Market failure, policy failure and other distortions in chronic disease markets

Background: The increasing prevalence of chronic disease represents a significant burden on most health systems. This paper explores the market failures and policy failures that exist in the management of chronic diseases.
Discussion: There are many sources of market failure in health care that undermine the efficiency of chronic disease management. These include incomplete information as well as information asymmetry between providers and consumers, the effect of externalities on consumer behaviour, and the divergence between social and private time preference rates. This has seen government and policy interventions to address both market failures and distributional issues resulting from the inability of private markets to reach an efficient and equitable distribution of resources. However, these have introduced a series of policy failures such as distorted re-imbursement arrangements across modalities and delivery settings.
Summary: The paper concludes that market failure resulting from a preference of individuals for 'immediate gratification' in the form of health care and disease management, rather than preventative services, where the benefits are delayed, has a major impact on achieving an efficient allocation of resources in markets for the management of chronic diseases. This distortion is compounded by government health policy that tends to favour medical and pharmaceutical interventions further contributing to distortions in the allocation of resources and inefficiencies in the management of chronic disease.

Policy change and industry associability: the Australian mining sector

In this paper we use evidence from the recent trajectories of mining industry associations in the Australian federation to argue for the significance of institutional explanations for the formation and maintenance of interest groups. We argue that the recent lack of consultation by the Commonwealth government with the Minerals Council of Australia over resources rent taxation proposals reflected a weakness that resulted from the shifting basis of associability stemming from institutional changes.

Obesity prevention programs and policies: practitioner and policy-maker perceptions of feasibility and effectiveness

Objectives:

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

The dynamic interplay of news media and bilingual education policy in Australia's Northern Territory 1988-2008

his study investigates the dynamic interplay between news media and the Northern Territory’s policy of bilingual education for indigenous children living in some remote communities. It provides evidence to support the argument that the media-related practices of a range of policy actors resulted in policy processes being shaped to a significant degree by ‘media logic’. The research is based on depth interviews and uses the spoken words of participants to gain access to the local experiences and perspectives of those invested in developing, influencing and communicating the bilingual education policy. Through the analysis of more than 20 interviews with journalists, public servants, academics, and politicians as well as indigenous and non-indigenous bilingual education advocates, I have identified a range of media-related practices that have enabled policy actors to penetrate the policy debate, define problems for policymaking and public discussion through the news media, and thereby exert particular forms of influence in the policy process. The study also provides a ‘southern theory’ analysis of the Yolngu public sphere and a Bourdesian understanding of the journalism sub-field of indigenous reporting in the Northern Territory. It shows that issues of physical and cultural remoteness and the need for journalists to develop cultural competence are the hallmarks of this reporting specialization. It also identifies marked differences in journalists’ relationships with government, academic and indigenous sources and how these differences play out in the way participants understand the production and reception of media texts. This research makes an innovative contribution to Australian Journalism Studies by demonstrating how indigenous epistemologies and knowledges offer fresh perspectives and insights about news media and indigeneity that can be brought into balance with northern theories to build what Connell (2007) has called ‘southern theory’. This dovetails with another key outcome, which is the development of an academic form of journalism that serves indigenous peoples’ self-determinist aims for scholarly research, based in indigenous perspectives and research methodologies.

The influence of faith-based organisations on Australian social policy

This historical overview explores the crucial and changing relationships between faith-based organisations and governments, not only in the implementation of social services but also in the formation of social policy. Historically Australian governments have left large areas of social provision to the non-government sector. For example, income support for the unemployed was not taken up by governments until World War II and income support for sole parents remained largely a responsibility for non-government organisations (NGOs) until the 1970s. Prior to governments taking responsibility for income support, most of these NGOs were religious organisations surviving on donations, philanthropic support and limited government funding. It is argued that the dominant, semi-public role of religious organisations in service delivery and social policy formation is an important but largely overlooked aspect of the Australian historical experience.

More yuppy stuff coming soon: gentrification, cultural policy, social inclusion and the arts

Responding to gentrification has become a key planning issue for many urban municipalities. Local governments need to balance the often-competing agendas of urban regeneration, social inclusion and arts access and participation. This paper argues that arts and cultural units within local government bear the impact of such tensions. More importantly, however, local government policies and their implementation represent a third position in the polarised discussion on the cultural impact of gentrification. The example discussed here is the rapidly gentrifying City of Maribyrnong in Melbourne’s western suburbs: a municipality where any potential realisation of the economic benefits of gentrification is balanced against the needs of a significant population of resident professional artists, and the social inclusion needs of socio-economically disadvantaged residents. Maribyrnong’s arts and cultural unit, like those within many municipalities in the developed world, has had to develop cultural policies and plans as tools for negotiating complex relationships and diverse needs of community members by considering the economic, social and cultural benefits of the arts for all residents.

