Observations of corporate and political interests in public health: improving health equity in the context of drugs, gambling and refugee health

This thesis presents studies that were undertaken as a Fellow of the Victorian Public Health Training Scheme (VPHTS) funded by the Victorian Department of Health. The purpose of this two-year workforce capacity building program is to develop individuals capable of taking on positions of leadership in public health. To fulfil the requirements of the VPHTS the author completed a series of research projects across a diverse range of professional placements. The four studies presented here use different methods, address four contemporary public health challenges – and were developed in consultation with host organisations to inform program, policy or practice improvements. The specific studies were: • A study reviewing trends in oxycodone-related deaths and community supply of this drug to Victoria from 2000-2009. This was the main output of a placement with the Victorian Institute of Forensic Medicine (VIFM). • A population-based review of heroin-related deaths in Victoria from 1990-2010. This study identified trends in the detection of benzodiazepines in heroin-related deaths as well as the community supply of these drugs. This was undertaken whilst based at the Victorian Department of Health. • A study of the relationship between socioeconomic disadvantage and gambling harm. This study also produced a spatial model of vulnerability to harm across Melbourne. This was the main academic product of a placement at the Victorian Health Promotion Foundation (VicHealth). • A qualitative study exploring the maternal and mental health of Afghan refugees in south-east Melbourne. This study used interviews and focus group discussions with Afghan community representatives, community and health workers in the region. This study was conducted whilst based at the Victorian Foundation for Survivors of Torture and Trauma (Foundation House). This apparently eclectic mix of research is presented to demonstrate breadth and a capacity of the VPHTS fellow to tackle a range of contemporary public health challenges. The overall goal of this thesis is to contribute to understanding of how policies and programs can be developed to improve health equity. In doing so it uses a social determinants of health framework. Its objectives are to: 1. examine ways in which corporate and political interests influence public health; 2. contribute evidence and identify actions to improve health equity; and 3. reflect on how evidence may be used to address the social determinants of health and improve the health of vulnerable populations. A social determinants of health framework requires an understanding of where, how and for whom inequity is created in order to improve health for all. The studies explore the differential burden of disease within populations by exploring geographic, cultural and/or socioeconomic factors. Each study incorporates a critical reflection of the research findings and a discussion of how a discourse of ‘vulnerable populations’ can shift attention from social and structural forces that create vulnerability. This can lead to an emphasis on internal deficiencies and individual responsibility. The thesis observes how corporate and political interests may contribute to the entrenchment or perpetuation of inequity, through increasing the supply of harmful products and corrupting the evidence base.