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PubMed2005

Making health policy: networks in research and policy after 1945.

Science and policy in health and medicine have interacted in new ways in Britain since 1945. The relationship between research and policy has a history. The changing role of social medicine, the rise of health services research and "customer contractor" policies in government have been important. The relationship between research and policy has been analysed by different schools of thought. This chapter categorises them as several groups: "evidence-based", "journalism", "sociology of scientific knowledge" and "science policy studies". The chapters in the book illuminate aspects of these changing relationships. The role of chronic disease epidemiology, of new networks in public health, of media-focussed activism, and of health technology and its advocates have been more important than political interest.

Biomedical Research↗
PubMed2005

Bridging the gap between doctors and policymakers: the use of scientific knowledge in local school health care policy in The Netherlands.

BACKGROUND: The decentralization of school health care policy in The Netherlands was followed by an increase in diversity, which was most often not evidence-based. This study aims to clarify the use of scientific knowledge in school health care policy-making processes: multi-actor processes in networks, trying to solve certain problems. METHODS: Case-study design in four Municipal Health Service regions, using documents and half-structured interviews as data sources. RESULTS: Scientific knowledge is used by only 42% of the actors in 58% of decision-making rounds in policy-making processes. 'Recent' regional data on health indicators are used more often than 'established' (inter)national knowledge of theoretical models. Mainly school health professionals use knowledge as a resource to influence the policy process. Other actors (e.g. managers and municipalities) use formal power, money or 'initiative' as their main resources. Powerful actors put forward less scientific knowledge than actors in dependent positions. Individual actors with a combined scientific and political frame of reference put forward knowledge most frequently, especially in complex networks with many actors, more than one powerful actor, more than one arena, more than one dominant resource and more than one dominant frame of reference. CONCLUSION: The use of scientific knowledge in school health care policy-making processes can and must be improved. Liaison officers can bridge the gap between doctors and policymakers, especially in complex policy networks. They combine a scientific and a political frame of reference and act upon scientific knowledge as a resource in their efforts to influence the policy-making process.

Adolescent↗
PubMed2001

Environmental quality and sustainability in the province of Reggio Emilia (Italy): using multi-criteria analysis to assess and compare municipal performance.

Sustainability has become an increasingly significant issue, although practical implementation remains difficult. In Italy, promoting sustainability is particularly problematic at the provincial and municipal level, where the lack of resources and expertise, and the effects of uncoordinated policies make it difficult to achieve minimum requirements to make sustainable policies operational. One essential requirement is knowledge of baseline environmental conditions in each municipality. In the province of Reggio Emilia (Northern Italy) Legambiente, an environmental association, launched an initiative called 'Ecopaese' aimed at gathering data on environmental conditions and stimulating local administrations to implement sustainable policies. To this end, the state of the environment in the 45 municipalities within the province has been monitored using 25 indicators. Their values have been used to rank the municipalities by multiple criteria analysis (MCA). The results of this comparative approach provide information about the level of sustainability attained in the province as a whole as well as in the single municipalities. It is hoped that it will provide the basis for direct action plans at the provincial level by identifying areas for remedial action, as recommended by Agenda 21, the declaration adopted by many countries attending the Rio Summit in 1992.

Conservation of Natural Resources↗
PubMed2002

Discourse in different voices: reconciling N = 1 and N = many.

When groups are convened to discuss the making of policy, people are chosen to represent particular interests because they have relevant experience. Different stakeholders, however, may use differing discourses, and particular discourses may be privileged in particular contexts. This means that important contributions to the discussion may not be reflected in final reports. Discursive incommensurability is particularly seen when individual, personal experience is presented in meetings where quantification or "numbers talk" is privileged. While pooled personal experience may carry some weight in such a context, individual anecdote does not. The inclusion of 'consumers' in policy making groups may result in their dysempowerment. Their presence promises that they will have influence, but their voices disappear from the final document. The promise of empowerment is not realised. Dysempowerment may translate into empowerment with time, as it has done with feminism and the HIV/AIDS lobby. In order to speed the process, we suggest some practical means whereby mixed discourses may be generated and monitored. For constructive interchange, each party to the discourse needs to express the interests and arguments relevant to the group he or she represents. Supporting this principle of representation are principles of implicature and radical respect. Implicature is the act of implying what is relevant to others involved in the discourse. Radical respect is a fundamental and foundational respect for others in their roles as representatives of stakeholders with legitimate interests in the topic of the discourse.

