Interplanetary health

by Evelyne de Leeuw

There is a class of government actors and entrepreneurs that is beyond hubris. Without any hesitation or limitation, they believe that by flying to the stars we can fix our own tiny blue speck that floats in orbit in Sol’s circumstellar habitable zone. There is much to critique when we consider their space ambitions. For instance, by spending the trillions that will be launched into the vacuum of space here on Terra we could fix many if not all ails of the planet. We could give everyone, boys and girls, a quality education. We could invest in renewable energy and water systems.

These are good and hopeful arguments. However, in current deliberations around outer space three groups dominate: entrepreneurs, bureaucrats, and politicians. Like so often in discussions around well-being, communities and citizens are absent. Elon Musk and his fellow entrepreneurs may not necessarily act in coherence with advancing planetary harmony, well-being and equity. Nor will Jim Bridenstine (the National Aeronautics and Space Administration (NASA) Administrator) and his cabal of space bureaucrats, and certainly not statesmen (or less – failed real estate Mar a Lago faux millionaires peddling Space Forces). None will lose sleep over any human and ecological earthbound challenge to their ambitions. Space is the word.

We are slowly being prepared for a future where we might routinely leave the Terran environment, first hop to Luna, and then on to the planets – and beyond. The key motivation for such travel is not Gene Roddenberry’s aspirational humanist Star Trek agenda. Roddenberry deliberately left religion out of the Star Trek universe and adopted a harmonious multi-species humanitarian conglomerate of space quadrants.

Why go to space?

The motivation of space travel is not, or only remotely, to save our planet. It is exploration and resource extraction. Not for humanity or balance or preservation, but for money and continuing relentless growth. The forces that have brought Terra to the brink (rampant capitalism, inexorable unbalanced expansion, ecological, human and cultural exploitation and destruction) will simply be taken to galaxies far, far away. The way things go now there will not be a brighter future beyond the Kuiper Belt and Oort Cloud.

Don’t get me wrong. I love to while away time with Star Trek (with TNG as my favourite, but Commander Burnham may stop by any time), Babylon 5, or the Mandalorian. This is the way. Obviously. Travelling to the stars is written in humanity’s stars. But could we set some firm foundations for a better intergalactic future than Terra’s current track record, please? You may think that we have already thought about that, and that Roddenberry’s egalitarian future has been codified in some sort of treaty. You are right. In 1967 the Treaty on Principles Governing the Activities of States in the Exploration and Use of Outer Space, including the Moon and Other Celestial Bodies came into force. Essentially, the Treaty commits nation-states and the peoples of planet Terra to be exploring space for the benefit of all. No-one can own space, no-one is allowed to weaponise it or deploy armaments into outer space.  Humanity is not to contaminate and pollute it, and just to be clear: space is not the purview of privately owned corporations, it will always be under the control of nation-states.

The future is ours

What a happy-go-lucky agreement! The future is safe in the hands of the UN body that maintains this Compact – the United Nations Office for Outer Space Affairs, and more specifically its standing Committee on the Peaceful Uses of Outer Space. Or is it…? Unfortunately, the world seems to have spun out of control since the Space Treaty came into force. When both the Americans and the Russians intended to deploy weaponry into orbit in the 1980s (Ronald Reagan’s Strategic Defense Initiative (SDI), nicknamed the “Star Wars program”) there was some feeble protest and commentary with hilarious references to science fiction.

Seriously though, there are other violations of the Treaty. The cloud of junk orbiting Earth (‘space debris’) should worry more people than just the occasional aerospace nerd. It is a unique and potentially lethal form of pollution. What the Great Pacific Garbage Patch is for the terrestrial and marine environments of our planet, the cloud of junk orbiting the third rock from the Sun is for the entire trans-planetary geosphere, hydrosphere, atmosphere, cryosphere, biosphere and beyond – manmade material terror in space.

But what has not entered popular disbelief properly yet is the strident breach of all these harmonious intents by the USA launched Artemis Accords.

The Americans have effectively privatised space, its exploration, and its exploitation. Space-faring nations and businesses have already made outings to our neighbours. We are eyeing Luna and Mars, and possibly Venus. Mining enterprises are already landing on smaller entities like asteroids, a proof-of-concept demonstrated by Hayabusa 2. The Americans realised that there was an opportunity to set capitalist and neo-liberal standards for our presence in space. The Artemis Accords, superficially, can be seen as an American proposal to manage the Moon in line with the Outer Space Treaty. But the Accords also suggest a platform for government and non-government bodies to agree on arrangements for the exclusive ownership of very precious commodities in space – oxygen and water not the least. And yes – in space no-one can hear you scream, so why would entrepreneurs, bureaucrats and politicians bother to listen?

