Anaf, J.Freeman, T.Baum, F.2025-10-082025-10-082025International Journal of Social Determinants of Health and Health Services, 2025; 55(4):428-4402755-19382755-1946https://hdl.handle.net/2440/147693Changes to the public sector in Australia over recent decades result from the adoption of neoliberal policies and New Public Management techniques. By the 1990s Australian governments were privatizing a significant portion of public sector roles, including outsourcing a range of traditional government services, policy, and decision making to the private sector, often to large global consultancy firms. While much is known about privatization and outsourcing, less is known about the health and equity impacts. Using a qualitative approach, data collection included documents, website searches, Parliament of Australia Hansard transcripts, media items, and semi-structured interviews (n=11). Six key themes were identified, including the scope of outsourcing, consultants’ strategies, conflicts of interest, undermining the public sector, poor outcomes for the public, and implications for equity. The use of private sector actors in the Australian public sector has led to promoting private over public interests. There are legitimate reasons for governments to engage the services of global consulting firms in instances when public sector capacity cannot deliver specific highly specialized work. However, the current extensive use of consultants should be decreased through rebuilding public sector capacity to promote health and equity, and public over private interests.en© The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).privatization; outsourcing; health; equity; democracyHumansQualitative ResearchPrivate SectorPublic SectorHealth PolicyConflict of InterestOutsourced ServicesPrivatizationAustraliaHealth EquityJournal article10.1177/27551938251355452746206Anaf, J. [0000-0002-9562-2309]Freeman, T. [0000-0002-2787-8580]Baum, F. [0000-0002-2294-1368]