A review of methods and tools to assess the implementation of government policies to create healthy food environments for preventing obesity and diet-related non-communicable diseases

BACKGROUND: Policies to create healthy food environments are recognized as critical components of efforts to prevent obesity and diet-related non-communicable diseases. There has not been a systematic review of existing methods and tools used to assess the implementation of these government policies. The purpose of this study was to review methods and tools used for assessing the implementation of government policies to create healthy food environments. The study conducted a systematic literature search. Multiple databases as well as the grey literature were searched. All study designs and review papers on assessing the implementation of government policies to create healthy food environments were included. A quality assessment of the methods and tools identified from relevant studies was carried out using the following four criteria: comprehensiveness, relevance, generalizability and feasibility. This quality assessment was completed by two independent reviewers. RESULTS: The review identified 52 studies across different policy areas, levels and settings. Self-administered questionnaires and policy checklists were most commonly applied to assess the extent of policy implementation, whereas semi-structured interviews were most commonly used to evaluate the implementation process. Measures varied widely, with the existence of policy implementation the aspect most commonly assessed. The most frequently identified barriers and facilitators for policy implementation were infrastructure support, resources and stakeholder engagement. The assessment of policy implementation on food environments was usually undertaken in combination with other policy areas, particularly nutrition education and physical activity. Three tools/methods were rated 'high' quality and 13 tools/methods received 'medium' quality ratings. CONCLUSIONS: Harmonization of the available high-quality methods and tools is needed to ensure that assessment of government policy implementation can be compared across different countries and settings and over time. This will contribute to efforts to increase government accountability for their actions to improve the healthiness of food environments.

Bailouts, monitoring, and penalties: an integrated framework of government policies to manage the too-big-to-fail problem

This paper discusses optimal government bailout policy where the costs of systemic failures and moral hazard problems are considered. We find that a three-tiered bailout policy that includes an ex post monitoring and bailout scheme for financial institutions with large systemic impacts ('too big to fail') is optimal. The optimal policy also requires a randomized bailout for medium-impact institutions ('Constructive Ambiguity'), and no bailout for institutions that have only minimal systemic consequences ('too small to save'). However, in a volatile, innovative market environment where individual institutions may know more than the government regulator, monitoring error could contribute to risk taking, leaving the government regulator to always play a 'catch-up' role in revising policy. Moreover, the optimal bailout policy may not be time-consistent: institutions not deemed 'too big to fail' may still have an incentive to take excessive risks and expect to be bailed out in case of insolvency, primarily due to the short-term orientation of the government. Finally, because an institution's systemic cost affects the probability of a bailout, we show that the boundary of an institution may be extended by the government subsidy.

The plasticity of professional boundaries: a case study of collaborative care in maternity services

A case study of twenty-nine midwives and nine obstetricians working in a regional, public sector Australian hospital demonstrates the plasticity of professional boundaries within a post-welfare state. Driven by new discourses of globalisation, marketisation, managerialism and consumerism, professional boundaries in health care are being blurred, reordered and reconstituted. Government policies that call for a new interdisciplinarity between maternity professionals may be seen as responses to the above pressures. However, there remain considerable barriers to achieving collaborative models including conflicting interpretations of risk, of women's bodies and of childbirth; the veto power of decision-making retained by obstetricians; questions of professional accountability; and diversity over appropriate styles of micro-interaction. Collaboration demands a new egalitarianism to eclipse the old vertical system of obstetric dominance and this means that midwives need to create a distinctive professional specialty, or new object of knowledge. Midwives' skill in 'emotion management' could provide this speciality in addition to their rational-technical knowledge and thus elevate midwifery to an equivalent professional status with obstetrics but as yet neither obstetrics nor midwifery have realised its professionalising potential

Impact of the extended family on microenterprise growth in Ghana : a case study of Accra

