Pandemic (H1N1) Influenza 2009 and Australian emergency departments : implications for policy, practice and pandemic preparedness

Objective: To describe the reported impact of Pandemic (H1N1) 2009 on EDs, so as to inform future pandemic policy, planning and response management.

Methods: This study comprised an issue and theme analysis of publicly accessible literature, data from jurisdictional health departments, and data obtained from two electronic surveys of ED directors and ED staff. The issues identified formed the basis of policy analysis and evaluation.

Results: Pandemic (H1N1) 2009 had a significant impact on EDs with presentation for patients with ‘influenza-like illness’ up to three times that of the same time in previous years. Staff reported a range of issues, including poor awareness of pandemic plans, patient and family aggression, chaotic information flow to themselves and the public, heightened stress related to increased workloads and lower levels of staffing due to illness, family care duties and redeployment of staff to flu clinics. Staff identified considerable discomfort associated with prolonged times wearing personal protective equipment. Staff believed that the care of non-flu patients was compromised during the pandemic as a result of overwork, distraction from core business and the difficulties associated with accommodating infectious patients in an environment that was not conducive.

Conclusions: This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.

Opportunities and challenges in developing a whole-of-government national food and nutrition policy: lessons from Australia's National Food Plan

OBJECTIVE: The present article tracks the development of the Australian National Food Plan as a 'whole of government' food policy that aimed to integrate elements of nutrition and sustainability alongside economic objectives. DESIGN: The article uses policy analysis to explore the processes of consultation and stakeholder involvement in the development of the National Food Plan, focusing on actors from the sectors of industry, civil society and government. Existing documentation and submissions to the Plan were used as data sources. Models of health policy analysis and policy streams were employed to analyse policy development processes. SETTING: Australia. SUBJECTS: Australian food policy stakeholders. RESULTS: The development of the Plan was influenced by powerful industry groups and stakeholder engagement by the lead ministry favoured the involvement of actors representing the food and agriculture industries. Public health nutrition and civil society relied on traditional methods of policy influence, and the public health nutrition movement failed to develop a unified cross-sector alliance, while the private sector engaged in different ways and presented a united front. The National Food Plan failed to deliver an integrated food policy for Australia. Nutrition and sustainability were effectively sidelined due to the focus on global food production and positioning Australia as a food 'superpower' that could take advantage of the anticipated 'dining boom' as incomes rose in the Asia-Pacific region. CONCLUSIONS: New forms of industry influence are emerging in the food policy arena and public health nutrition will need to adopt new approaches to influencing public policy.

Overlapping forms of knowledge in environmental governance: comparing environmental policy workers' perceptions

Public sector environmental governance involves complex interactions between different forms of knowledge. Public sector reforms have important implications for environmental governance by changing the relationships between knowledge systems. By comparing the views of environmental policy workers the implications of public sector management reform for environmental governance are explored. The analysis presented highlights that environmental policy work is contested in ways that mainstream public sector management and environmental governance literature often overlook. It is concluded that the adequacy of the conceptual frameworks informing public sector environmental reform are unclear, as are the implications of such reforms for effective environmental governance.

Bourdieu and doing policy sociology in education

Despite Bourdieu having written nothing explicitly about education policy, the chapter argues the usefulness of his social theory to doing policy analysis in education within a policy sociology frame. The chapter draws on Bourdieu's 'thinking tools', including the concepts of habitus, capitals, fields and practice, which sit in a synergistic relationship with each other, and applies them to an approach for doing education policy analysis. It then considers the education policy field, logics of practice of different fields in relation to the policy cycle, policy habitus, and the emergent global education policy field.

