Creating change in government to address the social determinants of health: How can efforts be improved?

Carey, Gemma, Crammond, Brad, & Keast, Robyn (2014) Creating change in government to address the social determinants of health: How can efforts be improved? BMC Public Health, 14, Article number-1087.

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  • The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government.


  • In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives.

  • We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government.


  • We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design.


  • Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next.

Impact and interest:

16 citations in Scopus
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10 citations in Web of Science®

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ID Code: 88625
Item Type: Journal Article
Refereed: Yes
DOI: 10.1186/1471-2458-14-1087
ISSN: 1471-2458
Divisions: Current > QUT Faculties and Divisions > QUT Business School
Current > Schools > School of Management
Copyright Owner: Copyright 2014 Carey et al.
Copyright Statement: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Deposited On: 04 Nov 2015 22:59
Last Modified: 18 Nov 2016 02:12

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