Elsevier

Social Science & Medicine

Volume 172, January 2017, Pages 10-18
Social Science & Medicine

A network approach to policy framing: A case study of the National Aboriginal and Torres Strait Islander Health Plan

https://doi.org/10.1016/j.socscimed.2016.11.011Get rights and content

Highlights

  • Connections between stakeholders are used to drive the health policy discourse.

  • Combining network and framing analysis highlights competing interests within a network.

  • This approach provides stakeholders with a snapshot of their strategic and discursive ties.

  • Where network structure does not wholly align with frames there may be opportunity for new impetus in the policy process.

  • Peripheral actors may reframe arguments in order to align with the core actors in the network.

Abstract

Aboriginal health policy in Australia represents a unique policy subsystem comprising a diverse network of Aboriginal-specific and “mainstream” organisations, often with competing interests. This paper describes the network structure of organisations attempting to influence national Aboriginal health policy and examines how the different subgroups within the network approached the policy discourse. Public submissions made as part of a policy development process for the National Aboriginal and Torres Strait Islander Health Plan were analysed using a novel combination of network analysis and qualitative framing analysis. Other organisational actors in the network in each submission were identified, and relationships between them determined; these were used to generate a network map depicting the ties between actors. A qualitative framing analysis was undertaken, using inductive coding of the policy discourses in the submissions. The frames were overlaid with the network map to identify the relationship between the structure of the network and the way in which organisations framed Aboriginal health problems. Aboriginal organisations were central to the network and strongly connected with each other. The network consisted of several densely connected subgroups, whose central nodes were closely connected to one another. Each subgroup deployed a particular policy frame, with a frame of “system dysfunction” also adopted by all but one subgroup. Analysis of submissions revealed that many of the stakeholders in Aboriginal health policy actors are connected to one another. These connections help to drive the policy discourse. The combination of network and framing analysis illuminates competing interests within a network, and can assist advocacy organisations to identify which network members are most influential.

Introduction

This article presents a unique approach to analysing policy development, combining two conceptual-methodological approaches in order to concurrently examine the network structure of organisations attempting to influence national policy, and the way in which the policy discourse is framed by different subgroups within the network.

Australian Aboriginal and Torres Strait Islander (Aboriginal) people, like other Indigenous populations within colonised Western countries, experience significant health inequalities compared to the non-Indigenous population (Anderson et al., 2007, Bramley et al., 2004, Ring and Brown, 2003). Life expectancy for Aboriginal Australians is ten years less than that of other Australians (Australian Institute of Health and Welfare, 2015, Anderson et al., 2016).

Section snippets

Aboriginal health policy in Australia

Aboriginal health policy, a subsystem of health policy in Australia, is characterized by pressing and often seemingly intractable policy problems, and a large number of stakeholders and interest groups with competing discourses.

To many Aboriginal people, “health” is viewed as “not just the physical well-being of the individual but the social, emotional, and cultural well-being of the whole community. This is a whole-of-life view and includes the cyclical concept of life-death-life” (National

The National Aboriginal and Torres Strait Islander Health Plan

In November 2011, it was announced that a new National Aboriginal and Torres Strait Islander Health Plan (“Health Plan”) would be developed (Roxon and Snowdon, 2011) to guide action towards achieving the Closing the Gap targets over the next decade. The Australian Government's Department of Health and Aging released a discussion paper (Department of Health and Ageing, 2012) in September 2012, and invited written comments and answers to specific questions from key stakeholders to inform the

Conceptual-methodological approach

The number of policy process investigations deploying network theories has been increasing (Adam and Kriesi, 2007). This is unsurprising, since policy decisions result from engagement by, and reciprocally impact on, a variety of stakeholders; therefore, many of these individuals and organisations devote resources to attempt to influence the policy agenda, and each other, in order to progress their particular interests. It is suggested that these actors essentially determine policy, with the

Methods

In order to understand the structural and discursive features of the network of actors attempting to influence Aboriginal health policy in Australia, qualitative framing analysis was layered onto social network analysis. The organisational approach (Laumann et al., 1985), in which organisations participate in discrete “policy events”, was used to define the boundaries of the network. The submission process used in the development of the Health Plan is the policy event examined in this study.

The

Results

The Submissions (n = 80) were provided by a variety of Aboriginal and mainstream peak health bodies, service providers, professional associations, research institutions, Non-Government Organisations (NGOs) and Government agencies. Supplementary Table 1 summarizes the type of organisations included in the sample. The majority of submissions were from health professional groups (n = 16), followed by Aboriginal-controlled organisations or coalitions (n = 13) and mainstream health services/primary

Discussion

The publication of Health Plan submissions presented an opportunity to analyse the network of actors within this policy subsystem and their framing practices. Analysis of these submissions revealed that many actors were connected to one another in a variety of ways, and that network connections aligned with the collective action frames used to influence policy development.

The network maps produced in this study provide a clear picture of the structure of the network of organisations attempting

Conclusions

The combination of social network analysis with framing theory provides a methodology for concurrently examining the structural and discursive aspects of the Aboriginal health policy network. It has been suggested that the study of network structure and the function of actors in a policy subsystem should be integrated (Skok, 1995). The present study embraces the framework proposed by Skok, and adds the additional perspective of framing in order to analyse the actor behaviour within policy issue

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