Understanding the dynamics of health policy change

This thesis examines the dynamics of health policy change and uses Discursive Institutionalism (DI), explained in Chapter 2, as a lens to examine the empirical case of primary health policy in Tasmania, Australia. Health policy internationally has been slow to change from an emphasis on treating ill health to a broader focus on health improvement. There is a growing awareness that health is partly socially determined and poor health follows the gradient of relative disadvantage such that more equitable populations have better health overall. The discursive nature of the debate regarding the causes of ill health highlights the need to analyse competing frames and values that shape contemporary health policy. A DI approach is applied in the study because its emphasis on the dynamics of change provides significant insights into policy debates central to this thesis. The dissertation employs a case study approach that examines material relating to the Tasmania Health Plan (THP) in the period between September 2005 and May 2010. Tasmania has a population of 500,000 and relatively poor health outcomes compared with other Australian jurisdictions. The THP is intentional in taking a multi-agency and multi-strategy approach to improve the health of the Tasmanian population. The thesis concludes that DI is a useful theoretical lens to observe the dynamics of health policy change in practice, particularly with the diversity and volume of actors and organisations, the structures of communication, and the multiple discourses. It shows that there is potential for expertise and honest brokerage to facilitate the best outcomes between governments, citizens and private and not for profit organisations. Acknowledging complexity and adapting locally. This could open the opportunity for a revival of a civil society discourse, and an investment in policymaking leadership and capability.