Equity-focused health impact assessment: a tool to assist policy makers in addressing health inequalities.

In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA.

Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.

Are policy makers,researchers and educators 'addicted' to the equity failure cycle?’

Introduction : In this paper,  I suggest part of the key to equity progress is to remove our gaze from the equity defined ‘others’ to focus on recognising and transforming the ‘privilege- benefit loop’ (author’s term) that underpins the creation and maintenance of hegemonic Western educational institutions. As a modest contribution to the efforts to address the ‘equity failure cycle’ (author’s term, later expanded on), I suggest three combined approaches (drawing from critical theory and critical pedagogy ) that incorporate and illustrate the interconnected, usually concurrent and complementary political, cultural/institutional and personal levels of understanding, experience and action that I think are necessary ingredients for change. Each of the three levels or domains are inter-related and ‘co-constructive’ and therefore, potentially ‘de-constructive’ .

Job stress as a preventable upstream determinant of common mental disorders: a review for practitioners and policy-makers

There is growing recognition of the important role of mental health in the workforce and in the workplace. At the same time, there has been a rapid growth of studies linking job stress and other psychosocial working conditions to common mental disorders, and a corresponding increase in public concern media attention to job stress and its impact upon worker health and well-being. This article provides a summary of the relevant scientific and medical literature on this topic for practitioners and policy-makers. It presents a primer on job stress concepts, an overview of the evidence linking job stress and common mental disorders, a summary of the intervention research on ways to prevent and control job stress, and a discussion of the strengths and weakness of the evidence base. We conclude that there is strong evidence linking job stress and common mental disorders, and that it is a substantial problem on the population level. On a positive note, however, the job stress intervention evidence also shows that the problem is preventable and can be effectively addressed by a combination of work- and worker-directed intervention.

The entrepreneurial arts leader : cultural policy, change and reinvention

"The Entrepreneurial Arts Leader is grounded in an understanding of cultural policy, management, art history, entrepreneurship and creativity, and is cross-disciplinary. It features a comprehensive bibliography and models of entrepreneurial arts leaders, and will be of seminal importance to arts managers, administrators, cultural policy makers and students."--BOOK JACKET

Transitional labour markets : a social investment and risk mitigation strategy for social policy

Drawing on transitional labor market (TLM) theory, this introductory chapter highlights major themes, overviews the contributions to this volume and suggests a future agenda for policy makers. The focus of applied research projects has been the impact of post-modem social transformations on systems of social protection, looking through the lens of the labor market and shifts in household and family structure. The Transitional Labor Market project uses the TLM model as a means of developing new thinking on how flexibility and innovation might be paired with social investment and new forms of social protection. TLM theory emphasizes the importance of institutions and of the links between different institutions which frequently operate as policy silos, rather than integrated systems to buffer risks and support capability and enhance employability. The great advantage of the TLM model is that it draws attention to the right places for strategic reform. It does not offer a standard set of institutions to facilitate transitions however.

Widening development prescriptions: policy implications of an index of sustainable economic welfare (SEW) for Thailand

Over the past three decades, Thailand has recorded consistently high levels of economic growth, making it one of the most successful economies in the world during this period. However, economic growth has associated costs that can also reduce social welfare. This study will estimate an Index of Sustainable Economic Welfare (ISEW) for Thailand over a twenty-five year period, 1975–1999. This paper concludes that even low-middle income countries are beginning to approach the point at which economic growth produces both diminishing and, at times, negative welfare returns as the costs of achieving growth begin to outweigh the associated benefits. These results are important for policy makers and highlight the importance of widening policy prescriptions in order to increase social welfare. However, the policy guidelines that are suggested must be critically accepted before being adopted due to possible weaknesses of the ISEW approach.

Implementing IT policy and the bedevilment of post-colonialism- A case study of Tanzania

This chapter is concerned with how Tanzania has been socially and economically affected by post-colonialism at a policy level as well as at an ordinary (public) level during the IT policy development process in the country. An IT policy according to Corbitt (1999:309) "is a reflection of the society in which it is formed and is socially constructed within the ideologies which frame that society." Corbitt (1999:312) goes on to describe the implementation phase of the policy: Policy is implemented in an environment influenced by ideologies which spawn values and beliefs, some of which are known, recognized and obvious to the actors involved, whilst other influences are not recognized, nor obvious.This chapter examines the post-colonial influence, which comprises both directly and indirectly, observed implications within the IT policy development process in Tanzania. The discussion focuses on challenges which face decision and policy-makers in the country. The chapter also proposes an IT policy model which might be developed or designed using a different approach from the traditional policy-making model.

A chaos theory interpretation of community perceptions of Australian forest policy

This paper proposes a methodology for measuring community values towards Australian forest policy using chaos theory. The use of chaos theory within social sciences has been restricted due to chaos-based analysis requiring time-continuous data. Using scale-based data, iconographs are suggested as a method of dynamically representing community values for forestry at a higher phase plane. In addition, the method also provides opportunity for control of chaos by policy makers in altering community attitudes.

'Creative destruction': knowledge economy policy and the future of arts and humanities in the academy

Policy conceptualizations of the global knowledge economy have led to the channelling of much Higher Education and Research and Development funding into the priority areas of science and technology. Among other things, this diversion of funding calls into question the future of traditional humanities and creative arts faculties. How these faculties, and the disciplines within them, might reconfigure themselves for the knowledge economy is, therefore, a question of great importance, although one that as yet has not been adequately answered. This paper explores some of the reasons for this by looking at how innovation in the knowledge economy is typically theorized. It takes one policy trajectory informing Australia's key innovation statement as an example. It argues that, insofar as the formation of this knowledge economy policy has been informed by a techno-economic paradigm, it works to preclude many humanities and creative arts disciplines. This paper, therefore, looks at how an alternative theorization of the knowledge economy might offer a more robust framework from within which to develop humanities and creative arts Higher Education and Research policy in the knowledge economy, both in Australia and internationally.
1 This article draws on the Australian Research Council project, Knowledge/economy/society: a sociological study of an education policy discourse in Australia in globalising circumstances, being conducted by Jane Kenway, Elizabeth Bullen and Simon Robb. This 3-year project looks at how understandings of the knowledge economy and knowledge society inform current education policy and, in turn, how this policy translates into educational practice. The methodology includes policy analysis, interviews with policy makers in government, and supranational organizations. It also includes cameo studies of innovative educational practice, two of which we draw on here.