In many federated countries, there is divided health system responsibility that can affect primar... more In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.
Abstract Studies have consistently shown that living in disadvantaged neighbourhoods is associate... more Abstract Studies have consistently shown that living in disadvantaged neighbourhoods is associated with poor health. There is also some evidence that low income individuals may benefit from living in more advantaged neighbourhoods. However, while neighbourhoods are regarded by policy makers as key social determinants of health and important intervention sites for addressing health inequalities, the exact mechanisms linking neighbourhoods to health remain unclear. Key aspects of neighbourhoods previously shown to be associated with neighbourhood health are neighbourhood reputation, safety and disorder, which have also been linked to the built environment. Residents in disadvantaged neighbourhoods tend to perceive these aspects of their neighbourhood less favourably than residents of advantaged areas. This paper uses Bourdieu’s critical theory of the social reproduction of inequalities to explore how different perceptions of safety, disorder and reputation in contrasting socioeconomic neighbourhoods may influence the health and wellbeing of low-income residents. We identified a group of low income individuals residing in divergent socioeconomic areas in Adelaide, South Australia and explored their neighbourhood perceptions, using survey, in-depth and photo voice interviews. Our findings suggest that low-income individuals benefited from living in an advantaged area where the built environment was well resourced by the economic, cultural and social capital present in the neighbourhood resulting in a more positive perception of the built environment with few signs of disorder, which in turn promoted healthy behaviour and community engagement. However, the impact of the built environment and perception of disorder and safety seemed to affect individual’s health behaviour and wellbeing differently depending on their individual circumstances. Overall this study found that perception of the neighbourhood’s built environment reflected the area’s reputation and levels of disorder and safety, which were influenced by resources of neighbourhood capital suggesting that neighbourhoods can be sites of inequalities for people who are already disadvantaged.
Health Promotion Journal of Australia, Dec 8, 2021
Issue addressedDeindustrialisation and transitions from traditional manufacturing to new technolo... more Issue addressedDeindustrialisation and transitions from traditional manufacturing to new technologies and service industries in many high‐income countries including Australia has resulted in rising employment insecurity, unemployment and increased income and health inequities. In this paper, we explore potential impacts of an automotive plant closure on health in a disadvantaged area of South Australia. Our aim was to examine how prevailing factors affecting social and health inequity might be further affected following the plant closure and to identify levers for potential policy responses.MethodsIn workshop discussions with 28 policy and 14 community stakeholders through an iterative process participants discussed how existing factors contributing to community social and health inequity might be worsened (or remediated) by the looming economic shock from the plant closure.ResultsWe identified eight key themes highlighted in the workshops. In particular local economic investment, availability of job opportunities, and appropriate training were identified as key factors influencing individual financial security, which was in turn linked to social and health impacts.ConclusionsThe pathways mapped between the plant closure and social and health equity impacts highlighted differential potential impacts on individuals and the community, and identified policy levers to reduce adverse health outcomes resulting from economic shocks such as the closure of a major employer.So what?The study highlighted a broad range of intersecting factors affecting the health of the local community that policy responses to the plant closure needed to address to promote health and health equity. This included novel factors identified by community members, reinforcing the importance of including community perspectives when constructing policy responses.
