Stephanie M Topp

• PhD, MPhil (Devpt.Stud), MIPH
• Professor at James Cook University

Issue Addressed Nearly a million people die by suicide annually, with military personnel being at heightened risk. For every suicide, about 20 cases of suicidality, including ideation and attempts, are reported. Social determinants of health may influence suicide risk factors, but research within military contexts, particularly in Australia, is sca...

Taxes on sugar-sweetened beverages (SSBs) in Vanuatu and Fiji are praised for their alignment with the World Health Organization’s noncommunicable diseases Best Buy policy recommendations. SSB taxes also intersect with economic, trade and commercial interests as well as complex domestic and international power dynamics. Yet, to date, the role of th...

Background Culture and its practice is a recognised, but not well understood factor, in Aboriginal health and wellbeing. Our study aimed to explore how health and wellbeing are phenomenologically connected to cultural practices, foods, medicines, languages, and Country, through the platform of ‘on-Country’ camps facilitated by Aboriginal cultural k...

Background Aboriginal and Torres Strait Islander peoples’ have sustained their cultural practices for over 60,000 years which fundamentally impacts their health and wellbeing. Recent literature emphasizes cultural connection as a contributor to good public health, yet the mechanisms through which cultural engagement promotes health and wellbeing re...

Indigenous cultural health is an emerging field of research and reflects the unique connections Indigenous peoples have with their Country, culture, and knowledge systems. This narrative review explores the concept of cultural health focusing on the interplay between culture, health, and wellbeing within settler colonial contexts. The review is mos...

Issue Addressed An important part of preventing and managing Aedes ‐borne mosquito disease outbreak risk is engaging the community. Research shows that high‐income countries tend to use top‐down measures for Aedes mosquito management, favouring educational approaches to engage the community over participatory approaches that actively involve and em...

Background When managed effectively, oil wealth can drive economic development and improve wellbeing. Conversely, as has been the experience in Ogoniland in the Niger Delta, the presence of the oil industry can lead to environmental degradation and social and economic vulnerabilities with negative impacts on health and wellbeing. Few studies have e...

The final chapter presents a summary of the key themes and insights from the Elgar Handbook as workshopped in Dublin in October 2023 and developed by the named authors. Health system resilience is a potent and useful concept which has shown a versatility and appeal across a range of health system crises. Nevertheless, it still needs to gain maturit...

The concept of health system resilience has gained prominence in global health discourse, especially in response to the Ebola and COVID-19 pandemics. This commentary responds to Saulnier and colleagues’ 2022 review, which used the Dimensions of Resilience Governance framework to synthesize of COVID-19 related health system resilience research and e...

Introduction Australia’s ageing population is driving an increased demand for residential aged care services, yet concerns about the quality and safety of such care remain. The recent Royal Commission into Aged Care Quality and Safety identified various limitations relating to leadership within these services. While some competency frameworks exist...

Background People in correctional settings are a key population for HIV epidemic control.

In this analysis, we argue against seeing health system resilience as an inherently positive concept. The rise in the popularity of health system resilience has led to its increasingly normative framing. We question this widely accepted perspective by examining the underlying assumptions associated with this normative framing of ‘good’ resilience....

Background The vast region of northern Queensland (NQ) in Australia experiences poorer health outcomes and a disproportionate burden of communicable diseases compared with urban populations in Australia. This study examined the governance of COVID-19 surveillance and response in NQ to identify strengths and opportunities for improvement. Methods T...

Introduction The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in ‘cultural camps’ held on sites of cultural significance...

Background Aedes -borne disease risk is increasing in tropical and sub-tropical regions across the globe. While Aedes -borne disease continues to disproportionally affect low- and middle-income countries, parts of high-income countries, such as the Torres Strait region in Australia are also at risk. The Torres Strait is a group of islands located b...

Introduction The Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO’s Best Buys recommendations for addressing non-communicable diseases (NCDs), little is known about the tax’s adoption process or whose interests it serves. Methods Using case study methodology, th...

