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At least 73 records · Page 4Linked to original sources
PubMed1993

Quantified road safety targets: a useful tool for policy making?

The safety performance of Norwegian countries where quantified road safety targets were set is compared to the safety performance of countries where only qualitative road safety targets were set. Quantified targets are classified according to their ambitiousness. Safety performance is compared for two four-year road planning terms: 1982-1985 and 1986-1989. The study shows that countries where quantified safety targets were set succeeded in reducing the accident rate per kilometre of travel more than counties relying on qualitative targets only. The best performance was achieved by counties with highly ambitious quantified targets. Safety performance was related both to targets and to the level of spending on road safety programmes. Improving safety did not lead to reduced mobility, with the exception of lowered speed limits on less than 10% of the road system. The possibility that confounding factors generated these results is discussed. It is concluded that none of the confounding factors included in the study exerted a major influence. A number of potentially confounding factors could not be included, due to lack of data. The chief policy implication of the study is that setting ambitious quantified road safety targets can help policy making by making it easier to implement effective countermeasures and set priorities effectively.

Accidents, Traffic↗
PubMed2006

Using knowledge brokering to promote evidence-based policy-making: The need for support structures.

Knowledge brokering is a promising strategy to close the "know-do gap" and foster greater use of research findings and evidence in policy-making. It focuses on organizing the interactive process between the producers and users of knowledge so that they can co-produce feasible and research-informed policy options. We describe a recent successful experience with this novel approach in the Netherlands and discuss the requirements for effective institutionalization of knowledge brokering. We also discuss the potential of this approach to assist health policy development in low-income countries based on the experience of developing the Regional East-African Health (REACH)-Policy Initiative. We believe that intermediary organizations, such as regional networks, dedicated institutional mechanisms and funding agencies, can play key roles in supporting knowledge brokering. We recommend the need to support and learn from the brokerage approach to strengthen the relationship between the research and policy communities and hence move towards a stronger culture of evidence-based policy and policy-relevant research.

Africa, Eastern↗
PubMed2005

An Australian childhood obesity summit: the role of data and evidence in 'public' policy making.

BACKGROUND: Overweight and obesity in Australia has risen at an alarming rate over the last 20 years as in other industrialised countries around the world, yet the policy response, locally and globally, has been limited. Using a childhood obesity summit held in Australia in 2002 as a case study, this paper examines how evidence was used in setting the agenda, influencing the Summit debate and shaping the policy responses which emerged. The study used multiple methods of data collection including documentary analysis, key informant interviews, a focus group discussion and media analysis. The resulting data were content analysed to examine the types of evidence used in the Summit and how the state of the evidence base contributed to policy-making. RESULTS: Empirical research evidence concerning the magnitude of the problem was widely reported and largely uncontested in the media and in the Summit debates. In contrast, the evidence base for action was mostly opinion and ideas as empirical data was lacking. Opinions and ideas were generally found to be an acceptable basis for agreeing policy action coupled with thorough evaluation. However, the analysis revealed that the evidence was fiercely contested around food advertising to children and action agreed was therefore limited. CONCLUSION: The Summit demonstrated that policy action will move forward in the absence of strong research evidence. Where powerful and competing groups contest possible policy options, however, the evidence base required for action needs to be substantial. As with tobacco control, obesity control efforts are likely to face ongoing challenges around the nature of the evidence and interventions proposed to tackle the problem. Overcoming the challenges in controlling obesity will be more likely if researchers and public health advocates enhance their understanding of the policy process, including the role different types of evidence can play in influencing public debate and policy decisions, the interests and tactics of the different stakeholders involved and the part that can be played by time-limited yet high profile events such as Summits.

Journal Article↗
PubMed1999

Real world designs in economic evaluation. Bridging the gap between clinical research and policy-making.

