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.

Multicultural training experiences as predictors of psychology students’ cultural competence

The psychologists in the western world, including Australia, are required to be culturally competent due to the cultural diversity of these societies. Previous studies conducted in North America and Europe have found multicultural teaching, clinical experience with culturally diverse clients, and discussion of multicultural counselling issues in supervision to be related to the practitioner’s cultural competency. The present study examined factors contributing to trainee psychologists’ perceived level of cultural competence. It was hypothesised that multicultural teaching, clinical experience and supervision would be related to students’ level of cultural competence. One hundred and twenty seven postgraduate clinical psychology students completed an online survey battery that included demographic information, a social desirability measure, and the Multicultural Mental Health Awareness Scale (Khawaja, Gomez & Turner, 2009). This hypothesis was partially supported. Clinical experience and supervision focusing on multicultural issues were found to be related to participants’ perceived cultural competence, however, multicultural teaching was not. These results provide insight into how universities around Australia can facilitate future psychologists’ competence in working with clients from different cultural backgrounds.

Training clinical psychologists : The current situation and a way forward [Guest Editorial]

In the past, training in clinical psychology in Australia and overseas has been dominated by definitions of input— hours of classes or supervision and of specific components. While prospective practitioners have been required to demonstrate the acquisition of generic competencies, satisfaction of these input driven criteria has been required for both accreditation and registration. Ironically, for a discipline that prides itself on requiring empirical bases for practice and communicating those to students (Calhoun, Moras, Pilkonis, & Rehm, 1998), training criteria have been primarily derived from accepted wisdom, rather than from a sound body of data. The situation has been remarkably like that of a treatment establishing standards of fidelity before its effective components are known—an action our profession has correctly criticised in the past (Herbert & Mueser, 1992).

Business leadership development in Iran

Throughout the twentieth century the economics of the Middle East rose and fell many times in response to the external environment, including European de-colonization and the US and former USSR competing to provide military and economic aid after World War II. Throughout these upheavals the Middle East has remained internationally significant politically and economically not least for the region's large reserves of oil and gas, as discussed in the Introduction to this volume. In recent decades, Western nations have moved to invest into the Middle East in the rapidly developing technology, tourism and education industries that have proliferated. For its part, Iran has been the world's fourth largest provider of petroleum and second largest provider of natural gas and, despite years of political unrest, has made rapid expansion into information technology and telecommunications. Increased involvement in the global economy has meant that Iran has invested heavily in education and training and moved to modernize its management practices. Hitherto there has been little academic research into management in either Western or local organizations in Iran. This chapter seeks to address that gap in knowledge by exploring business leadership in Iran, with particular reference to cultural and institutional impacts.

Vocational education and training in schools : career advisers' perceptions and practices

This paper explores the currently highly topical issue of Vocational Education and Training in Schools (VETiS). Specifically, it focuses upon career advisers' perceptions of VETiS, their advising practices as pertaining to this program and their views of others' perceptions of VETiS. It draws upon a national research project and data derived from interviews conducted with career advisers during the course of the project. The paper demonstrates that career advisers perceive VETiS in a favorable light on the whole, and they advocate the practice of advising all students to do VETiS if students desire to do so. That said, the paper goes on to highlight tensions apparent in the career advisers' perceptions of, and subsequent advice-giving practices regarding VETiS - particularly in terms of the potential benefits it affords all students. It becomes clear that careers advisers have different agendas for advising different students - academic and non-academic students - to undertake VETiS as a course of study. Finally, the paper demonstrates the ways in which career advisers become complicit in the marginalisation of VETiS programs and the status of VET.

Can transfer of learning be enriched by valuing knowledge transformation and co-creation? Exploring new ways to improve training design

This paper argues that a possible cause of issues with management education outcomes is the fact that most training models operate from a limited ‘transfer’ metaphor. This theoretical paper contends that by reconceptualising existing models, specifically Holton’s transfer of learning model, to incorporate multiple processes and acknowledge the importance of educator- or trainer-student interaction in co-creating knowledge, there is potential to improve training design and ultimately achieve more satisfactory training outcomes.

Design and implementation of a virtual world training simulation of ICU first hour handover processes

Nursing training for an Intensive Care Unit (ICU) is a resource intensive process. High demands are made on staff, students and physical resources. Interactive, 3D computer simulations, known as virtual worlds, are increasingly being used to supplement training regimes in the health sciences; especially in areas such as complex hospital ward processes. Such worlds have been found to be very useful in maximising the utilisation of training resources. Our aim is to design and develop a novel virtual world application for teaching and training Intensive Care nurses in the approach and method for shift handover, to provide an independent, but rigorous approach to teaching these important skills. In this paper we present a virtual world simulator for students to practice key steps in handing over the 24/7 care requirements of intensive care patients during the commencing first hour of a shift. We describe the modelling process to provide a convincing interactive simulation of the handover steps involved. The virtual world provides a practice tool for students to test their analytical skills with scenarios previously provided by simple physical simulations, and live on the job training. Additional educational benefits include facilitation of remote learning, high flexibility in study hours and the automatic recording of a reviewable log from the session. To the best of our knowledge, we believe this is a novel and original application of virtual worlds to an ICU handover process. The major outcome of the work was a virtual world environment for training nurses in the shift handover process, designed and developed for use by postgraduate nurses in training.