A framework for sustainable ecotourism : application to Costa Rica

Costa Rica is a small Central American nation that has gained an international reputation as a leader in environmental conservation. This has formed the base for its highly successful and lucrative small-scale ecotourism industry. However, there are threats from high rates of deforestation and expanding large-scale tourism that is trading on strong environmental credentials, so it is appropriate to conduct this policy analysis on such a significant ecotourism area. The paper develops an ecologically sustainable economic framework, drawing on the works of Adolph Lowe (1893-1995) and Michalstrok Kalecki (1899-1970), to examine the Costa Rican experience and then analyse lessons for general policy development of any ecotourism area. The analysis is conducted from a political economy (and not a tourism management) perspective on the trade-offs between small-scale and large-scale ecotourism.

Ambivalent relations : the 'tricky footwork' of parental involvement in school communities

Parental involvement in schools, generally seen to be a good thing, is now closely linked through policy to the educational achievement of their children. In this Victorian case study, teacher and parent responses to policies advocating parental involvement are examined. It explores the intersections of gender and class in the context of changing home/school relationships characterised by policies and processes of institutionalisation, familialisation and individualisation that are shaping parental involvement. It suggests that the current discursive construction of parent/school relationships around partnerships for student learning fail to recognise the complexity of parent/teacher relations and its gendered nature. Feminist critical policy analysis framed by the sociology of the family inform our understandings of the ways changing discourses and practices currently are informing parental involvement in a culturally and socio-economically diverse school.

The politics of developing reference standards for nutrient intakes : the case of Australia and New Zealand

Objective Nutrient Reference Values (NRV) are evidence-based benchmarks for assessing the dietary adequacy of individuals and population groups as well as informing public health nutrition policies and programmes. The present paper presents the findings of an analysis of the views of submitters to a draft document associated with the development of the 2006 NRV for Australia and New Zealand. The aim of the study was to explore how these views were reflected in the policy-making process and final policy document.

Design The information necessary to fulfil this aim required access to stakeholder submissions to the NRV development process and this necessitated exploiting the provisions of the Commonwealth of Australia’s Freedom of Information (FOI) Act 1982. We understand that the present research represents the first time that an FOI request seeking information about a National Health and Medical Research Council food and nutrition policy process has been made and therefore is novel in its approach to public health nutrition policy analysis.

Results The analysis of stakeholder submissions identified that stakeholders had particular concerns about the conduct of the review process and the future application of the nutrient values to policy and programmes. There is a lack of evidence that the majority of stakeholder comments were addressed in the final NRV document.

Conclusion Although these findings cannot be interpreted to assess the validity or otherwise of the set nutrient values, they do raise questions about the process for their development and the adequacy of the final document to reflect the views of key stakeholders.

Assessing cost-effectiveness in obesity (ACE-Obesity) : an overview of the ACE approach, economic methods and cost results

Background : The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study.

Methods : The Assessing Cost-Effectiveness (ACE) approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'.

Results : The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum) and when expressed as a 'cost per child' estimate (from <AUD1.0 [reduction of TV advertising of high fat foods/high sugar drinks] to >AUD31,000 [laparoscopic adjustable gastric banding for morbidly obese adolescents]). High costs per child reflected cost structure, target population and/or under-utilisation.

Conclusions : The use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and second stage filter considerations for each intervention assessed will be presented and analysed.

Lay healing practices in the household

This thesis explores the power-knowledge relationship underlying lay healing practices in the household; a non-traditional area of study in public health. Lay knowledge continues to be discounted as illegitimate and !non-expert' by policymakers, health professionals and academics. Given the absence of theory on lay knowledge and decision-making, an eclectic theoretical approach was undertaken in this study. Theory is drawn from medical anthropology, sociology of the body, health economics, gender studies, social theory, psychology, nursing, ethics, philosophy and history of medicine in order to contribute to and advance debate. Operating within the genre of a 'multi-sited ethnography' (working across different sites), methods for data collection included 'anthropology at home' by undertaking fieldwork in Geelong, Victoria, Australia. I conducted interviews and focus group discussions with, and administered a questionnaire to, 98 participants who are parents of young children. They were recruited via primary schools and snowball sampling. The quantitative data presents a socio-demographic 'picture' of 78 women and 20 men (representing 98 households) from urban, rural and coastal areas of the region. The qualitative data contains case studies as well as narratives, analysed for their content and discourses. Additional methods included maintenance of a 'reflexive journal', inter-sectoral consultations and public health policy analysis. Research findings indicate laypeople's conceptualisations of the body, self, health and illness rest upon a notion of the embodied self and health that is physical, mental and spiritual. Lay people have a substantial knowledge base on health and ill-health that derives from many sources, is both generalised and specialised, and is set within the context of everyday life. Laypeople make diagnoses and treat illness and injury within the household. They also exercise substantial agency in determining their choice of healer(s) for therapeutic intervention and management of ill-health outside the household. This study has substantial implications for public health in terms of healers' clinical practices, research and policy.

