The political economy of co-ordination challenges in the National Health Service: a postpositivist evaluation of diabetes policy and governance

The present PhD thesis develops and applies an evaluative methodology suited to the evaluation of policy and governance in complex policy areas. While extensive literatures exist on the topic of policy evaluation, governance evaluation has received less attention. At the level of governance, policymakers confront choices between different policy tools and governance arrangements in their attempts to solve policy problems, including variants of hierarchy, networks and markets. There is a need for theoretically-informed empirical research to inform decision-making at this level. To that end, the PhD develops an approach to evaluation by combining postpositivist policy analysis with heterodox political economy. Postpositivist policy analysis recognises that policy problems are often contested, that choices between policy options can involve significant trade-offs and that knowledge of policy options is itself dispersed and fragmented. Similarly, heterodox economics combines a concept of incommensurable values with an appreciation of the strengths and weaknesses of different institutional arrangements to realise them. A central concept of the field is coordination, which orientates policy analysis to the interactions of stakeholders in policy processes. The challenge of governance is to select the appropriate policy tools and arrangements which facilitate coordination. Via a postpositivist exploration of stakeholder ‘frames’, it is possible to ascertain whether coordination is occurring and to identify problems if it is not. Evaluative claims of governance can be made where arrangements can be shown to frustrate the realisation of shared values and objectives. The research makes a contribution to knowledge in a number of ways a) a distinctive evaluative approach that could be applied to other areas of health and public policy b) greater appreciation of the strengths and weaknesses of different forms of evidence in public policy and in particular health policy and c) concrete policy proposals for the governance and organisation of diabetes services, with implications for the NHS more broadly.

Complexity theory and tourism policy research

This paper investigates applications of complexity theory in the social sphere and considers its potential contribution to enhance understanding of tourism policy making. Five concepts are identified to explore complex social circumstances and human interactions that influence policy. Social applications of complexity suggest a move towards localised and deeper studies to explore the dynamics of policy enactment in context. It suggests complexity theory might be used as a thinking tool to enable a more holistic approach to policy analysis and investigate policy in its context, considering interactions between different policies/programmes, and the implications of human agency.

“跨境人口流动及其政策含义: 基于香港的分析” (Trans-border mobility and its policy implications: the case of Hong Kong)

This paper employs a ‘regional approach’ in the study of Hong Kong population that goes beyond the taken-for-granted analytical framework defined by fixed geographical and social boundaries. It identifies the pattern and tend of population movement between Hong Kong and mainland China, with emphasis on trans-border marriage and child-bearing, trans-border housing and retirement and trans-border employment. The author argues that a 'regional approach' will shed new light on existing trans-migration studies, and bring in a new way of thinking for the making of population policies.

Improving health and wellbeing independently of GDP: dividends of greener and prosoical economies

Increases in gross domestic product (GDP) beyond a threshold of basic needs do not lead to further increases in well-being. An explanation is that material consumption (MC) also results in negative health externalities. We assess how these externalities influence six factors critical for well-being: (i) healthy food; (ii) active body; (iii) healthy mind; (iv) community links; (v) contact with nature; and (vi) attachment to possessions. If environmentally sustainable consumption (ESC) were increasingly substituted for MC, thus improving well-being and stocks of natural and social capital, and sustainable behaviours involving non-material consumption (SBs-NMC) became more prevalent, then well-being would increase regardless of levels of GDP. In the UK, the individualised annual health costs of negative consumption externalities (NCEs) currently amount to £62 billion for the National Health Service, and £184 billion for the economy (for mental ill-health, dementia, obesity, physical inactivity, diabetes, loneliness and cardiovascular disease). A dividend is available if substitution by ESC and SBs-NMC could limit the prevalence of these conditions.

Gold, power, protest: Digital and social media and protests against large-scale mining projects in Colombia

Colombia’s Internet connectivity has increased immensely. Colombia has also ‘opened for business’, leading to an influx of extractive projects to which social movements object heavily. Studies on the role of digital media in political mobilisation in developing countries are still scarce. Using surveys, interviews, and reviews of literature, policy papers, website and social media content, this study examines the role of digital and social media in social movement organisations and asks how increased digital connectivity can help spread knowledge and mobilise mining protests. Results show that the use of new media in Colombia is hindered by socioeconomic constraints, fear of oppression, the constraints of keyboard activism and strong hierarchical power structures within social movements. Hence, effects on political mobilisation are still limited. Social media do not spontaneously produce non-hierarchical knowledge structures. Attention to both internal and external knowledge sharing is therefore conditional to optimising digital and social media use.