkets to promote fresh rather than energy-dense, nutrient-poor foods; cease provision of government subsidies to food processing industries; tax energy-dense, nutrient-poor foods to create a disincentive to purchasing of these foods; and regulate the location and number of fast-foo...
The considerable evidence base linking social conditions to population health has spurred many in... more The considerable evidence base linking social conditions to population health has spurred many in public health to call for political action. Most of these conditions fall outside the purview of health departments, meaning that advocates are increasingly calling on other government sectors to improve health. Whether levelled at the whole-of-government or individual departments these calls seek a paradigm shift in governmental goals. Paradigmatic political change is an essentially normative process – one based upon ethical, rather than empirical, reasoning. Successfully achieving political change requires that public health advocates improve their normative justification for change and reduce their reliance upon evidence-based arguments.
The recent review of taxation in Australia - the Henry tax review - has recommended that the fede... more The recent review of taxation in Australia - the Henry tax review - has recommended that the federal government increase the taxes already levied on tobacco and alcohol. Tobacco and alcohol taxes are put forward as the best way of reducing the social harms caused by the use and misuse of these substances. Junk foods have the same pattern of misuse and the same social costs as tobacco and alcohol. The Henry tax review rejects the idea of taxing fatty foods, and to date the government has not implemented a tax on junk food. We propose that a tax on junk food be implemented as a tool to reduce consumption and address the obesity epidemic.
While the causes of obesity are well known traditional education and treatment strategies do not ... more While the causes of obesity are well known traditional education and treatment strategies do not appear to be making an impact. One solution as part of a broader complimentary set of strategies may be regulatory intervention at local government level to create environments for healthy nutrition and increased physical activity. Semi structured interviews were conducted with representatives of local government in Australia. Factors most likely to facilitate policy change were those supported by external funding, developed from an evidence base and sensitive to community and market forces. Barriers to change included a perceived or real lack of power to make change and the complexity of the legislative framework. The development of a systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level, coupled with cost benefit analysis for any potential regulatory intervention, are crucial to developing a regulatory environment which create...
The recognition that certain characteristics (such as poverty, disadvantage or membership of marg... more The recognition that certain characteristics (such as poverty, disadvantage or membership of marginalised social or cultural groups) can make individuals more susceptible to illness has reignited interest in how to combine universal programmes and policies with ones targeted at specific groups. However, 'universalism' and 'targeting' are used in different ways for different purposes. In this glossary, we define different types and approaches to universalism and targeting. We anticipate that greater clarity in relation to what is meant by 'universalism' and 'targeting' will lead to a more nuanced debate and practice in this area.
It is now well documented that many of the key drivers of health reside in our everyday living co... more It is now well documented that many of the key drivers of health reside in our everyday living conditions. In the last two decades, public health has urged political action on these critical social determinants of health (SDH). As noted by the World Health Organisation, encouraging action in this area is challenging. Recent research has argued that public health researchers need to gain a deeper understanding of the complex and changing rationalities of policymaking. This, it seems, is the crucial next step for social determinants of health research. In this paper, we turn our attention to the practitioners of 'the art of government', in order to gain insight into how to secure upstream change for the SDH. Through interviews with policy actors (including politicians, senior government advisors, senior public servants and experienced policy lobbyists) the research sought to understand the nature of government and policymaking, as it pertains to action on the SDH. Through exploring the policy process, we examine how SDH discourses, evidence and strategies align with existing policy processes in the Australian context. Participants indicated that approaches to securing change that are based on linear conceptualisations of the policy process (as often found in public health) may be seen as 'out of touch' with the messy reality of policymaking. Rather, a more dialogic approach that embraces philosophical and moral reasoning (alongside evidence) may be more effective. Based on our findings, we recommend that SDH advocates develop a deeper awareness of the political and policy structures and the discursive conventions they seek to influence within specific settings.
Public health researchers are increasingly concerned with achieving 'upstream' change to achieve ... more Public health researchers are increasingly concerned with achieving 'upstream' change to achieve reductions in the global burden of disease and health inequalities. Consequently, understanding policy and how to change it has become a central goal of public health. Yet conceptualisation of what constitutes policy and where it can be found is very limited within this field. Our glossary demonstrates that policy is many headed. It is located in a vast array of documents, discussions dialogues and actions which can be captured variously by formal and informal forms of documentation and observation. Effectively understanding policy and its relevance for public health requires an awareness of the full range of places and contexts in which policy work happens and policy documents are produced.
Understanding and modifying the influence of structural factors on health is one of the core aims... more Understanding and modifying the influence of structural factors on health is one of the core aims of contemporary public health. The currently dominant account in public health treats structure as being synonymous with indicators of social status such as income, education or occupation level. The unequal distribution of these indicators is further treated as the 'fundamental cause' of health inequalities. In this paper we build an account of structure which is grounded in social theory and responsive to the empirical evidence on health inequalities. We start with Bourdieu's model of habitus which positions social structures more proximally to the individual and redraws the hierarchy of up-, mid-and downstream influences. Bourdieu's theory does not adequately account for the role of public health interventions in changing attitudes and behaviours and it is particularly ill-suited to explaining the considerable reductions in smoking prevalence seen in industrialised countries. For these reasons we supplement habitus with Foucault's notion of governmentality. Structural influences on health behaviour are understood to combine equally with the myriad individual concerns of daily life. Describing some structures as being 'fundamental causes' owing to their distant position from the individual leads to misunderstanding the crucially important roles of all levels of structure.