Abstract: Aboriginal and Torres Strait Islander people are ten times more likely than non-Indigen... more Abstract: Aboriginal and Torres Strait Islander people are ten times more likely than non-Indigenous people to be homeless, which is an indicator of the level of health and social disparity that exists between the two groups. This paper presents the experiences of homelessness for a group of ten Aboriginal people located in Adelaide. Using Bourdieu's theoretical approach, we explore how these individuals interact with their environment, notably in the context of historical institutional disadvantage, and explore how this affects health and wellbeing. We highlight the subjective nature of homelessness, which is influenced by factors such as culture, age, and poor mental and physical health. We demonstrate the complex, diverse needs and heterogeneous nature of homelessness for Aboriginal people, which occur in the context of an enduring, specific historical experience of disadvantage, where the pathways into homelessness may vary and where homelessness may not always be perceived as negative. All participants experienced racism and reported resultant ill effects. Our study indicates the need for effective responses to homelessness to take account of the historical context of dispossession in developing culturally sensitive responses that reflect the nuances and diversity among homeless Aboriginal and Torres Strait Islander people. Introduction Aboriginal and Torres Strait Islander people are overrepresented among the population of people who are homeless in Australia. Homelessness is one of many contributing factors to the poor health outcomes for Indigenous and Torres Strait Islander people. Despite this, there is little in the literature documenting Aboriginal people's experiences of homelessness and the health impacts (Memmott et al. 2012; Parsell 2011). In this paper we use Bourdieu's critical theory of practice, which explores the production of social inequality, to examine the experiences of Aboriginal and Torres Strait Islander people who are homeless in an urban location in the context of their overall socioeconomic disadvantage. In Australia the availability of affordable housing, including boarding houses, has decreased over the past decade (Chamberlain and McKenzie 2008). Likewise, housing affordability relative to social security benefits has declined (Beer et al. 2007). Homelessness is increasing, with in excess of 100,000 homeless people on any given night (Chamberlain and McKenzie 2008). The reasons people become homeless are multifactorial and may include drug and alcohol addictions, domestic violence, mental and physical illness, family breakdown, unemployment and accumulation of debt (Halloran and Chambers 2011). Aboriginal and Torres Strait Islander peoples are one of four key demographic groups over-represented in the homeless population in Australia, which includes single people, people under 25 years of age and single parents (AIHW 2011; Chamberlain and McKenzie 2008)--and Aboriginal and Torres Strait Islander people may also be further represented in these other three groups. In general, homelessness can be categorised into three types: primary homelessness, such as sleeping rough or living in an improvised dwelling; secondary homelessness, which includes staying with family or friends or in specialised homeless services; and tertiary homelessness, which involves people staying in boarding houses or caravan parks with no secure lease (Chamberlain and McKenzie 2008). The majority of people who become homeless remain so for a short time, typically less than three months, while those experiencing long-term homelessness are more likely to accept their situation as normal (Burns et al. 2009). For all homeless people the relationship between homelessness and health issues is complex (Hwang 2002). Those who experience long-term homelessness often suffer from disabilities, substance abuse, and medical and psychiatric comorbidity (Burns et al. 2009). Homelessness has also been shown to be an independent risk factor for mortality in individuals who are already in poor health and socio-economically disadvantaged (Morrison 2009). …
Australian Journal of Public Administration, Jun 20, 2019
National Health and Medical Research Council, Grant/Award Numbers: APP1078046, NHMRC Centre of Re... more National Health and Medical Research Council, Grant/Award Numbers: APP1078046, NHMRC Centre of Research Excellence on the Social determinants of health equity
In many federated countries, there is divided health system responsibility that can affect primar... more In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.
Abstract Studies have consistently shown that living in disadvantaged neighbourhoods is associate... more Abstract Studies have consistently shown that living in disadvantaged neighbourhoods is associated with poor health. There is also some evidence that low income individuals may benefit from living in more advantaged neighbourhoods. However, while neighbourhoods are regarded by policy makers as key social determinants of health and important intervention sites for addressing health inequalities, the exact mechanisms linking neighbourhoods to health remain unclear. Key aspects of neighbourhoods previously shown to be associated with neighbourhood health are neighbourhood reputation, safety and disorder, which have also been linked to the built environment. Residents in disadvantaged neighbourhoods tend to perceive these aspects of their neighbourhood less favourably than residents of advantaged areas. This paper uses Bourdieu’s critical theory of the social reproduction of inequalities to explore how different perceptions of safety, disorder and reputation in contrasting socioeconomic neighbourhoods may influence the health and wellbeing of low-income residents. We identified a group of low income individuals residing in divergent socioeconomic areas in Adelaide, South Australia and explored their neighbourhood perceptions, using survey, in-depth and photo voice interviews. Our findings suggest that low-income individuals benefited from living in an advantaged area where the built environment was well resourced by the economic, cultural and social capital present in the neighbourhood resulting in a more positive perception of the built environment with few signs of disorder, which in turn promoted healthy behaviour and community engagement. However, the impact of the built environment and perception of disorder and safety seemed to affect individual’s health behaviour and wellbeing differently depending on their individual circumstances. Overall this study found that perception of the neighbourhood’s built environment reflected the area’s reputation and levels of disorder and safety, which were influenced by resources of neighbourhood capital suggesting that neighbourhoods can be sites of inequalities for people who are already disadvantaged.
