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Studies have consistently shown that living in disadvantaged neighbourhoods is associated with poor health. There is also some evidence that low income individuals may benefit from living in more advantaged neighbourhoods. However, while neighbourhoods are regarded by policy makers as key social determinants of health and important intervention sites for addressing health inequalities, the exact mechanisms linking neighbourhoods to health remain unclear. Key aspects of neighbourhoods previously shown to be associated with neighbourhood health are neighbourhood reputation, safety and disorder, which have also been linked to the built environment. Residents in disadvantaged neighbourhoods tend to perceive these aspects of their neighbourhood less favourably than residents of advantaged areas.This paper uses Bourdieu’s critical theory of the social reproduction of inequalities to explore how different perceptions of safety, disorder and reputation in contrasting socioeconomic neighbourhoods may influ...

The 1978 World Health Organisation Alma Ata Declaration on Primary Health Care (PHC) emphasised a comprehensive view which stressed the importance of cure, prevention, promotion and rehabilitation delivered in a way that involved local communities and considered a social, economic and political perspective on health. Despite this, selective approaches have dominated. This paper asks why this has been the case in Australia through a multi-method study of regional PHC organisations. Interviews with senior policy players, focus groups with non-government organisations and document analysis inform an institutional and power analysis of PHC. The findings indicate that there are different interests competing for attention in PHC but that medical perspectives prove the most powerful and are reinforced by the actors, ideas and institutions that shape PHC. Community perspectives which stress lived experience and social perspectives on health are marginal concerns in the implementation of PHC. The other important interest is that of a neo-liberal perspective on health policy which stresses cost-containment, close measurement of activity and fragmented contracting out of services. This perspective is not compatible with a social determinants of health perspective and can also conflict with a medical view. The result of the interplay between competing interests and the distribution of power is a selective PHC system that is not likely to change without radical shifts in power and perspectives.

© The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Background Worldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems’ responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011–2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning. Methods We reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff. Results Despite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals’ performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity. Conclusions There are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in such a way that the impact of the social determinants on health and health equity are taken into account. The policy environment favours a focus on clinical services to the detriment of health promotion informed by a social determinants focus. Electronic supplementary material The online version of this article (10.1186/s12889-018-5273-4) contains supplementary material, which is available to authorized users.

OBJECTIVE To examine the strength and extent of collaborations between primary health care organisations and local government in population health planning. METHODS Methods included: a) online surveys with Medicare Locals (n=210) and Primary Health Networks (n=66), comparing the two using two-level mixed models; b) interviews with Medicare Local (n=50) and Primary Health Network (n=55) executives; c) interviews with members of local government associations and Primary Health Network board members with local government experience (n=7); and d) review of 54 Medicare Local and 31 Primary Health Network publicly available annual reports. RESULTS Despite partnership being a policy objective for Medicare Locals/ Primary Health Networks, they reported limited time and financial support for collaboration with local government. Organisational capacity and resources, supportive governance and public health legislation mandating a role for local governments were critical to collaborative planning. CONCLUSIONS Local government has the potential to tackle social factors affecting health; therefore, their inclusion in population health planning is valuable. Legislative mandates would help to achieve this, and PHNs require a stronger Federal Government mandate backed by sufficient resources and a governance structure that supports collaboration. Implications for public health: Improving primary health care and local government collaboration has great potential to improve the quality of health planning and action on social determinants, thus advancing population health and health equity.

Traffic light scoring. Definition of key elements of the population health planning for traffic light scoring system. The table shows the definition of each element of population health planning that were used to score Medicare Localsâ activities using traffic light scoring method. (DOCX 14 kb)

Implementing mixed tenure projects is an ongoing practice in Australian cities despite questions raised about the soundness of the underlying assumptions. This paper draws on the concept of ‘right ...

This is an Accepted Manuscript of an article published by Taylor & Francis in AUSTRALIAN GEOGRAPHER on 24 August 2015, available online: http://wwww.tandfonline.com/10.1080/00049182.2015.1075270. An embargo period of 12 months from the date of publication will apply.

