Policy analysis of disaster health management in China

Humankind has been dealing with all kinds of disasters since the dawn of time. The risk and impact of disasters producing mass casualties worldwide is increasing, due partly to global warming as well as to increased population growth, increased density and the aging population. China, as a country with a large population, vast territory, and complex climatic and geographical conditions, has been plagued by all kinds of disasters. Disaster health management has traditionally been a relatively arcane discipline within public health. However, SARS, Avian Influenza, and earthquakes and floods, along with the need to be better prepared for the Olympic Games in China has brought disasters, their management and their potential for large scale health consequences on populations to the attention of the public, the government and the international community alike. As a result significant improvements were made to the disaster management policy framework, as well as changes to systems and structures to incorporate an improved disaster management focus. This involved the upgrade of the Centres for Disease Control and Prevention (CDC) throughout China to monitor and better control the health consequences particularly of infectious disease outbreaks. However, as can be seen in the Southern China Snow Storm and Wenchuan Earthquake in 2008, there remains a lack of integrated disaster management and efficient medical rescue, which has been costly in terms of economics and health for China. In the context of a very large and complex country, there is a need to better understand whether these changes have resulted in effective management of the health impacts of such incidents. To date, the health consequences of disasters, particularly in China, have not been a major focus of study. The main aim of this study is to analyse and evaluate disaster health management policy in China and in particular, its ability to effectively manage the health consequences of disasters. Flood has been selected for this study as it is a common and significant disaster type in China and throughout the world. This information will then be used to guide conceptual understanding of the health consequences of floods. A secondary aim of the study is to compare disaster health management in China and Australia as these countries differ in their length of experience in having a formalised policy response. The final aim of the study is to determine the extent to which Walt and Gilson’s (1994) model of policy explains how disaster management policy in China was developed and implemented after SARS in 2003 to the present day. This study has utilised a case study methodology. A document analysis and literature search of Chinese and English sources was undertaken to analyse and produce a chronology of disaster health management policy in China. Additionally, three detailed case studies of flood health management in China were undertaken along with three case studies in Australia in order to examine the policy response and any health consequences stemming from the floods. A total of 30 key international disaster health management experts were surveyed to identify fundamental elements and principles of a successful policy framework for disaster health management. Key policy ingredients were identified from the literature, the case-studies and the survey of experts. Walt and Gilson (1994)’s policy model that focuses on the actors, content, context and process of policy was found to be a useful model for analysing disaster health management policy development and implementation in China. This thesis is divided into four parts. Part 1 is a brief overview of the issues and context to set the scene. Part 2 examines the conceptual and operational context including the international literature, government documents and the operational environment for disaster health management in China. Part 3 examines primary sources of information to inform the analysis. This involves two key studies: • A comparative analysis of the management of floods in China and Australia • A survey of international experts in the field of disaster management so as to inform the evaluation of the policy framework in existence in China and the criteria upon which the expression of that policy could be evaluated Part 4 describes the key outcomes of this research which include: • A conceptual framework for describing the health consequences of floods • A conceptual framework for disaster health management • An evaluation of the disaster health management policy and its implementation in China. The research outcomes clearly identified that the most significant improvements are to be derived from improvements in the generic management of disasters, rather than the health aspects alone. Thus, the key findings and recommendations tend to focus on generic issues. The key findings of this research include the following: • The health consequences of floods may be described in terms of time as ‘immediate’, ‘medium term’ and ‘long term’ and also in relation to causation as ‘direct’ and ‘indirect’ consequences of the flood. These two aspects form a matrix which in turn guides management responses. • Disaster health management in China requires a more comprehensive response throughout the cycle of prevention, preparedness, response and recovery but it also requires a more concentrated effort on policy implementation to ensure the translation of the policy framework into effective incident management. • The policy framework in China is largely of international standard with a sound legislative base. In addition the development of the Centres for Disease Control and Prevention has provided the basis for a systematic approach to health consequence management. However, the key weaknesses in the current system include: o The lack of a key central structure to provide the infrastructure with vital support for policy development, implementation and evaluation. o The lack of well-prepared local response teams similar to local government based volunteer groups in Australia. • The system lacks structures to coordinate government action at the local level. The result of this is a poorly coordinated local response and lack of clarity regarding the point at which escalation of the response to higher levels of government is advisable. These result in higher levels of risk and negative health impacts. The key recommendations arising from this study are: 1. Disaster health management policy in China should be enhanced by incorporating disaster management considerations into policy development, and by requiring a disaster management risk analysis and disaster management impact statement for development proposals. 2. China should transform existing organizations to establish a central organisation similar to the Federal Emergency Management Agency (FEMA) in the USA or the Emergency Management Australia (EMA) in Australia. This organization would be responsible for leading nationwide preparedness through planning, standards development, education and incident evaluation and to provide operational support to the national and local government bodies in the event of a major incident. 3. China should review national and local plans to reflect consistency in planning, and to emphasize the advantages of the integrated planning process. 4. Enhance community resilience through community education and the development of a local volunteer organization. China should develop a national strategy which sets direction and standards in regard to education and training, and requires system testing through exercises. Other initiatives may include the development of a local volunteer capability with appropriate training to assist professional response agencies such as police and fire services in a major incident. An existing organisation such as the Communist Party may be an appropriate structure to provide this response in a cost effective manner. 5. Continue development of professional emergency services, particularly ambulance, to ensure an effective infrastructure is in place to support the emergency response in disasters. 6. Funding for disaster health management should be enhanced, not only from government, but also from other sources such as donations and insurance. It is necessary to provide a more transparent mechanism to ensure the funding is disseminated according to the needs of the people affected. 7. Emphasis should be placed on prevention and preparedness, especially on effective disaster warnings. 8. China should develop local disaster health management infrastructure utilising existing resources wherever possible. Strategies for enhancing local infrastructure could include the identification of local resources (including military resources) which could be made available to support disaster responses. It should develop operational procedures to access those resources. Implementation of these recommendations should better position China to reduce the significant health consequences experienced each year from major incidents such as floods and to provide an increased level of confidence to the community about the country’s capacity to manage such events.