Health Promotion Journal of Australia, Dec 8, 2021
Issue addressedDeindustrialisation and transitions from traditional manufacturing to new technolo... more Issue addressedDeindustrialisation and transitions from traditional manufacturing to new technologies and service industries in many high‐income countries including Australia has resulted in rising employment insecurity, unemployment and increased income and health inequities. In this paper, we explore potential impacts of an automotive plant closure on health in a disadvantaged area of South Australia. Our aim was to examine how prevailing factors affecting social and health inequity might be further affected following the plant closure and to identify levers for potential policy responses.MethodsIn workshop discussions with 28 policy and 14 community stakeholders through an iterative process participants discussed how existing factors contributing to community social and health inequity might be worsened (or remediated) by the looming economic shock from the plant closure.ResultsWe identified eight key themes highlighted in the workshops. In particular local economic investment, availability of job opportunities, and appropriate training were identified as key factors influencing individual financial security, which was in turn linked to social and health impacts.ConclusionsThe pathways mapped between the plant closure and social and health equity impacts highlighted differential potential impacts on individuals and the community, and identified policy levers to reduce adverse health outcomes resulting from economic shocks such as the closure of a major employer.So what?The study highlighted a broad range of intersecting factors affecting the health of the local community that policy responses to the plant closure needed to address to promote health and health equity. This included novel factors identified by community members, reinforcing the importance of including community perspectives when constructing policy responses.
Abstract: Aboriginal and Torres Strait Islander people are ten times more likely than non-Indigen... more Abstract: Aboriginal and Torres Strait Islander people are ten times more likely than non-Indigenous people to be homeless, which is an indicator of the level of health and social disparity that exists between the two groups. This paper presents the experiences of homelessness for a group of ten Aboriginal people located in Adelaide. Using Bourdieu's theoretical approach, we explore how these individuals interact with their environment, notably in the context of historical institutional disadvantage, and explore how this affects health and wellbeing. We highlight the subjective nature of homelessness, which is influenced by factors such as culture, age, and poor mental and physical health. We demonstrate the complex, diverse needs and heterogeneous nature of homelessness for Aboriginal people, which occur in the context of an enduring, specific historical experience of disadvantage, where the pathways into homelessness may vary and where homelessness may not always be perceived as negative. All participants experienced racism and reported resultant ill effects. Our study indicates the need for effective responses to homelessness to take account of the historical context of dispossession in developing culturally sensitive responses that reflect the nuances and diversity among homeless Aboriginal and Torres Strait Islander people. Introduction Aboriginal and Torres Strait Islander people are overrepresented among the population of people who are homeless in Australia. Homelessness is one of many contributing factors to the poor health outcomes for Indigenous and Torres Strait Islander people. Despite this, there is little in the literature documenting Aboriginal people's experiences of homelessness and the health impacts (Memmott et al. 2012; Parsell 2011). In this paper we use Bourdieu's critical theory of practice, which explores the production of social inequality, to examine the experiences of Aboriginal and Torres Strait Islander people who are homeless in an urban location in the context of their overall socioeconomic disadvantage. In Australia the availability of affordable housing, including boarding houses, has decreased over the past decade (Chamberlain and McKenzie 2008). Likewise, housing affordability relative to social security benefits has declined (Beer et al. 2007). Homelessness is increasing, with in excess of 100,000 homeless people on any given night (Chamberlain and McKenzie 2008). The reasons people become homeless are multifactorial and may include drug and alcohol addictions, domestic violence, mental and physical illness, family breakdown, unemployment and accumulation of debt (Halloran and Chambers 2011). Aboriginal and Torres Strait Islander peoples are one of four key demographic groups over-represented in the homeless population in Australia, which includes single people, people under 25 years of age and single parents (AIHW 2011; Chamberlain and McKenzie 2008)--and Aboriginal and Torres Strait Islander people may also be further represented in these other three groups. In general, homelessness can be categorised into three types: primary homelessness, such as sleeping rough or living in an improvised dwelling; secondary homelessness, which includes staying with family or friends or in specialised homeless services; and tertiary homelessness, which involves people staying in boarding houses or caravan parks with no secure lease (Chamberlain and McKenzie 2008). The majority of people who become homeless remain so for a short time, typically less than three months, while those experiencing long-term homelessness are more likely to accept their situation as normal (Burns et al. 2009). For all homeless people the relationship between homelessness and health issues is complex (Hwang 2002). Those who experience long-term homelessness often suffer from disabilities, substance abuse, and medical and psychiatric comorbidity (Burns et al. 2009). Homelessness has also been shown to be an independent risk factor for mortality in individuals who are already in poor health and socio-economically disadvantaged (Morrison 2009). …
Australian Journal of Public Administration, Jun 20, 2019
National Health and Medical Research Council, Grant/Award Numbers: APP1078046, NHMRC Centre of Re... more National Health and Medical Research Council, Grant/Award Numbers: APP1078046, NHMRC Centre of Research Excellence on the Social determinants of health equity
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