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PUBH6300 Introduction To Public Health

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Course Code: PUBH6300
University: The University Of Newcastle

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Country: Australia

Question:
In the case of forced marriage in Australia, the ACF has been used successfully to determine competing coalition priorities (persecution vs prevention),and identify the external events and parameters framing the issue in contemporary Australian society (political context, cases in the media and commitment to international doctrines 

Answer:
Introduction
Advocacy Coalition Framework is a tool for policy making and analysis and has been successfully used in dealing with intense or complicated public policy systems. Due to the complex nature of public policies, the framework provides an understanding of the policy priorities that are involved in dispute management from the interaction of the various stakeholders interested in the policy (Coombes et al., 2018, p. 132). The Advocacy Coalition Framework takes into account and explains the complicated policy-making environment to enhance the efficiency of the policy-making process and decision making. Healthy aging has been advocated by various stakeholders in the healthcare sector with the aim of improving the quality of health care for the aging population. Development of healthy aging policies requires the integration of various perspectives and views from different stakeholders. Healthy ageing policies focus on improving the health conditions of the elderly against a wide range of objectives which are related to an individual wellbeing (McNamara, Rosenwax, Lee & Same, 2016, p. 32). The policies also focus on reducing the overall costs of ageing to society. This essay will, therefore, apply the use of the Advocacy Coalition Framework in analyzing the different aspects of healthy ageing. Current policies in healthy ageing will also be discussed as well as their impact on public health policies. Alternate policies will also be discussed to enhance the development of the theoretical framework of the Healthy
Theoretical Framework:  Advocacy Coalition Framework
Advocacy Coalition Framework (ACF) is an action based framework that is used to analyze policy changes over a given period of time (Jenkins-Smith, Nohrstedt, Weible & Sabatier, 2014, p. 190). It, therefore, provides a framework of policy processes and is very essential in analyzing intense public policy systems.  The framework was developed by Sabatier and Jenkins in the 1980s but was first published in the year 1988. ACF argument is that policy participants or stakeholders will seek to develop allies or coalitions with other stakeholders’ interest in the policy. It’s development as a reaction to the three main limitations which existed in the contemporary policy process and therefore encourages the development of advocacy coalitions thinking rather than focusing at the power struggles to understand primary policy changes (Weible & Jenkins-Smith, 2016, p. 24). The Advocacy Coalition Framework has three main principal theoretical domains which include advocacy coalitions, policy subsystems as well as policy changes. The framework provides that both policy subsystems and advocacy coalitions are the most efficient ways of organizing all the actors or stakeholders interested in the policy process. However, it also provides that policy subsystems is the main unit of policy analysis and plays a critical role in the policy development and implementation process (Pierce & Weible, 2016, p. 22).  The Advocacy Coalition Framework has established itself in the field of policy as a powerful reference in understanding and explaining complex policy processes. It will be critical in helping us understand the policy of Healthy living, better ageing in the development and improvement of the healthcare status of the aged populations across different countries.
Healthy ageing Policy Area: Healthy life Better Ageing
The Advocacy coalition framework (ACF) can be applied to in the analyses of various aspects of healthy ageing. According to the World health organization, there is a distinction between active  ageing and healthy ageing in policy making where active ageing health policies focus on the longer activities such as working at old age to promote healthy ageing process (Jenkins-Smith, Nohrstedt, Weible & Ingold, 2018, p. 162). Active ageing according to World Health Organization is the optimization of health opportunities and participation enhance the quality of life as people continued to age.  On the other hand, WHO defines healthy ageing as the through which individuals are able to maximize the available opportunities for social, mental and physical health to enable the older people to participate in the society without necessarily been discriminated against as well as to enable them to enjoy a quality and independent life. Healthy ageing policies presume that older people are valuable to the society and therefore they should be treated as such and not to be viewed as a burden. Therefore their autonomy of personal control is critical for maintaining human dignity as well as their integrity.
