Public Health Assignment: Advocacy Coalition Framework For Australian Community Health

Question

Task:
The purpose of this public health assignment is to apply contemporary theoretical frameworks to a specific policy issue or problem. The aim of the paper is to use one of the policy theories outlined in class to analyse and evaluate a contemporary policy issue.

Key to developing sound theoretical analysis is to delve into the assumptions and implications of a policy problem and the current manner in which the policy is implemented. Developing your understanding of policy making is, in my view, enhanced by using theories of the policy process to gain insight into why we have the policies we do, why policies fail and perhaps, to help identify the conditions that enable policies to change.

Answer

Introduction
It is stated in this public health assignment that a policy framework is referred to as a document that outlines a set of processes that can be used as negotiation guides for implementing new policies or restructuring old ones. A policy is referred to as the high strategic directive that enables the policymakers to establish an approach based on principle. The policy framework helps in establishing the hierarchy and categories of procedures that support documentation and sets out the needs and requirements for each stage of development and improvement procedure. The Policy Developmental framework comprises of majorly three elements that are governance, principles, and Predictable Procedures Steps. All the elements need to work together for desired outcomes. In this view, the Public Health Framework Outcomes sets standards attaining public health thus protecting the national health. The Public Health Policy ensures that health service is provided to all irrespective of their income and another background. This report will outline the Advocacy Coalition Framework in public health domains.

Outlining Policy Framework
Advocacy Framework Coalition & Public Health
The Advocacy Coalition Framework was propounded by Sabatier and Jenkins- Smith for dealing with wicked issues that includes goal conflicts, technical disputes, and actors that belong to varied government levels. The ACF framework helps in predicting the stakeholder beliefs and behavior that are embeds in networks that are informal and structured policy-making that involves important policy participants. The ACF assumes that the participants of the policy making aim to translate their personal beliefs into policy decisions. Thus, it is important for policymakers to seek allies, indulge in sharing resources, and developing complementary strategies. The Advocacy Coalitions Framework is considered a useful tool for evaluating the behavioral patternsof organizations and individuals that are involved in policy-making for several years and decades.

In Australia, National Primary Health Care Strategic Framework is public health approach for Commonwealth, States, and regions for working in partnership for integrating the improved health care facilities in care settings thereby improving health outcomes for average Australians. The health system of Western Australia is the responsibility of the General Director. The Health Service Providers are majorly responsible for delivering health services in determining catchment areas. The aforementioned governance system helps in improving local health services thereby responding to the needs and requirements of different communities. Domains like mental health, public health, procurement, financial management, and other 16 policy framework are determined for providing high-quality care for all living in Australia.

The rationale for selecting the AdvocacyCoalition Framework
The AdvocacyCoalition Framework has been selected as the latter is a promising theoretical approach towards policy change and stabilization of the economy. The ACF includes belief systems concepts, collaborative actions, role and interdependence of external activities, political resources, and others. In this view, the public health systems of Australia require change with the advancement of technology that will help the government in providing quality to care to rural areas and individual living in outskirts. Advocacy Coalition Framework will be appropriate to formulating recommendations about the ongoing policy issues.

Since using technology has become less- expensive and more efficient than the traditional public health policy of Australia. Thus, ACF will be highly effective in analysing the change in public health. Advocacy Coalition plays an important role in the global health landscape, associating actors, and institutions for attracting political attention and other resources (Brooks, 2018). ACF will focus on explaining how policy changes are undertaken in scenarios where conflicts arise due to concerning goals and technical approaches taken by varied institutional actors. Health Policy-Making is an area of contested interests, usage of power, and ideologies that are further shaped by the coalition.

Literature Review for Advocacy Coalition Framework
Leifeld (2013) depicted weakness in conceptualizing innovative change in policies in alignment with the Advocacy Coalition Framework. The author depicted that policy belief change have preceded in innovative reforms in German subsystems in old- aged security as an important aspect of major policies. The transition phases of the policies are characterized through the bipolarization of policy beliefs and shifting coalition memberships of state actors. The author based his study on discourse network analysis that combines qualitative content and social network which further deals with the intertemporal measurement of advocacy coalition realignment in the policy belief level in the subsystems. Also, to understand the ACF in a better way, Pierce et al, (2017) analysed 1631 applications of ACF from the year 2007 till 2017.