This paper identifies the information that economic evaluation should provide to adequately inform policy-makers. First, policy-makers need cost-effectiveness information that is both internally and externally valid. The latter aspect is often ignored and refers to the relevance of the results of economic trials to the specific decision-making context of the policy-maker. Second, policy-makers, like purchasers of care, may want assessments of the overall budget and health impacts of adopting an intervention in a disease or treatment area. This requires more of an aggregate analysis than the current approaches to economic evaluation (which are typically individual-orientated). There are 3 main conceptual approaches to economic evaluation: the use of randomised controlled trials (RCTs), observational studies and modelling. The RCT can be considered as the gold standard in economic evaluation because of its high internal validity, but results should be interpreted with caution because of its low external validity. There a number of options to enhance external validity; of these, additional modelling and observational data seem to be the most promising. To address issues at the system level, disease modelling or public health modelling is suggested. A 3-step approach, comprising successive assessment of internal validity, external validity (real world relevance) and net impact at the system level, can enhance the informative value of economic analyses. For example, this approach has been used to assess the informative value to decision-makers of an RCT in benign prostatic hyperplasia. The analysis emphasised the feasibility and importance of additional modelling beyond the results from an RCT-based economic analysis and provided important information of relevance for policy-making. Because of the need to increase the real world relevance of pharmacoeconomic analyses, there is potentially a large role for modelling in economic evaluation; however, in order to enhance its credibility, more attention should be paid to validity aspects.

Cost-Benefit Analysis↗
PubMed2004

The Australian government's review of positron emission tomography: evidence-based policy-making in action.

The Commonwealth Government constituted the Medicare Services Advisory Committee (MSAC) to implement its commitment to entrench the principles of evidence-based medicine in Australian clinical practice. With its recent review of positron emission tomography (PETReview), the Commonwealth intervened in an established MSAC process, and sanctioned the stated objective to restrict expenditure on the technology. In our opinion: The evaluation of evidence by PETReview was fundamentally compromised by a failure to meet the terms of reference, poor science, poor process and unique decision-making benchmarks. By accepting the recommendations of PETReview, the Commonwealth is propagating information which is not of the highest quality. The use of inferior-quality information for decision-making by doctors, patients and policy-makers is likely to harm rather than enhance healthcare outcomes.

Australia↗
PubMed1988

Governing the health sector: power and policy making in the English and Swedish health services.

Although both are publicly owned and financed, the health care systems of England and Sweden are widely different in levels of funding, patterns of resource allocation, and types of planning and management. In England, control is more closely tied to national government; in Sweden, it is shared between national and local governments. A comparative analysis of decision making in the two systems reveals critical differences in determinations of how resources are allocated among competing interests, and how resources are used. Interestingly, as the English move toward more decentralization, the Swedes are considering greater central controls, but, in any event, convergence is unlikely.

Decision Making, Organizational↗
PubMed2000

State legislative staff influence in health policy making.

State legislative staff may influence health policy by gathering intelligence, setting the agenda, and shaping the legislative proposals. But they may also be stymied in their roles by such institutional constraints as hiring practices and by turnover in committee leadership in the legislature. The intervening variable of trust between legislators and their support staff is also key to understanding influence and helps explain how staff-legislator relationships play an important role in designing state health policy. This study of legislative fiscal and health policy committee staff uses data from interviews with key actors in five states to model the factors important in explaining variation in the influence of committee staff on health policy.

Decision Making, Organizational↗
PubMed1999

Evidence-based educational commissioning and policy making: a case for the prospective use of a psychometric approach in defining the role and preparation of the nurse practitioner in Australia.

The concept of evidence-based care and the profile of the nurse practitioner (NP) have together assumed mounting importance as possible solutions to the problem of meeting escalating demands for high quality health care with decreasing resources. With regard to the former, concerted efforts to ensure that clinical practice has its base in scientific evidence, have resulted in health care delivery that is increasingly informed by research rather than ritual and tradition. This success notwithstanding, health management and policy-making have remained grounded in assumption, principally because of the paucity of available research in these areas. With regard to the NP, there is little agreement regarding the boundaries of professional practice and preparatory education, both of which need to be defined to some degree at the local level, if the health needs of the indigenous population are to be met. If these two issues are integrated, the policies regarding the preparation and occupational scope of the NP could incorporate research-based decision-making, and thus could simultaneously develop the NP according to locally specified needs, as well as meeting the requirements of the evidence-based care culture. This paper discusses a psychometrically valid and reliable instrument that has the capacity to provide research data which can inform strategic thinking regarding the definition, education and operation of the NP at a variety of levels. The technique has been used extensively in the UK, repeatedly demonstrating its value in NP educational commissioning. While the instrument has not yet been used to inform NP education in Australia, it has been administered to a cohort of acute sector nurses in Victoria. It is argued that the relevance of the instrument to the Australian health system, coupled with its proven importance in the development of the NP in comparable health care cultures, makes this approach worthy of consideration for the preparation of the NP for a variety of Australian health contexts.