Inclusive schooling : contexts, texts and politics

The title ‘Inclusive schooling: contexts, texts and politics’, names a thesis which critically analyses the development of inclusive schooling in the small Australian Island state of Tasmania between 1996 and 1998. The ‘Inclusion of Students with Disabilities’ policy, introduced in 1995 by the Tasmanian Department of Education, Community and Cultural Development, provides an opportunity to understand the cultural context and politics of change in schooling over this period. The qualitative methodology deployed here is informed by poststructuralism and captures the everyday experiences of university teaching as a research site. The teacher/researcher as the visible maker of the research use metaphors of fibre and textile practice, techniques of textual juxtaposition and her positioned subjectivity as a female academic to tell a 'big story'. The researcher develops a 'double method' as a possible model for Inclusive research practice and educational policy analysis. Using a critical ethnographic method, derived from the work of Carspecken (1996), 'data stories' (Lather & Smithies 1997, p.34) are produced from the narratives of five key informants – a parent, two teachers, a policy-maker and the researcher. Assembled as the data of the thesis the multi-voiced texts provide an account of the sociocultural, professional and systemic context of Inclusive schooling over a three-year period. In the analysis these data are interpreted from a feminist poststructural standpoint. A deconstructuive reading of the data stories interprets the discourse of inclusive schooling emphasising the dominant foundation of the special education knowledge tradition. The idea of author function (after Foucault 1975, 1984b and Grundy and Hatton 1995) is used to interpret the 'texts' of the key Informants as discursive constructions. The researcher theorises inclusive schooling as an entangled, multiple and contradictory discourse, embedded in the social, cultural and material contexts, rather than a singular unitary Idea of the progress within the special education knowledge tradition. The study contributes a fine-grained analysis of the constructed knowledge of inclusive schooling in one locality. The thesis advocates continuing engagement with questions of epistemology and social transformation in inclusive schooling, rather than persisting with technical rationality and the status quo. The researcher takes the position that the opportunities to theorise inclusive schooling lie within the multiple and disparate constructed texts of the micro world of everyday practice and the macro understanding of understandings of contemporary social justice. The poststructuralist writing/reading questions traditionalist theorising in the special education field. Central to the negotiations of power and truth inclusive schooling research and practice is a communicative theory that transforms populist conceptions of inclusion.

The ambiguous politics of teachers in the reconstruction of Iraq

The opportunity to rebuild community after conflict requires rapid responses to reinstall key institutions. This paper examines the role of educators in the reconstruction of educational systems and in the rebuilding of community through a case study of Iraq. While ongoing conflict continues in Iraq, reconstruction efforts persist through large scale infrastructure and institutional rebuilding that aims to bring stability to political, legal and financial systems. The interim Iraqi government, given sovereignty on June 28, 2004, continues to support the road map underpinning rebuilding efforts in Post-Saddam Iraq.1 The restructuring of education systems is a cornerstone of rebuilding efforts since an intact and functioning education system complements other social and economic transformations, rebuilds social relations and instigates a routine normalcy to post conflict communities . The paper problematises rebuilding efforts through critical policy analysis that questions the nature of policy, how assistance is constructed and the ambiguous political role of educators in educational rebuilding.

