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Authors: Fran Baum and Judith Dwyer

This chapter argues that contemporary health policy in Australia is shaped by its response to three fundamental challenges: how to maximise health outcomes; how to ensure equity in access to health care; and how to operate an effective health care delivery system within constrained resources. The chapter describes how health policy continues to be conducted as a ‘strife of interests’, involving powerful professional and industry groups. It argues that Medicare (universal public health insurance scheme) remains as one of the strengths of the health system, providing affordable and effective care for most Australians. Health inequities remain and these reflect the distribution of the social determinants of health, including access to health care. For the future special efforts need to be made to close the gap in life expectancy between Indigenous and non-Indigenous Australians, strengthen primary health care and reshape health care delivery so that it can be sustainable, efficient and effective.

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This paper describes a partnership between researchers and policy actors that was developed within a short timeframe to produce a rapid appraisal case study of a government policy initiative – South Australia’s Social Inclusion Initiative – for the Social Exclusion Knowledge Network of the international Commission on Social Determinants of Health. The paper does not focus on the case study findings or content, but rather on the researcher–policy actor partnership that developed in the process of producing the case study and its report. The paper is set against the broader literature on researcher–policy collaboration and is written to share lessons that may help others quickly establish or improve researcher–policy partnerships. It sets out six key elements for success in a framework for partnership that can meet policy rather than academic timeframes and which can effectively co-produce knowledge that meets both research and policy objectives.

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Background:

Insufficient progress has been made towards reducing health inequities, due in part to a lack of action on the root causes of health inequities. At present, there is a limited evidence base to guide policy decision making in this space.

Key points for discussion:

This paper proposes new principles for researchers to conduct health equity policy evaluation. Four key principles are presented: (1) where to evaluate – shifting from familiar to unfamiliar terrain; (2) who to evaluate – shifting from structures of vulnerability to structures of privilege; (3) what to evaluate – shifting from simple figures to complex constructs; and (4) how to evaluate – shifting from ‘gold standard’ to more appropriate ‘fit-for-purpose’ designs. These four principles translate to modifying the policy domains investigated, the populations targeted, the indicators selected, and the methods employed during health equity policy evaluation. The development and implementation of these principles over a five-year programme of work is demonstrated through case studies which reflect the principles in practice.

Conclusions and implications:

The principles are shared to encourage other researchers to develop evaluation designs of sufficient complexity that they can advance the contribution of health equity policy evaluation to structural policy reforms. As a result, policies and actions on the social determinants of health might be better oriented to achieve the redistribution of power and resources needed to address the root causes of health inequities.

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