This study examines the extended family's impact on microenterprise growth at the individual level, where microenterprise operators have some control over constraints affecting their operations. Beyond the individual level, microenterprise operators have little control over constraints such as government policies and regulations, competition from import-substitution industries and exploitation by corrupt officials. Therefore, it is at the individual level that the extended family serves as a crucial parameter of microenterprise growth and the success with which MEs graduate from the informal sector into the mainstreams of small business. Within this domain, this author has examined the extended family and found that there is a need for policy makers and MED administrators to adopt a more culturally sensitive approach to microenterprise growth if the extended family is to be engaged as a partner in their efforts to support microenterprises as a source of income and employment generation, A central question posed is why most writers on microenterprise activities in Ghana have neglected the extended family as a factor that should be considered in the design of microenterprise growth strategies and policies? The answer to this question was explored in the process of data gathering for this thesis and the results are presented here, especially in chapter 3 below. Suffice it to note here that this neglect has many roots, not least of which is the proclivity of mainstream economics, modern administration practice and the objectivity of double entry accounting based documentation procedures to focus on measurable growth in the formal sectors of the economy and structural constraints such as the lack of finance, lack of market demand, lack of access to technology and government regulations. Consequently, a noticeable trend among these writers is that they rightly advocate finance be made accessible to microenterprises, however, few question whether the finance is effectively used towards microenterprise growth. This issue is crucial in the face of evidence from this study which shows that finance accessed towards microenterprise growth is often put to other uses that negate growth thus keeping microenterprises within the bounds of the informal sector as against graduating out of the informal sector. As a result, these writers have neglected the intimate relations between the extended family and microenterprises, and most importantly, the constraint that the extended family inflicts on microenterprise growth at the individual level of activity. This study, by targeting the growth of the individual microenterprise in the socio-cultural context in which this growth must be achieved, has highlighted the constraint that the extended family does pose on MED. However, the study also shows that these constraints are important not because there is anything inherently wrong with the extended family, but because the socio-economic and policy environment is not consistent with the positive role that the extended family can and should play in the graduation of microenterprises from the informal to the formal sector of the economy in Ghana.

Australian national critical infrastructure protection : a case study

Australia has developed sophisticated national security policies and physical security agencies to protect against current and future security threats associated with critical infrastructure protection and cyber warfare protection. This paper will discuss some of the common security risks that face Australia and how their government policies and strategies have been developed and changed over time, for example, the proposed Australian Homeland Security department. This paper will discuss the different steps that Australia has undertaken in relation to developing national policies to deal with critical infrastructure protection.

FDI location at the subnational level: a study of EJVs in China

The location of FDI activities by MNEs is of interest to international business researchers, especially in light of the rapidly changing economic landscapes in many regions of the world. This paper adds to the literature on MNEs' location choices, focusing on how business characteristics are related to location, in a sample of 6430 foreign equity joint ventures (EJVs) in China during 1984–1996. The results show that the duration of the EJV agreement, the origin of the foreign investor, and the type of business activity are related to the location of the EJVs' business activities within China. Significant differences are noted in the locations of ventures in the manufacturing and service sectors, and there is evidence of an increasing preference for MNEs to locate their activities in China's large, metropolitan cities. These findings reflect the dynamic nature of government policies toward FDI in China and their impact on the location choices of MNEs.

Optimising leisure participation: a pilot intervention study for adolescents with physical impairments

Purpose: To assess the feasibility of an intervention to improve participation in leisure activities of adolescents with physical impairments by changing aspects of the activity or environment.

Methods: A pre-test/post-test pilot study of a multi-strategy intervention was used to explore the effectiveness of the strategies and to determine whether the intervention was practical to apply in a community setting. The intervention involved establishing adolescent and family focused goals, measuring and addressing environmental barriers and building activity performance skills. The Goal Attainment Scale (GAS) and the Canadian Occupational Performance Measure measured outcomes.

Results: Eight participants (aged 12–19 years; five males) with physical disabilities set participation goals using a structured approach. Analysis of personal and environmental barriers and facilitators for participation guided the choice of intervention strategies to support goal attainment. The natural environment, government policies and availability of transport were identified as the most frequent barriers to participation in leisure. Support to secure appropriate devices to enable participation was commonly required. As a group, attainment of 12 of 17 GAS goals, and progress on four more goals, was demonstrated.