The poor mental and physical health of people with disabilities has been well documented and there is evidence to suggest that inequalities in health between people with and without disabilities may be at least partly explained by the socioeconomic disadvantage (e.g. low education, unemployment) experienced by people with disabilities. Although there are fewer studies documenting inequalities in social capital, the evidence suggests that people with disabilities are also disadvantaged in this regard. We drew on Bourdieu's conceptualisation of social capital as the resources that flow to individuals from their membership of social networks. Using data from the General Social Survey 2010 of 15,028 adults living in private dwellings across non-remote areas of Australia, we measured social capital across three domains: informal networks (contact with family and friends); formal networks (group membership and contacts in influential organisations) and social support (financial, practical and emotional). We compared levels of social capital and self-rated health for people with and without disabilities and for people with different types of impairments (sensory and speech, physical, psychological and intellectual). Further, we assessed whether differences in levels of social capital contributed to inequalities in health between people with and without disabilities. We found that people with disabilities were worse off than people without disabilities in regard to informal and formal networks, social support and self-rated health status, and that inequalities were greatest for people with intellectual and psychological impairments. Differences in social capital did not explain the association between disability and health. These findings underscore the importance of developing social policies which promote the inclusion of people with disabilities, according to the varying needs of people with different impairments types. Given the changing policy environment, ongoing monitoring of the living circumstances of people with disabilities, including disaggregation of data by impairment type, is critical.

Sport is highly valued in Australian society and is one of few environments where Aboriginal Australians have opportunities to excel and engage with non-Aboriginal people; however, there is little evidence to suggest that sport has led to social improvements in Aboriginal communities or any transfer of engagement into non-Aboriginal dominated activities. While much has been written about elite Aboriginal sportspeople, less is known about how other Aboriginal people feel about sport and its place in their lives, including how it is linked to social capital (the benefits that accrue to individuals and groups through their network membership). Drawing on in-depth interviews and applying Bourdieu's theory of practice, this paper examines the role of sport in social capital creation for Aboriginal people living in urban settings. While sport facilitated important social and cultural resources, there were limitations to its ability to reduce disadvantage for Australian Aboriginal people.

Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.

The social mix policy approach has become a common reaction to the multiple-disadvantage increasingly present in public housing estates in western cities. This approach and its social effects on socially-mixed communities have been studied widely; however the physical form or arrangement of models that such communities are formulated around have been largely missing from this discussion. The importance of design principles as well as the barriers to their implementation in mixed-tenure communities has been largely overlooked. We investigate these factors in a case study of the Carlton Public Housing Estate Redevelopment in Melbourne, Australia, using an analysis of in-depth interviews with public housing tenants, private residents and service providers. The findings show how the implementation of design ‘principles’ was contingent on political and economic decisions made by government and private enterprise stakeholders. Perceptions of whether the physical design of the redevelopment contributed to the lack of successful social mix varied between tenants, government officials, private developers and private residents. We conclude that partly due to the way that economic interests compromised the implementation of preferred design principles undertaken in the Carlton Redevelopment Project (Stage 1), neither housing tenure mix nor social interaction has been successfully experienced by public and private residents in the estate.

Objectives To examine the role of socioeconomic, sociodemographic, and social capital factors in buffering or exacerbating the mental health impacts of job loss. Methods A 2-year longitudinal cohort study of 300 workers experiencing job loss from a motoring manufacturer in Adelaide, South Australia. Data were collected on mental health (12-item version of the General Health Questionnaire) and socioeconomic, sociodemographic, and social capital factors. Analysis used linear mixed-effects regression. Results Workers had poorer mental health than the general population. Female gender, less years at the plant, and not being partnered were associated with poorer mental health. The effects of financial status depended on current employment and levels of social support. Trust and social contact were associated with better mental health. Conclusion A number of socioeconomic, sociodemographic, and social capital factors influence mental health in workers experiencing job loss, offering clues on how to support workers.

Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web-based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state-managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state-managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services.

Over the past twenty years interest has grown in the concept of social capital in international and Australian public policy. We explore how social capital is understood as a concept and used in practice for guiding policy development and program delivery in South Australian public health programs. The empirical research compared policy makers’ and practitioners’ understandings of social capital and how theories about social capital and health inequality were translated into practice in three case study projects. It found that there are shifting discourses between social capital and related concepts, including community capacity building, and social inclusion/exclusion. Policy makers reported less use of the concept of social capital in favour of social inclusion/exclusion reflecting changing political and policy environments where terms come into favour and then go out of fashion. In this transition period the two terms are often used interchangeably although there are some conceptual points of difference.

This article appeared in a journal published by Elsevier Ltd. Under Elsevier's copyright, mandated authors are not permitted to make work available in an institutional repository., This project was funded by the Australian National Health and Medical Research Council (NHMRC, Project grant 324725) and the Australian Cooperative Research Centre for Aboriginal Health (Project SD 142). It was also supported by NHMRC project grant 324724, Prof Baum's Australian Research Council (ARC) Federation Fellowship and Dr Ziersch's ARC Future Fellowship.