Utilizing industry-led innovation capacity to enhance supply chain performance : an empirical study

A fundamental principle of the resource-based (RBV) of the firm is that the basis for a competitive advantage lies primarily in the application of bundles of valuable strategic capabilities and resources at a firm’s or supply chain’s disposal. These capabilities enact research activities and outputs produced by industry funded R&D bodies. Such industry lead innovations are seen as strategic industry resources, because effective utilization of industry innovation capacity by sectors such as the Australian beef industry are critical, if productivity levels are to increase. Academics and practitioners often maintain that dynamic supply chains and innovation capacity are the mechanisms most likely to deliver performance improvements in national industries.. Yet many industries are still failing to capitalise on these strategic resources. In this research, we draw on the resource-based view (RBV) and embryonic research into strategic supply chain capabilities. We investigate how two strategic supply chain capabilities (supply chain performance differential capability and supply chain dynamic capability) influence industry-led innovation capacity utilization and provide superior performance enhancements to the supply chain. In addition, we examine the influence of size of the supply chain operative as a control variable. Results indicate that both small and large supply chain operatives in this industry believe these strategic capabilities influence and function as second-order latent variables of this strategic supply chain resource. Additionally respondents acknowledge size does impacts both the amount of influence these strategic capabilities have and the level of performance enhancement expected by supply chain operatives from utilizing industry-led innovation capacity. Results however also indicate contradiction in this industry and in relation to existing literature when it comes to utilizing such e-resources.

Determinants of China’s regional innovation capacity

This paper investigates the determinants of China’s regional innovation capacity (RIC) and variations in these determinants between different types of regions. Based on the framework of national innovation capacity (NIC) and research on innovation system, this paper develops a framework of RIC in the Chinese context. Using panel data from 1991 to 2009, clustering analysis is first employed to classify regions according to their innovation development path. Panel data regressions with fixed effect model are conducted to explore the determinants of RIC and how these vary across the different regional clusters. We find that the 30 regions can be clustered into three groups, and there are considerable differences in the drivers of RIC between these different regional groups.

Using virtual reality modelling in cultural management, archiving and research

This paper outlines how the Ortelia project’s 3D virtual reality models have the capacity to assist our understanding of sites of cultural heritage. The VR investigation of such spaces can be a valuable tool in 'real world' empirical research in theatre and spatiality. Through a demonstration of two of Ortelia's VR models (an art gallery and a theatre), we suggest how we might consider interpreting cultural space and sites as contributing significantly to cultural capital. We also introduce the potential for human interaction in such venues through motion-capture to discuss the potential for assessing how humans interact in such contexts.