The policy of Healthy life better ageing was developed through a coalition in Australia as a policy guideline that sought to provide access to quality healthcare for the older people in Australia. It is the responsibility of the government is the main stakeholder to strive and provide a healthcare system that treats all the Australian at their old age with the dignity, respect, and integrity they deserve. On the other hand, it is the responsibility of the family members also to develop trust with the system in that it will be able to deliver quality healthcare to their members (Beard et al., 2016, p. 2150). The application of the advocacy coalition framework requires the identification of all the stakeholders in who are interested in the health policy and in this case we have the government, the families of the aged people, healthcare global organizations such as the World Health Organization, the community as well as the medical or the healthcare practitioners (Howlett, McConnell &Perl, 2017, p. 72). Through advocacy coalition principle, the success of the Healthy life Better living policy is depended on the integration of these stakeholders in developing the best strategies to overcome the health condition and development of appropriate activities to enhance active ageing. The older people have been discriminated against in society as many view them as a burden and therefore do not receive adequate care attention. Most governments are spending a lot of money on treatment for medical conditions which are associated with old age as well as increased chronic diseases which could be prevented through prevention strategies aimed at promoting healthy ageing.
Another level of application of the advocacy coalition framework is the understanding of the political context concerning the Healthy life Better ageing policy. Politically the ageing population is taken as a primarily economic and political challenge in which it is misunderstood often under political realm. Before changing healthcare policies, structures as well as funding streams it is critical for the policymakers, the government as well as the healthcare practitioners to understand the complexity of the healthcare issues of the ageing population (Sotirov & Winkel, 2016, p. 132). Despite the government promising to prioritize aged care in their second term, the Rudd-Gillard government had a good intent but delivering the promise to the citizens has lacked progress. The report for caring for the older Australians was not responded by the government for over 250 days as well as the introduction of the report in the parliament for legislation also tool over 327 days and hence affecting the implementation of the policy. The changes in the policy were only legislated by the government few weeks at the end of the 43rd parliament. According to the advocacy coalition framework, there must be a certainty on going forward with the implementation process of the proposed policy changes.
The implementation of the Healthy life Better ageing policy was also affected by previous health policies. According to the Advocacy Coalition framework principle of policy subsystems, the effectiveness of implementation of a policy is dependent on the previous policies (Henry, Ingold, Nohrstedt & Weible, 2014, p. 306). One the policy that has had an impact on the implementation of the Healthy Life better Ageing is the Mental Health policy which has been neglected the older population. Healthy ageing is a function of the mental health of older people. The policy has not taken into consideration the mental healthcare issues of older people in Australia and as a result, many older people have suffered from depression and other related mental conditions.  Lack of enforcement and implementation of the policies has led to increased ignorance and normalization of healthcare for the aged population (Bandelow, 2015, p. 12). The policy subsystems made of various stakeholders in Australia healthcare, the media, the community as well as international healthcare organizations such as the World Health Organization through the coalition has led to improved efforts in implementation of healthcare practices and especially community-based preventive practices for healthy eating and physical exercise have been critical in promoting healthy ageing in the country.
Review of the current Policy on Healthy Ageing
The current policy on ageing policy area in Australia is the Healthy ageing policy which is focused on increasing the longevity of individuals working population to an eligibility of 70 years to access aged care services. The policy seeks to promote increased participation in physical activities a way of active ageing and increased savings for healthcare at old age (Bousquet et al., 2015, p. 956). The policy impacts the labor markets that are required to change the existing retirement age to increase the time spent at work. This is because there was a mismatch between life expectancy in the country where people are living longer and the retirement policy in which people were retiring earlier. The policy has been found to be effective in promoting healthy ageing through the contribution of the increase in aged care services which have reduced government expenditures on aged care by approximately 30 per cent annually on health care services (Sadana, Blas, Budhwani, Koller & Paraje, 2016, p. 181). The healthy ageing policy has contributed significantly to the promotion of public health principles of equity, social justice as well as addressing social discrimination. Through the establishment of a retirement policy for eligibility to aged care has provided an equal opportunity for the development of market labor policies which do not discriminate some groups in the society. Social justice has also been achieved through increased participation and active engagement at work at old age without been discriminated against because of their social status of being old and been seen as an economic burden and challenge to the society.
Alternative Strategies
