Incorporating an economic model in the health impact assessment approach

The current policy decision making in Australia regarding non-health public investments (for example, transport/housing/social welfare programmes) does not quantify health benefits and costs systematically. To address this knowledge gap, this study proposes an economic model for quantifying health impacts of public policies in terms of dollar value. The intention is to enable policy-makers in conducting economic evaluation of health effects of non-health policies and in implementing policies those reduce health inequalities as well as enhance positive health gains of the target population. Health Impact Assessment (HIA) provides an appropriate framework for this study since HIA assesses the beneficial and adverse effects of a programme/policy on public health and on health inequalities through the distribution of those effects. However, HIA usually tries to influence the decision making process using its scientific findings, mostly epidemiological and toxicological evidence. In reality, this evidence can not establish causal links between policy and health impacts since it can not explain how an individual or a community reacts to changing circumstances. The proposed economic model addresses this health-policy linkage using a consumer choice approach that can explain changes in group and individual behaviour in a given economic set up. The economic model suggested in this paper links epidemiological findings with economic analysis to estimate the health costs and benefits of public investment policies. That is, estimating dollar impacts when health status of the exposed population group changes by public programmes – for example, transport initiatives to reduce congestion by building new roads/ highways/ tunnels etc. or by imposing congestion taxes. For policy evaluation purposes, the model is incorporated in the HIA framework by establishing association among identified factors, which drive changes in the behaviour of target population group and in turn, in the health outcomes. The economic variables identified to estimate the health inequality and health costs are levels of income, unemployment, education, age groups, disadvantaged population groups, mortality/morbidity etc. However, though the model validation using case studies and/or available database from Australian non-health policy (say, transport) arena is in the future tasks agenda, it is beyond the scope of this current paper.

Infrastructure project planning decision making : challenges for decision support system applications

Most infrastructure projects share the same characteristics in term of management aspects and shortcomings. Human factor is believed to be the major drawbacks due to the nature of unstructured problems which can further contribute to management conflicts. This growing complexity in infrastructure projects has shift the paradigm of policy makers to adopt Information Communication Technology (ICT) as a driving force. For this reason, it is vital to fully maximise and utilise the recent technologies to accelerate management process particularly in planning phase. Therefore, a lot of tools have been developed to assist decision making in construction project management. The variety of uncertainties and alternatives in decision making can be entertained by using useful tool such as Decision Support System (DSS). However, the recent trend shows that most DSS in this area only concentrated in model development and left few fundamentals of computing. Thus, most of them were found complicated and less efficient to support decision making within project team members. Due to the current incapability of many software aspects, it is desirable for DSS to provide more simplicity, better collaborative platform, efficient data manipulation and reflection to user needs. By considering these factors, the paper illustrates four challenges for future DSS development i.e. requirement engineering, communication framework, data management and interoperability, and software usability

Digital media literacy : connecting young people’s identities, creative production and learning about video games

This chapter outlines examples of classroom activities that aim to make connections between young people’s everyday experiences with video games and the formal high school curriculum. These classroom activities were developed within the emerging field of digital media literacy. Digital media literacy combines elements of ‘traditional’ approaches to media education with elements of technology and information education (Buckingham, 2007; Warschauer, 2006). It is an educational field that has gained significant attention in recent years. For example, digital media literacy has become a significant objective for media policy makers in response to the increased social and cultural roles of new media technologies and controversies associated with young people’s largely unregulated online participation. Media regulators, educational institutions and independent organizations1 in the United States, Canada, the United Kingdom and Australia have developed digital media literacy initiatives that aim to provide advice to parents, teachers and young people.

Vocational psychological and organisational perspectives on career : towards a multidisciplinary dialogue

It has long been lamented that, although several disciplines contribute to career scholarship, they work in isolation from one another, thus denying career theory, research, and practice the benefits that multidisciplinary collaboration would bring. This constitutes a lost opportunity at a time when new understandings and approaches are needed in order to respond effectively to global changes in society and work. This book takes a major step towards remedying this situation by bringing together two key perspectives on career, the vocational psychological and the organisational (interpreted broadly to include organisation behaviour and human resource management). Written by international experts, the book opens by identifying some of the “tributaries” that flow into the “great delta of careers scholarship”, and noting the need to link what are at present separate “islands” of scholarship. It is structured to allow comparison between the ways in which the two perspectives address career development and career management theory, research and interventions. It concludes by pointing to the possibilities for dialogue, and even collaboration, between these perspectives, and suggesting ways in which these could be brought about. The book will be essential reading for career scholars because, with its potential to stimulate new thinking and developments in theory and research and also, importantly, in practice (with beneficial spin-offs for policy-makers), this dialogue could open a new phase in career scholarship. With its overviews of the history, theory, research and practice of both perspectives, the book will also be a valuable resource for students of both perspectives.