Co-management to solve homelessness : wicked solutions to wicked problems

While governments are engaged in developing social policy responses to address wicked issues such as poverty, homelessness, drug addiction and crime, long term resolution of these issues through government policy making and state-based programmatic action has remained elusive. The use of vehicles for joint action and partnership between government and the community sector such as co-management has been offered as a way of harnessing productive capability and innovative capacity of both these sectors to resolve these complex problems. However, it is suggested that while there is a well advanced agenda with the intent for collaboration and partnership, working with the models for undertaking this joint action are not well understood and have not been fully developed or evaluated. This chapter examines new approaches to resolving the wicked issue of homelessness through applying the lens of co-management to understand the complexities of this issue and its resolution. The chapter analyses an attempt to move away from traditional bureaucratic structures of welfare departments, operating through single functional ‘silos’ to a new horizontal ‘hub-based’ model of service delivery that seeks to integrate actors across many different service areas and organizations. The chapter explores case studies of co-management in the establishment, development and operation of service hubs to address homelessness. We argue that the response to homelessness needs a ‘wicked solution’ that goes beyond simply providing shelter to those in need. The case of the hub models of community sector organizations working across organizational boundaries is evaluated to determine whether this approach can be considered successful co-managing of an innovative initiative, and understanding the requirements for developing, improving and extending this model. The role of the third sector in co-managing public services is examined through the in-depth case studies and the results are presented together with an assessment of how co-management can contribute to service quality and service management in public services.

Managing open incremental process innovation : absorptive capacity and distributed learning

In this conceptual article, we extend earlier work on Open Innovation and Absorptive Capacity. We suggest that the literature on Absorptive Capacity does not place sufficient emphasis on distributed knowledge and learning or on the application of innovative knowledge. To accomplish physical transformations, organisations need specific Innovative Capacities that extend beyond knowledge management. Accessive Capacity is the ability to collect, sort and analyse knowledge from both internal and external sources. Adaptive Capacity is needed to ensure that new pieces of equipment are suitable for the organisation's own purposes even though they may have been originally developed for other uses. Integrative Capacity makes it possible for a new or modified piece of equipment to be fitted into an existing production process with a minimum of inessential and expensive adjustment elsewhere in the process. These Innovative Capacities are controlled and coordinated by Innovative Management Capacity, a higher-order dynamic capability.

Simple rules to contain an invasive species with a complex life cycle and high dispersal capacity

Designing practical rules for controlling invasive species is a challenging task for managers, particularly when species are long-lived, have complex life cycles and high dispersal capacities. Previous findings derived from plant matrix population analyses suggest that effective control of long-lived invaders may be achieved by focusing on killing adult plants. However, the cost-effectiveness of managing different life stages has not been evaluated. We illustrate the benefits of integrating matrix population models with decision theory to undertake this evaluation, using empirical data from the largest infestation of mesquite (Leguminosae: Prosopis spp) within Australia. We include in our model the mesquite life cycle, different dispersal rates and control actions that target individuals at different life stages with varying costs, depending on the intensity of control effort. We then use stochastic dynamic programming to derive cost-effective control strategies that minimize the cost of controlling the core infestation locally below a density threshold and the future cost of control arising from infestation of adjacent areas via seed dispersal. Through sensitivity analysis, we show that four robust management rules guide the allocation of resources between mesquite life stages for this infestation: (i) When there is no seed dispersal, no action is required until density of adults exceeds the control threshold and then only control of adults is needed; (ii) when there is seed dispersal, control strategy is dependent on knowledge of the density of adults and large juveniles (LJ) and broad categories of dispersal rates only; (iii) if density of adults is higher than density of LJ, controlling adults is most cost-effective; (iv) alternatively, if density of LJ is equal or higher than density of adults, management efforts should be spread between adults, large and to a lesser extent small juveniles, but never saplings. Synthesis and applications.In this study, we show that simple rules can be found for managing invasive plants with complex life cycles and high dispersal rates when population models are combined with decision theory. In the case of our mesquite population, focussing effort on controlling adults is not always the most cost-effective way to meet our management objective.

Meta-evaluation to improve learning, evaluation capacity development and sustainability : Findings from a participatory evaluation project in Nepal