The author focused his study on the application of three theoretical frameworks that is advocacy coalitions, policy changes, and policy- oriented learning and found that ACT has the capability of balancing the common approaches for the application of frameworks within particular contexts. In another work by Sotirov & Memmler (2012), the Advocacy Coalition Framework was depicted as a promising theoretical approach for determining changes in the policy and stability. The author had conducted a study on various ACF applications in natural resources policy studies and had related them to the current theoretical debates. The author suggested theoretical proposals for detailing the considerations on interactions of actors with the political and socio-political environment they are surrounded by. Elgin & Weible (2013) also suggested that the conceptual development of this framework will be highly dependent on ACF theorists for integrating insights that are obtained through rival research programs. Also, work by Brooks (2018) demonstrated that ACF has been the common theory to be applied in determining the policy process. In this view, the policymakers of North America and Europe have use ACF on a broader scale than other countries. However, the author said that the ACF application was weak and limited when it was applied in India, China, the Philippines, and Kenya.

Howlett et al, (2017) supported the argument depicting that Policy Analytical Capacity and Advocacy Coalition Framework was the best framework for approaching the policy subsystems through the emphasis on the individual and organizational for conducting stakeholder analysis. Argued that ACF, policy cycle, and multiple streams help in understanding the policy processes through analytical value. However, the author raises the question of whether ACF and the framework of multiple streams should be applied in different dimensions of policy-making procedures that are set out in the policy cycle model. This argument was further strengthened by Ingold et al, (2017) as through his work he demonstrated that dealing with a new problem in the policymaking, the institutional actors ignore shared leadership or ideas. Applying the ACF on the fracking policy of Switzerland and the UK, it was identified that policy agrees with each thought and ideas, however, they did not define final policy outputs and observe long term relations. Markard et al, (2016) contemplated the gaps and coalition in the context of Swiss Context Policy. The study by the author depicted that Advocacy Coalitions in the regions of Switzerland have also almost remained stable regardless of the Fukushima Shock. In 2013, many of the institutional actors had supported major policy changes in the context of energy policies. The author suggested that interplaying socio-technical systems and policy streams should be integrated with an advocacy coalition for constructing theories and analysis in transitional studies.

Policy Issues
Policies Implemented
The current policies that the Australian Health System relates to

1. Funding Australian’s Health Systems like Medicare and Pharmaceutical Benefits Scheme (PBS)
2. Public Health Programs like cancer screening and prevention of chronic disease
3. Primary health service
4. Mental Health Care settings
5. Funding for Australian Hospitals
6. Management of health and aged care employee base
7. Provision of health services for varied individual groups that include indigenous people
8. Promotion of best health care practice for broad needs range

Issues in Health Systems due to Inadequate Policies and Temporal Aspects (Policy Issues)
Changes in Demography
The population of Australia has been aging, it is difficult for the Australian Government for strengthening health care services for the health and well-being of elderly people. Also, budget constraints and increasing costs of health care services have posed a major challenge for the Australian government to manage its health care policies. It is predicted that by the year 2053, 21% of the total population will be comprised of elderly people (Macri, 2016). The Australian government is resisting the substantial modifications in the Medicare systems fearing backlash from the voters. In the current year, the various governments are increasing their budgets, efficiency gains while also subsidizing private care so that the health burden can be shifted to privately- owned health care units. The rapid changes in demography with the aging population have also impacted the disease patterns thereby increasing the burdens of chronic illness.

Costs of Technology
In the recent era, the government has been planning the provision of health care through digital platforms especially for rural areas. Thus, improving patient outcomes in the context of diagnostics and handling serious disease and infections. The continual costs of diffusing technology will increase the budgetary burdens on governments. Unlike the other industries, the technology will increase in the health industry thus impacting health budgets and the provision of care for all individuals (Macri, 2016). The government has been facing the increasing costs of advancing health care for ensuring comprehensive and transparent health technology in the regions.

Health Care Funding
In Australian regions, there is a mixture of private and public resources in context to health care in which the private sector contributes 30% in the expenditures. The governments are facing issues related to the aging population, increasing costs of technology, managing disease, and other thus forcing the governments to funds their expenses from privately- owned resources.

Problems related to medical research
In Australia, there is a lack of fundamental structures and links of stakeholders that are required for integrating national health and medical research plans also there is a lack of aligning medical research and national health importance. There are issues in strategic objectives for allocating scarce research funds.

Health Care Inequality
There are inequality issues in the distribution of health care services amongst various communities. For instance, life expectancies amongst the indigenous population (70 years) are approximately low than the average Australian of 84 years. Thus, there is a huge difference in health care treatment between affluent individuals with that of less affluent. Also, the government has been issued in formulating the policies for balancing public and private sectors in the context of providing supplies and funding. There have been persistent concerns about ensuringquality and safety services deliveries related to health care while there have been issues in managing the employee supply and distribution.

Rising Issues due to Rapid Urbanisation
The rapid industrialization in the Australian region has created several issues in planning policies in the context of health care. For instance, rapid urbanizations have increased issues in accessing fresh foods, high obesity rates, increasing asthma patients, high mental health issues, and others. the rising urbanisation has also resulted in addictions of younger populations to drug abuse, smoking, and health issues.