Because of the complex aetiology of modern obesity patterns, isolated therapeutic or public healt... more Because of the complex aetiology of modern obesity patterns, isolated therapeutic or public health measures will not solve the obesity problem. Consumers must be made aware of the ways in which the food industry influences their food purchases. Government needs to prioritise health ahead of industrial productivity and increased consumption. An obesity intervention wish list is presented as a suggested reform package: > prohibit all forms of marketing of energy-dense, nutrient-poor foods; introduce measures such as kilojoule caps, prohibition of bundling, and greater uniformity in packaging design to make energy-dense, nutrient-poor foods less enticing and less amenable to bulk purchase; redesign supermarkets to promote fresh rather than energy-dense, nutrient-poor foods; cease provision of government subsidies to food processing industries; tax energy-dense, nutrient-poor foods to create a disincentive to purchasing of these foods; and regulate the location and number of fast-foo...
The considerable evidence base linking social conditions to population health has spurred many in... more The considerable evidence base linking social conditions to population health has spurred many in public health to call for political action. Most of these conditions fall outside the purview of health departments, meaning that advocates are increasingly calling on other government sectors to improve health. Whether levelled at the whole-of-government or individual departments these calls seek a paradigm shift in governmental goals. Paradigmatic political change is an essentially normative process – one based upon ethical, rather than empirical, reasoning. Successfully achieving political change requires that public health advocates improve their normative justification for change and reduce their reliance upon evidence-based arguments.
The recent review of taxation in Australia - the Henry tax review - has recommended that the fede... more The recent review of taxation in Australia - the Henry tax review - has recommended that the federal government increase the taxes already levied on tobacco and alcohol. Tobacco and alcohol taxes are put forward as the best way of reducing the social harms caused by the use and misuse of these substances. Junk foods have the same pattern of misuse and the same social costs as tobacco and alcohol. The Henry tax review rejects the idea of taxing fatty foods, and to date the government has not implemented a tax on junk food. We propose that a tax on junk food be implemented as a tool to reduce consumption and address the obesity epidemic.
While the causes of obesity are well known traditional education and treatment strategies do not ... more While the causes of obesity are well known traditional education and treatment strategies do not appear to be making an impact. One solution as part of a broader complimentary set of strategies may be regulatory intervention at local government level to create environments for healthy nutrition and increased physical activity. Semi structured interviews were conducted with representatives of local government in Australia. Factors most likely to facilitate policy change were those supported by external funding, developed from an evidence base and sensitive to community and market forces. Barriers to change included a perceived or real lack of power to make change and the complexity of the legislative framework. The development of a systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level, coupled with cost benefit analysis for any potential regulatory intervention, are crucial to developing a regulatory environment which create...
The recognition that certain characteristics (such as poverty, disadvantage or membership of marg... more The recognition that certain characteristics (such as poverty, disadvantage or membership of marginalised social or cultural groups) can make individuals more susceptible to illness has reignited interest in how to combine universal programmes and policies with ones targeted at specific groups. However, 'universalism' and 'targeting' are used in different ways for different purposes. In this glossary, we define different types and approaches to universalism and targeting. We anticipate that greater clarity in relation to what is meant by 'universalism' and 'targeting' will lead to a more nuanced debate and practice in this area.
It is now well documented that many of the key drivers of health reside in our everyday living co... more It is now well documented that many of the key drivers of health reside in our everyday living conditions. In the last two decades, public health has urged political action on these critical social determinants of health (SDH). As noted by the World Health Organisation, encouraging action in this area is challenging. Recent research has argued that public health researchers need to gain a deeper understanding of the complex and changing rationalities of policymaking. This, it seems, is the crucial next step for social determinants of health research. In this paper, we turn our attention to the practitioners of 'the art of government', in order to gain insight into how to secure upstream change for the SDH. Through interviews with policy actors (including politicians, senior government advisors, senior public servants and experienced policy lobbyists) the research sought to understand the nature of government and policymaking, as it pertains to action on the SDH. Through exploring the policy process, we examine how SDH discourses, evidence and strategies align with existing policy processes in the Australian context. Participants indicated that approaches to securing change that are based on linear conceptualisations of the policy process (as often found in public health) may be seen as 'out of touch' with the messy reality of policymaking. Rather, a more dialogic approach that embraces philosophical and moral reasoning (alongside evidence) may be more effective. Based on our findings, we recommend that SDH advocates develop a deeper awareness of the political and policy structures and the discursive conventions they seek to influence within specific settings.
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Papers by Brad Crammond