Australia↗
PubMed2001

[Policy science and health policy].

Policy science provides the analytical frameworks to examine (1) the process of policy formation and implementation (Issue definition, Agenda setting, Alternative development, Decision and implementation, and Appraisal); (2) the initial and final shapes of policy content (Temporal and special distribution of costs and benefits, Selection of administrative organizations, and Choice of instruments to secure policy compliance); and (3) the effects and efficiencies of policy (Expected and unexpected effects of policy, beneficial and adverse ones). These three aspects are closely associated, and determine the functions of policy in society. Overseas, the application of policy science framework to health issues has thus far produced substantive knowledge which helps to improve both the policy making and policy designs, and at the same time, has provided good opportunities on which the workings of health and policy, both at the social and individual levels, are explored. The paper first outlines the themes and frameworks of political science, and then, introduces their application to the field of health. Issues associated with human life and health have special characteristics that distinguish them from those of other market commodities: special values placed on life and health, information inequality between service providers and consumers, and externalities, leading to a variety of moral hazards and market failures. Furthermore, there are some conflicts in values and technical opinions in society, regarding both the ends and means of health policies. In addition to the main topics in the field, empirical studies, from Japan or from other countries, are also summarized. Finally, future research needs and expectations are addressed.

Efficiency, Organizational↗
PubMed2005

Life cycle assessment in management, product and process design, and policy decision making: a conference report.

On 24 September 2003, life cycle assessment (LCA) practitioners and decision makers gathered at the InLCA/LCM Conference in Seattle, Washington, USA (see http://www.lcacenter.org/InLCA-LCM03/index.html) to discuss the role of LCA in management, product design, process development, and regulatory/policy development decisions and to compare life cycle-based methods and tools with traditional product evaluation methods and tools. This article is a summary of that meeting and was prepared by the organizers as an overview of the many different technical, regulatory policy, and decision-making policy perspectives presented to an international gathering of participants representing academia and the industrial and regulatory communities.

Decision Making↗
PubMed1995

A conversation about the work environment.

The author looks at work environment matters from the perspective of public policy-making and the policy instruments used to deal with workplace health and safety: standard setting; joint health and safety committees; compliance, enforcement, and prosecution; workers' compensation as an economic incentive; and collective bargaining. While regarding all as necessary, the author considers them as separately and collectively, fundamentally flawed and therefore insufficient, because liberal public policy-making itself is problematic. He proposes an alternative way of thinking about this subject from the perspective of the "politics of meaning."

Canada↗
PubMed1989

Making health policy management intersectoral: issues of information analysis and use in less developed countries.

There is a growing awareness of the need to approach health problems intersectorally. This has important implications for health policy management, centrally so for the informations systems which should enable 'managers' to monitor performance and also provide feedback to those with broader policy responsibilities. Yet relatively little is being done to adjust the information systems to this new intersectoral awareness: the focus of health information systems remains the collection of health service data. Much of the information collected is not used to provide adequate feedback to planners and managers, and to influence programme implementation. The paper--which focuses on the problems in less developed countries--argues that more attention needs to be paid to analysing the expected links between interventions and outcomes, as well as to cost considerations. Flexible procedures are required to address locally or regionally relevant problems. Thought must be given to making information of interest to health workers by linking it to the outcomes of activities, and by enabling them to discuss the implications of findings. Community members may also be thus involved. Often such processes are wholly neglected. The paper examines institutional and political arrangements that influence the capacity to use information for management and policy making, and which need to be understood if information systems are to be broadened beyond the health sector. The paper ends by discussing the main indicators which have been proposed, and occasionally used, to broaden health monitoring in an intersectoral direction. It argues that much relevant information is being routinely produced by the various departments and discusses briefly how such information can be used to build up gradually an intersectoral information system for health.

Decision Making, Organizational↗
PubMed1997

The limits of social learning: translating analysis into action.

In what respects does public-policy making reflect social learning, drawing lessons from previous experiences and from the experiences of governments in other settings? Starting with an examination of the effect of policy legacies on current policy making, I present a process model of social learning embedded within the larger policy-making process resting at the intersection of the nation's constitutional context, technological change, and political influences exogenous to social learning. The model first distinguishes between the structural and the social learning effects of policy legacies. I then conceptually divide social learning into separate streams of substantive learning and situational learning. The effect that each of these has on policy making depends on the relative position of three categories of participants in the policy-making process (experts, organized interests, and politicians), as well as on the scope of the policy issue being considered (ranging from routine change to major reform). This analysis, with reference to recent health care policy making, reveals the full extent to which social learning is often a decidedly political struggle over ideas and information in which advocates promote lessons that severe their specific interests within a given institutional context and political setting. I consider the implications of social learning for understanding likely policy responses to the rise of market forces in health care.

