Equity-focused health impact assessment framework

Background to the Development of the Equity-Focused HIA Framework
The equity focused health impact assessment (EFHIA) framework arises out of a two year research project funded for the most part by the Australian Government’s Public Health Education Research Program (PHERP) Innovations Grants (Round 2) scheme. This project had as its primary objective the development of a framework for health inequalities impact assessment, subsequently renamed equity focused health impact assessment. A partnership between the University of Newcastle, Deakin University and the University of New South Wales (the Project Management Steering Committee) received the funding and the Australasian Collaboration for Health Equity Impact Assessment (ACHEIA) was formed to undertake appropriate background research and to develop, pilot test, modify and disseminate the framework. The work commenced in September 2002 and concluded in October 2004. Part of the funding included a capacity building workshop in August 2004. ACT Health and the Division of Medicine at the John Hunter Hospital, Newcastle, also provided financial support for the project. The August 2004 Workshop was supported by NSW Health. All participants and organisations involved in the project gave extensive in-kind support.
The aims of the workshop were to bring together an international collaboration of multidisciplinary investigators, public health experts, and key senior health managers working in national, state and local settings, to inform the further development of the framework and to provide training in its application. The initial goals of the project were to work collaboratively to develop a strategic framework to assess the health inequalities of public health-related policies, plans, strategies, decisions, programs and services. The EFHIA framework as presented at the August workshop was developed through:
1. an extensive review of the relevant literature
2. formal and informal consultation with members of ACHEIA (the international
reference group), members of the Project Management Steering Committee and
other relevant experts; and
3. testing of the draft EFHIA framework with the 5 case study partners – who applied the draft framework in a range of health settings (see
Acknowledgements).
The result of this work has been the development of an equity focused health impact assessment framework that can be used to determine the unanticipated and systemic health inequities that may exist within the decision making processes or activities of a range of organisations and sectors. The EFHIA framework provides one approach that can be used to assist decision makers to put equity and health on their agenda in a more obvious and systematic way. The framework represents a ‘moment in time’ rather than a definitive statement or ‘toolkit’ on the best way to proceed. Further practice, refinement and adjustment will be needed over many years to consolidate both HIA and EFHIA. As well as this guide to the framework, additional outputs from the project team include:
- A literature review
- A position paper
- A report on the five case studies
- An evaluation report.
With the consent of the Australian Government, a monograph will be made available to workshop participants at the end of October which contains the framework and the appropriate background papers.

Girls and computing-still a way to go

Years after the introduction of computing in Australian schools, computer classrooms are still heavily dominated by male students studying subjects which have little appeal to female students, explains the author. This article looks at why girls are less likely to choose computing as a subject to study or to consider computing for a future career.

The key learning area movement : A force for pedagogical change or a facade for continued conservatism?

Throughout the early 1990s the formal curriculum across all Australian States and Territories was re-organised to accommodate a Key Learning Area (KLA) focus.  The KLA approach to schooling marked a departure from an historical reliance on individualised school subjects as the organisers of disciplinary knowledge.  Indeed a KLA structure has the potential to promote interdisciplinary teaching and learning, a focus on the skills, values, attitudes and knowledge students are to learn and to break away from the sometimes divisive subject subcultures that permiate schools.  In short the potential for a KLA 'movement' of positive benefit to teaching and learning exists.

Over the last decade however, the impact of the 'KLA movement' on teacher practice has become more apparent.  Far from being a force for pedagogical change, some KLAs are merely re-badged versions of traditionalist conceptions of school subject and knowledge.  This paper draws on data from a study of New South Wales (NSW) history and Human Society and Its Environment (HSIE) teachers and provides an evidenced argument about the use and misuse of Key Learning Areas.

Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Who's afraid of designer babies?

Australian scientists in Sydney made medical history by creating a life-saving brother for a child with an incurable genetic disease. Features the case of a Tasmanian couple who, with their help, have this life-saving baby, at their third try. The pioneering IVF treatment, which is legal only in N.S.W., hit the news headlines, sparking an ethical storm. Examines the moral and ethical issues that genetic manipulation raises, including the potential uses and misuses of genetic technology. Raises also the spectre of an extreme form of eugenics, as seen in the World War II Nazi push to create a master race through human genetics. Some view eugenics as another form of PGD. Presents the diverse views of eminent ethicists and the Catholic Church, world wide.

Patient safety, ethics and whistleblowing : a nursing response to the events at the Campbelltown and Camden Hospitals

In November 2002, in what stands as one of the most significant whistleblowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned.