Conclusions: The intervention model was applicable and practical to use in a community therapy setting and the majority of the participation goals set were achieved.

An `upside-down` view of rural health care

Access to high quality health care services plays an important part in the health of rural communities and individuals. This fact is reflected in efforts by governments to improve the quality of such services through better targeting of funds and more efficient management of services. In Australia, the difficulties experienced by rural communities in attracting and retaining doctors has long been recognized as a contributing factor to the relatively higher levels of morbidity and mortality in rural areas. However, this paper, based on a study of two small rural communities in Australia, suggests that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services. Over recent years, that cohesion has diminished, undermined in part by government policies that have fuelled an exodus from small rural communities to urban areas. Until governments begin to take an 'upside-down' perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated.

Race, identity and education achievements among Arab-Australian students

This paper discusses the challenge of managing cultural diversity in secondary schools, focusing on key structural, ideological, cultural, attitudinal and identity factors affecting the educational experiences and outcomes of Australian students from Arabic-speaking background (ASB). Recent research indicates that there are complex processes at play that hinder the ability of non English-speaking background (NESB) students to access constructive and meaningful education, and that such processes need further systematic investigation. It has also been argued that Australian schools are failing the test of social equity and that the dominant approach to curriculum and pedagogy does not meet the needs of the growing numbers of students from divergent cultural and socio-economic backgrounds. This paper focuses on identifying the social, cultural and attitudinal factors that affect the educational achievements of ASB students within a broad multidimensional approach to multicultural education. By linking thorough empirical research and innovative theory with practical, tested plans of action, this study proposes an in-principled approach to multicultural education that is extendable to a variety of schooling contexts while retaining its core focus on effecting positive learning outcomes. The key objectives of the larger study upon which this paper is based are to (a) address the disadvantages and barriers faced by NESB young people, particularly ASB young people, in achieving positive educational outcomes; (2) increase their chances for better life opportunities and self fulfilment; and (3) develop a good practice model for diversity management in Victorian schools. This latter objective will complement Victorian Government policies on cultural diversity and multicultural education.

A comparison of search functions and other navigational tools provided on government websites

This paper reports the outcomes of a study that evaluated the effectiveness of search functions compared to other navigational tools available on government websites. The study used an observation exercise triangulated with a post observation interview. Results suggest that while there wasn't any significant difference in effectiveness between search functions and other navigational tools, the skill with which the search function is implemented and participants' familiarity with the website, are fundamental determinants of users' opinions. Implications of the findings for research and practice are discussed.

The Australian Government`s abandoned infrastructure outsourcing program: what can be learned?

Early in 2001, after a damning public report by the Auditor-General, the Australian Federal Government abandoned its highly promoted “whole of government” IT infrastructure outsourcing initiative. This about-face was greeted in the press with reports that the initiative was a “fiasco”. Yet a four-year case study conducted by the authors suggests a more complex picture. Like many other “selective” outsourcers of IT, the Federal Government had been led to believe that it was adopting a relatively low risk strategy that would, if well managed, lead to significant cost savings and operational benefits. Instead, despite having implemented many widely promoted “best practices”, the Federal Government found a substantial discrepancy between what outsourcing promised to deliver, and what was actually achieved. In this respect their experiences were no different from those of many other large IT organizations engaged in selective IT outsourcing, who responded to a substantial contemporaneous survey. This case study examines why the Government’s expectations were not achieved, and arrives at conclusions that have important implications for decision makers confronted with choices about sourcing IT service delivery.

