Toby Freeman

World Cafés are a method to promote inclusive, constructive dialogue to identify solutions to large scale problems. These attributes make World Cafés a potentially valuable tool for multi-sectoral dialogue to identify solutions to health promotion issues such as addressing social determinants of health inequities. However, there are few accounts of World Cafés being used to bring disparate sector knowledges together to address common problems. We sought to test how the World Café method could aid bringing together multi-disciplinary and multi-sector expertise to identify solutions to reduce increasing health inequities in Australia. We conducted World Cafés in each Australian state and territory (N = 8) with a total of 162 participants from academia, government, and civil society. Participants were drawn from sectors including health, education, housing, urban planning, economics, and employment, and from organizations representing Aboriginal and Torres Strait Islander peoples, people with a disability, multicultural communities, youth, and older people. We found different sector participants readily found common ground and collaborated to identify potential public policy solutions to health inequities, generating deep discussion on structural drivers that would not be possible without bringing together these sector knowledges. This upstream focus is likely to identify opportunities to make meaningful changes to create healthier, more equitable societies. Participants reported valuing participation in the World Cafés, making the research more of an exchange compared to other data collection methods. We would suggest World Cafés are a valuable addition to a research toolkit for seeking structural solutions to health promotion issues.

Employment-related suicide is a global public health problem, which is becoming more urgent as the world’s workforce is increasingly employed under i

Community health and primary health care (PHC) concepts are contested globally. We analysed 122 Australian federal and state government policy documents relating to women's, Aboriginal community controlled, generalist and workers’ community health services from the 1970s to 2022 using institutional theory to understand how ideas and interests had shaped community health and PHC in Australia. We found an initial flourishing of diverse ideas was contested and constrained over time to reflect a more biomedical, general practice-centric approach to PHC. This was influenced by federal government decisions to prioritise general practice, and state governments’ emphasis on reducing hospital costs. This reflects the power of established institutions and biomedical framings that have constrained debate over what is possible and what practices can be considered. From the content of the policies we reviewed, community health ideas and a comprehensive vision of PHC have persisted in Aboriginal community controlled health services, in women's health policy, and in Victorian community health services. Since pursuing comprehensive PHC remains a vital global goal to improve population health and health equity, our examination of policy history can shed light on how ideas and interests have shaped community health and PHC, and how future policies could be strengthened.

Background: This paper examines the social movements that influenced the development and implementation of the original Whitlam Government Community Health Program, the community health movement that emerged, and the opportunities it created for people to develop and deliver health programs in new ways. Methods: Oral history interviews with 93 people involved in community health in South Australia, Victoria and New South Wales, and 212 community health policy and archival documents were collected as a part of an Australian Research Council study documenting the history of community health services in Australia since the 1970s. Results: Ideas about community health in Australia were influenced by several social movements that had overlapping, but distinctive, contributions: (1) left-wing movements: political parties, workers’ health; trade unions, anti-war and anti-establishment; (2) international social medicine and community-oriented primary care; (3) Indigenous rights/Black Power; (4) feminist; and (5) community development/community power. These movements influenced Australian community health to embrace community management, advocacy and community development strategies in addition to multi-disciplinary care. However, these progressive elements were undermined by neo-liberal management reforms and medical opposition to elements of the Community Health Program. Conclusions: The early passion for community health in the 1970s and 1980s was fuelled by social movements, but the inconsistent support from the federal and most state governments limited progressive and innovative community health practice. The window of opportunity for the Community Health Program was supported by progressive social movements, but restricted from the 1990s onwards.

Changes to the public sector in Australia over recent decades result from the adoption of neoliberal policies and New Public Management techniques. By the 1990s Australian governments were privatizing a significant portion of public sector roles, including outsourcing a range of traditional government services, policy, and decision making to the private sector, often to large global consultancy firms. While much is known about privatization and outsourcing, less is known about the health and equity impacts. Using a qualitative approach, data collection included documents, website searches, Parliament of Australia Hansard transcripts, media items, and semi-structured interviews ( n = 11). Six key themes were identified, including the scope of outsourcing, consultants’ strategies, conflicts of interest, undermining the public sector, poor outcomes for the public, and implications for equity. The use of private sector actors in the Australian public sector has led to promoting private over public interests. There are legitimate reasons for governments to engage the services of global consulting firms in instances when public sector capacity cannot deliver specific highly specialized work. However, the current extensive use of consultants should be decreased through rebuilding public sector capacity to promote health and equity, and public over private interests.

Inequities in infant and child mortality are an urgent public health issue for lower- and middle-income countries (LMICs). We sought to establish whether gross domestic product (GDP) is associated with the extent of health inequalities within LMICs. We conducted a secondary analysis of publicly available health equity data from the Health Equity Database of LMICs and GDP data from the World Bank. We used infant and under-five mortality rates by socioeconomic quintile. The slope of inequality index and relative index of inequality were calculated for both outcomes for each country ( n = 83). Mixed effect linear regression analysis was used to investigate the relationship with GDP. Higher GDP was associated with a significant decrease in absolute socioeconomic inequities in both infant ( f ² = 0.26) and under-five mortality ( f ² = 0.33). Higher GDP was also associated with relative inequities in infant ( f ² = 0.08) and under-five mortality ( f ² = 0.07). Thus, increasing GDP may help reduce absolute inequities in infant and under-five mortality, but may increase relative inequities. Understanding drivers of the distribution of wealth and income to flatten the socioeconomic gradient in health are crucial to reducing health inequities.

Background: The Aboriginal community controlled health sector has been a leader in community health in Australia. We sought to understand the influence this sector has had on the non-Indigenous community health movement in Australia since the 1970s. Methods: We interviewed 87 key informants on the history of community health in Australia, including policy makers, researchers, medical doctors, allied health, social workers, nurses and politicians. Five were Aboriginal, and 11 had particular experience in Aboriginal community health. A team approach was taken to qualitative analysis using a codebook. We interrogated data to seek evidence for the influence of Aboriginal community health on non-Indigenous community health, and the relationship between the two sectors. This was complemented by construction of a policy timeline. Results: Aboriginal community health services were regarded as best practice community health, and informed and influenced practice in non-Indigenous community health services. Non-Indigenous community health was sometimes more of a competitor than an ally. The respect for the Aboriginal community health sector, particularly community controlled, was seen to have grown over time, acknowledging the strengths of the model. Although establishing Aboriginal community health services was a struggle, the resulting model has better resisted managerialist control compared with non-Indigenous community health. Conclusions: The Aboriginal health sector developed a vision and practice of community health that went on to inform generalist non-Indigenous community health sector in Australia. The sector continues to remain strong today as an example model of community health that is relevant to all Australians.