Vision, functional and cognitive determinants of motor vehicle incidents in older drivers

Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine: (i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia; (ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and (iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards. Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year. For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers. Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated. Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation. For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established. The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill. The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident. The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents. Discussion: The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents. Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved. The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.

Introduction

The title of this book, Hard Lesson: Reflections on Crime control in Late Modernity, contains a number of clues about its general theoretical direction. It is a book concerned, fist and foremost, with the vagaries of crime control in western neo-liberal and English speaking countries. More specifically, Hard Lessons draws attention to a number of examples in which discrete populations – those who have in one way or another offended against the criminal law - have become the subjects of various forms of stare intervention, regulation and control. We are concerned most of all with the ways in which recent criminal justice policies and practices have resulted in what are variously described as unintended consequences, unforeseen outcomes, unanticipated results, counter-productive effects or negative side effects. At their simplest, such terms refer to the apparent gulf between intention and outcome; they often form the basis for considerable amount of policy reappraisal, soul searching and even nihilistic despair among the mamandirns of crime control. Unintended consequences can, of course, be both positive and negative. Occasionally, crime control measures may result in beneficial outcomes, such as the use of DNA to acquit wrongly convicted prisoners. Generally, however, unforeseen effects tend to be negative and even entirely counterproductive, and/or directly opposite to what were originally intended. All this, of course, presupposes some sort of rational, well meaning and transparent policy making process so beloved by liberal social policy theorists. Yet, as Judith Bessant points out in her chapter, this view of policy formulation tends to obscure the often covert, regulatory and downright malevolent intentions contained in many government policies and practices. Indeed, history is replete with examples of governments seeking to mask their real aims from a prying public eye. Denials and various sorts of ‘techniques of neutralisation’ serve to cloak the real or ‘underlying’ aims of the powerful (Cohen 2000). The latest crop of ‘spin doctors’ and ‘official spokespersons’ has ensured that the process of governmental obfuscation, distortion and concealment remains deeply embedded in neo-liberal forms of governance. There is little new or surprising in this; nor should we be shocked when things ‘go wrong’ in the domain of crime control since many unintended consequences are, more often than not, quite predictable. Prison riots, high rates of recidivism and breaches of supervision orders, expansion rather than contraction of control systems, laws that create the opposite of what was intended – all these are normative features of western crime control. Indeed, without the deep fault lines running between policy and outcome it would be hard to imagine what many policy makers, administrators and practitioners would do: their day to day work practices and (and incomes) are directly dependent upon emergent ‘service delivery’ problems. Despite recurrent howls of official anguish and occasional despondency it is apparent that those involved in the propping up the apparatus of crime control have a vested interest in ensuring that polices and practices remain in an enduring state of review and reform.

Youth, Sport and the Social Inclusion Agenda

The purpose of this paper is to assess aspects of the British Government's attempts to use sporting participation as a vehicle to re-integrate socially disadvantaged, excluded and 'at-risk' youth into mainstream society. A number of organisations, policy-makers, commentators, and practitioners with a stake in the 'sport and social inclusion agenda' were interviewed. General agreement was found on a number of points: that the field was overly crowded with policies, programmes and initiatives; that the field worked in a 'bottom-up' way, with the most significant factor determining success being effective local workers with good networks and cultural access; that the dichotomising rhetoric of inclusion/exclusion was counter-productive; that the notion of the 'at-risk youth' was problematic and unhelpful; and that they all now dealt with a marketplace, where 'clients' had to be enrolled in their own reformation. There was also disagreement on a number of points: that policy acts as a relatively accurate template for practice, as opposed to the argument that it was simply regarded as a cluster of suggestions for practice; that policy was exceptionally piecemeal in its formulation and application, as opposed to regarding policy as necessarily targeted and dispersed; and that the inclusion agenda was largely politically driven and transitory, as opposed to the optimistic view that it had become ingrained in local practice. Finally, the paper examines some issues that are the most likely points of contribution by researchers in the area: that more research needs to be done on the processes of identity formation associated with participation in sport; that more effective programme evaluation needs to be done for such forms of governmental intervention to work properly; and that the relationship between different kinds of physical activity and social and personal change needs to be more thoroughly theorised.