Economic Competition↗
PubMed2003

Strategic management and public policy.

Making strategic decisions that ensure a productive fit between the internal situation and external environment of a healthcare entity--sometimes, even decisions that ensure its survival--is a great challenge. The author suggests that hospitals must adopt specific strategies to anticipate and respond appropriately to changes in policy.

Administrative Personnel↗
PubMed2005

Research use in children's mental health policy in Canada: maintaining vigilance amid ambiguity.

Many researchers hope to see the best available research evidence used in policy-making to address important public problems. However, policy often appears to be based on anything but the research evidence, as the problem of conduct disorder (or severe antisocial behaviour in children) shows. In Canada, few children receive effective prevention or treatment programs, and incarceration is overused, despite evidence that it is ineffective and potentially harmful. Using the example of conduct disorder, we investigated why policy-making has not reflected the research evidence, examining research use in the context of competing influences on the policy process. Qualitative methods were used to analyze data from interviews with thirty-two politicians and senior civil servants. Our allegiance to rationality wavered as we listened to policy-makers who contended with the inherent ambiguity in the policy process. They told us that they managed institutional constraints including fragmentation across levels and sectors of government, and the long-term effects of fiscal restraint. They also reconciled the competing interests of stakeholders' priorities, the public's response to negative events involving children and the media's role in shaping this response. Ideas about youth violence were morally charged, but policy-makers remained committed to improving children's lives. Day-to-day, policy-makers obtained most of their information internally and informally. Research evidence was valued and used, but as just one source of ideas and information among many. In this environment of ambiguity, creative civil servants formed partnerships with trusted researchers in order to change policy. Our findings suggest that the use of research evidence in policy-making could be enhanced if researchers learned about the competing influences on the policy process, formed research-policy partnerships, challenged the incentives within research institutions, and engaged in public debates about important problems, such as child antisocial behaviour.

Child↗
PubMed1999

Making U.S. Maternal and Child Health policy: from "early discharge" to "drive through deliveries" to a national law.

OBJECTIVES: To examine the national policy-making process in maternal and child health through a case study of the passage of a national law aimed at extending postpartum hospital stays. METHODS: The study is based on a review of official and unofficial documents associated with the bill's legislative progress as well as an examination of scholarly research on early discharge and media coverage of the issue. Interviews were also conducted with legislative and interest group staff. RESULTS: The passage of early discharge legislation occurred in an unusually short time frame and was aided by its minimal public costs, the willingness of its supporters to compromise on key elements, and its perceived appeal to female voters in an election year. Clinical and public health research had little influence on the process. CONCLUSIONS: Maternal and child health advocates, while facing a problem with a politically weak constituency base, can benefit from their important symbolic role in policymakers' minds. They must respect the importance of compromise to legislative institutions and be alert to opportunities to frame their issues in a politically popular way.

Child Welfare↗
PubMed2004

A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes.

OBJECTIVES: to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes. DESIGN: a cluster randomised controlled trial of the policy in nursing and residential homes, with the home as the unit of randomisation. SETTING: 127 nursing and residential homes in the greater Belfast area of Northern Ireland. PARTICIPANTS: 40 homes in the intervention group (representing 1,366 occupied beds) and 87 homes in the control group (representing 2,751 occupied beds). INTERVENTIONS: a policy of making hip protectors available free of charge to residents of nursing homes and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use, over a 72-week period. MAIN OUTCOME MEASURES: the rate of hip fractures in intervention and control homes, and the level of adherence to use of hip protectors. RESULTS: there were 85 hip fractures in the intervention homes and 163 in the control homes. The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes, giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 (95% CI 0.77, 1.43, P = 0.76). Initial acceptance of the hip protectors was 37.2% (508/1,366) with adherence falling to 19.9% (272/1,366) at 72 weeks. CONCLUSIONS: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture. This research does not support the introduction of a policy of providing hip protectors to residents of nursing homes.

Accidental Falls↗
PubMed1988

Managing new technology: economics research and practical decisions.

