Globalisation, security and international order after 11 September

This article advances the discussion of the contentious question of links between global inequalities of power and violent responses, focussing on globalisation and non-inclusive forms of governance. Drawing on international political economy, the article criticises the nationstate-centrism in much political discourse, suggesting that both authority and security need to be reconsidered - to account for less plausible national borders and controls. It suggests that human security (including issues of development and equality) ought to replace national security as the primary focus of public policy. It draws attention to the intractability of difference, insisting that the terrorism of 2001 has complex transnational antecedents. Realist approaches to international order have become part of a problem to be overcome through further intellectual debate.

Cadence, war and security

An increased incidence of attack has been identified as a major characteristic of the new threat posed by terrorist groups such as al Qaeda. This article considers what such a change means for Western national security systems by examining bow different parts of the system change over time. It becomes evident that Western national security systems are structured on an assumption of comparatively slow state-based threats. In contrast, terrorist franchises operate at a faster pace, are more 'lightweight' and can adapt within the operational and capability cycles of Western governments. Neither network-centric warfare nor an improved assessment of the threat, called for by some, offers a panacea in this regard. Rather, it is clear that not only do Western governments need to adjust their operational and capability cycles, but that they also need a greater diversity of responses to increase overall national security resilience and offer more tools for policy-makers.

Encouraging practitioners to use resources: evaluation of the national implementation of a resource to improve the clinical management of alcohol-related problems in Indigenous primary care settings

This paper reports on the evaluation of the implementation of the National Recommendations for the Clinical Management of Alcohol-Related Problems in Indigenous Primary Care Settings undertaken in 2001 through 74 standardized workshops, which sought to determine: ( 1) whether this approach to implementation influenced the likelihood that the National Recommendations would be used; ( 2) whether it influenced participants' willingness to engage with Indigenous patients regarding alcohol-related issues; and ( 3) whether the implementation as a whole influenced both practice and clinicians' willingness to engage. Evaluation included pre-/post-workshop and follow-up questionnaires and a focus group. The findings presented indicate that distribution of clinical resources alone is not sufficient to ensure use and that, particularly for medical practitioners, appropriate introduction not only increases use but also positively influences willingness to engage with alcohol-related problems as part of primary clinical care. Further, the enthusiasm for guideline production should be tempered by the need to develop effective implementation strategies.

Developments in National Physical Activity Policy: An international review and recommendations towards better practice

Physical activity (PA) is increasingly considered an important public health issue and as such requires the development of good public health policy. This paper provides a summary of the literature on policy development and defines what a policy on PA may usefully comprise. The results of an international review of national level PA policies, using a defined set of criteria, are reported. Considerable similarities were found in the methods and approaches to policy development on PA across countries, with most adopting an intersectoral approach, with consultation and partnership between sectors occurring at a high level of government. The need for action across the lifespan is recognised, as is the need for multiple strategies across a variety of settings. A review of Australian PA policy found that, after promising strategic developments through Active Australia in the late 1990s, PA policy and the role of the federal health sector has become less clear, with PA policy existing now only as a component part integrated into other chronic disease prevention policy initiatives. Recommendations towards better practice in policy making are made with particular reference to developing a clearly defined integrated national PA policy in the Australian context.

Serious adverse events in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

Aims The study estimated serious adverse event (SAE) rates among entrants to pharmacotherapies for opioid dependence, during treatment and after leaving treatment. Design A longitudinal study based on data from 12 trials included in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Participants and settings A total of 1.244 heroin users and methadone patients treated in hospital, community and GP settings. Intervention Six trials included detoxification; all included treatment with methadone, buprenorphine, levo-alpha-acetyl-methadol (LAAM) or naltrexone. Findings During 394 person-years of observation, 79 SAEs of 28 types were recorded. Naltrexone participants experienced 39 overdoses per 100 person-years after leaving treatment (44% occurred within 2 weeks after stopping naltrexone). This was eight times the rate recorded among participants who left agonist treatment. Rates of all other SAEs were similar during treatment versus out of treatment, for both naltrexone-treated and agonist-treated participants. Five deaths occurred, all among participants who had left treatment, at a rate of six per 100 person-years. Total SAE rates during naltrexone and agonist treatments were similar (20, 14 per 100 person-years, respectively). Total SAE and death rates observed among participants who had left treatment were three and 19 times the corresponding rates during treatment. Conclusions Individuals who leave pharmacotherapies for opioid dependence experience higher overdose and death rates compared with those in treatment. This may be due partly to a participant self-selection effect rather than entirely to pharmacotherapy being protective. Clinicians should alert naltrexone treatment patients in particular about heroin overdose risks. Duty of care may extend beyond cessation of dosing.

Lessons from the National Mental Health Integration Program

Three projects were funded under the national Mental Health Integration Program (MHIP) in 1999, each of which employed a different model aimed at improving linkages between disparate parts of the mental health system. A national evaluation framework guided local evaluations of these projects, and this paper presents a synthesis of the findings. For providers, the projects improved working relationships, created learning opportunities and increased referral and shared care opportunities. For consumers and carers, the projects resulted in a greater range of options and increased continuity of care. For the wider system, the projects achieved significant structural and cultural change. Cost-wise, there were no increases in expenditure, and even some reductions. Many of the lessons from the projects (and their evaluations) may be generalised to other mental health settings and beyond.

Computerizing the welfare state: An international comparison of computerization in social security

Although computer technology is central to the operation of the modern welfare state, there has been little analysis of its role or of the factors shaping the way in which it is used. Using data generated by expert informants from 13 OECD countries, this paper provides an indicative comparison of the aims of computerization in national social security systems over a 15-year period from 1985 to 2000. The paper seeks to identify and explain patterns in the data and outlines and examines four hypotheses. Building on social constructivist accounts of technology, the first three hypotheses attribute variations in the aims of computerization to different welfare state regimes, forms of capitalism, and structures of public administration. The fourth hypothesis, which plays down the importance of social factors, assumes that computerization is adopted as a means of improving operational efficiency and generating expenditure savings. The findings suggest that, in all 13 countries, computerization was adopted in the expectation that it would lead to increased productivity and higher standards of performance, thus providing most support for the fourth hypothesis. However, variations between countries suggest that the sociopolitical values associated with different welfare state regimes have also had some effect in shaping the ways in which computer technology has been used in national social security systems.

The Politics of Decentralizing National Parks Management in the Philippines

International donors and state bureaucrats in the developing world have promoted decentralization reform as the primary means to achieve equitable, efficient and sustainable natural resource management. Relatively few studies, however, consider the power interests at stake. Why do state agencies decentralize power, what political patterns unfold, and how do outcomes affect the responses of resource users? This paper explores decentralization reform by investigating the political processes behind the Philippine state's decisions to transfer authority over national parks management to local government units. Drawing on a case of devolved management at Puerto Princesa Subterranean River National Park, Palawan Island, we examine how political motives situated at different institutional scales affect the broader process of decentralization, the structure of management institutions, and overall livelihood security. We demonstrate how power struggles between the Philippine state and City Government of Palawan over the right to manage the national park have impacted the livelihood support offered by community-based conservation. We conclude that decentralization may offer empowering resu