Objective: Knowledge is growing about cancer care and financial costs for Aboriginal and Torres Strait Islander people. However, much remains unknown about the true costs of cancer care, encompassing financial, emotional, and spiritual aspects. We aimed to explore and explain how non-financial costs affect the health-seeking behaviours of these cl...

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neg...

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neg...

Understanding the health status of a population or community is crucial to equitable service planning. Among other uses, data on health status can help local and national planners and policy makers understand patterns and trends in current or emerging health and well-being, especially how disparities relating to geography, ethnicity, language and l...

In this commentary, we reflect on how the three processes of translating, contexting, and institutionalising knowledge translation (KT) practices, as introduced in a critical interpretive synthesis on sustaining KT, might be drawn on to improve KT sustainability in the northern Australian health system, and some likely challenges. The synthesis pro...

Introduction: In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To add...

Introduction: While disengagement from HIV care threatens the health of persons living with HIV (PLWH) and incidence-reduction targets, re-engagement is a critical step towards positive outcomes. Studies that establish a deeper understanding of successful return to clinical care among previously disengaged PLWH and the factors supporting re-engage...

The onset and impacts of COVID-19 have prompted attention to national health system preparedness for, and capacity to adapt in response to, public health emergencies and other shocks. This preparedness and adaptive capacity are often framed as ‘health system resilience’ a concept previously associated more with assessments of health systems in conf...

Background: Corporations in unhealthy commodity industries (UCIs) have growing influence on the health of national populations through practices that lead to increased consumption of unhealthy products. The use of government-led public health surveillance is best practice to better understand any emerging public health threat. However, there is mi...

Medical professionals exercised structural and productive power in the Global Fund’s Country Coordinating Mechanism in Nigeria, directly impacting the selection of approaches to HIV/AIDS care, as described in a case study by Lassa and colleagues. This research contributes to a robust scholarship on how biomedical power inhibits a holistic understan...

Background Oil is the mainstay revenue for a number of African countries. However, extraction can result in multiple impacts on the health and wellbeing of communities living in oil-rich areas. This review explored evidence of oil industry-related social exclusion on community health and wellbeing on the African continent. Methods We used a system...

Fast Track models—in which patients coming to facility to pick up medications minimize waiting times through foregoing clinical review and collecting pre-packaged medications—present a potential strategy to reduce the burden of treatment. We examine effects of a Fast Track model (FT) in a real-world clinical HIV treatment program on retention to ca...

Health policy and systems research (HPSR) is critical in developing health systems to better meet the health needs of their populations. The highly contextualised nature of health systems point to the value of local knowledge and the need for context-embedded HPSR. Despite such need, relatively few individuals, groups or organisations carry out HPS...

Background Academic health centres (AHCs) are organisations that aim to mobilise knowledge into practice by improving the responsiveness of health systems to emerging evidence. This study aims to explore the population health role of AHCs in Australia and England, where AHCs represent novel organisational forms. Methods A multiple-case study desig...

Background Senior management teams in residential aged care facilities (RACFs) face a range of challenges in providing quality health care services. With increasing attention directed at quality problems in Australian RACFs, there is an urgent need to better understand the experiences of this crucial cadre. This qualitative study sought to identify...

Background Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous resear...

Background With increasing recognition of the quality and safety issues in residential aged care, there is an urgent need to better understand what skills senior managers require to deliver on the spectrum of leadership functions in residential aged care facilities. This qualitative study sought to explore the leadership skills that positively infl...

Objective: Australian federal, state and territory government responses to the COVID-19 pandemic have been subject to public oversight by various domestic inquiries and investigations, despite little analysis about what accountability these processes deliver in the context of public health emergencies (PHEs) involving communicable disease. This ar...

Background: In northern Australia, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are unique members of nominally integrated teams of primary care professionals. Spurred by research documenting ongoing structural violence experienced by Indigenous health providers and more recent challenges to recruitment and retention of A&TSIHWs...

Background Documented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills and personal qualities are necessary to d...

Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by...

Introduction Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-inco...