Australia↗
PubMed2005

Evaluating inspection and maintenance programs: a policy-making framework.

This article presents a new analysis approach to design and evaluate motor vehicle inspection and maintenance (I/M) programs. The new approach, called I/M-Design, uses real-world data to provide two resources not previously available: (1) a transparent framework to quantitatively illustrate the range of emission reductions available from I/M, and (2) a sensitivity analysis tool to evaluate how key variables affect I/M performance. In addition, the approach satisfies a policy-making information need--how to convey, in a logical and straightforward manner, the expected benefits from I/M without relying on modeling tools inaccessible to those outside the air quality field. The material presented in this article illustrates the new approach by estimating hydrocarbon (HC) emission reduction benefits available from enhanced I/M in southern California's South Coast Air Basin. I/M-Design estimates that enhanced I/M results in a 14-28% reduction in light-duty motor vehicle HC exhaust emissions; this estimate compares well to other California I/M program evaluations. Even more importantly, I/M-Design sensitivity analyses illustrate how I/M programs that implement stringent failure thresholds, motivate pre-test repair work, and improve repair effectiveness can provide emission reductions that substantially exceed the performance of existing programs.

Air Pollutants↗
PubMed1989

An evaluation of the psychological and social effects of malocclusion: some implications for dental policy making.

Initial findings are reported from a longitudinal study investigating the effects of malocclusion on dental health and psychological well-being and the effectiveness of orthodontic treatment. Implicit in the orthodontic intervention decision process is the view that there are discernible social and psychological benefits of good occlusion. This view has not been adequately validated. The primary psychological question addressed by this study concerns the relationship between adolescents' orthodontic status and their psychological status and well-being. Empirical evidence allowed an examination of the major hypothesis that children with poor occlusion are likely to be socially and psychologically disadvantaged. Ratings of dental status and physical attractiveness, and measures of psychosocial well-being were obtained for sample of 1018, 11-12-year-old children and the associations between these variables were examined. The results provide little support for the major hypothesis that children 'suffer' psychologically from having poor dentition. Several points of caution are made with regard to this conclusion and some implications for dental policy making are considered.

Adolescent↗
PubMed1990

Legislative incapacity: the congressional role in environmental policy-making and the case of Superfund.

Congress plays a central role in national environmental policy formation but appears ill equipped to set policy priorities and devise integrative legislation. Fragmentation of authority among a multiplicity of committees and subcommittees, especially in the House, contributes to these problems. This pattern is evident in the evolution of Superfund, the national program to clean up abandoned hazardous waste sites. The prolonged process of reauthorization in the 1980s contributed to serious program delay and failed to resolve a number of fundamental questions concerning the national cleanup effort. Institutional reforms could contribute to a more effective congressional role in future environmental policy deliberations.

Environmental Health↗
PubMed2002

Courts and health policy: judicial policy making and publicly funded health care in Canada.

The 1982 Canadian Charter of Rights and Freedoms provided political actors with the opportunity to make rights-based challenges to public policy decisions. Two challenges launched by providers and consumers of health care illuminate the impact of judicial review on health care policy and the institutional capacity of courts to formulate policy in this field. The significant impact of rights-based claims on cross-jurisdictional policy differences in a federal regime is noted.

Canada↗
PubMedDate not supplied

Agenda setting for smoking control in Japan, 1945-1990: influence of the mass media on national health policy making.

Agenda setting is regarded as a key process in policymaking. This study first examines the trends in newspaper articles on smoking and health and the debates on the issue in the Diet in Japan for the period 1945-1990. Then relationships of those articles and debates with national administrative actions are analyzed. Although the media helped set the agenda in the Diet before the emergence of the nonsmokers' rights movement, it did not do so thereafter. On the other hand, media reports continued to be associated with various aspects of administrative policy making throughout the study period and played an important role in mobilizing administrative agencies. Effects of mass media on agencies were regarded as largely independent of the debates in the Diet. It is also noted that simple "scientific" reports on the health hazards of smoking had no association either with agency action or with Diet debates. This indicates that issue building, which consists of creating a package of ideas about the facts, the causal theories, the responsibilities, and the feasible solutions, is important when scientific facts are to be dealt with by policymakers.

Government Programs↗