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PUBH5430 Public Health Advocacy Question: You are required to critically appraise a health issue related to one of the UN’s sustainable development goals (excluding the Health Goal) and discuss the application of a theory of change for effective health advocacy. Answer: SDGs or Sustainable Development Goals represent collection of 17 different global goals that have been enforced and formulated by the United Nations General Assembly, as a part of transforming the world by the year 2030 (Griggs et al., 2013). The goal selected for the assignment is goal 8 that titled ‘Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all’ (United Nations, 2017). Hence, the major issue identified with regards to the selected goal is unemployment and less economic growth. Joblessness, most commonly referred to as unemployment refers to the circumstances that encompass active searching for employment opportunities. Periods of recession are characteristically marked by high rates of unemployment. There are four major types of unemployment namely, structural, seasonal, cyclical, and frictional (Pigou, 2013). While the Austrian School of economics, new classical economics, and classical economics consider market mechanisms as reliable sources of unemployment elimination, the cyclical nature of the issue is emphasized by Keynesian economics (Hamilton, 2017). The issue is in accordance to the SDG owing to the fact that reducing rates of unemployment, increasing productivity of labour, and enhancing the access to different financial benefits and services are considered imperative for economic growth of the nations. “What’s the Problem” analysis- ‘What’s the problem represented to be?’ refers to an approach related to policy analysis that elaborates on the different ways by which the policies are able to represent the problems and the impacts of such problematisations. The WPD approach is based on a discourse analysis and post-structuralist theory and focuses on drawing conclusions from the findings presented by governmentality scholars. The major attribute of the WPD approach can be associated with the fact that the government is considered largely responsible for the development of major problems in the society (Bacchi, 2009). The government when fails to guarantee complete employment opportunities to the citizens through the enforcement of monetary policies, fiscal policies, and trade policies, leads to joblessness. In other words, involuntary unemployment can be accredited to the lack of government intervention, market structure, and levels of aggregate demands that are found to operate an individual. The six questions encompassed by the WPR approach focus on the problem, the presuppositions, representation, silences, effects, and dissemination. It can be stated that the SDG focuses on higher rates of unemployment among women and youth, among other population groups. Furthermore, it also elaborates on the high rates of child labour (85 million), with the majority working in the agricultural sector (United Nations, 2017). Besides general economic assumptions, underemployment and unemployment has also been found to create an impact on the product experiences that pay the joblessness benefits. This in turn reflects the probable loss of the household income. Furthermore, the issues that are critical to economy and sustainable growth such as, power load management remain unaddressed (Schmitt-Grohé & Uribe, 2016). Unemployment has been found to go hand-in-hand with lack of secure housing and also carriers several disadvantages related to health. Unemployment and lack of economic growth has the potential of putting the health of the individuals of a nation at risk and this risk is usually greater in regions where there occurs widespread joblessness (Benach et al., 2014). Unemployed people and their immediate family members are at an increased risk of facing premature death and other health co-morbidities. The health impacts of unemployment and poor economic growth are related to financial problems and major psychological consequences that are related to debt (Vives et al., 2013). Unemployed and homeless people are exposed to worse health outcomes, which can be accredited to the fact that lack of secure job and housing results in poor living conditions and insecurity of food. Additionally, the people also show an increased tendency to access self-care resources. Jobless people also reside in places that do not have access to primary healthcare facilities or with little transportation options. These issues lead to the onset of major challenges for the healthcare provider in reaching the unemployed patients. Furthermore, the establishment of the patient-provider relationship are also not established under such circumstances, thus impeding the process of effective treatment (Herbig, Dragano & Angerer, 2013). Thus, residents of a state or nation with slow economic growth are often in need of steady primary care services. In addition, macroeconomic changes that occur in a nation, in accordance to the world economy also plays an important role in the poor health of the unemployed. Some of the major health issues found in the unemployed population include anxiety, depression, hypertension, high cortisol, poor mental status, cardiovascular problems and mortality (Brydsten, Hammarström & San Sebastian, 2018). Thus, it can be stated that poor income, low social status, economic deprivation and low cash margin are largely responsible for impeding physical and mental health among the unemployed. From the review of problems faced by unemployed people, it is seen that their health and well-being is seriously hampered because of poor job security. They lead a poor quality of life because of regular exposure to stress and anxiety. This is because unemployment comes with its own package of troubles and difficulty for patient and loss of job make them prone to depression (Holland, 2012). Hence, to effectively address the issue, there is a need to use a theory of change framework to prepare for health advocacy on the issue. Application of the theory of change framework is important as it help to adapt appropriate process to engage in change process and health advocacy for unemployment. As per the UN goal 8, the main goal is to promote inclusive, sustainable and economic growth and full employment for all. Hence, the role of certain organizations and focused campaigns is essential to maintain equal employment for all. Application of theory of change will help to understand the manner in which health advocacy for the issue can be executed. A theory of change is the set of pathways that defines the manner in which desired outcomes can be achieved. It is a conceptual model for achieving collective vision (Arensman, Van Waegeningh & Van Wessel, 2018). Application of the theory of change can significantly transform the advocacy strategy and increase the likelihood of achieving maximum impact from a public campaigns or organization alliance in relation to preventing unemployment issue. The theory of change is an approach that defines how an organization can achieve specific long term outcomes through a logical sequence of intermediate outcomes (Breuer et al., 2015).  