Community views on responding to a local asbestos disease epidemic : implications for policy and practice

The Latrobe Valley region of Victoria, Australia, has the highest rate of asbestos disease in the state due to extensive past use of asbestos in the power industry. Current responses to asbestos disease epidemics in Australia and internationally are dominated by medical, scientific, legal and government perspectives. The voices and perspectives of those most directly affected – exposed and diseased workers, their families and communities – are relatively rarely heard.A qualitative interview study was conducted to determine what people in the Latrobe Valley community think could or should be done following their own asbestos disease epidemic. Analysis identified several themes. Notably, these represent a sophisticated community understanding of issues that is largely consistent with state-of-the-art occupational health and public health knowledge.Some themes are well known already, eg the need for fair and timely compensation, adequate healthcare facilities and services, and more education. Others point to neglected possibilities, such as the need for reconciliation and social healing to complement the dominant individual medico-legal focus. Employer suppression of hazard information and denial of asbestos-related disease in past decades continues to have a profound effect on people's views in the present. Reconciliation in some form, eg acknowledgement of or apology for past wrongs, was identified as a necessary first step in developing new and better policy and practice responses; action in this regard has important implications for the implementation and effectiveness of other policy and practice interventions. Further, a need for substantive community participation in the development of policy and practice responses – currently lacking – was identified. Findings suggest that community is an under-recognised and under-utilised resource in responding to a local asbestos disease epidemic.The Latrobe Valley situation is a microcosm of the broader Australian and international story. It offers insights on the perspectives of those most affected by asbestos issues, how such people and their views can be used to strengthen current policy and practice responses, and how their participation is essential to building comprehensive public and social health responses to this global problem.

Neoliberalism, economic restructuring and policy change : precarious housing and precarious employment in Australia

Housing, employment and economic conditions in many nations have changed greatly over the past decades. This paper explores the ways in which changing housing markets, economic conditions and government policies have affected vulnerable individuals and households, using Australia as a case study. The paper finds a substantial number and proportion of low income Australians have been affected by housing and employment that is insecure with profound implications for vulnerability. Importantly, the paper suggests that in Australia the economic gains achieved as a consequence of mining-related growth in the early 2000s were translated as greater employment security for some on low incomes, but not all. Enhanced access to employment in this period was differentiated by gender, with women largely missing out on the growth in jobs. For the population as a whole, employment gains were offset by increased housing insecurity as accommodation costs rose. The paper finds low income lone parents were especially vulnerable because they were unable to benefit from a buoyant labour market over the decade 2000–2010. They were also adversely affected by national policy changes intended to encourage engagement with paid work. The outcomes identified for Australia are likely to have been mirrored in other nations, especially those that have embraced, or been forced to adopt, more restrictive welfare and income support regimes.

Northern Lights: the positive policy example of Sweden, Finland, Denmark and Norway

The nations of Scandinavia and Finland, or Nordic Europe, continue to provide living proof that economic prosperity can be combined with social equality and environmental responsibility. This book, written from an Australian perspective, explores previous outside policy interest in the Nordic nations and outlines some lessons which the English-speaking world, in particular, can learn now from the achievements of the four main Nordic European nations. In terms of income distribution these countries are still much more equal than Australia, Britain, New Zealand and Canada – and nearly twice as equal as the United States. Workforce participation rates are high in the Nordic nations but working hours remain within reasonable limits, enabling genuine work–life balance. Sweden has played a leading role in improving wellbeing, and lowering poverty, among children. Finland has achieved stunning success in schools since the 1990s. Denmark invests in comprehensive skills training as part of providing security, as well as flexibility, in people’s employment lives. Norway’s taxation approach and other measures ensure that its natural resources are used sustainably for the entire nation’s long-term wealth. All of these achievements are relevant to the policy choices for the future which Australia, and other English-speaking countries, can now make.

A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol

Background: The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'.Methods/design: The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using logistic regression models adjusting for baseline values.Discussion: The proposed trial will represent a novel contribution to the literature, being the first randomised trial internationally to examine the effectiveness of an intervention to facilitate implementation of a healthy canteen policy.