When we are going to colonise space in the not-to-distant future, the things that make life possible may well be under the control of private industries. There is a current discourse around global health governance and the influence of very large philanthropies. They set opaque and unaccountable standards for priorities in international and global health – this is a potentially obscure and obscene business. And these unchecked practices will continue in interplanetary developments (and health!). Who has oversight of these dealings? Who represents those colonised? Who is accountable for allocating resources – hopefully to those who need it most? Are the disadvantaged (and I reckon there may be billions of creatures from virtually all species currently inhabiting Terra) appropriately represented in decision-making on priorities in those Artemis Accords? Why would just the Americans and a few other space faring nations and corporations control this arena at all?

From Planetary to Interplanetary Health

In recent years we have seen mounting enthusiasm for the idea of Planetary Health. The Lancet and the Rockefeller Foundation even launched a Commission and a new masthead in this area. Planetary Health is a field focused on characterizing the human health impacts of human-caused disruptions of Earth’s natural systems. It recognises that we now live in the Anthropocene, and that mankind is actively engaging in the destruction of Terran biosphere. Planetary Health has become a thriving industry, with conferences, professors and grants flying around the world – and perhaps soon away from it.

Some of this energy ought well be redirected to the near future and the assessment of the privatisation and colonisation of space. We have made terrible mistakes in the past through colonist practices, leading to vast and seemingly insurmountable inequities – particularly in health and well-being. It seems there still is time to get the next stage in our evolution right. Interplanetary Health is not a science fiction fantasy – it is a necessity. This must be the way.

May the Force be with us…

Alcohol consumption during COVID-19 significantly impacts vulnerable communities: The case study of Miller

by Andrew Reid

A national YouGov poll commissioned by The Foundation for Alcohol Research and Education (FARE) found one in five (20 percent) Australian households buying more alcohol than usual since the COVID-19 outbreak in Australia. Within these households, 70 percent are drinking more, with 34 percent drinking now daily. This is  likely to be a result of job loss, financial stress, family pressures, social isolation, declining mental health and a loss of structure and routine during the pandemic.

While we are waiting on further research and study results to uncover the full extent of the impact caused by alcohol consumption during COVID-19, it is highly likely those Australians who are already poor, unemployed or underemployed, with high levels of existing debt, suffering homelessness, or facing existing difficulties with access to health and social services, will be most affected. This is supported by available evidence that suggests disadvantaged communities have more significant alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level.

Community profile of Miller

Miller is a suburb within the Liverpool Local Government Area (LGA). In 2016, Miller had a population of 3,237 people, an unemployment rate of 15.5% more than double that of NSW (6.3%), 3.9% of the population were Aboriginal and/or Torres Strait Islander, 43.4% of Miller residents were in social housing, many with multiple and complex needs. Miller remains one of the most socio-economically disadvantaged suburbs in the state with the SEIFA Index of Relative Social Disadvantage (IRSD) score of 701 in 2016.

Alcohol Related Assault

Figure 1: Incidents of Alcohol Related Assault, July 2018 – June 2020, Miller

(Source: New South Wales Bureau of Crime and Research Statistics (BOCSAR), 2020)

The latest figures for incidents of alcohol-related assault from New South Wales (NSW) Bureau of Crime and Research Statistics (BOCSAR) show incidents of alcohol-related assault in Miller in May 2020 increased to 58.5 compared to 13 for NSW (see Figure 1). 

A breakdown of the data reveals incidents of alcohol-related assault (non-domestic assault) in Miller in May 2020 also increased to 58.5 compared to 4 for NSW. Compared to this time last year (May 2019), incidents of alcohol-related assault (non-domestic assault) in Miller was 0 compared to 8.5 for NSW

Incidents of Assault (Domestic Assault)

BOSCAR data for the same period (May 2020) showed incidents of assault (domestic assault) in Miller increased to 117 compared to 30.3 for NSW. While this may be due to several factors, existing evidence has found this could be linked to alcohol consumption. In 2010, research revealed alcohol was “present” in 41% of domestic assaults in NSW. Other studies since have found alcohol was involved in up to half of partner violence in Australia and 73% of partner physical assaults. The same studies also pointed out that alcohol features prominently in police data, although not all jurisdictions keep consistent records.    