Recent studies suggest that meta-evaluation can be valuable in developing new approaches to evaluation, building evaluation capacities, and enhancing organizational learning. These new extensions of the concept of meta-evaluation are significant, given the growing emphasis on improving the quality and effectiveness of evaluation practices in the South Asian region. Following a review of the literature, this paper presents a case study of the use of concurrent meta-evaluation in the four-year project Assessing Communication for Social Change which developed and trialled a participatory impact assessment methodology in collaboration with a development communication Non-government organization (NGO) in Nepal. Key objectives of the meta-evaluation included to: continuously develop, adapt and improve the impact assessment methodology, Monitoring and Evaluation (M&E) systems and process and other project activities; identify impacts of the project; and build capacities in critical reflection and review. Our analysis indicates that this meta-evaluation was essential to understanding various constraints related to the organizational context that affected the success of the project and the development of improved M&E systems and capacities within the NGO. We identified several limitations of our meta-evaluation methods, which were balanced by the strengths of other methods. Our case study suggests that as well as assessing the quality, credibility and value of evaluation practices, meta-evaluations need to focus on important contextual issues that can have significant impacts on the outcomes of participatory evaluation projects. They include hierarchical organizational cultures, communication barriers, power/knowledge relations, and the time and resources available. Meta-evaluations also need to consider wider issues such as the sustainability of evaluation systems and approaches.

From 'what' to 'how' : capacity building in health promotion for HIV/AIDS prevention in the Solomon Islands

This paper describes a capacity building process undertaken within the HIV/AIDS prevention project of the Adventist Development and Relief Agency (ADRA) in the Solomon Islands. ADRA HIV/AIDS has recently reoriented its project structure, moving beyond its awareness raising approach to incorporate health promotion frameworks, theories, strategies and assumptions. These have been used to inform project practice in project planning, delivery and evaluation. This paper shares what has worked and not worked in the capacity building process, including a project evaluation of the initial HIV/AIDS awareness raising project and the application of a number of capacity building strategies, including utilising a volunteer Australian Youth Ambassador for Development (AYAD) funded by the Australian Agency for International Development (AusAID). Existing and new projects are outlined. The underlying theme is that any capacity building exercise must include structural support (e.g. management, national frameworks) to ensure the incorporation of new initiatives and approaches. With time this enables ownership by counterparts and external partnerships to develop. The presence of an AYAD volunteer has been an effective strategy to achieve this. Reflections from the evaluators, the AYAD volunteer and the HIV/AIDS team are included.

Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss

Does exercise promote weight loss? One of the key problems with studies assessing the efficacy of exercise as a method of weight management and obesityis that mean data are presented and the individual variability in response is overlooked. Recent data have highlighted the need to demonstrate and characterise the individual variability in response to exercise. Do people who exercise compensate for the increase in energy expenditure via compensatory increases in hunger and food intake? The authors address the physiological, psychological and behavioural factors potentially involved in the relationship between exercise and appetite, and identify the research questions that remain unanswered. A negative consequence of the phenomena of individual variability and compensatory responses has been the focus on those who lose little weight in response to exercise; this has been used unreasonably as evidence to suggest that exercise is a futile method of controlling weight and managing obesity. Most of the evidence suggests that exercise is useful for improving body composition and health. For example, when exercise-induced mean weight loss is <1.0 kg, significant improvements in aerobic capacity (+6.3 ml/kg/min), systolic (−6.00 mm Hg) and diastolic (−3.9 mm Hg) blood pressure, waist circumference (−3.7 cm) and positive mood still occur. However, people will vary in their responses to exercise; understanding and characterising this variability will help tailor weight loss strategies to suit individuals.

Application of Resilience concept for enhanced management of water supply systems

This paper presents an approach to developing indicators for expressing resilience of a generic water supply system. The system is contextualised as a meta-system consisting of three subsystems to represent the water catchment and reservoir, treatment plant and the distribution system supplying the end-users. The level of final service delivery to end-users is considered as a surrogate measure of systemic resilience. A set of modelled relationships are used to explore relationships between system components when placed under simulated stress. Conceptual system behaviour of specific types of simulated pressure is created for illustration of parameters for indicator development. The approach is based on the hypothesis that an in-depth knowledge of resilience would enable development of decision support system capability which in turn will contribute towards enhanced management of a water supply system. In contrast to conventional water supply system management approaches, a resilience approach facilitates improvement in system efficiency by emphasising awareness of points-of-intervention where system managers can adjust operational control measures across the meta-system (and within subsystems) rather than expansion of the system in entirety in the form of new infrastructure development.