According to the Advocacy Coalition Framework, it is critical to developing an understanding of the policy alternatives as suggested by the interested stakeholder groups. These strategies play a critical role in shaping the policy implementation process. One of the alternatives raised by the World Health Organization is the fighting of non-communicable diseases over life-course. This is because non-communicable diseases have been found to contribute to increased mortality to people over the age of 60 years (Daskalopoulou et al., 2017, p. 15). This strategy will, therefore, contribute to increased health gains in at old age and hence an effective prevention and healthy ageing promotion strategy. Fall prevention strategies have also been suggested as effective strategies to enhance healthy ageing. According to the  reports by healthcare practitioners and the WHO as well as research, it has provided that raising over 30% of the people over 65 years and 70 % of the people over 80 years are at risk of fall. To promote healthy ageing, these stakeholders have suggested that creating awareness of risk factors for fall prevention, increasing physical exercise programs in community-based healthcare systems and balance retraining are critical in reducing falls in the country and promoting healthy lifestyles and better ageing in the country as well as globally.
Theoretical Framework Usefulness and Limitation
The Advocacy coalition framework has been effective in enhancing and promoting collective health efforts to improve the current aged care situations.  Through coalitions, it has been effective in enlarging the policy base support through networks and coalitions which is critical for any successful policy implementation. The theoretical framework also provides safety for advocacy efforts as well as protection for members who may not be able to take actions on their own as well as magnifying the existing financial resources by pooling them together towards a common objective (Nohrstedt & Olofsson, 2016, p. 21). The framework has also been effective in enhancing credibility and influence of advocacy campaigns as well as through the establishment of individual coalition members. However, the framework is limited in a number of ways in meeting its objectives or goals. The framework is limited in terms of its objectives as it lacks a clear objective as a result of increased difficulty to agree on common objectives from the stakeholders. It is also limited in terms of control since it is likely to be dominated by one powerful organization and also presents an increased potential for donor interference with the policy implementation process.
Conclusion
 Healthy life Better ageing policy can contribute to improved health care quality for the aged populations. Through the advocacy coalition framework, the policy can contribute to the development of effective strategies to address aged healthcare concerns in the country and globally. Development of coalitions with the relevant stakeholders who have interest in the healthy ageing policy will contribute to increased efficiency in the policy implementation. It will play a critical role in reducing health inequalities and the underlying socioeconomic factors which act as barriers to achieving equity, social justice as well as addressing social discrimination for the aged population.
List of References
Bandelow, N.C., 2015. Advocacy coalition framework. In Handbuch Policy-Forschung (pp. 305-324). Springer VS, Wiesbaden.pp.12.
Beard, J.R., Officer, A., de Carvalho, I.A., Sadana, R., Pot, A.M., Michel, J.P., Lloyd-Sherlock, P., Epping-Jordan, J.E., Peeters, G.G., Mahanani, W.R. and Thiyagarajan, J.A., 2016. The World report on ageing and health: a policy framework for healthy ageing. The Lancet, 387(10033), pp.2145-2154.
Bousquet, J., Kuh, D., Bewick, M., Standberg, T., Farrell, J., Pengelly, R., Joel, M.E., Mañas, L.R., Mercier, J., Bringer, J. and Camuzat, T., 2015. Operational definition of active and healthy ageing (AHA): a conceptual framework. The journal of nutrition, health & aging, 19(9), pp.955-960.
Coombes, J., Lukaszyk, C., Sherrington, C., Keay, L., Tiedemann, A., Moore, R. and Ivers, R., 2018. First Nation Elders’ perspectives on healthy ageing in NSW, Australia. Australian and New Zealand journal of public health.pp.123-140.
Daskalopoulou, C., Stubbs, B., Kralj, C., Koukounari, A., Prince, M. and Prina, A.M., 2017. Physical activity and healthy ageing: a systematic review and meta-analysis of longitudinal cohort studies. Ageing research reviews, 38, pp.6-17.
Henry, A.D., Ingold, K., Nohrstedt, D. and Weible, C.M., 2014. Policy change in comparative contexts: Applying the advocacy coalition framework outside of Western Europe and North America. Journal of Comparative Policy Analysis: Research and Practice, 16(4), pp.299-312.
Howlett, M., McConnell, A. and 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), pp.65-79.
Jenkins-Smith, H.C., Nohrstedt, D., Weible, C.M. and Ingold, K., 2018. The advocacy coalition framework: An overview of the research program. In Theories of the policy process (pp. 145-182). Routledge.
Jenkins-Smith, H.C., Nohrstedt, D., Weible, C.M. and Sabatier, P.A., 2014. The advocacy coalition framework: Foundations, evolution, and ongoing research. Theories of the policy process, 3, pp.183-224.
McNamara, B., Rosenwax, L., Lee, E.A. and Same, A., 2016. Evaluation of a healthy ageing intervention for frail older people living in the community. Australasian journal on ageing, 35(1), pp.30-35.
Nohrstedt, D. and Olofsson, K., 2016. A review of applications of the advocacy coalition framework in Swedish policy processes. European Policy Analysis, 2(2), pp.18-42.
Pierce, J.J. and Weible, C.M., 2016. Advocacy Coalition Framework. American Governance, eds. Stephen Schechter, Thomas S. Vontz, Thomas A. Birkland, Mark A. Graber, and John J. Patrick. Farmington Hills, MI: Cengage Learning, pp.22-23.
Sadana, R., Blas, E., Budhwani, S., Koller, T. and Paraje, G., 2016. Healthy ageing: raising awareness of inequalities, determinants, and what could be done to improve health equity. The Gerontologist, 56(Suppl_2), pp.S178-S193.
Sotirov, M. and Winkel, G., 2016. Toward a cognitive theory of shifting coalitions and policy change: linking the advocacy coalition framework and cultural theory. Policy Sciences, 49(2), pp.125-154.
Weible, C.M. and Jenkins-Smith, H.C., 2016. The advocacy coalition framework: an approach for the comparative analysis of contentious policy issues. In Contemporary Approaches to Public Policy (pp. 15-34). Palgrave Macmillan, London.

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