Outdoor experiential training as a medium for the development of today’s leaders

Outdoor experiential training is often used for the enhancement of generalised workplace skills including those considered relevant for effective leadership. Traditionally, facilitation processes and strategies employed in outdoor experiential training have often relied on theories delivered as part of an outdoor leadership training program. This was premised on the assumption that skills and capabilities developed in such programs transfer to the mainstream business market. In this paper we present data from an International study on the characteristics of outdoor education professionals that adds further insights into the role that outdoor experiential training plays in the development of generic leadership characteristics. Outdoor leaders were found to characterise transformational leadership qualities and considered that the development of these qualities were directly linked to their outdoor experiential training.

Strengthening the role of the adult education sector in training workers for the digital content industries in Australia and Singapore

In 2009, QUT’s Office of Research and the Institute for Adult Learning Singapore funded a six-month pilot project that represented the first stage of a larger international comparative study. The study is the first of its kind to investigate to what extent and how digital content workers’ learning needs are being met by adult education and training in Australia and Singapore. The pilot project involved consolidating key theoretical literature, studies, policies, programs and statistical data relevant to the digital content industries in Australia and Singapore. This had not been done before, and represented new knowledge generation. Digital content workers include professionals within and beyond the creative industries as follows: Visual effects and animation (including virtual reality and 3D products); Interactive multimedia (e.g. websites, CD-ROMs) and software development; Computer and online games; and Digital film & TV production and film & TV post-production. In the last decade, the digital content industries have been recognised as an industry sector of strong and increasing significance. The project compared Australia and Singapore on aspects of the digital content industries’ labour market, skill requirements, human capital challenges, the role of adult education in building a workforce for the digital content industries, and innovation policies. The consolidated report generated from the project formed the basis of the proposal for an ARC Linkage Project application submitted in the May 2010 round.

Evaluation of an Australian solar community : implications for education and training

1.1 Background What is renewable energy education and training? A cursory exploration of the International Solar Energy Society website (www.ises.org) reveals numerous references to education and training, referring collectively to concepts of the transfer and exchange of information and good practices, awareness raising and skills development. The purposes of such education and training relate to changing policy, stimulating industry, improving quality control and promoting the wider use of renewable energy sources. The primary objective appears to be to accelerate a transition to a better world for everyone (ISEE), as the greater use of renewable energy is seen as key to climate recovery; world poverty alleviation; advances in energy security, access and equality; improved human and environmental health; and a stabilized society. The Solar Cities project – Habitats of Tomorrow – aims at promoting the greater use of renewable energy within the context of long term planning for sustainable urban development. The focus is on cities or communities as complete systems; each one a unique laboratory allowing for the study of urban sustainability within the context of a low carbon lifestyle. The purpose of this paper is to report on an evaluation of a Solar Community in Australia, focusing specifically on the implications (i) for our understandings and practices in renewable energy education and training and (ii) for sustainability outcomes. 1.2 Methodology The physical context is a residential Ecovillage (a Solar Community) in sub-tropical Queensland, Australia (latitude 28o south). An extensive Architectural and Landscape Code (A&LC) ‘premised on the interconnectedness of all things’ and embracing ‘both local and global concerns’ governs the design and construction of housing in the estate: all houses are constructed off-ground (i.e. on stumps or stilts) and incorporate a hybrid approach to the building envelope (mixed use of thermal mass and light-weight materials). Passive solar design, gas boosted solar water heaters and a minimum 1kWp photovoltaic system (grid connected) are all mandatory, whilst high energy use appliances such as air conditioners and clothes driers are not permitted. Eight families participated in an extended case study that encompassed both quantitative and qualitative approaches to better understand sustainable housing (perceived as a single complex technology) through its phases of design, construction and occupation. 1.3 Results The results revealed that the level of sustainability (i.e. the performance outcomes in terms of a low-carbon lifestyle) was impacted on by numerous ‘players’ in the supply chain, such as architects, engineers and subcontractors, the housing market, the developer, product manufacturers / suppliers / installers and regulators. Three key factors were complicit in the level of success: (i) systems thinking; (ii) informed decision making; and (iii) environmental ethics and business practices. 1.4 Discussion The experiences of these families bring into question our understandings and practices with regard to education and training. Whilst increasing and transferring knowledge and skills is essential, the results appear to indicate that there is a strong need for expanding our education efforts to incorporate foundational skills in complex systems and decision making processes, combined with an understanding of how our individual and collective values and beliefs impact on these systems and processes.