Analysing Health Policies Under Advocacy Coalition Framework
Role of Institutional or State Actors
Different Australian States and territories play major roles in formulating the policies, implementing, and evaluation. The policy formulations and adoptions undertake series of negotiations amongst the private sectors and the states that eventually result in compromising actual policy components in alignment with the different stakeholders. In this view, Land et al, (2014) opined that multiple communities, health, and government organizations have detected the need for reducing dietary salt consumption to eliminate various health hazards to the aging population and young adults. In such cases, community-based actors become important for implementing the use of dietary salts policies in restaurants and other public eateries in Australia. The state actors can implement WHO recommendations regarding the controlling in communicable diseases for implementing policies for reducing averaged salt consumption. Also, this will help in reducing various health issues that will arise due to the increasing aging population thereby reducing current issues in providing health care services (as public health policy). Thus, the government and other institutional actors should possess limited interests of personal benefits while emphasizing solving issues of the public while initiating discussions and linking the research for reducing current health policy problems.

Role Played by Private Actors
As the government supports the private heal sector units by subsidizing and providing the basic health infrastructure, this sector plays an essential role in influencing policies through their economic strengths. The technocrats play actively in supporting the government in implementing technology driven health units forreducing the costs of public expenditures. Participation in policy formulation is done through social, economic, and scientific research thus providingpolicy alternatives. Since the health sector expenditure is huge and private borrowing will be a mandatory option for funding its infrastructure. Hence the roles of private actors will be critical in identifying issues, articulations of objectives, and providing a solution to policy challenges for achieving quality care to all Australians.

Policy Implementation
The involvement of private sectors in the health policy implementation of Australia is crucial. Usually, the government possess a huge infrastructure and result in inefficiencies to complete projects due to highbeau racy, lack of human capacities, and poor handling or resources. Policy implementing responsibilities like incorporating telehealth and the use of their technological tools in the public health sector should be transferred to the privately- owned firms. In this view, a study conducted by Nau et al, (2019) on the application of whole systems and cross agencies for promoting physical activities in the organizations and health care units concluded that the government of Australia should improve policy implementation and coordination in the relation to increasing physical inactivity of the population. This will help the government to cope with rising health issues due to obesity in young children. Hence, it can be said various aspects of health can be formulated into health care policies that will further reduce health issues and the cost of providing care facilities (Ananthapavan et al, 2020).

Role of actors from civil society
Actors from Civil society refers to the citizens that constitute NGOs, advocacy groups, and other movements. The roles of these actors are also very criticalas they have the capabilities to pressure governmental organizations through advocacies, lobbying, and mobilization. Jolley et al, (2014) analysed the different health policy documents for determining the primary health care workforce experiences. Thus, it was determined that health promoters in Australia were facing contradictions in policy and practice thus, the public actors should link research while formulating policies about workforce distribution which help in reducing current issues of the inadequate workforce for catering quality care to the gaining population. the media plays an essential role in formulating and implementing policies. In this view, the Australian Government has used reverse marketing techniques, thereby drafting a policy that cigarettes will be packed in plain black and white wrappings for discouraging smoking. The government received criticisms from various industrialists, however, this policy helped in reducing the smoking by 10- 12%.

The use of ACF is less in health and education sectors thus encouraging institutional actors and scholars to broaden their scope of ACF for involving beliefs. The ACF belief System integrates the policy core and secondary beliefs as per the agenda. Policy-oriented learning is underutilized in the public health sector. The prevailing evidence-based in context drug policy depicts the technical relationship between alcohol and drug policy actions. Ritter et al, (2018) interrogated theories like ACF and Multiple Streams extracting information about drug detection dogs in New South Wales. It was analyzed ACF highlights various types of insights that are only influential as they provide opportunities for altering the beliefs of decision-makers. In the public health domains, ACF and multiples streams do present an uncomplicated relation with evidence and policy actions. It was argued by Land et al, (2014) state and policy decision-makers might adopt procedures and policies in alignment with their interests while also considering the benefits of the citizens. ACF adaptation will assist the Australian Government in broadening the beneficiaries of the policies.

In current conditions, the policymakers are recognizing health care improvements through system-wide policies. The model of Care policies is generally practiced in a clinical environment; however, the health official is alternating with the new health networks for involving broader engagements and achieving sustainable scope (Briggs et al, 2014). Cigarette Smoking has been one of the major problems amongst the young populations of Australia. Thus, ACF has been used for drafting different policies for controlling the smoking habits of Australians.

Recommendations
Australia is a large nation with a strong public infrastructure for providing quality health care services. The health care expenditure of the Australian Government is lower than other nations hence the policymakers have flexibility in increasing public health spending. The country has a high number of MRI equipment on 1 Million people moreover, MRIs on 1000 individuals are comparatively low. Hence, the policy makers are suggested to solve the resource allocation issues due to which quality care is impacted, and public health expenditure rises.