Towards a model of the institutional logics of climate change

The proliferation of innovative schemes to address climate change at international, national and local levels signals a fundamental shift in the priority and role of the natural environment to society, organizations and individuals. This shift in shared priorities invites academics and practitioners to consider the role of institutions in shaping and constraining responses to climate change at multiple levels of organisations and society. Institutional theory provides an approach to conceptualising and addressing climate change challenges by focusing on the central logics that guide society, organizations and individuals and their material and symbolic relationship to the environment. For example, framing a response to climate change in the form of an emission trading scheme evidences a practice informed by a capitalist market logic (Friedland and Alford 1991). However, not all responses need necessarily align with a market logic. Indeed, Thornton (2004) identifies six broad societal sectors each with its own logic (markets, corporations, professions, states, families, religions). Hence, understanding the logics that underpin successful –and unsuccessful– climate change initiatives contributes to revealing how institutions shape and constrain practices, and provides valuable insights for policy makers and organizations. This paper develops models and propositions to consider the construction of, and challenges to, climate change initiatives based on institutional logics (Thornton and Ocasio 2008). We propose that the challenge of understanding and explaining how climate change initiatives are successfully adopted be examined in terms of their institutional logics, and how these logics evolve over time. To achieve this, a multi-level framework of analysis that encompasses society, organizations and individuals is necessary (Friedland and Alford 1991). However, to date most extant studies of institutional logics have tended to emphasize one level over the others (Thornton and Ocasio 2008: 104). In addition, existing studies related to climate change initiatives have largely been descriptive (e.g. Braun 2008) or prescriptive (e.g. Boiral 2006) in terms of the suitability of particular practices. This paper contributes to the literature on logics by examining multiple levels: the proliferation of the climate change agenda provides a site in which to study how institutional logics are played out across multiple, yet embedded levels within society through institutional forums in which change takes place. Secondly, the paper specifically examines how institutional logics provide society with organising principles –material practices and symbolic constructions– which enable and constrain their actions and help define their motives and identity. Based on this model, we develop a series of propositions of the conditions required for the successful introduction of climate change initiatives. The paper proceeds as follows. We present a review of literature related to institutional logics and develop a generic model of the process of the operation of institutional logics. We then consider how this is applied to key initiatives related to climate change. Finally, we develop a series of propositions which might guide insights into the successful implementation of climate change practices.

Social procurement and its implications for social enterprise : a literature review [Working Paper No. CPNS48]

This paper reviews the available academic and policy literature to identify the possibilities and limitations of social procurement, and the factors that enable its implementation. In doing so, it aims to contribute to an evidence-based approach to social enterprise development in Australia, and to provide practical information of use to both policy makers and social enterprises considering social procurement arrangements. Based on the available evidence, the dominant focus of this review is on social procurement by governments.

An indexing model for stormwater quality assessment : stormwater management in the Gold Coast

In the age of climate change and rapid urbanisation, stormwater management and water sensitive urban design have become important issues for urban policy makers. This paper reports the initial findings of a research study that develops an indexing model for assessing stormwater quality in the Gold Coast.

Sustainable water provision : alternative strategy and sources in the era of climate change

As a result of rapid urbanisation, population growth, change in lifestyles, pollution and the impacts of climate change, water provision has become a critical challenge for planners and policy-makers. In the wake of increasingly difficult water provision and drought, the notion that freshwater is a finite and vulnerable resources is increasingly being realised. Many city administrations around the World are struggling to provide water security for their residents to maintain lifestyle and economic grouth. This paper review the glocalalternatives to current water sources, including that of desalination, water transfers, recycling, and integrated water management. A comparative study on alternative resources is undertaken and the results are discussed.

Translation of addictions science into practice : update and future directions.

Recent advances in the understanding of the genetic, neurochemical, behavioral and cultural underpinnings of addiction have led to rapid advances in the understanding of addiction as a disease. In fact, advances in basic science and the development of new pharmacological and behavioral therapies associated with them are appearing faster than can be assimilated not only by clinical researchers but practitioners and policy makers as well. Translation of science-based addictions knowledge into improved prevention, assessment and treatment, and communication of these changes to researchers and practitioners are significant challenges to the field. The general aim of this book is to summarize current and potential linkages between advances in addiction science and innovations in clinical practice. Whilst this book is primarily focused on translation, it also encompasses some scientific advances that are relevant to dissemination, and the book is itself a tool for disseminating innovative thinking. The goal is to generate interest in application opportunities from both recent research and theoretical advances.