Creating (in) capacity : teachers in globalized education policies

The relationship between education and globalization stands largely unexamined from teachers’ perspectives. By focusing on the teachers, as axiomatic to educational and pedagogical change, teachers feature in education policy and through their plight, the paper explores and challenges ideas that displacing teachers from input into educational reforms facilitates progressive implementation of new education. Demonstrating teachers' displacement from the policy making process becomes evident through the use of computer assisted qualitative research examining and drawing inference from textual evidence. Using text analysis focuses on teachers' work and how it is shaped and represented. On a policy continuum beginning from the policy makers and leading towards the policy takers, the way that teachers are represented in education policy demonstrates their limited capacity to influence policy making. By examining how teachers and their work are thus defined in macro policies, the intension is to raise concerns about the uncontested way that globalization driven educational reforms have entered the discourse of educational policy and the implications for educators. Educational policy advocates teachers’ critical role yet blurs teachers' participative capacity and leads towards the conclusion that policy obscures teachers’ agency in order to ensure that teachers are objects of policy rather than integral to policy making.

A healthy diet consistent with Australian health recommendations is too expensive for welfare-dependant families

Objective: Examine the cost of healthy food habits for welfare-dependent families in Australia.

Method:  A seven-day meal plan was developed, based on Australian public health recommendations, for two typical welfare-dependent families: a couple-family (two adults, two children) and a one-parent family (one adult, two children). The cost of the meal plan was calculated using market brand and generic brand grocery items, and total cost compared to income.

Results: In Australia, the cost of healthy food habits uses about 40% of the disposable income of welfare-dependent families. Families earning an average income would spend only 20% of their disposable income to buy the same healthy food. Substituting generic brands for market brands reduced the weekly food cost by about 13%. This is one of few economic models to include generic brands.

Conclusion: Compared with average-income Australian families, healthy food habits are a fiscal challenge to welfare-dependent families.

Implications: These results provide a benchmark for economic and social policy analysis, and the influence disposable income has on prioritising healthy food habits.

Payoff, capital and teachers : education policies of the 90s

Although education remains in the flux of change, reviewing the trends in educational reforms in the last decade provides opportunity to learn from the past with a view to improving the educational strategies guiding reforms in the future. As globalisation has become more consolidated in education policy, investigating how particular ideas about globalisation inhabited policy and established over time, presents ways of addressing and challenging the assumptions about education and globalization in the 90s and the fall out from these ideas. Using evidence based policy research, this paper explores how educational policies from OECD, UNESCO and the World Bank coalesced with certain notions of globalisation that strategically guided educational reforms. An analysis of education-globalisation nexus in the policies of OECD, UNESCO and the World Bank evidences the distinct character and agenda of each agency. By focusing on textual evidence, in a range of education policy from the 90s, the paper discusses how policy consolidated particular ideas about globalization and presented ‘simple’ recipes for educational change. When reviewing the 90s, the relationship between education and global change shows that OECD policy emphasized education as a social and individual payoff, World Bank policy focused on education creating certainty enabling the free flow of capital, and UNESCO policy problematised globalization and focused on the importance of teachers as a way to create stability in education during the paradoxical times.

Cross-field effects and temporary social fields : a case study of the mediatization of recent Australian knowledge economy policies

This paper utilizes Bourdieu's conceptual frame to examine the mediatized effects of policy processes concerned with the growth and support of knowledge industries in Australia. These policies span education, science, research and other knowledge industries (such as venture capital firms and intellectual property law). The paper argues that some policy processes are best represented as temporary social fields. The nature of these fields can be described by the kinds of cross-field effects that they produce, A case study of an Australian knowledge economy policy, The chance to change, and associated policy processes demonstrates the broad analytic capacities of Bourdieu 's conceptual frame for policy analysis, when combined with the concepts of cross-field effects and temporary social field developed here.