Introduction Rapid antiretroviral therapy (ART) initiation can improve patient outcomes such as viral suppression and prevent new infections. However, not everyone who can start ART does so immediately. Methods We conducted a qualitative study to inform interventions supporting rapid initiation in the ‘Test and Start’ era. We purposively sampled 2...

Power is a growing area of study for researchers and practitioners working in the field of health policy and systems research (HPSR). Theoretical development and empirical research on power are crucial for providing deeper, more nuanced understandings of the mechanisms and structures leading to social inequities and health disparities; placing cont...

Background Documented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of, and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills are necessary to deliver and strengthen...

Background In sub-Saharan Africa, 3 community-facility linkage (CFL) models—Expert Clients, Community Health Workers (CHWs), and Mentor Mothers—have been widely implemented to support pregnant and breastfeeding women (PBFW) living with HIV and their infants to access and sustain care for prevention of mother-to-child transmission of HIV (PMTCT), ye...

The focus of behavioural sciences in shaping behaviour of individuals and populations is well documented. Research and practice insights from behavioural sciences improve our understanding of how people make choices that in turn determine their health, and in turn the health of the population. However, we argue that an isolated focus on behaviour -...

Background With increasing recognition of the quality and safety issues in residential aged care (RAC), there is an urgent need to better understand the role of leadership teams who are often responsible for addressing these concerns. This qualitative study sought to explore the leadership skills that positively influence quality of care within Aus...

Background Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including r...

By 2050 the number of older persons is expected to double with figures reaching nearly 2.1 billion worldwide. This projection will challenge every nation’s ability to provide the leadership required to reform and develop systems of care for the aged. The purpose of this review is to explore senior management characteristics that impact the performa...

Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are a professional cadre of Australian health workers typically located in primary care clinics. The role is one of only two that is ‘identified’— that is, it must be occupied by an Aboriginal and/or Torres Strait Islander person — and holds specific responsibilities in relation to adv...

Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of ‘Health for All’. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health e...

Background: Both globally and in Australia, there has been a sharp rise in cesarean births (CB). Commonly, this rise has been attributed to the changing epidemiology of women giving birth. A significant body of knowledge exists on the risk factors associated with a greater need for cesarean. Yet, we have little information on the reasons recorded...

Objective The aim of this study was to report on the rates of obstetric interventions within each hospital jurisdiction in the state of Queensland, Australia.Methods This project used a whole-of-population linked dataset that included the health and cost data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n=186789),...

Introduction: Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues...

Background: Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement. Methods: From a probability-based sample of lost to follow-up, adult patients traced by peer educators from 31 Zamb...

Background While HIV programmes have started millions of persons on life-saving antiretroviral therapy in Africa, longitudinal health information systems are frail and, therefore, data about long-term survival is often inaccurate or unknown to HIV programmes. The ‘Better Information for Health in Zambia’ (BetterInfo) Study – a regional sampling-bas...

Purpose: Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-S...

Background: Taxation of tobacco, food, alcohol and other beverages has gained renewed attention in responding to non-communicable diseases (NCDs). While largely built on evidence from high-income countries (HICs), the projected economic and health benefits of these measures have increased calls for their use in price-sensitive low- and middle-inco...

Background Despite the global scale-up of antiretroviral therapy (ART), incarcerated people have not benefited equally from test-and-treat recommendations for HIV. To improve access to ART for incarcerated people with HIV, we introduced a universal test-and-treat (UTT) intervention in correctional facilities in South Africa and Zambia, and aimed to...

High-income countries (HICs) in sub-tropical and tropical regions are at an increasing risk of Aedes mosquito-borne disease (MBD) outbreaks such as dengue fever. As the Aedes mosquito predominately lives and breeds in and around people's homes, community participation in MBD management is an important part of preventing MBD outbreaks. Historically,...

Background Current models of HIV service delivery, with frequent facility visits, have led to facility congestion, patient and healthcare provider dissatisfaction, and suboptimal quality of services and retention in care. The Zambian urban adherence club (AC) is a health service innovation designed to improve on-time drug pickup and retention in HI...