Damages for pain and suffering in tort law

Legislation enacted between 2002 and 2005 by each Australian State and Territory reformed and partially codified the common law of personal injuries. This column examines the nature and history of damages for pain and suffering and analyses the approach taken by different Australian jurisdictions to compensation for non-economic loss. Non-economic loss is generally composed of pain and suffering, loss of amenities of life, and loss of enjoyment of life (some jurisdictions, eg New South Wales, also include disfigurement, and loss of expectation of life). Several jurisdictions have imposed thresholds that a claimant must meet as a prerequisite to suing for damages at common law.

Multimedia campaign on a shoestring : promoting 'Stay Active - Stay Independent' among seniors

Issue addressed: This paper describes a multimedia campaign implemented in rural New South Wales on a budget smaller than that typical of many published campaigns. The 'To Be Young at Heart- Stay Active Stay Independent' (SASI) campaign was one arm of a multi- strategic program to reduce falls among seniors by promoting physical activity. Methods: This 18-month campaign used social marketing techniques. Central to this campaign was strong formative research, significant use of corporate, community and media partnerships and a detailed, strategic distribution plan. Campaign reach was evaluated by a community intercept survey. Results: A variety of high quality information, education and communication (IEC) resources were developed. Overall, the campaign cost was calculated at $191,000. The actual cost of $42,000 (excluding staff time) was used to generate almost double this amount in sponsorship ($82,000). In the mid-campaign reach survey, 36% recognised the campaign and attributed this to television (58%), newspaper (33%), poster (13%) and bus-back advertising (8%). Of these respondents, 21% reported seeking information about physical activity, 33% reported increased intention to be more active, and 22% reported becoming more active as a result of the campaign. Conclusions: It is possible to develop and deliver a well designed, multimedia campaign on a limited budget by using sound formative research and engaging community and corporate partners to generate sponsorship. An effective distribution strategy is crucial and may require additional partnerships at State or national level.

Defendants' liability for pure mental harm to third parties in Australia : still a work in progress

In Australia, both common and statutory law allows compensation for negligently occasioned recognised psychiatric injury, but distinguishes between pure mental harm and consequential mental harm. This column briefly discusses the concept of pure "mental harm" and the major Australian cases relating to defendants' liability to third parties for causing them pure mental harm (Jaensch v Coffey (1984) 155 CLR 549 [PDF]; Tame v New South Wales; Annetts v Australian Stations Pty Ltd (2002) 211 CLR 317 [PDF]; Sullivan v Moody (2001) 207 CLR 562 [PDF]; and Gifford v Strang Patrick Stevedoring Pty Ltd (2003) 214 CLR 269 [PDF]). The analysis focuses on judicial approaches to determining liability in these cases, especially causation. Lack of guiding principles and precise tests for attribution of liability are illustrated by Kemp v Lyell McEwin Health Service (2006) 96 SASR 192 [PDF]. This case is analysed first in the context of common law, and then in the light of the reform legislation contained in the Civil Liability Act 1936 (SA) and similar provisions in other jurisdictions.

The changing face of the Australian teaching profession : new generations and new ways of working and learning

Today’s workforce is characterised by an increasing mix of people with varying career aspirations, work motivators and job satisfiers. This paper discusses the intergenerational nature of today’s workforce, which is currently dominated by the age groups commonly referred to as Baby Boomers and Generation X. The Baby Boomers defined and redefined work during the last quarter of the twentieth century, but as they track towards retirement, GenXers’ valued work patterns and their career and life aspirations are increasingly dominating. This paper draws on a body of literature about a younger generation of workers and the current world of work in today’s knowledge society, and discusses possible implications for the teaching profession, particularly for attracting and retaining young people as teachers.

The impact of racism upon the health and wellbeing of young Australians

The Institute for Citizenship and Globalisation at Deakin University has worked in partnership with the Foundation for Young Australians to conduct this research project into the impact of racism upon the health and wellbeing of young Australians. The research has been carried out in eighteen Australian secondary schools in Victoria, New South Wales, Northern Territory and Queensland. Students aged 15-18 were surveyed and interviewed in both the government and Catholic education systems in order to ascertain the experience of racism and racist behaviours among Australian youth and their impact on health and wellbeing. The scope of the research brief included the nature of the racist experience, its setting, the individual and institutional responses and its reporting. The research also aimed to examine the impact of the experience of racism upon the health and wellbeing of Australian youth. A glossary of terms is included in Appendix 1 to assist with the reading of this Report.

