Despite a significant amount of evidence demonstrating the need for public policies that address the social determinants of health (SDH), health inequities continue to increase for some population groups both within and between countries. The failure to elevate multi-sectoral ‘healthy public policies’ at the centre of mainstream government agendas suggests that generating evidence is not enough on its own to influence policymakers. Greater understanding of the political processes and the factors that enable or constrain inclusion of health and health equity on government agendas is needed.
This paper compares multiple policy process theories for their ability to explain empirical findings from a within-case study of how health became an agenda-setting force for Australia’s national paid parental leave scheme. The paper answers the following question: how did Australia’s paid parental leave scheme come about and how did health come to be considered a key policy goal? In 2009, the Australian Government announced a national paid parental leave scheme with clear goals to improve maternal and child health, gender equality and women’s workforce participation and economic productivity. Drawing on documentary sources and interview data with 25 key stakeholders from government, politicians, business, trade unions, women’s groups and civil society organisations, we compare our key empirical findings for agenda-setting against established policy process theories.
We find that several policy process theories were useful to explain our data. However, no one theory adequately explained our results, indicating the importance of a multiple-theory approach for SDH policy research. We also identified gaps where some our key findings were missing or under-emphasized in the policy process theories. In particular, the personal experiences of advocates, their tactics and strategies, and how power operated to both constrain and enable arguments for health were not adequately captured in the policy theories. We drew on other concepts and frameworks from outside the policy process theory literature to help explain this missing data. This suggests the importance of a cross-disciplinary approach to SDH policy research.