Stephanie M. Topp

Introduction Electronic health (E-Health) technologies present a valuable opportunity to enhance healthcare access and outcomes for Indigenous populations by addressing persistent, often structurally determined, health disparities. Despite increasing recognition of the potential of E-Health interventions, there remains a lack of comprehensive synthesis of their modalities, cultural appropriateness and implementation within Indigenous communities globally. This scoping review will aim to systematically map the landscape of E-Health interventions for Indigenous populations, identifying effective strategies and gaps in current research and practice. By documenting global evidence, this review will contribute to broader efforts to integrate Indigenous health considerations into policy and practice, supporting health equity and realising the United Nations Declaration on the Rights of Indigenous Peoples. Methods and analysis This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) guidelines. A comprehensive search of multiple databases will be conducted to identify studies on E-Health interventions in Indigenous communities between 2013 and 2025. The review will focus on interventions targeting Indigenous populations published in English. A two-stage screening process, comprising abstract/title screening followed by full-text screening, will be independently conducted by two reviewers. A standardised data extraction template will be used, and qualitative data will be synthesised using narrative synthesis and thematic analysis. Quantitative data will be presented descriptively using graphs, diagrams or tables. Ethics and dissemination As the study relied on publicly available research, institutional review board approval is not required. Findings will be disseminated through peer-reviewed publications and conference presentations.

Objective: This study aimed to systematically map the scope, focus, and distribution of Queensland’s health workforce (HWF) policies and examine their alignment with strategic HWF objectives. Methods: A descriptive policy review was conducted using documents sourced from the Queensland Health and Health Workforce Queensland websites between January and May 2025. Documents were coded by policy type (system-level, individual-level, employment), document type, strategic domain (supply, distribution, performance), health profession, policy author, and publication year. Results: A total of 275 policy documents were identified. Among 11 major policy groupings, most policies related to ‘general HWF’ and ‘medical doctors and specialists’ with minimal policy attention to pharmacists, physician assistants, paramedics, and aged care workers. Employment-focused policies accounted for 52% of all documents, compared with 38% focused on individual career development and only 10% on system-level strategic objectives. Most documents addressed workforce performance (65%), with fewer addressing supply (39%) or distribution (11%). Employment policy documents were largely authored by human resources and industrial relations bodies, reflecting the prominence of these actors in the HWF policy landscape. Conclusions: Despite a high volume of HWF policy in Queensland, the policy architecture is fragmented. Profession-specific siloes, a strong emphasis on employment and industrial policy, and uneven focus across supply, distribution and performance domains suggest coordination and alignment challenges when it comes to addressing broader workforce goals. Further work is needed to understand whether and how these patterns may constrain the development of integrated, equitable workforce strategies capable of addressing persistent system-wide planning issues such as skills mix, retention and rural maldistribution.

Community engagement plays a crucial role in preventing and managing Aedes-borne mosquito disease outbreaks, such as dengue. There is limited research on the engagement approaches used in high-income country contexts with existing research suggesting a preference for top-down vector control relying on one-way communication to engage and mobilize at-risk communities. The reasons behind why authorities use certain engagement approaches over others are underexplored. This study explores the community engagement approaches used in Aedes mosquito management in Townsville, Australia, and the factors influencing the choice of these approaches. The study used a case study design employing two qualitative methodologies: semi-structured key informant interviews (N = 15) and a review of key documents (N = 13). Both inductive and deductive approaches were used to thematically analyse the data. A range of approaches were used to engage the community in Aedes mosquito management. From mass media campaigns and door-to-door inspections, to engaging the community in Wolbachia mosquito-releases, and helping authorities with indoor spraying during outbreak response. The factors influencing the choice of these approaches included legal obligations and regulatory compliance, vector control norms, leadership beliefs, human and financial resourcing. This study provides new insights into why authorities adopt specific community engagement approaches in Aedes mosquito management, within a high-income country context. It identifies barriers to enhancing community engagement and suggests strategies for addressing them in future planning. These findings are particularly relevant given the increasing Aedes mosquito risk in similar high-income country settings.

Objective: To identify which federal health workforce policies are current in Australia, and describe their mode, scope, and focus. Study design: Descriptive policy document review; categorisation according to the Howlett–Ramesh policy instrument framework. Setting: Health workforce policy documents available on the Australian Department of Health and Aged Care website, 1 June – 31 October 2024. Main outcome measures: Primary policy focus (specific health profession, population group or location); scope of policy (alignment with one or more strategic domains: supply, distribution, or performance), service sectors affected by policy, substantive mention of specific health professions; policy instrument types. Results: We included 121 policy documents in our analysis. By policy group, the number of documents was greatest for the rural health workforce (35), aged care (22), and Aboriginal and Torres Strait Islander health workforce (19); the numbers were lowest for pharmacy (three) and allied health (one), and none had public health or emergency care as their focus. Mixed policy instruments (multiple interest group programs, sub‐programs, incentives, grants) were more numerous (98 documents) than government‐led instruments (23 documents). Health workforce supply was a focus of 72 documents, performance of 57 documents, and distribution of 42 documents. Document nomenclature was inconsistent; 44 documents had policy labels that did not correspond to their content or purpose. Conclusion: We identified substantial fragmentation in Australian federal health workforce policy. The absence of a unified federal health workforce strategy exacerbates policy fragmentation, undermining coordinated workforce planning and equity. Adopting a consistent policy nomenclature and reducing imbalances in strategic focus are critical for effective health workforce reform. Our findings provide a baseline for analyses of policy processes and governance in Australian health workforce policymaking.