Contribution of multi-tenure reserve networks to biodiversity conservation

A consistent and integrated approach to nature conservation across the landscape and regardless of tenure is widely recognised as essential in ensuring the effective conservation of biodiversity. 'Multi-tenure reserve networks', which incorporate public and private lands managed for conservation, are considered a means of achieving landscape scale conservation. Biosphere Reserves (BR) and Conservation Management Networks (CMN) are characteristic models in Australia. This thesis aims to evaluate the role of such networks in protecting biodiversity, specifically by: (1) analysing the spatial configuration (size, shape, connectivity) of networks and their individual components; (2) evaluating the contribution of networks (in real terms and in reporting procedures) to biodiversity conservation objectives; (3) analysing the influence of the attitudes and perceptions of land managers on the functionality of networks; and (4) evaluating the influence of coordinating bodies on network functionality. In order to account for deficiencies in existing classifications of conservation lands, a new classification system was developed for this thesis - the Conservation Lands Classification. This classification incorporates conservation mechanisms on public and private lands and forms the basis for comparing network components in three Australian case studies - the Bookmark BR located in the Murray Mallee of South Australia, the Gippsland Plains CMN on the eastern Gippsland Plains of Victoria and the Grassy Box Woodlands CMN across the inland slopes of New South Wales. The spatial configuration of individual components within networks was measured using spatial analysis techniques within a geographic information system (GIS). GIS was also used to measure the contribution that networks made to a comprehensive, adequate and representative reserve system through the ecosystems they protected. The attitudes and perceptions of landowners and managers within the networks were obtained using questionnaires. Questionnaires were also sent to network coordinators. Statistical and descriptive analysis was conducted on the results. The sizes of individual components varied markedly between the three networks, however within each network public reserves were on average larger than private conservation lands. Although levels of physical connectivity varied between networks, Bookmark BR and Gippsland Plains CMN showed greater similarity to each other than to the Grassy Box Woodlands CMN. The findings raise important questions about the real and perceived differences in the BR and CMN models. All networks, and particularly those components outside the public protected area estate, contributed to enhancing the protection of ecosystems unrepresented or under-represented in the reserve system, although the extent of this contribution varied between networks. Trade-offs between reserve design efficiency and a contribution to a comprehensive, adequate and representative reserve system were evident between networks. Bookmark BR was characterised by high connectivity, strong reserve design integrity but a lower contribution to protecting under-reserved ecosystems, whereas the opposite was evident in the Grassy Box Woodlands CMN. Over 88% of managers considered their involvement in multi-tenure reserve networks to be a positive or very positive experience. A lack of resources and time for management were considered major limitations of these networks. The majority (80%) of private land managers within networks were willing to be included in a national reserve system of conservation lands. This has important implications for the Australian National Reserve System, which currently incorporates mostly public land. The changing nature of the network coordination arrangements suggests an organic fluid evolution of network structures is likely, contrasting with the desire for legalistic and administrative rigidity promoted by government agencies. The thesis concludes that all the networks studied contribute in varying degrees to biodiversity conservation. The key factors influencing the current and potential contribution that such networks make are: (1) the aims, directions and restrictions set by or imposed upon the coordinating body; and (2) the biophysical nature of the surrounding bioregion and resultant historical land use and tenure pattern. Although the successful operation of such 'multi-tenure' networks ultimately relies on the willing participation of private landholders, ongoing institutional support is likely to be required for maintaining networks in the longer term. Considering networks are increasingly formed outside of the influence of government institutions, this presents a significant challenge for effective coordinated conservation.