The Government has efficient health policy but there is a lack in the implementation due to inequality in health care distribution has increased from several years. The government should enforce policies for indicating the performance and regulations of health care units for dealing with rising health care issues. Also, the government should reap opportunities in shifting its health care model to patient-centered thereby satisfying care receivers through payment mechanisms. Moreover, the bundled payment models will help the government in reducing costs without impacting patient outcomes and quality care.

Besides, since the private sector plays a dynamic role in health care, thus the role of private institutions should be increased informulating policies and implementing it which also helps the policymakers in acting for the benefits of the citizens.

Conclusion
The policy-making procedures are a crucial part of the government as it directly impacts the welfare of citizens. This Advocacy Coalition Framework has been selected for addressing the policy issues of health care in Australia. In current scenarios, the Australian Government has been facing rising costs or providing health care facilities due to varied reasons. The draftedpolicies are detected with issues of resource allocation, implementation, and low involvement of private sectors. The ACF belief System integrates the policy core and secondary beliefs as per the agenda. Policy-oriented learning is underutilized in the public health sector.The Australian Government should increase the roles of private sectors to improve the health policies and their implementations.

References
Ananthapavan, J., Sacks, G., Brown, V., Moodie, M., Nguyen, P., Veerman, L., ... & Carter, R. (2020). Priority-setting for obesity prevention—The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PloS one, 15(6), e0234804.

Briggs, A. M., Towler, S. C., Speerin, R., & March, L. M. (2014). Models of care for musculoskeletal health in Australia: now more than ever to drive evidence into health policy and practice. Australian Health Review, 38(4), 401-405.

Brooks, E. (2018). Using the Advocacy Coalition Framework to understand EU pharmaceutical policy. European journal of public health, 28(suppl_3), 11-14.

Elgin, D. J., &Weible, C. M. (2013). A Stakeholder Analysis of C olorado Climate and Energy Issues Using Policy Analytical Capacity and the Advocacy Coalition Framework. Review of Policy Research, 30(1), 114-133.

Howlett, M., McConnell, A., & Perl, A. (2017). Moving policy theory forward: connecting multiple stream and advocacy coalition frameworks to policy cycle models of analysis. Australian Journal of Public Administration, 76(1), 65-79.

Ingold, K., Fischer, M., & Cairney, P. (2017). Drivers for policy agreement in nascent subsystems: an application of the advocacy coalition framework to fracking policy in Switzerland and the UK. Policy studies journal, 45(3), 442-463.

Jolley, G., Freeman, T., Baum, F., Hurley, C., Lawless, A., Bentley, M., ... & Sanders, D. (2014). Health policy in South Australia 2003–10: primary health care workforce perceptions of the impact of policy change on health promotion. Public health assignment Health Promotion Journal of Australia, 25(2), 116-124.

Land, M. A., Jeffery, P., Webster, J., Crino, M., Chalmers, J., Woodward, M., ... & Neal, B. (2014). Protocol for the implementation and evaluation of a community-based intervention seeking to reduce dietary salt intake in Lithgow, Australia. BMC Public Health, 14(1), 357.

Leifeld, P. (2013). Reconceptualizing major policy change in the advocacy coalition framework: A discourse network analysis of German pension politics. Policy Studies Journal, 41(1), 169-198.

Macri, J. (2016). Australia’s health system: some issues and challenges. J Health Med Econ, 2(2).

Markard, J., Suter, M., & Ingold, K. (2016). Socio-technical transitions and policy change–Advocacy coalitions in Swiss energy policy. Environmental Innovation and Societal Transitions, 18, 215-237.

Nau, T., Lee, K., Smith, B. J., Bellew, W., Reece, L., Gelius, P., ... & Bauman, A. (2019). Toward Whole-of-System Action to Promote Physical Activity: A Cross-Sectoral Analysis of Physical Activity Policy in Australia. Journal of Physical Activity and Health, 1(aop), 1-10.

Pierce, J. J., Peterson, H. L., Jones, M. D., Garrard, S. P., & Vu, T. (2017). There and back again: A tale of the advocacy coalition framework. Policy Studies Journal, 45(S1), S13-S46.

Ritter, A., Hughes, C. E., Lancaster, K., & Hoppe, R. (2018). Using the Advocacy Coalition Framework and Multiple Streams policy theories to examine the role of evidence, research and other types of knowledge in drug policy. Addiction, 113(8), 1539-1547.

Sotirov, M., &Memmler, M. (2012). The Advocacy Coalition Framework in natural resource policy studies—Recent experiences and further prospects. Forest policy and economics, 16, 51-64.