Significant factor – access and availability of alcohol

There currently are 2 packaged liquor outlets and 1 hotel in Miller.

While the NSW Government COVID-19 restrictions forced the pubs and clubs to close between March 23, 2020 and 1 June 2020, Miller residents were still able to purchase alcohol from packaged liquor stores. The normal trading hours for one of these outlets in the area includes Monday to Saturday, 8:00am to 9:00pm and Sunday, 10:00am to 8:00pm. These alcohol outlets in Miller are in a Statistical Areas Level 1 (SA1) quadrant of approximately 280 households belonging to the lowest 1 percent of the most disadvantaged quantile in NSW.

In addition to this, Miller residents also had the option of buying alcohol online. In April 2020, Retail Drinks Australia reported one national retailer’s deliveries were up 300% from December 2019 to March 2020, while the size of the average order had increased by 50%. Around the same time, the Commonwealth Bank data showed a 34 percent increase in spending on alcohol over a week from March 27, 2020, compared to the same week in the previous year.

Despite no locally available data, Miller residents may be subject to the unsavoury and illegal delivery practices of some of the most popular online alcohol retailers in Australia. A study in January 2020, found 69 percent of these retailers advertised that they were willing to leave alcohol unattended at an address without verifying the purchaser’s age.

Conclusion

Alcohol consumption during the COVID-19 pandemic has the potential to impact all Australians. However, it can potentially further affect vulnerable communities. More research is needed to understand the full extent of the impact on these communities. In the case of Miller, preliminary data shows alcohol has contributed to an increase in incidents of assaults (non-domestic) and, most likely, incidents of assault (domestic assault). Access and availability of alcohol is a major contributing factor. Therefore, there needs to be more action taken around managing the economic and physical availability of alcohol, as well as provision of support for disadvantaged communities. We must remember this is an avoidable burden on our communities.  Let’s act now before it is too late!

Adequacy of the NSW LiveData site for evidence-based liquor licence decisions

By Andrew Reid, Dr Alison Ziller and Dr John Crozier

This commentary examines the adequacy of the NSW Liquor and Gaming LiveData website in providing evidence to assist decision making about liquor licences and trading hours.

Introduction

On 4 May 2020, Liquor and Gaming NSW [L&GNSW] invited feedback on the draft Liquor Amendment (24-hour Economy) Bill. The aim of the Bill, once COVID-19 restrictions are eased, is to ‘create a vibrant and safe 24-hour economy with risk-based liquor laws that support business’. Among the proposed changes is ‘a refined evidence-based approach to help manage the density of licensed premises, and associated risks of alcohol-related violence and anti-social behaviour, in areas of high venue concentration’. The draft Bill says that the Authority may prepared an ‘evidence-based’ cumulative impact assessment.

In December 2019, L&GNSW introduced a trial version of its LiveData site, which ‘is an online tool that allows you to search the latest liquor licence information alongside demographic, alcohol-related crime and health data for every suburb and Local Government Area in NSW’. There are, however, a number of significant flaws in the LiveData tool. We showcase several of these here with reference to the NSW suburb of Miller.

The Live Data evidence profile and the Miller suburb
The community of Miller

Miller suburb is located in Liverpool LGA. In 2016, Miller had a population of 3,237 people, an unemployment rate of 15.5% more than double that of NSW (6.3%), 3.9% of the population were Aboriginal and/or Torres Strait Islander, 43.4% of Miller residents were in social housing, many with multiple and complex needs. Miller remains one of the most socio-economically disadvantaged suburbs in the state with the SEIFA Index of Relative Social Disadvantage [IRSD] score of 701 in 2016.

The LiveData profile

The LiveData site does not provide the SEIFA IRSD score, preferring instead the SEIFA Index of Relative Advantage and Disadvantage.  It notes that Miller is in the bottom 1% of NSW households but Liverpool LGA is in the top 38% . Presenting this information suggests that the LGA is not too badly off and the suburb score is unusual. However, Miller is one of a cluster of highly disadvantaged suburbs in the relatively large Liverpool LGA.

