The project

Promoting Equity, Environmental Sustainability and Health: a framework for local action
Updated 2018, project complete

Vegies at Christ Church community garden, St Kilda

In the “Promoting Equity, Sustainability and Health” project, I investigated how local health promotion in Victoria can promote equity and environmental sustainability.

This was a participant action research project, with the over-arching research questions:

  • How can we integrate a focus on both equity and environmental sustainability into our work in health promotion?
  • How can health promotion frameworks support this goal?
The project is now completed. I submitted the thesis on 7 December 2017. A summary of the project and findings is below.

The first stage of the project (2011-12) looked at:
  •  How local health and community workers and community members think they can promote equity and environmental sustainability; and 
  • Whether they see commonalities between the issues that make it feasible to address them together.
Results of stage one

Forum participants in a Victorian Primary Care Partnership (PCP) developed common principles for addressing equity and sustainability, including:
  • Take a community development approach, starting small and working out, and also advocate to government and power brokers
  • Respect elders and seek knowledge – ensure the wisdom of Aboriginal heritage and diverse cultures is given voice in programs, and build on evidence from what others have done 
  •  Address the causes – the social and economic factors that lead to inequity and environmental degradation. Health and community services can help people cope with the impact of these factors but that should not be their only focus. 
  • Make equity and sustainability everybody’s business – ensure the voice of disadvantaged people  is heard and also ensure the wealthy and powerful take responsibility
  • Focus efforts where they will have most impact – particularly for early life and disadvantaged groups
  • Ensure good communication – have clear messages, include the voice of disadvantaged people, and appeal to both reason and emotion in a balanced way
  • Plan for outcomes – develop meaningful indicators and evaluate these regularly, advocate for government and organisations to do the same
These principles reflect values of inclusion, cooperation and a shared responsibility for looking after each other and the earth, plus a commitment to working effectively.

Participants identified key action areas for promoting equity, sustainability and health, including:
  • Community gardens/affordable fresh food programs; improving housing and reducing energy costs; and developing clear advocacy messages 
  • Providing training and support (including payment) for community members to be champions, mentors and advocates and ensure the voice of disadvantaged people is heard
  • Working in settings (e.g. streets, neighbourhoods, housing estates, schools) and bringing different people together (e.g. age groups, cultural groups, Aboriginal elders and others)
  • Seeking funding for infrastructure such as community hubs
  • Incorporating a focus on equity and sustainability in all programs (potentially develop a checklist for sustainability similar to the ISEPICH Social Inclusion and Equity checklist)

In discussion groups, research participants also identified barriers to promoting equity and sustainability, such as individuals’ sense of ownership and entitlement to consumer goods, and the role of corporations. Research questions raised: what is the meaning of equity? what values underly these principles? what are the relevant discourses, including competing discourses?

Stage 2
In the second stage of the project (2013-15) the research was broadened to include two other PCPs in Victoria who were also addressing equity and environmental sustainability, Southern Grampians and Glenelg PCP (SGGPCP) and Wimmera PCP.

Some key questions in this stage were:
  • What actions have organisations or community members taken?
  • What are the factors that help or challenge them in doing this work?
Thirty eight research participants from the three PCPs had been involved in the project at this stage. They provided information on projects addressing environmental sustainability/climate change and equity/social justice.  

A table of projects (final number included is 32), including themes from analysis of potential benefits for environmental sustainability and equity, is shown here

The table below shows topics and themes regarding what helps or challenges people in this work. The themes in bold are the most common, while those in lighter shades and smaller fonts were less frequently mentioned. This does not necessarily mean that common themes are more important than less common ones.



Topic 1: “what gets to the table” - knowledge, evidence, policy and power

·        Knowledge, evidence and expertise 
·        Supportive government policies (at all levels of government)
·         Being flexible
·         Understanding how power or influence works in your community
·         Elected representatives
·         Local autonomy

·        Management, organisational culture
·        Changes of government policy and politicisation
·         Power, influence and inequality in general

Topic 2: “walk in their shoes” - engaging people and building relationships

·        Relevance to participants, partners and community
·        Contacts, networks, partnerships and collaboration
·         Leadership, champions 
·         Building relationships and trust

·        Engagement, particularly of ‘hard to reach’ participants

Topic 3: “that’s a point of view” - ideas, values and communication

·        Communication, language and underlying values
·         [Frameworks]*

·        Different ideas and understandings, ‘silos’, narrow definitions of health
·         Culture and practice, the way things are done

Topic 4: “funding is always an issue [but] money isn’t everything” - practical factors

·        Funding, time and resources (particularly funding)
·         Materials and technology

·        Lack of time, resources or money (particularly time and resources)
·         Burden of responsibility (volunteers)
·         Technical challenges
 * responses to specific question, therefore not strictly comparable 

Themes were checked with participants in stage three in 2016, and have been generally validated, but theme two 'walk in their shoes', particularly the challenges of engaging 'hard to reach' participants, was given more emphasis. I think this greater emphasis reflects challenges in health promotion generally, whereas the order of priority above reflects the particular circumstances at the time of the research in 2013. This was probably because research participants were talking about actual rather than potential projects, where participants had already been engaged, and because climate change was particularly politicised at that time, due to the approaching federal election.

Stage 3 Reflections

In 2015 I analysed all findings to date, using an ecofeminist theoretical framework. I also analysed health promotion frameworks, including the ISEPICH framework, in relation to the key findings, and wrote up a detailed project report.  

In 2016 I met with participants at one workshop and two follow up meetings in ISEPICH, and as part of two scheduled health promotion meetings in SGGPCP and Wimmera PCP, to present the key findings of the project and give participants an opportunity to provide feedback. Ethics approval for this stage was granted in January 2016. Results of the feedback sessions and some further reflections can be found here, here and here.
This was the final stage of research with participants. The total number who participated in the project overall was 52, plus myself as participant-researcher. There was also a larger number of people who participated through forums, discussions and comments on the project blog. I submitted the thesis on 7 December 2017.
A key conclusion is that the work of health promoters and community members promoting equity and environmental sustainability at local level has multiple potential benefits, but faces major political and discursive challenges. Health promotion frameworks fit well with the ethical basis of practice, such as the principles of caring, inclusion and localism, but do not appear to address the challenges. Supporting local work and addressing the challenges requires coordinated action and advocacy at local, state, national and global levels.
For more information, please contact me: Valerie Kay, PhD candidate, Monash University, Ph: (03) 99030252 or 0488294848 or email 


Colin Cook said...

May I suggest you look at Dr Steven Hail's article, 'Paying for public services.......' and 'The great economic divide explained' both on my website
Good luck with your project and Phd

Val Kay said...

Thanks, I will have a look