This article appeared in Social Science and Medicine, published by Elsevier Ltd. Under Elsevier's copyright, mandated authors are not permitted to make work available in an institutional repository., People on low-income living in low socio-economic neighbourhoods have poorer health in comparison with those living in advantaged neighbourhoods. To explore neighbourhood effects on health and social capital creation, the experiences of low-income people living in contrasting socio-economic neighbourhoods were compared, in order to examine how low-income status and differing levels of neighbourhood resources contributed to perceived health and wellbeing. Quantitative and qualitative data were analysed: survey data from 601 individuals living in contrasting socio-economic areas and in-depth interviews with a new sample of 24 individuals on low-incomes. The study was guided by Bourdieu's theory of practice, which examines how social inequalities are created and reproduced through the relationship between individuals' varying resources of economic, social and cultural capital. This included an examination of individual life histories, cultural distinction and how social positions are reproduced. Participants' accounts of their early life experience showed how parental socio-economic position and socially patterned events taking place across the life course, created different opportunities for social network creation, choice of neighbourhood and levels of resources available throughout life, all of which can influence health and wellbeing. A definition of poverty by whether an individual or household has sufficient income at a particular point in time was an inadequate measure of disadvantage. This static measure of ‘low income’ as a category disguised a number of different ways in which disadvantage was experienced or, conversely, how life course events could mitigate the impact of low-income. This study found that the resources necessary to create social capital such as cultural capital and the ability to socially network, differed according to the socio-economic status of the neighbourhood, and that living in an advantaged area does not automatically guarantee access to potentially beneficial social networks., NHMRC ARC This research was supported by a National Health and Medical Research Council grants (22913 & 974009) and the Australian Research Council through the Federation Fellowship (FF0883216) of Prof Fran Baum.

Background Precarious employment has been associated with poor health, but the potential mechanisms are unclear. We examined the relationships between precarious employment and health, and investigated psychosocial working conditions as potential mediators. Methods A cross-sectional population-based survey was conducted in South Australia in 2009 (N = 1,016 employed). SF-12 measures of mental and physical health were modeled using logistic regression in relation to employment arrangement, controlling for socio-demographics, years in job and psychosocial working conditions. Results There was no association between casual full-time or part-time employment and poor mental health in multivariate analyses. Conversely, there was a significant association between casual full-time employment and poor physical health (compared to permanent full-time workers, OR = 3.14, 95% CI 1.26–7.85). The association with physical health was unaffected by adjustment for psychosocial working conditions. Conclusions Casual full-time employment was strongly associated with poor physical health but not with poor mental health. This association was not mediated by the psychosocial working conditions measured in this study, but may be related to other (unmeasured) working conditions. Am. J. Ind. Med. 56:838–844, 2013. © 2013 Wiley Periodicals, Inc.

This article draws on the concept of residential context of housing and its relationship to health. It considers a bundle of changes through implementation of a housing renewal initiative as part of the Carlton Housing Estate Upgrading Project in Melbourne, Australia. Beyond the quality and appropriateness of the housing, pertinent factors explored include social networks, safety and security, and green open space. Data collection for the research project included in-depth interviews with public housing tenants, private residents, and service providers who live on and service the estate, as well as neighborhood observations and participation in on-site events. A key finding was that the relational processes of how tenants were related to by others-specifically, the way housing was reallocated during the processes of renewal-affected social housing tenants' self-perceived health and well-being.

Job loss has negative consequences for health and evidence shows that the agency of workers experiencing job loss is affected by labour market and welfare policy. The policy environment into which workers emerge after losing their jobs strongly influences the way job loss and its aftermath is experienced. This article draws on findings from two waves of in-depth semi-structured interviews with 33 retrenched South Australian automotive workers. It discusses how, within the context of Australian welfare and industrial policy, workers experienced the consequences of mass job losses that occurred at Mitsubishi Motors during 2004 and 2005. Key findings include largely negative experiences associated with negotiating welfare-to-work policy, and a more precarious employment environment further entrenched under industrial relations policy. Job loss is both a personal and a structural story and we use an agency and structure perspective to examine how workers’ agency was enabled, but more often constrained, by policy.

