Dr Hannah Pitt and Dr Christina Zorbas will use their recently awarded VicHealth Fellowships to focus on creating opportunities for the voices of underrepresented groups, such as young people and people experiencing disadvantage, to reach policymakers so they can have a real say in the decisions that affect them.
Institute Director Professor Anna Peeters says the awarding of both available Fellowships to Institute researchers highlighted the depth of talent amongst the Institute’s EMCRs. “At the Institute for Health Transformation we are clear that one of our key roles is to support the growth and development of the research leaders of tomorrow,” she says.
“It is a great pleasure to see two of our emerging research leaders recognised for the excellence and potential in partnership research that will drive improvements in the health of Victorians.”
Making young people’s voices count
“Everyone is talking about the importance of including young people’s voices in the process of making decisions about their health but the structural mechanisms to embed young people and allow them to make real change aren’t there. We haven’t been able to successfully and systematically implement effective, evidence-based ways of doing so yet.” Dr Hannah Pitt
Dr Hannah Pitt, from the Institute’s Determinants of Health research domain, will use her VicHealth Fellowship to explore how local government authorities (LGAs) can effectively engage young people in public health advocacy strategies to respond to the public health threats posed by tobacco, alcohol, gambling, and climate change.
“Many local governments have youth engagement and pathway plans, but very few of these plans specifically consider how young people could be effectively engaged in public health advocacy strategies to convince decision makers of the need for policy change relating to the commercial determinants of health,” Dr Pitt says.
Dr Pitt, a member of Local Government Working Groups related to public health issues, points out that while young people’s advocacy over climate change has seen an increasing effort to include their voices in decision making about issues that affect them, too often they still have no say in the final decision.
“We know young people need to feel empowered to have a say in decision making, but we also need to investigate the barriers and facilitators local government bodies face in including them in the process. We need to understand what’s viable and realistic and how we can bring together what young people want, what LGAs can do and what resources they need to make it happen.”
With a clear focus on the commercial and political determinants of health, Dr Pitt’s VicHealth Fellowship project aims to identify young people’s concerns about their health and welling associated with tobacco, alcohol, gambling, climate and food while exploring their motivations for participating in advocacy about these issues in their local communities and the factors that help or hinder their efforts. It will also develop a strategy for effective and realistic engagement of youth in public health advocacy initiatives and a practical toolkit for Victorian LGAs to help mobilise youth engagement in public health advocacy initiatives.
“Public health advocacy strategies have been used to successfully respond to a range of complex public health issues, most notably tobacco control, and are often centred on protecting young people from harm. However, while young people have played a role in many campaigns associated with their own health and wellbeing, there’s been limited research in how public health advocacy frameworks could be used to engage them in responding to key public health threats in more meaningful and systematic ways,” Dr Pitt says.
An online survey conducted by Dr Pitt’s research team in 2020 explored youth engagement (15-24 years old) in responses to climate change using a public health advocacy lens. While the findings showed young people have a strong motivation to be involved in advocacy, there were tensions between what they felt would effectively engage them in advocacy and what could actually be implemented. For example, young people were passionate about creating their own user generated content on platforms like TikTok, but this was hampered by the long approval times required in LGAs’ processes.
“We want to know how these tensions can be negotiated and overcome, not only in climate change, but in other areas of public health including tobacco, alcohol, gambling and food.”
Dr Pitt is no stranger to advocating for young people and public health issues, having been involved in multiple public health projects seeking to build capacity at the local level to respond to young people’s health and wellbeing. Her award-winning PhD research took a public health advocacy approach to examine the impact and influence of sports betting advertising on the attitudes, behaviours, and gambling consumption intentions of 8 – 16 year olds and her findings have had a significant impact on local community responses to the normalisation of gambling for young people, leading to the development of youth-led and co-designed interventions for youth gambling at local, national, and international levels.
They’ve also been used to support state, national and international policy reform surrounding young people’s exposure to gambling advertising and included in the development of education campaigns and community awareness programs like the Victorian Responsible Gambling Foundation’s (VRGF) Love the Game program and school-based education programs in Wales.
Her PhD thesis and subsequent research was also among the first to consider how public health advocacy can be used to engage young people in responses to complex public health issues relating to harmful industries.
Dr Pitt’s interest in the public health impacts of harmful industries was piqued while undertaking a social marketing subject during her Masters of Public Health (she also holds a Bachelor of Public Health Nutrition). The class was taught by the Institute for Health Transformation’s Professor Samantha Thomas, an internationally recognised public health sociologist specialising in public health advocacy strategies relating to young people.
“I was just fascinated by how harmful industries were manipulating people with their marketing tactics, so when Professor Thomas explained how gambling was a public health issue and suggested a PhD I was really excited by the opportunity,” she says.
“Since then, most of my work has been focused on engaging young people to have a say about issues relating to gambling. This Fellowship with VicHealth builds on that, with a wider focus on young people and the ways we can embed their participation in local government policy making on a range of public health issues.”
Read more about Dr Pitt’s work:
“It’s just everywhere!” Children and parents discuss the marketing of sports wagering in Australia
Factors that influence children’s gambling attitudes and consumption intentions: lessons for gambling harm prevention research, policies and advocacy strategies
What do children observe and learn from televised sports betting advertisements? A qualitative study among Australian children
Factors that shape the gambling attitudes and behaviours of older adults in Victoria
Kids as young as eight are at risk of developing gambling problems
Advancing equity in food policy
“The more I look into it, the more I think the number one action for health and equity really should be to make sure that people aren’t living below the poverty line.” Dr Christina Zorbas
Dr Christina Zorbas, from the Institute’s Global Obesity Centre (GLOBE) will her use her VicHealth Fellowship to find ways of reducing inequities in healthy diets in Victoria.