Alcohol outlet density in Miller

The suburb of Miller has 2 packaged liquor outlets and 1 hotel. These are located in Miller town centre in a Statistical Areas Level 1 (SA1) quadrant of approximately 280 households belonging to the lowest 1 percent of the most disadvantaged quintile in NSW.

The LiveData profile

Alcohol outlet density is described on the LiveData site as outlet saturation and outlet clustering. Overall alcohol outlet saturation (number of outlets per 100,000 residents) is reported as lower in Miller suburb (61.8) compared to NSW as a whole (201.9) and Major Cities of Australia (NSW) (176.8) averages. However, the overall rate conceals the fact that for each of the years shown the alcohol outlet saturation rate for the licence types actually present in Miller presents a quite different profile. For example, in 2019 the saturation rate for hotels in Miller, major cities and NSW as a whole was 30.9, 19.1 and 28.5 respectively . The saturation rates for outlets authorised to sell packaged liquor was virtually the same for Miller 61.8 as for major cities (62.3) and significantly higher than the rate for Liverpool as a whole (34).

Public health profile in Miller

Since 1999, hazardous drinking in public spaces in Miller has been a significant concern. The last Miller Household Survey (2010) found 70.6 percent of the 301 people surveyed felt that drug and alcohol problems divided people in their neighbourhood a bit or a lot.  While most of the respondents reported good health overall, average scores on standardised physical and mental health assessments showed the sample was well below other Australian norms (CHETRE, 2010).

This issue has taken on a new urgency with the arrival of COVID-19 and the reporting of differential incidence of the virus, with residents of low-income areas at greater risk. There is concern that lockdown restrictions are associated with increased drinking, gambling and domestic violence.

LiveData health profile

The LiveData site reports alcohol attributable deaths in Liverpool LGA for the two years to 2015/16 and alcohol attributable hospitalisations to the two years to 2017/18. While alcohol attributable deaths declined in the reported period, alcohol attributable hospitalisations rose. The two charts (9 and 10) on the LiveData site have a similar format and would be easy to misread as being on the same scale (vertical axis) whereas the number of deaths is on a scale of 17.5 – 21.0 per annum while the number of hospitalisations is on a scale of 350 – 600 p.a.. Alcohol-attributable hospitalisations are increasing in Liverpool as well as NSW as a whole.

Risk of gambling related harm in Miller

Environmental factors, such as locational disadvantage, significantly influence gambling outcomes. In one US study, neighbourhood disadvantage was linked to a 69% increased odds of exhibiting a gambling problem and eight additional gambling occasions. Australian research has found gambling increased with risky alcohol consumption for all gamblers during a single visit to a gambling venue. That is, gambling is part of the health profile of hotels.

The LiveData gambling profile

LiveData does not provide information about gambling. However, gambling is a significant source of profit for hotels in NSW and the late trading hotel in Miller has its full complement of 30 gaming machines. There are 345 gaming machines in venues in Liverpool LGA. Data available to Liquor and Gaming NSW and provided in part on another L&GNSW site (reveals that in 2019, each machine was making an average $227,127 profit per annum. On this basis, the hotel in Miller would have made [$227,127 x 30 =] $6,813,820 in gaming profit in 2019. A particularly significant loss for the local community.

Assault and violence in Miller

The non-domestic assault rate in Miller for the year to December 2019 was 1462.0 per 100 000 population. NSW as a whole had a rate of 403.2.  The domestic assault rate in Miller for the year to December 2019 was 877.2, while the NSW rate was 390.4. All three alcohol establishments in Miller are located within a ‘hotspot’ for these incidents of assault which has persisted for many years.

The assault and violence LiveData profile

The LiveData site has charts (5 & 6) for alcohol-related domestic and non-domestic assault for Miller, Liverpool LGA, major cities and NSW as a whole . Both charts show significant declines in these crimes in Miller in the last two years while the rates for the LGA, major cities and the State show small changes. These charts do not present the significantly adverse data available on the BOCSAR website and summarised above. This is because, the charts use only those assaults recorded by police as alcohol-related. BOCSAR notes these rates cannot be relied on. The net effect of using these unreliable data is to present a misleading picture of these crimes in a suburb where their incidence is significant.