This paper draws on survey data from 143 Aboriginal participants living in Adelaide, South Australia, to examine factors associated with Australian Aboriginal urban residents’ satisfaction with living in their neighbourhoods. Associations were examined between neighbourhood satisfaction, individual socio-demographic measures and perceptions of the neighbourhood socio-cultural environment (including experiences of racism in the neighbourhood, perceived tolerance in the neighbourhood, perceived neighbourhood cohesion, trust in other neighbourhood residents and perceived neighbourhood safety). Staged multivariate logistic regression models led to a final model where trust in people in the neighbourhood and perceived safety in the neighbourhood were significant predictors of neighbourhood satisfaction. Experience of racism in the neighbourhood was a significant predictor in earlier steps in the model, but did not remain significant. Understanding factors contributing towards Aboriginal residents’ satisfaction with living in neighbourhoods is important in informing neighbourhood-based policies and programmes to enhance the well-being of Aboriginal residents in Australian cities.

This article contributes to research on the impact of job loss on families. It is based on survey responses from 371 workers and in‑depth interviews with 39 of them about the family impacts of their job loss from the Mitsubishi car factory in Adelaide in 2004‑2005. A majority of workers said family life had been affected by their job loss. Quantitative analysis identified four variables significantly associated with family impacts: marital status, children living at home, employment status and financial management. Qualitative responses showed the predominantly negative impacts were financial strain, loss of relationship stability, and general stress and worry, although few faced catastrophic impacts from their job loss. However, in contrast to most previous research, the in‑depth interviews also revealed positive impacts from job loss, such as having more time at home and to spend with their family. We conclude that the existence of ongoing income support and public health insurance in Australia were important in avoiding catastrophic financial impacts on these workers and their families., The authors acknowledge support from the National Health and Medical Research Council Capacity Building Grant (324724). The research was also supported by the SA Department of Health and the SA Department of Families and Communities through the Human Services Research and Innovation Program (HSRIP), and the Australian Research Council Linkage Program (LP0562288), with the Department of Health serving as Industry Partner. Professor Fran Baum was supported by an ARC Federation Fellowship and Drs Newman and Ziersch by the SA Premier’s Science and Research Fund.

This article reports on participation in local community groups from a postal survey of residents of four socio-economically contrasting suburbs in metropolitan Adelaide. A hierarchical logistic regression model was fitted to examine the socio-economic and neighbourhood-related determinants of participation in community groups within the local neighbourhood. In the final model, higher level of education, being female, longer length living in the neighbourhood, not being employed full time and having children under age 15 were significantly associated with local community group participation. Perceived social cohesion and higher ratings for local shops and recreational facilities were also associated with an increased likelihood of local community group participation. The implications for policies and initiatives that are designed to build ‘social capital’ within neighbourhoods are discussed.

This paper examines responses to racism and the pathways through which racism can affect health and wellbeing for Aboriginal people living in an urban environment. Face-to-face interviews were conducted in 2006/07 with 153 Aboriginal people living in Adelaide, Australia. Participants were asked about their experience of, and responses to, racism, and the impact of these experiences on their health. Racism was regularly experienced by 93% of participants. Almost two thirds of people felt that racism affected their health. Using a thematic analysis with a particular focus on how agency and structure interacted, a number of key reactions and responses to racism were identified. These included: emotional and physiological reactions; and responses such as gaining support from social networks; confronting the person/situation; ignoring it; avoiding situations where they might experience racism; 'minimising' the significance or severity of racism or questioning whether incidents were racist; and consuming alcohol, tobacco and other drugs. A further theme was a conscious decision to not 'allow' racism to affect health. Our study found that most people used more than one of these coping strategies, and that strategies were selected with an awareness of positive and negative health impacts. While individuals demonstrated substantial agency in their responses, there were clear structural constraints on how they reacted and responded. We found that not only was racism potentially detrimental to health, but so too were some responses. However, while some strategies appeared 'healthier' than others, most strategies entailed costs and benefits, and these depended on the meanings of responses for individuals. This paper concludes that initiatives to promote health-protective responses to racism need to consider structural constraints and the overarching goal of reducing systemic racism.

Within Australian cities, social and economic inequalities manifest themselves spatially. Perceived neighbourhood disorder and neighbourhood reputation are relevant to considering the ways in which social and economic inequalities translate into place-based inequalities. This article explores the ways in which residents of two socio-economically contrasting urban areas describe and explain neighbourhood disorder and neighbourhood reputation. It draws upon qualitative data from 40 in-depth interviews, in addition to quantitative data from a postal survey. The qualitative findings highlighted how issues of neighbourhood disorder and reputation were intertwined. In both areas, participants sought to portray themselves and their neighbourhoods in positive ways, by attributing responsibility for neighbourhood disorder to people who were unlike themselves, and by highlighting places that were perceived to have worse reputations and higher levels of disorder. The findings are considered in light of Bourdieu's th...

