Table 5.

Summary of findings on enablers and barriers to progression of equity by SA HiAP.

Key Elements of Institutional Theory	Enablers	Barriers
Ideas	-Equity accepted by policy actors as legitimate public policy concern Statement on the importance of equity evident in policy documents	-Dominance of economic priorities over social policy ideas ‘Trickle down’ economic benefits expected to address equity without further action Equity not seen as core business Equity evident in some policy statements but shift to concrete focus on lifestyle/individual behaviour in strategies Lack of shared understanding of equity
Actors	-Policy actors have value base supportive of equity Policy actors feel able to act on policy statements concerning equity	-Lack of political will to deal with fundamental social structural issues Policy actors operate within constraints of government institutional priorities Focus on social determinants of health in intersectoral policy, with equity remaining implicit and invisible Co-benefits prioritise partner agencies’ agendas over health agenda
Institutions	-SASP provided initial mandate and focus for SA HiAP and included some equity focus Government intersectoral policy agenda driving public sector focus on complex problems (potential for this to include equity)	-Neo-liberalism an overarching meta-institution Shift in government priority setting documents away from equity Siloed framing of agency core business Process focus on intersectoral collaboration preferenced over outcome focus on equity