Public health advocates and funders can use the theory of change in different ways. After the problem analysis process, the ‘Policy Windows theory can be applied to address unemployment issues in Australia. This theory is a part of agenda setting approach where the aim is to increase the attention of the issue on the policy agenda. This is particularly important when any problem has not achieved enough attention during the policy making process (Stachowiak, 2013). For example, in case of Australia, it has been found that policy thinking is advanced but limited attention has been paid to employment related issues. Australian government has invested on mental health, however collaborative government action across employment sector is very limited (OECD, 2015). Hence, the Policy Windows theory can help to advocate for strong policies in relation to equal employment for all. The Policy Windows theory can increase the attention of the political organization towards the unemployment issue by following the three step process of defining the problems to policy makers (problems), generating ideas to policy makers (policies) and inclusion of political factors like interest group and advocates in the change process (politics).  In addition, the success of the theory of change will depend on successful amalgamation of the three components. Hence, the three step process can act as a pathway to identify the strategies that can be implemented to advocate for people with unemployment issues. The first strategy for public health advocacy in relation to unemployment is to understand the magnitude of the issue by monitoring indicators or promoting constant feedback (Stachowiak, 2013).. Hence, non-government organization can be recruited to conduct a rapid survey with population and understand the extent to which unemployment and lack of job opportunities has affected lives of people. The data obtained from the survey can be used as the foundation to influence political bodies and raise attention towards the issue by means of a well planned campaign. Evidence has revealed that NGOs are important part of health policy and social systems. They play a major role in promoting social integration, building civil society and promoting participatory democracy (Piotrowicz & Cianciara, 2013). However, appropriate monitoring and self-regulatory activities needs to be implemented to confirm the validity and credibility of the work. The first strategy of collecting statistics on unemployment has the advantage of increasing the validity of the campaigns that can be implemented in the next step of the change process. Social media campaigns and media advocacy has the advantage of influencing the political climate related to the unemployment issues (Hornik, 2018). As it has been pointed out that unemployment has not received proper attention in policies, media advocacy can play a role in reducing unemployment. In the era of digitalization, increasing awareness about an issue through mass media has become a very easy task. Important and directive message can be disseminated to large class of public in a very short time. Social media or online platforms are strong sources to tackle public health issue and address economic and social crisis for affected people. The success of this type of strategy is understood from the review of a youth employment campaign implemented in UK. The campaigns used videos to show stereotyping of youths and after watching the video, the viewers are asked to provide job opportunities to such youth and send a tweet (Kate, 2015). Hence, this form of content is likely to have large impact and promote change process. In addition, coalition with many employment agencies and government can play a role in building capacity towards the changes process. Public health agencies and health promotion staffs can engage in constructive dialogue with government and other stakeholders to understand ways to change social norms, reduce disparities and set new precedents in relation to job opportunities. Proper collaboration among service providers and the backup of the governments towards a strong job policy would help to address issues faced by people with employment and rectify social determinants factors that impede their opportunity to get employment. The essay gave an insight into the need for health advocacy in relation to the issue of unemployment and limited job opportunities for youth. As unemployment has been associated with both physical and mental health effects, problem analysis was necessary to achieve the goal 8 of the UN sustainable development goals. The Bacchi framework was used to engage in problem analysis and the Policy Windows theory of change framework was used to engage in health advocacy in relation to the unemployment problem. The evaluation and critique of the strategies used suggest media advocacy has the potential to increase government’s attention towards unaddressed social issues and take constructive steps towards well-being of citizens. References: Arensman, B., Van Waegeningh, C., & Van Wessel, M. (2018). Twinning “Practices of Change” With “Theory of Change” Room for Emergence in Advocacy Evaluation. American Journal of Evaluation, 39(2), 221-236. Bacchi, C. (2009). Analysing policy. Pearson Higher Education AU. Benach, J., Vives, A., Amable, M., Vanroelen, C., Tarafa, G., & Muntaner, C. (2014). Precarious employment: understanding an emerging social determinant of health. Annual review of public health, 35. Breuer, E., Lee, L., De Silva, M., & Lund, C. (2015). Using theory of change to design and evaluate public health interventions: a systematic review. Implementation Science, 11(1), 63. Brydsten, A., Hammarström, A., & San Sebastian, M. (2018). Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health. International journal for equity in health, 17(1), 59. Griggs, D., Stafford-Smith, M., Gaffney, O., Rockström, J., Öhman, M. C., Shyamsundar, P., … & Noble, I. (2013). Policy: Sustainable development goals for people and planet. Nature, 495(7441), 305. Hamilton, D. (2017). Evolutionary economics: A study of change in economic thought. Routledge. Herbig, B., Dragano, N., & Angerer, P. (2013). Health in the long-term unemployed. Deutsches Ärzteblatt International, 110(23-24), 413. Holland, K. (2012). Effects of Unemployment on Health and Mental Health Based on Gender. Retrieved from: Hornik, R. (2018). Public health education and communication as policy instruments for bringing about changes in behavior. In Social marketing (pp. 45-58). Psychology Press. Kate, M. (2015). Youth employment campaign asks ‘Give them a job’. Retrieved from: Organisation for Economic Co-operation and Development (OECD). (2015). Mental Health and Work AUSTRALIA ASSESSMENT AND RECOMMENDATIONS. Retrieved from: Pigou, A. C. (2013). Theory of unemployment. Routledge. Piotrowicz, M., & Cianciara, D. (2013). The role of non-governmental organizations in the social and the health system. Przeglad epidemiologiczny, 67(1), 69-74. Schmitt-Grohé, S., & Uribe, M. (2016). Downward nominal wage rigidity, currency pegs, and involuntary unemployment. Journal of Political Economy, 124(5), 1466-1514. Stachowiak, S. (2013). Pathways for change: 10 theories to inform advocacy and policy change efforts. Seattle: ORS Impact. United Nations. (2017). PROGRESS OF GOAL 8 IN 2017. Retrieved from Vives, A., Amable, M., Ferrer, M., Moncada, S., Llorens, C., Muntaner, C., … & Benach, J. (2013). Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health. Journal of environmental and public health, 2013.

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