Discussion

LiveData is presented as a useful source of information for liquor licence applicants and members of local communities alike. However, these are unlikely bedfellows. The information on the site appears more favourable to licence applicants than to local residents, as shown above for the suburb of Miller, namely:

  • The community profile fails to report the most relevant measure of social disadvantage – a measure known to correlate with alcohol-related harm.
  • Outlet saturation is presented in aggregate concealing concerning rates of density for the licence types actually in the suburb.
  • Crime data is treated selectively, minimising the number of domestic and non-domestic assaults in the suburb by reporting only those assaults recorded as alcohol related — notwithstanding the known limitations to the data presented and the high rates of assault actually occurring.
  • Data on gaming machine losses in the local hotel is omitted entirely.
  • Health data for the LGA is presented in visually similar charts with such different scales as to render them non-comparable.

Conclusion

There is growing evidence to suggest the adverse impact of increasing liquor licenses and extended trading hours in disadvantaged communities. It is of significant concern that the LiveData site being trialled by Liquor and Gaming NSW fails to signal these risks. A data source that cannot signal risk in the case of a community as disadvantaged as Miller, cannot be relied on.

Authors’ information

Andrew Reid is a Research Officer at The Centre for Health Equity Training Research and Evaluation (CHETRE). Andrew is also the Chair of the Liverpool Community Drug Action Team (CDAT).

Dr Alison Ziller is a Lecturer in the Department of Geography and Planning, Macquarie University.

Dr John Crozier is a vascular and endovascular surgeon. He is appointed as Visiting Medical Officer to Liverpool Hospital. Dr John Crozier is the current Chair of the Royal Australasian College of Surgeons’ national trauma committee.

References

Centre for Health Equity Training, Research and Evaluation. (2010). Miller Household Survey (pp. 1-72). Liverpool, NSW: CHETRE

Alcohol Harm Reduction in South Western Sydney – Webinar 3: Working Together (Wed 16 Sept 1.00 -2.30)

Wed 16 Sept  1.00 -2.30

Register for Webinar 3: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-116168397805

Program includes:

– Social Policy Research Centre UNSW on alcohol promotion and consumption during COVID-19

– walk through the range of programs and support provided by the  Alcohol and Drug Foundation (ADF)

– discussion of a culturally responsive approach to reducing alcohol harms among CALD communities from the Drug and Alcohol Multicultural Centre

– Matilda Centre for Research in Mental Health and Substance Use on two evidence-based programs for young people: Climate Schools and Strong and Deadly Futures

Use of natural experiment for gambling related harm?

The issue

The cessation of gambling during the early stages of the COVID-19 response provides a potential avenue for understanding the impact of gambling on the region. Research suggests ‘natural experiments’ are a useful way to understand the impact of policy decisions and actions that occur in real time. However, there is little  understanding relating to the conduct and usefulness of applying a natural experiment design to evaluating and measuring complex issues like gambling-related harm. The challenge for natural experiments is adequately capturing the complex pathways between an ‘intervention’ (policy decision or action) and the various elements that might influence what this means for health, wellbeing, and equity.

 Context

Research has shown harms related to gambling reflect social and health inequalities, negative effects unequally distributed among economically and socially disadvantaged groups, and are commonly associated with a range of mental and physical health issues. Furthermore, evidence shows this group is more vulnerable to harmful gambling when experiencing financial distress or hardship, which is more prevalent during the pandemic. In 2017-18, total gambling turnover (i.e., the total amount wagered) in Australia was $218.9 billion.  During the first wave of COVID-19, Australians saved approximately $1.5 billion, which would otherwise have gone into pokie machines, due to the closure of pubs and clubs across the nation. The New South Wales (NSW) Government allowed clubs and pubs to reopen their gambling rooms on June 1, 2020. 

The project

The project involves conducting a rapid review of the literature to assess the appropriateness and usefulness of using natural experiment methodology to evaluate or measure gambling-related harm on health, wellbeing and health equity. The output of the project may be (a) a report; (b) a peer reviewed publication.

Contact

Patrick Harris or Andrew Reid

Community STaR – Screening for Gambling Harm: A pilot project – 10:30-11:30 17 Sept 2020

Community STaR (outreach service of the Centre for Health Equity Training, Research and Evaluation) presents:

Speaker:  Nick McGhie,

Project Manager – Gambling

South Western Sydney Primary Health Network

Topic: Screening for gambling harm: A pilot project

This project has focused on the creation of a gambling harm screening and referral model to:

•    Assist GPs, health professionals and community workers assess and refer patients needing gambling support more effectively.