Obesity prevention : the role of policies, laws and regulations

The commercial drivers of the obesity epidemic are so influential that obesity can be considered a robust sign of commercial success – consumers are buying more food, more cars and more energy-saving machines. It is unlikely that these powerful economic forces will change sufficiently in response to consumer desires to eat less and move more or corporate desires to be more socially responsible. When the free market creates substantial population detriments and health inequalities, government policies are needed to change the ground rules in favour of population benefits.
Concerted action is needed from governments in four broad areas: provide leadership to set the agenda and show the way; advocate for a multi-sector response and establish the mechanisms for all sectors to engage and enhance action; develop and implement policies (including laws and regulations) to create healthier food and activity environments, and; secure increased and continued funding to reduce obesogenic environments and promote healthy eating and physical activity.
Policies, laws and regulations are often needed to drive the environmental and social changes that, eventually, will have a sustainable impact on reducing obesity. An 'obesity impact assessment' on legislation such as public liability, urban planning, transport, food safety, agriculture, and trade may identify 'rules' which contribute to obesogenic environments. In other areas, such as marketing to children, school food, and taxes/levies, there may be opportunities for regulations to actively support obesity prevention. Legislation in other areas such as to reduce climate change may also contribute to obesity prevention ('stealth interventions'). A political willingness to use policy instruments to drive change will probably be an early hallmark of successful obesity prevention.

Leaving the bush : why did they do it?

The demand for allied health professionals (AHPs) in rural areas is increasing due to changes in lifestyle, disease and disability of the population. Recruitment and retention of AHPs in rural Australia is an issue that continues to challenge policy makers. However, recent initiatives from the Commonwealth Government have focused on boosting the rural health workforce through grants that support education and training, expand health services and increase the number of rural and remote clinical placements. In addition to this funding, suggested restructure of the current allied health service delivery model is gaining much attention. Although this funding and organisational reform is much needed and welcomed, the changing nature of allied health work, increasing demand, and shortages across most rural areas highlight the need for research to address the complexities associated with recruitment and retention of these professionals.

Gaining insight into the experiences of rural AHPs can assist with enhancing government funded recruitment and retention programs and developing sustainable and efficient workforce policies. This study hopes to build on our previous research that implies recruitment is enhanced when retention is optimal, since AHPs are willing to recommend their workplace. Therefore, the factors that influence retention are just as valid and important as the factors that influence recruitment, but many of the existing workforce models have solely focused on recruitment.4 Additionally, these models do not adequately address issues regarding rural employment, they are difficult to implement, and costly to sustain.

In order to make policy recommendations on recruitment and retention in Australia, this paper aims to explore the experiences of AHPs who resigned from rural employment

Firms as adaptive organizations : the case of Australian trading banks

The conventional accounting notion of ‘going concern’ — that a firm will continue its business operations in the same manner indefinitely — has underpinned accounting practice for over one hundred years. This idea has provided a rationale for spreading costs over accounting periods and for deferring costs as assets in balance sheets. An alternative idea that is widely regarded as reliable in the literatures of economics and deliberate action is that firms continually adapt to changes in market and economic conditions. That is economic behaviour. The implications of that view of a firm for accounting have been systematically explored by Chambers (1966). While not examining those particular implications, many other accounting theorists have been critical of the conventional accounting idea of 'going concern' and of its impact on accounting practice. The two notions of ‘going concern’ - as static or adaptive enterprises - are examined by referring to the business operations of the four major Australian trading banks over the period 1983-1991. Banks were selected because they are commonly thought to be particularly ‘conservative’ organizations. The period 1983—1991 was chosen because it covers the era of deregulation of the Australian financial system. The evidence adduced by this study indicates that the Australian trading banks have continually adapted their organizational structures and business operations in the light of changes in technology, markets for financial services, government policies and domestic and global economic conditions. Illustrations of adaptive behaviour by banks ate drawn from their normal operating procedures such as the provision of products and services, loan services, acquisitions, sale of property, non-core banking operations and international banking. It is argued on analytical grounds that the cost basis of accounting does not yield financial statements that provide factual and up-to-date information about the financial capacity of firms to pay their debts and to continue trading generally; that is, to be going concerns. At any time, those financial capacities are determined by the amount of money commanded by a firm, including the money's worth of its assets, and by its level of debt. It is concluded on empirical grounds that the Australian trading banks, at least, are adaptive entities.