In 2006, the Fiji Government introduced a 0.05FJ$ (0.03USD) per litre excise tax on domestically produced sugar-sweetened beverages (SSBs). Since then, the tax has been abandoned, reintroduced, or adjusted at least ten times, while tariffs on imported SSBs have also undergone reform. These rapid iterations of Fiji's SSB tax raise questions about which interests and motivations underpin the tax, what instigated the multiple adjustments, and implications for its impact on health versus economic and political considerations. Using case study methodology, this study maps the history of SSB tax adjustments in Fiji and examines the political economy forces that have shaped, and continually re-shaped, this policy landscape. We used policy analysis and theories of power to analyse the intersection of ideas, interests and institutions, drawing on policy documents (n = 304), key informant interviews (n = 32) and direct observations of socio-political events (n = 7) as data sources. Findings from this study indicate that the introduction of the SSB tax and subsequent adjustments were motivated more by economic, than health, imperatives. The relationship of mutual dependence between the Fiji Government and domestic SSB industry actors led policymakers to make multiple adjustments, seesawing in an attempt to balance the immediate need for revenue and long-term economic development through strengthened local industries. Early SSB tax lobbying from health actors alone had minimal impact. However, a subsequent alliance between government health actors and politically savvy and well-positioned civil society actors proved persuasive in both increasing the tax rate and ensuring a health and rights focus, arguably achieving a health and economic 'win-win'. Global adoption of SSB taxes is increasing. Examining the protracted history of Fiji's SSB tax reveals the political ebbs and flows that alter how prospective population health 'wins' are weighed up against other policy imperatives. For health-interested actors, these insights point to important strategic in-roads around the explicit use of political economy analysis to complement technical policy insights. Building and maintaining coalitions that extend beyond government and into civil society also proved pivotal. Health system leadership that champions political thinking and cross-sectoral partnerships holds great promise for enhancing health actors' engagement with SSB tax-specific policy making and other multisectoral reform in Fiji and elsewhere.

The World Health Organisation’s non communicable disease (NCD) Best Buys provides a comprehensive package of technically sound policy advice in response to the growing global burden of NCDs. However, despite these policy mechanisms being touted as beneficial to countries’ health and economic bottom lines, uptake has remained slow and globally disparate. Loffreda et al.’s analysis draws attention to the importance of political economy forces in shaping governments’ responses to NCDs and, in particular, their uptake of the NCD Best Buys. In building on this work, we examine the history and instances of contemporary application of the NCD Best Buys to consider the limitations of these technocratically framed policy recommendations. In doing so, we highlight the risks present in focusing on the technical – while negating the contextually nuanced political – dimension of policy adoption. We thus advocate for greater political engagement in policy design and implementation as well as a revitalised ‘double-loop’ approach to NCD policy learning, where policy and system feedback is not solely used to reify policy advice but rather interrogate the assumptions underpinning such.

Background: Public health is a core governmental responsibility, with ministries or departments of health responsible for setting and ensuring adherence to standards, managing performance and instituting reforms as required. Although North Queensland (NQ), Australia has a well-developed health infrastructure, the COVID-19 pandemic exposed significant vulnerabilities in its public health surveillance and response system. Globally, research has highlighted how human and cultural elements ("system software") influence the effectiveness of infrastructure, governance, and data systems ("system hardware"). This study examines the interaction between these elements to examine specific governance challenges and opportunities for strengthening communicable disease surveillance and response in NQ. Methods: Using an embedded case study design, we analysed four disease units—COVID19, tuberculosis, arboviruses, and sexually transmitted infections—through interviews (n=47), document review, and observations across NQ health services (October 2020– December 2021). Data were mapped against Sheikh et al’s hardware-software framework to examine the nature of governance bottlenecks in this region of northern Australia. Results: Two key governance challenges emerged: (1) Accountability deficits—Hospital and Health Services (HHSs) lacked clear reporting or performance monitoring systems within Queensland’s devolved health service governance model, contributing to inconsistent prioritisation of resourcing for communicable disease functions by health service leadership. Within HHSs, Public Health Units faced systemic underfunding, with prevention services accounting for as little as 0.1% of some health service budgets. (2) Data governance failures—Fragmented, siloed data systems, restrictive data-sharing norms, and risk-averse culture hindered coordinated surveillance and response efforts. Weak interoperability and mistrust in data-sharing partnerships further compromised system effectiveness. Conclusion: This study highlights how political, normative, and structural factors shape public health performance alongside the more commonly assessed functional and technical dimensions. Findings suggest the need to improve performance monitoring systems, leadership, and data governance to build an effective, accountable, and data-driven surveillance and response system in NQ.