•    Ensure people affected by gambling harm receive the right support quickly and efficiently.

All interested health, welfare, and community workers are welcome.

 When: Thursday, September 17, 2020 

Time: 10:30am – 11:30am 

Where: Online – MS TEAMS 

If you need any further information, please contact Andrew Reid:andrew.reid@health.nsw.gov.au  

Alcohol Harm Reduction in South Western Sydney – Webinar Series (Sept 2020)

SWSLHD Population Health and Drug Health Services invite you to attend any, or all, of 3 free webinars to explore strategies to reduce alcohol-related harm.  All interested health, welfare and community workers are invited.  Discussion will focus on issues for communities in South Western Sydney.

Please note: you will need to register separately for each webinar via the specific links provided.

Alcohol Harm Reduction in South Western Sydney

Webinar 1:   Setting the Scene 

Wed 2 Sept  1.00 – 2.30

Register for Webinar 1: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-116071963367

Keynote presentations:

 Effective Prevention of Alcohol Harms –   Emeritus Professor Ian Webster AO

– FARE fight? Opposing Woolworths, Australia’s Alcohol Giant – Di Martin, Public Interest Manager, Foundation for Alcohol Research and Education (FARE)

This session will include a discussion led by SWSLHD A/Director Population Health and General Manager Drug Health Services about alcohol issues in south western Sydney and services to reduce alcohol-related harms. Plus a personal story from someone who has dealt with significant alcohol issues in her life.

Alcohol Harm Reduction in South Western Sydney

Webinar 2:   Making a Difference

Wed 9 Sept  1.00 -2.30

Register for Webinar 2: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-115947190167

Program includes:

– SWSLHD Aboriginal Health Directorate

– implications and opportunities arising from the state’s 24Hour Economy Legislation and liquor licensing regulations

– Ministry of Health initiatives to support local action around liquor licensing applications and alcohol harm reduction

– a successful campaign in a local community to stop an unwelcome liquor licensing development 

– an exciting pilot program Planet Youth being implemented in the Blue Mountains and Marrickville

Alcohol Harm Reduction in South Western Sydney

Webinar 3:   Working Together

Wed 16 Sept  1.00 -2.30

Register for Webinar 3: https://www.eventbrite.com/e/alcohol-harm-reduction-in-south-western-sydney-webinar-series-tickets-116168397805

Program includes:

– Social Policy Research Centre UNSW on alcohol promotion and consumption during COVID-19

– walk through the range of programs and support provided by the  Alcohol and Drug Foundation (ADF)

– discussion of a culturally responsive approach to reducing alcohol harms among CALD communities from the Drug and Alcohol Multicultural Centre

– Matilda Centre for Research in Mental Health and Substance Use on two evidence-based programs for young people: Climate Schools and Strong and Deadly Futures

Unpacking the black box of policy, with a cube!

by Patrick Harris and Evelyne de Leeuw

One of the enduring myths among researchers is that policy-making is a black box of unknowable dark arts that is to be avoided at all costs. This myth is particularly pervasive in the field of Public Health. Public Health is a field that thinks it is enough to generate evidence to then give to policy makers to do something about.

At CHETRE, we do not subscribe to this myth. Our core interest is of course equity. We recognise that equity is largely determined by political decisions and policy institutions. And to improve health equity we have recognised that we need to know how the evidence of equity morphs into policy systems and decisions about what (not) to do. We require knowledge about what policy and political processes are. 

I (Patrick) have been thinking about what policy is for around a decade now. Over that time I have been systematically breaking down what public policy is, with the aim of better articulating how to then go about influencing public policy to be more equitable. Evelyne has been on a similar journey over the past 20 or so years. Both of us have built our understanding from the discipline of Political Science.

Very recently I was trying to explain what policy is to some colleagues who are undertaking a systematic review of the literature on intersectoral action (for health). At the same time, I was putting the finishing touches to a book on my research, the first part of which is a manifesto for how to research (healthy) public policy. I had also just published a bibliography of ‘healthy public policy’ as well as a glossary of how the concept of power plays out in policy (see sources). During that recent conversation I suddenly had a brainwave that the ‘black box’ of policy is actually a cube. So I went away and, with Evelyne, came up with the ‘Policy Cube’.

Figure 1 shows that the cube is made up of smaller cubes; they are not separate, of course, but this is a way of abstracting complex realities.