Her project, ADVANCing Equity and commUnity voiceS in food policymaking (ADVANCE-US), aims to identify food policy options that reflect the views of Victorians experiencing disadvantage and embed these into strategic advocacy efforts to increase political commitment for adopting equitable food policies.
“The voices and values of those experiencing social and economic exclusion are underrepresented in food policy decisions, research and advocacy efforts – with significant implications for the efficacy and equity impacts of such policies.”
She says Australian food policy research has made few attempts to place the voices, values and lived experiences of health inequities at the forefront of equitable food policy recommendations and advocacy efforts, even though obesity is estimated to affect half of Australians experiencing socioeconomic disadvantage by 2025.
“In Australia, diet-related health inequities are widening and unless food policy actions consider the voices, values, and first-hand experiences of diet-related health inequity, these inequities are likely to keep widening,” Dr Zorbas says.
“For decades, society has blamed and stigmatised people for having unhealthy diets and for living in poverty, with little effort made to listen to their stories. When you do make the effort, you see how difficult it is to eat healthily on a low-income. There are real structural barriers that most people don’t have the power to change. You can’t increase your income if you need government support to get by,” Dr Zorbas points out.
“It’s all very well to say people choose to eat healthily or not, but in reality, many people don’t have much flexibility to choose. They are doing the best they can with what they have to work with. Equitably improving the diet-related health of Victorians relies on addressing the conditions in which people are born, work, live and age – the social determinants of inequities in diets.”
Although she’s an Accredited Practicing Dietitian, Dr Zorbas admits she’s always been interested in the role equity and poverty play in poor diets and obesity.
“My dad and his family grew up in poverty in Greece, the type of poverty where you don’t have shoes to walk to school. When they came to Australia, like many migrants and refugees then and now, they ate what they could afford and what was most accessible, not necessarily what was most healthy. That’s what leads to weight gain, high blood pressure, kidney failure, type 2 diabetes. We need to better support people in these situations and help them overcome the barriers they face to purchasing and consuming healthy diets.”
Dr Zorbas and her research team will work with a cross-sectoral Advocacy Coalition of partners including the Victorian Aboriginal Community Controlled Health Organisation Inc (VACCHO), the Obesity Policy Coalition (OPC) and the Ethnic Communities Council of Victoria (ECCV) to establish an Advocacy Coalition to reduce inequities in diet-related health in Victoria. The project will also develop culturally appropriate, evidence-based and co-designed advocacy toolkits to advocate for food policy actions that reflect the voices and values of those experiencing social and economic disadvantage in Victoria.
Drawing on the project’s partnerships and the researchers’ expertise in the social determinants of health, health equity, policy analysis, and critical theory, Dr Zorbas’ team plan to conduct in-depth participatory research, including ethnographic fieldwork, alongside four groups of Victorians who commonly experience social and economic exclusion: Aboriginal and Torres Strait Islander peoples, migrant and refugee communities, people living in regional/rural areas, and people receiving low or no income.
“We need to keep having these conversations about health inequity – it’s too important not to. If we want government to change policies, we need the stories to support why they need to change. That’s what this project is at the end of the day: collecting those stories and putting them in front of the people who can change things.”
Dr Zorbas says the project’s findings have potential to increase political attention and commitment to equitable food policy actions and improving the health of Victorians.
“Our study can also be replicated with other groups and health topics to further elevate experiences with social and economic exclusion in policymaking, promoting increased adoption of policies that will reduce health inequities into the future,” she says.
The project builds on research Dr Zorbas conducted last year into how people receiving government income support spent the temporary increase in their payments during COVID-19 and how they fared afterwards. Dr Zorbas’ preliminary findings indicated the majority had spent any additional income on paying their bills and that permanent increases are urgently required to help people prioritise buying better quality food.
“What I find interesting is the intersection between food policies and social policies, because to improve health equity and diets we need to look at both sides,” she says.
“We know that people talk about food prices as a big barrier to eating healthy, so our research has looked at how to make healthy food more affordable. But when you look at the social policy side, you realise that if the little money people have is going towards paying the rent and bills, then we also need to advocate for governments to raise income support payments above the poverty line and invest more in affordable housing.
“It’s a systemic problem and we need action on all fronts. We need to change the traditional narrative that poverty is a choice. It is a different way of thinking about it, but I don’t see how we can reduce inequity in diets without thinking differently.
“All these social issues are health issues at the end of the day. We’re starting to make those links to social factors that drive obesity but there is still work to be done in this space.”
Read more about Dr Zorbas’ work:
Dr Christina Zorbas: HDR path and career highlights
Policy Opportunities to Equitably Promote Healthy Diets in High-Income Countries
National nutrition policy in high-income countries: is health equity on the agenda?
Getting the Price Right: How Nutrition and Obesity Prevention Strategies Address Food and Beverage Pricing Within High-Income Countries
Costing recommended (healthy) and current (unhealthy) diets in urban and inner regional areas of Australia using remote price collection methods
Streamlined data-gathering techniques to estimate the price and affordability of healthy and unhealthy diets under different pricing scenarios
To address social inequities in obesity, let’s focus on housing and education
Supermarkets put junk food on special twice as often as healthy food, and that’s a problem
Don’t believe the myths – taxing sugary drinks makes us drink less of it
EMCR COVID-19 Think Tank: opportunities for policy reform in Australia