Australia and East Timor : elitism, pragmatism and the national interest

For over two decades the issue of East Timor's right to self-determination has been a ‘prickly’ issue in Australian foreign policy. The invasion by Indonesian forces in 1975 was expected, as Australian policy-makers had been well informed of the events leading up to the punitive action being taken. Indeed, prior discussions involving the future of the territory were held between the Australian Prime Minister and the Indonesian President in 1974. In response to the events unfolding in the territory the Australian Labor Government at the time was presented with two policy options for dealing with the issue. The Department of Defence recommended the recognition of an independent East Timor; whereas the Department of Foreign Affairs proposed that Australia disengage itself as far as possible from the issue. The decision had ramifications for future policy considerations especially with changes in government. With the Department of Foreign Affairs option being the prevailing policy what were the essential ingredients that give explanation for the government's choice? It is important to note the existence of the continuity and cyclical nature of attitudes by Labor governments toward Indonesia before and after the invasion. To do so requires an analysis of the influence ‘Doc’ Evatt had in shaping any possible Labor tradition in foreign policy articulation. The support given by Evatt for the decolonisation of the Netherlands East Indies (Indonesia) gave rise to the development of a special relationship-so defined. Evidence of the effect Evatt had on future Labor governments may be found in the opinions of Gough Whitlam. In 1975 when he was Prime Minister, Whitlam felt the East Timor issue was merely the finalisation of Indonesia's decolonisation honouring Evatt's long held anti-colonialist tradition existing in the Australian Labor Party. The early predisposition toward Indonesia's cohesiveness surfaced again in the Hawke and Keating Labor governments of later years. It did not vary a great deal with changes in government The on-going commitment to preserving and strengthening the bilateral relationship meant Indonesia's territorial integrity became the focus of the Australian political elites’ regional foreign policy determinations. The actions taken by policy-makers served to promote the desire for a stable region ahead of independence claims of the East Timorese. From a realist perspective, the security dilemma for Australian policy-makers was how to best promote regional order and stability in the South East Asian region. The desire for regional cohesiveness and stability continues to drive Australian political elites to promote policies that gives a priority to the territorial integrity of regional states. Indonesia, in spite of its diversity, was only ever thought of as a cohesive unitary state and changes to its construct have rarely been countenanced. Australia's political elite justifications for this stance vacillate between strategic and economic considerations, ideological (anti-colonialism) to one of being a pragmatic response to international politics. The political elite argues the projection of power into the region is in Australia’s national interest. The policies from one government to the next necessarily see the national interest as being an apparent fixed feature of foreign policy. The persistent fear of invasion from the north traditionally motivated Australia's political elite to adopt a strategic realist policy that sought to ‘shore up’ the stability, strength and unity of Indonesia. The national interest was deemed to be at risk if support for East Timorese independence was given. The national interest though can involve more than just the security issue, and the political elite when dealing with East Timor assumed that they were acting in the common good. Questions that need to be addressed include determining what is the national interest in this context? What is the effect of a government invoking the national interest in debates over issues in foreign policy? And, who should participate in the debate? In an effort to answer these questions an analysis of how the ex-foreign affairs mandarin Richard Woolcott defines the national interest becomes crucial. Clearly, conflict in East Timor did have implications for the national interest. The invasion of East Timor by Indonesia had the potential to damage the relationship, but equally communist successes in 1975 in Indo-China raised Australia's regional security concerns. During the Cold War, the linking of communism to nationalism was driving the decision-making processes of the Australian policy-makers striving to come to grips with the strategic realities of a changing region. Because of this, did the constraints of world politics dominated by Cold War realities combined with domestic political disruption have anything to do with Australia's response? Certainly, Australia itself was experiencing a constitutional crisis in late 1975. The Senate had blocked supply and the Labor Government did not have the funds to govern. The Governor-General by dismissing the Labor Government finally resolved the impasse. What were the reactions of the two men charged with the responsibility of forming the caretaker government toward Indonesia's military action? And, could the crisis have prevented the Australian government from making a different response to the invasion? Importantly, and in terms of economic security, did the knowledge of oil and gas deposits thought to exist in the Timor Sea influence Australia's foreign policy? The search for oil and gas requires a stable political environment in which to operate. Therefore for exploration to continue in the Timor Sea Australia must have had a preferred political option and thoughts of with whom they preferred to negotiate. What was the extent of each government's cooperation and intervention in the oil and gas industry and could any involvement have influenced the Australian political elites’ attitude toward the prospect of an independent East Timor? Australia's subsequent de jure recognition that East Timor was part of Indonesia paved the way for the Timor Gap (Zone of Cooperation) Treaty signing in 1989. The signing underpinned Australia's acceptance of Indonesian sovereignty over East Timor. The outcome of the analysis of the issues that shaped Australia's foreign policy toward East Timor showed that the political elite became locked into an integration model, which was defended by successive governments. Moreover, they formed an almost reflexive defence of Indonesia both at the domestic and international level.

A panel data analysis of the determinants of oil consumption : the case of Australia

The goal of this paper is to examine the determinants of oil consumption for a panel consisting of six Australian States and one territory, namely Queensland, New South Wales, Victoria, Tasmania, South Australia, Western Australia, and the Northern territory, for the period 1985–2006. We find that oil consumption, oil prices and income are panel cointegrated. We estimate long-run elasticities and find that oil prices have had a statistically insignificant impact on oil consumption, while income has had a statistically significant positive effect on oil consumption.