Figure 1. The Policy Cube

Each of the elements of the cube is based in the policy and political science literature, the knowledge about which can be found in the source references at the end of this blog. The essentials are as follows.

The ‘top’ of the cube corresponds to what policy-making is and what it is intending to achieve. Policy is in large part made up of processes (indeed there is a whole body of political science labelled ‘Theories of the Policy Process’). These processes are in place to influence decisions and choices, and their foundations. In turn, these processes, then choices, go on to influence ‘events’ or, what we are most interested in public health research, ‘outcomes’ – such as inequity or disease or so forth.

The left side corresponds to how political scientist break down the sub-systems that influence the processes of policy making. I tend to explain these sub-systems as ‘institutions’, although others, like Evelyne, think sub-systems is a better description. This is mostly a discourse about constructs and metaphors – but the key is that we can distinguish between different sorts of elements that influence, and operate, processes. The elements of these institutions or subsystems are essentially actors (the organisations and individuals involved in policy making), their ideas (largely based on interests and values) and structures (the rules and mandates that flow through systems).

Three other fundamentals of policy-making form the rest of the cube.

First of these is ‘Governance’, in the figure on the right side. The literature on governance is vast and sometimes confusing. A very brief definition goes ‘how we do things around here’.  Essentially it refers to the types and functions of networks of stakeholders involved in policy making. Importantly, especially in current times, these actors include but go beyond government. Government tends to facilitate governance networks to achieve various policy goals. Evelyne has written extensively on Governance for Healthy Public Policy and has helpfully divvied up three essential forms of Governance: constitutive, setting the principles; directive, providing guidance; operational, promoting individual actions.

Power is crucial to policy, and so this is the first of the through arrows in the figure. Power is a tricky and slippery concept, which is sometimes clearly visible but often needs to be explicitly brought out into view in research. Making power visible is actually achieved by clearly articulating the various other dimensions of the cube. But essentially policy is embodied by power.

Time is the final critical factor and is the second through arrow. Policy stays the same or changes (often quite suddenly) over time. Perhaps most importantly for public health researchers, the outcomes we so desperately want to observe from policy making processes and sub-systems often take a very long time to become apparent.

So there you have it! The Policy Cube. Before you go off and think you know it all, we have however a warning. The cube is what we call in academia a ‘heuristic’. It is merely a way of breaking up the black box to articulate the core dimensions of what policy making is. The reality of policy is much more messy and will be different for different policies and different contexts – figure 2! The cube should only be used to draw out core elements of what a particular policy or policy system is made up of.  

Figure 2. Heuristics are not reality
References
Cairney, P. (2011). Understanding public policy: theories and issues. Macmillan International Higher Education.
Clavier, C., & de Leeuw, E. (2013). Health promotion and the policy process. OUP Oxford.
de Leeuw, E. (2017). Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action. Annual Review of Public Health, 38(1), 329–349. https://doi.org/10.1146/annurev-publhealth-031816-044309
Harris, P., & Wise, M. (2020). Healthy Public Policy - Public Health - Oxford Bibliographies. https://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0196.xml
Harris, P., Baum, F., Friel, S., Mackean, T., Schram, A., & Townsend, B. (2020). A glossary of theories for understanding power and policy for health equity. J Epidemiol Community Health, 74(6), 548–552. https://doi.org/10.1136/jech-2019-213692
Howlett, M., Perl, A., & Ramesh, M. (2009). Studying Public Policy: Policy Cycles & Policy Subsystems. Oxford University Press.
Peters, B. G. (2019). Institutional Theory in Political Science, Fourth Edition: The New Institutionalism. Edward Elgar Publishing.
Weible, C. M., & Sabatier, P. A. (2017). Theories of the policy process. Hachette UK.

The SWSLHD Equity Framework and COVID-19

Presented by Evelyne de Leeuw (2 June 2020)

Presentation for the plenary of the Division of Population Health of the South Western Sydney Local Health District about the (health and social) equity dimensions of the COVID-19 pandemic and its consequences – including changed use and access to emergency departments, income and employment, and social isolation.

SWSLHD Equity Framework to 2025

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Link to the map on unemployment and poverty due to COVID-19 in Australia :

https://www.newcastle.edu.au/newsroom/featured/researchers-map-emerging-disadvantage-in-australia-due-to-covid-19-job-loss