Training the public to collect oral histories of our community : the OHAA Queensland Chapter’s model

In a digital age, the skills required to undertake an oral history project have changed dramatically. For community groups, this shift can be new and exciting, but can also invoke feelings of anxiety when there is a gap in the skill set. Addressing this gap is one of Oral History Association of Australia, Queensland (OHAA Qld) main activities. This paper reports on the OHAA Qld chapter’s oral history workshop program, which was radically altered in 2011.

Assisting ICU training management with virtual worlds

Conventional training methods for nurses involve many physical factors that place limits on potential class sizes. Alternate training methods with lower physical requirements may support larger class sizes, but given the tactile quality of nurse training, are most appropriately applied to supplement the conventional methods. However, where the importance of physical factors are periphery, such alternate training methods can provide an important way to increase upper class-size limits and therefore the rate of trained nurses entering the important role of critical care. A major issue in ICU training is that the trainee can be released into a real-life intensive care scenario with sub optimal preparation and therefore a level of anxiety for the student concerned, and some risk for the management level nurses, as patient safety is paramount. This lack of preparation places a strain on the allocation of human and non-human resources to teaching, as students require greater levels of supervision. Such issues are a concern to ICU management, as they relate to nursing skill development and patient health outcomes, as nursing training is potentially dangerous for patients who are placed in the care of inexperienced staff. As a solution to this problem, we present a prototype ICU handover training environment that has been developed in a socially interactive virtual world. Nurses in training can connect remotely via the Internet to this environment and engage in collaborative ICU handover training classes.

Theoretical perspectives on motorcycle training: reducing risk taking

Little past empirical support has been found for the efficacy of motorcycle rider training as a road safety countermeasure. However, it has been argued that rider training should focus more particularly on the psychosocial factors that influence risk taking behaviour in addition to the traditional practice of developing vehicle-handling skills. This paper examines how rider training to reduce risk taking could be guided by appropriate theories. Two fundamental perspectives are examined: firstly training can be considered in terms of behaviour change, and secondly in terms of adult learning. Whilst behaviour change theories assume some pre-existing level of dysfunctional behaviour, an adult learning perspective does not necessarily carry this assumption. This distinction in perspectives conceptually aligns with the notions of intervention and prevention (respectively), with possible implications for specific target groups for pre-licence and post-licence training. The application of the Theory of Reasoned Action (Ajzen & Fishbein, 1975, 1980) and Transformative Learning Theory (Mezirow, 1997) to a pre-licence rider training program in Queensland, Australia is discussed.

Measuring the effect of motorcycle rider training on psychosocial influences for risk taking

Aim: Whilst motorcycle rider training is commonly incorporated into licensing programs in many developed nations, little empirical support has been found in previous research to prescribe it as an effective road safety countermeasure. It has been posited that the lack of effect of motorcycle rider training on crash reduction may, in part, be due to the predominant focus on skills-based training with little attention devoted to addressing attitudes and motives that influence subsequent risky riding. However, little past research has actually endeavoured to measure attitudinal and motivational factors as a function of rider training. Accordingly, this study was undertaken to assess the effect of a commercial motorcycle rider training program on psychosocial factors that have been shown to influence risk taking by motorcyclists. Method: Four hundred and thirty-eight motorcycle riders attending a competency-based licence training course in Brisbane, Australia, voluntarily participated in the study. A self-report questionnaire adapted from the Rider Risk Assessment Measure (RRAM) was administered to participants at the commencement of training, then again at the conclusion of training. Participants were informed of the independent nature of the research and that their responses would in no way effect their chance of obtaining a licence. To minimise potential demand characteristics, participants were instructed to seal completed questionnaires in envelopes and place them in a sealed box accessible only by the research team (i.e. not able to be viewed by instructors). Results: Significant reductions in the propensity for thrill seeking and intentions to engage in risky riding in the next 12 months were found at the end of training. In addition, a significant increase in attitudes to safety was found. Conclusions: These findings indicate that rider training may have a positive short-term influence on riders’ propensity for risk taking. However, such findings must be interpreted with caution in regard to the subsequent safety of riders as these factors may be subject to further influence once riders are licensed and actively engage with peers during on-road riding. This highlights a challenge for road safety education / training programs in regard to the adoption of safety practices and the need for behavioural follow-up over time to ascertain long-term effects. This study was the initial phase of an ongoing program of research into rider training and risk taking framed around Theory of Planned Behaviour concepts. A subsequent 12 month follow-up of the study participants has been undertaken with data analysis pending.