BACKGROUND: This paper examines whether reported experience of racism by Aboriginal people living in Adelaide is negatively associated with mental health, and whether social resources ameliorate the mental health effects of racism. METHODS: Face-to-face structured and semi-structured interviews were conducted with 153 Aboriginal people. Data on self-reported experiences of racism (average regularity of racism across a number of settings, regular racism in at least one setting), social resources (socialising, group membership, social support, talking/expressing self about racism), health behaviours (smoking, alcohol), socio-demographic (age, gender, education, financial situation) and mental health (SF-12 measure) are reported. Separate staged linear regression models assessed the association between the two measures of racism and mental health, after accounting for socio-demographic characteristics and health behaviours. Social resource variables were added to these models to see if they attenuated any relationship between racism and mental health. RESULTS: The two measures of racism were negatively associated with mental health after controlling for socioeconomic factors and health behaviours. These relationships remained after adding social resource measures. Non-smokers had better mental health, and mental health increased with positive assessments of financial situation. CONCLUSION AND IMPLICATIONS: Reducing racism should be a central strategy in improving mental health for Aboriginal people.

The article draws on our examination of the connections between location, health and social capital in four socio-economically contrasting areas in South Australia. Our third ranking socio-economic area often equalled or scored better on some social capital and mental health variables than the higher ranking area. We examined whether these findings may be explained by the quality of social planning some 20 years earlier. Our case study confirmed that the integration of social and physical planning based on best practice had, on the balance of evidence, contributed to the better than expected performance of one of the less advantaged suburbs.

Participation in community groups is argued to be an important way to create health-promoting social capital. However, relatively little attention has been paid to the ways in which gender affects the health promotion potential of participation. This paper reports on a qualitative study of women's experiences of participation in a diverse range of community groups, and considers how such involvement can potentially have a negative impact upon mental well-being. In-depth interviews were conducted with 30 women in Adelaide, South Australia. Women's accounts of their group involvement reflected that their identities as mothers were particularly important in shaping their participation. Some women reported difficulties in combining group involvement with their family responsibilities. Stress attached to negotiating social interaction within groups was also raised as an issue. It was found that participation can reinforce gender inequality and potentially have severe negative consequences for mental health, issues that need to be considered alongside the potential health benefits. The findings are considered in light of Bourdieu's critical conceptualization of social capital. Copyright © 2008 John Wiley & Sons, Ltd.

This paper seeks to compare the relationships between social capital and health for rural and urban residents of South Australia.Using data from a South Australian telephone survey of 2,013 respondents (1,402 urban and 611 rural), separate path analyses for the rural and urban samples were used to compare the relationships between six social capital measures, six demographic variables, and mental and physical health (measured by the SF-12).Higher levels of networks, civic participation and cohesion were reported in rural areas. Education and income were consistently linked with social capital variables for both rural and urban participants, with those on higher incomes and with higher educational achievement having higher levels of social capital. However, there were also differences between the rural and urban groups in some of the other predictors of social capital variables. Mental health was better among rural participants, but there was no significant difference for physical health. Social capital was associated with good mental health for both urban and rural participants, but with physical health only for urban participants. Higher levels of social capital were significantly associated with better mental health for both urban and rural participants, but with better physical health only for urban participants.The study found that social capital and its relationship to health differed for participants in rural and urban areas, and that there were also differences between the areas in associations with socioeconomic variables. Policies aiming to strengthen social capital in order to promote health need to be designed for specific settings and particular communities within these.

Participation in voluntary groups is potentially an important way to create health promoting social capital. This paper investigates women's participation in voluntary groups, utilising data from a postal survey of 968 female respondents and in-depth interviews with 30 women. Logistic regression was conducted to examine factors associated with frequency of women's group involvement. Not working full-time, living in a married relationship, and having a university education were all significantly associated with regular involvement. The qualitative data further illustrated some of the ways in which these three factors were linked with women's involvement in groups. We conclude that women who were able to regularly participate were those who already enjoyed levels of social and economic privilege. Policies to promote social capital via participation might focus on identifying what types of group involvement benefit women's health, and increasing the accessibility of such groups to include diverse groups of women.