The impact of health information technology on the quality of medical and health care : a systematic review

Objective: To systematically review the published evidence of the impact of health information technology (HIT) on the quality of medical and health care specifically clinicians’ adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. In order to be as inclusive as possible the research examined literature discussing the use of health information technologies and systems in both medical care such as clinical and surgical, and other health care such as allied health and preventive services.----- Design: Systematic review----- Data Sources: Relevant literature was systematically searched on English language studies indexed in MEDLINE and CINAHL(1998 to 2008), Cochrane Library, PubMed, Database of Abstracts of Review of Effectiveness (DARE), Google scholar and other relevant electronic databases. A search for eligible studies (matching the inclusion criteria) was also performed by searching relevant conference proceedings available through internet and electronic databases, as well as using reference lists identified from cited papers.----- Selection criteria: Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measures could be either changes in clinical processes resulting from a change of the providers’ behaviour or specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. ----- Methods: Studies were reviewed and summarised in tabular and text form. Due to heterogeneity between studies, meta-analysis was not performed.----- Results: Out of 17 studies that assessed the impact of health information technology on health care practitioners’ performance, 14 studies revealed a positive improvement in relation to their compliance with evidence-based guidelines. The primary domain of improvement was evident from preventive care and drug ordering studies. Results from the studies that included an assessment for patient outcomes however, were insufficient to detect either clinically or statistically important improvements as only a small proportion of these studies found benefits. For instance, only 3 studies had shown positive improvement, while 5 studies revealed either no change or adverse outcomes.----- Conclusion: Although the number of included studies was relatively small for reaching a conclusive statement about the effectiveness of health information technologies and systems on clinical care, the results demonstrated consistency with other systematic reviews previously undertaken. Widescale use of HIT has been shown to increase clinician’s adherence to guidelines in this review. Therefore, it presents ongoing opportunities to maximise the uptake of research evidence into practice for health care organisations, policy makers and stakeholders.

Conceptions of learning held by upper primary children in government schools in Brunei Darussalam

The current study examined the conceptions of learning held by upper primary children in government schools in Brunei. Previous studies have shown that the conceptions of learning held by students influence the ways in which they approach learning tasks and, in turn, impact on their learning outcomes. However, the majority of these studies were carried out with university and secondary school students, with little research involving primary school children. A phenomenographic research approach was used to describe the qualitatively different ways in which a group of sixteen upper primary children experienced learning in two government schools in Brunei. Data were gathered using scenariobased semi]structured interviews. Iterative cycles of analysis revealed three categories of description depicting three qualitatively different ways in which the children experienced the phenomenon. The three categories of description were: learning as acquiring information (Category 1), learning as remembering information (Category 2) and learning as doing hands]on activities (Category 3). These categories indicate a variation in the ways in which upper primary children experience learning in government schools in Brunei. The conceptions of learning held by the children provide a platform from which educators and policy]makers can consider possibilities for meaningful learning in government schools in Brunei.

Required hours of practice for learner drivers : a comparison between two Australian jurisdictions

Problem: This study considers whether requiring learner drivers to complete a set number of hours while on a learner licence affects the amount of hours of supervised practice that they undertake. It compares the amount of practice that learners in Queensland and New South Wales report undertaking. At the time the study was conducted, learner drivers in New South Wales were required to complete 50 hours of supervised practice while those from Queensland were not. Method: Participants were approached outside driver licensing centres after they had just completed their practical driving test to obtain their provisional (intermediate) licence. Those agreeing to participate were interviewed over the phone later and asked a range of questions to obtain information including socio-demographic details and amount of supervised practice completed. Results: There was a significant difference in the amount of practice that learners reported undertaking. Participants from New South Wales reported completing a significantly greater amount of practice (M = 73.3 hours, sd = 29.12 hours) on their learner licence than those from Queensland (M = 64.1 hours, sd = 51.05 hours). However, the distribution of hours of practice among the Queensland participants was bimodal in nature. Participants from Queensland reported either completing much less or much more practice than the New South Wales average. Summary: While it appears that the requirement that learner drivers complete a set number of hours may increase the average amount of hours of practice obtained, it may also serve to discourage drivers from obtaining additional practice, over and above the required hours. Impact on Industry: The results of this study suggest that the implications of requiring learner drivers to complete a set number of hours of supervised practice are complex. In some cases, policy makers may inadvertently limit the amount of hours learners obtain to the mandated amount rather than encouraging them to obtain as much practice as possible.