Impact of the internal business environment on knowledge management within construction organisations

Purpose: Recent knowledge management (KM) literature suggests that KM activities are influenced by the elements of the internal business environment (BE) of organisations. This paper attempts to provide some unique insights into the contextual input of the KM process through empirically identifying the major factors (i.e. “forces”) within the internal BE of construction organisations operating in Hong Kong, and investigating their impact on the intensity of KM activities. Design/methodology/approach: A questionnaire survey was administered to a sample of construction contractors operating in Hong Kong to elicit opinions on the internal BE and intensity of KM activities as executed by targeted organisations. A total of 149 usable responses were received from 99 organisations representing about 38 percent of the research population. In parallel, to the survey, a total of 15 semi-structured interviews were undertaken to provide more insights into the phenomenon under investigation. Findings: Supported by the empirical and qualitative evidence, this study established that firstly, both organisational and technical environments have the capacity to either positively or negatively impact the intensity of KM activities, and both environments serve as stimuli in increasing each other's dynamism; secondly, certain types of KM activities are stronger “energy receivers” and easily to be “powered up” by manipulating factors representing these two environments. Then, through interactions between KM activities, the intensity of the whole strategic KM cycle will be increased thus helping to strengthen organisational competitive advantage.

Empirical study of interactions between knowledge management activities

Purpose – Recent knowledge management (KM) literature suggests that KM activities are not independent of each other, rather they interact with each other to form a process which receives input from both external and internal business environments, and then produces new knowledge for future utilisation. The purpose of this paper is to empirically investigate the relationships between KM activities within the construction business context in order to identify and map the pattern of their interactions. Design/methodology/approach – A questionnaire survey was administered to a sample of contracting organisations operating in Hong Kong to elicit opinions of construction professionals on the intensity of KM activities currently being executed by their organisations in order to facilitate knowledge capture, sharing and utilisation. More than 150 respondents from 99 organisations responded to the survey. Additionally, a total of 15 semi-structured interviews were undertaken to provide a unique perspective on many of the challenges facing local construction organisations when dealing with KM activities. Findings – Knowledge acquisition and utilisation play paramount roles in the development of the organisational knowledge asset. The higher the intensity of these two activities, the larger the organisational knowledge pool which, in turn, demands greater knowledge dissemination capacity. This dissemination capacity enables more active and intense responses to market changes and clients' needs, thus facilitating and stimulating acquisition and utilisation of new tacit knowledge, thus improving organisational business performance. Originality/value – Interactions between KM activities were empirically investigated, from a strategic perspective, in the construction business context.

State asset management reform in Indonesia : a wicked problem

Efficient state asset management is crucial for government departments that rely on the operations of their state assets in order to fulfil their public functions, which include public service provision and others. These assets may be expensive, extensive and or, complex, and can have a major impact on the ability of governments to perform its function over extended periods. Various governments around the world have increasingly recognised the importance of an efficient state asset management laws, policies, and practices; exemplified by the surge in state asset management reform. This phenomenon is evident in Indonesia, in particular through the establishment of the Directorate General of State Assets in 2006, who was appointed as the ultimate state asset manager (of Republic of Indonesia) and the proprietor of state asset management reform. The Directorate General of State Assets too has pledged its adherence to good governance principles within its state asset management laws and policies reform. However the degree that good governance principles are conceptualised is unknown, resulting in questions of how and to what extent is good governance principles evident within Indonesia's reformed state asset management laws and policies. This study seeks to understand the level of which good governance principles are conceptualised and understood within reformed state asset management policies in Indonesia (as a case study), and identify the variables that play a role in the implementation of said reform. Although good governance improvements has been a central tenet in Indonesian government agenda, and state asset management reform has propelled in priority due to found neglect and unfavourable audit results; there is ambiguity in regards to the extent that good governance is conceptualised within the reform, how and whether this relationship is understood by state asset managers (i.e government officials), and what (and how) other variables play a supporting and/or impeding role in the reform. Using empirical data involving a sample of four Indonesian regional governments and 70 interviews; discrepancy in which good governance principles are conceptualised, the level it is conceptualised, at which stage of state asset management practice it is conceptualised, and the level it is understood by state asset managers (i.e government officials) was found. Human resource capacity and capability, the notion of 'needing more time', low legality, infancy of reform, and dysfunctional sense of stewardship are identified as specific impeding variables to state asset management reform; whilst decentralisation and regional autonomy regime, political history, and culture play a consistent undercurrent key role in good governance related reforms within Indonesia. This study offers insights to Indonesian policy makers interested in ensuring the conceptualisation and full implementation of good governance in all areas of governing, particularly within state asset management practices. Most importantly, this study identifies an asymmetry in good governance understanding, perspective, and assumptions between policy maker (i.e high level government officials) and policy implementers (i.e low level government officials); to be taken into account for future policy evolvements and/or writing. As such, this study suggests the need for a modified perspective and approach to good governance conceptualisation and implementation strategies, one that acknowledges and incorporates a nation's unique characteristics and no longer denies the double-edged sword of simplified assumptions of governance.

Gender and the capacity of women with NIDDM to implement medical advice

This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which Sender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.