This paper is a critical interpretive synthesis of community health workers (CHWs) and accountability in low-income and middle-income countries. The guiding questions were: What factors promote or undermine CHWs as accountability agents? (and) Can these factors be intentionally fostered or suppressed to impel health system accountability? We conduc...

Background In the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. T...

Background The aim of this study was to explore differences in experiences of care in Emergency Departments (EDs) for people with and without mental health conditions. Methods Secondary analyses of a survey of 15,995 patients from 82 EDs in New South Wales, Australia was conducted focusing on the most positive responses for 53 questions across nin...

Background: High quality maternity care is increasingly understood to represent a continuum of care. As well as ensuring a positive experience for mothers and families, integrated maternity care is responsive to mental health needs of mothers. The aim of this paper is to summarize differences in women's experiences of maternity care between women...

Background: It is known that health impacts economic performance. This article aims to assess the current state of health inequality in the tropics, defined as the countries located between the Tropic of Cancer and the Tropic of Capricorn, and estimate the impact of this inequality on gross domestic product (GDP). Methods: We constructed a serie...

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities...

Background: Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these est...

Background: The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes q...

Background: Designing effective universal health care systems has challenges, including the use of patient co-payments and the role of the public and private systems. This study sought to quantify the total amount of out-of-pocket fees incurred by women who gave birth in private and public hospitals within Australia-a country with universal health...

Aim: To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. Methods: CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base p...

Background: There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric...

Background: Sub-Saharan African correctional facilities concentrate large numbers of people who are living with HIV or at risk for HIV infection. Universal test and treat (UTT) is widely recognized as a promising approach to improve the health of individuals and a population health strategy to reduce new HIV infections. In this study, we explored t...

This review reflects on what the literature to date has taught us about how health systems of low- and middle-income countries (LMICs) respond to emerging infectious disease (EID) outbreaks. These findings are then applied to propose a conceptual framework characterising an EID prepared health system. A narrative synthesis approach was adopted to e...

Background: Although differentiated service delivery (DSD) models for stable patients on antiretroviral therapy (ART) offer a range of health systems innovations, their comparative desirability to patients remains unknown. We conducted a discrete choice experiment to quantify service attributes most desired by patients to inform model prioritizati...

Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to...

Background Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the numb...

Purpose To examine factors associated with unmet need for mental health services and links with barriers to access to care more broadly. Methodology The Commonwealth Fund International Health Policy Surveys from 2013 and 2016 were used to explore factors associated with unmet need for adults who experienced emotional distress for 1320 respondents...

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of...

Background: This Special Issue represents a critical response to the frequent silencing of qualitative social science research approaches in mainstream public health journals, particularly in those that inform the field of health policy and systems research (HPSR), and the study of equity in health. Methods: This collection of articles is presen...

Introduction Despite access to free antiretroviral therapy (ART), many HIV-positive Zambians disengage from HIV care. We sought to understand how Zambian health system ‘hardware’ (tangible components) and ‘software’ (work practices and behaviour) influenced decisions to disengage from care among ‘lost-to-follow-up’ patients traced by a larger study...

Background The Tropical Australian Academic Health Centre (TAAHC) is being established in northern Queensland across a vast rural geography. The study aim is to identify intended impact pathways and beneficiaries of TAAHC as well as experienced and anticipated challenges. Methodology The study is an empirical case study nested within a comparative...

Background: From 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. We present findings from a nested evaluation of the impact of eight PrHCs...

Purpose of review: To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release. Recen...

Background In public health HIV treatment programs in Africa, long-term retention remains a challenge. A number of improvement strategies exist (e.g., bring services closer to home, reduce visit frequency, expand hours of clinic operation, improve provider attitude), but implementers lack data about which to prioritize when resource constraints pre...

Standard operating procedures. (PDF)

Checklist for conjoint analyses methods and reporting. (DOCX)

Results of evaluation of DCE statistical efficiency. DCE, discrete choice experiment. (DOCX)