Bringing in critical frameworks to investigate agenda-setting for the social determinants of health: Lessons from a multiple framework analysis

Abstract

Public health scholars have increasingly called for greater attention to the political and policy processes that enable or constrain successful prioritisation of health on government agendas. Much research investigating policy agenda-setting in public health has focused on the use of single frameworks, in particular Kingdon's Multiple Streams Framework. More recently, scholars have argued that blending complementary policy frameworks can enable greater attention to a wider range of drivers that influence government agendas away from or towards progressive social and health policies. In this paper, we draw on multiple policy process frameworks in a study of agenda-setting for Australia's first national paid parental leave scheme. Introduced in 2011 after decades of advocacy, this scheme provides federal government-funded parental leave for eighteen weeks' pay at the minimum wage for primary caregivers, with evaluations showing improved health and equity outcomes. Drawing on empirical data collected from documentary sources and interviews with 25 key policy informants, we find that a combination of policy frameworks; in this case, Kingdon's Multiple Streams; Advocacy Coalition Framework; Punctuated Equilibrium; Narrative Policy Framework; and Policy Feedback helped explain how this landmark social policy came about. However, none of these frameworks were adequate without situating them within a critical feminist lens which enabled an explicit focus on the gendered nature of power. We argue that, alongside making use of policy process frameworks, social determinants of health policy research needs to engage with critical frameworks which share an explicit agenda for improving people's daily living conditions and the re-distribution of power, money, and resources in ways that promote health equity.