Rapidly advancing health technology poses problems for managers. Although clear conceptual frameworks exist for economic evaluation, in practice severe problems remain in carrying out timely research that is locally appropriate to the needs of managers. This paper explores some of these problems in the context of the policy analysis interface between economic research and the management of technology. In the light of experience gained from recent evaluation research it indicates how researchers and managers can each contribute to the provision of a stronger empirical basis for policy making and policy management. An earlier version of this paper was presented at the joint meeting of the Health Economists Study Group and Institute of Health Service Management, University of York, 6-8 July 1987. The author would like to thank Christopher Spry and Mike Drummond for helpful comments.

Decision Making↗
PubMed2001

Barriers to employment-related healthy public policy in Canada.

The Ottawa Charter for Health Promotion calls for building healthy public policy, that is for '[putting] health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health'. The objective of this study was to assess the past and potential future influence of information about the health consequences of unemployment and job insecurity on policy making and to identify the barriers to the use of such information in policy making. We conducted telephone interviews with 38 policy makers in the health and employment sectors of all three levels of Canadian government, as well as the executive directors of 10 Canadian non-governmental organizations that are active on employment issues. The interviews included both numerical ratings of the influence of this information and semi-structured questions about how this information could be used in policy making. Using an interpretive approach grounded in the political science literature, we identified barriers to using this information in their responses to these questions. Respondents rated the potential future influence of this information (mean 4.2 and median 5 on a seven-point Likert scale) higher than its past influence (mean 3.5 and median 3 on a seven-point Likert scale). Barriers related to the information itself or more commonly to the values of those who could respond to the information (i.e. idea-related barriers) were cited more frequently than either barriers related to how decisions are made (i.e. institution-related barriers) or barriers related to who would win and who would lose if the information were acted upon (i.e. interest-related barriers). We concluded that to build employment-related healthy public policy, these barriers would have to be overcome. Policy makers in health departments could, for example, frame information about health consequences in language that fits more easily with the values of other departments and advocate for institutional innovations that establish cross-departmental or cross-governmental accountability for health.

Administrative Personnel↗
PubMed2002

Environmental vulnerability indicators for environmental planning and decision-making: guidelines and applications.

Environmental decision-making and policy-making at all levels refers necessarily to synthetic, approximate quantification of environmental properties such as vulnerability, conservation status, and ability to recover after perturbation. Knowledge of such properties is essential to informed decision-making, but their definition is controversial and their precise characterization requires investments in research, modeling, and data collection that are only possible in the most developed countries. Environmental agencies and governments worldwide have increasingly requested numerical quantification or semiquantitative ranking of such attributes at the ecosystem, landscape, and country level. We do not have a theory to guide their calculation, in general or specific contexts, particularly with the amount of resources usually available in such cases. As a result, these measures are often calculated with little scientific justification and high subjectivity, and such doubtful approximations are used for critical decision-making. This problem applies particularly to countries with weak economies, such as small island states, where the most precious environmental resources are often concentrated. This paper discusses frameworks for a "least disappointing," approximate quantification of environmental vulnerability. After a review of recent research and recent attempts to quantify environmental vulnerability, we discuss models and theoretical frameworks for obtaining an approximate, standardizable vulnerability indicator of minimal subjectivity and maximum generality. We also discuss issues of empirical testing and comparability between indicators developed for different environments. To assess the state of the art, we describe an independent ongoing project developed in the South Pacific area and aimed to the comparative evaluation of the vulnerability of arbitrary countries.

Conservation of Natural Resources↗
PubMed2004

The Dutch National Atlas of Public Health.

The Dutch National Atlas of Public Health (http://www.zorgatlas.nl) maps the regional distribution of demand and usage of health care, public health status and influencing factors. The Atlas provides answers to locational questions, e. g. 'Where are the highest mortality rates?', 'Where are the longest waiting lists?' and 'Where are hospitals located?' Maps play a pivotal role in the Atlas. Texts, graphics and diagrams support the interpretation of the maps. The information in the Atlas specifically targets policy makers at the Ministry of Health, Welfare and Sport. For them, the Atlas is a tool for problem detection, policy making and policy evaluation. The Atlas is also aimed at all professionals in health care. In practice, also the general public appears to access and use the Atlas. The Atlas is part of the Dutch Public Health Status and Forecasts (PHSF). The PHSF is made by the National Institute of Public Health and the Environment mandated by the Ministry of Health, Welfare and Sport.

Atlases as Topic↗