Health governance : law, regulation and policy

This special issue of Public Health is devoted to health governance, examining the role of law, regulation and policy in safeguarding the public's health. Each of us has devoted a career to thinking carefully about the role of law as a tool to prevent injury and disease and to promote the population's health and wellbeing. 1, 2, 3 and 4 In this Guest Editorial we first explain what we mean by the term ‘governance’, as well as the role of law in a well-regulated society. Next, we explore the increasingly important, and challenging, concept of what we call national and global federalism—the inter-relationships among the various levels of governance (local, national, supranational and transnational) and among various actors in national and global health. Third, we explain the origins of this journal symposium, which arises from three conferences on the topic in Hong Kong and Sydney. Finally, we offer a brief introduction to the articles that follow.

Reproductive technology, public policy and single motherhood

In mid 2000, the Australian community engaged in a national debate over access to infertility treatment services. The debate was sparked by a Federal Court decision in late July. That decision, by Justice Sundberg in the case of McBain v State of Victoria 1 held that the provisions of the Infertility Treatment Act 1995 (Vic) which limited eligibility for infertility treatment to women who were married or in heterosexual de facto relationships, were inconsistent with section 22 of the Commonwealth Sex Discrimination Act 1984 (Cth) which prohibits discrimination on the basis of marital status. Justice Sundberg held that, by virtue of section 109 of the Constitution, 2 the provisions of the Victorian Act were inoperative to the extent of the inconsistency between the State and Commonwealth legislation.

The activation, appropriation and practices of student-equity policy in Australian higher education

Current national reforms in Australian higher education have prioritised efforts to reduce educational disadvantage within a vernacular expression of neoliberal education policy. Student-equity policy in universities is enmeshed in a set of competitive student recruitment relations. This raises practice-based tensions as universities strive to meet specific institutional targets for low-socio-economic status (SES) and Indigenous student participation, whilst broadening participation more generally within the sector. This paper seeks empirically to trace the activation and appropriation of federal policy through two sites of higher education policy practices: a state government-sponsored equity practitioner body and two differently positioned universities, Dawson and McIllwraith, as they engage with low-SES schools. Working together Dorothy Smith’s insights into the textually mediated activation of local practices, Levinson and colleagues’ concept of the local appropriation of authorised policy, and Bourdieu’s notion of the contested field, we demonstrate that the generation of state level and institutionally specific policies for student-equity practices not only articulates to federal policy, but also appropriates the ruling relations of mandated policy. Further, the scope of these creative local appropriations is organised within a hierarchical academic field through which particular institutional imperatives, as well as the needs of low-SES students, are negotiated. The analysis demonstrates the vernacularisation of policy in the national rearticulation of global discourses, in appropriation at the level of the state body and in the practices of equity workers.

Tensions between policy and practice : reconciliation agendas in the Australian curriculum English

In various parts of the world, Indigenous and non-Indigenous peoples are actively working towards Reconciliation. In Australia, the context in which we each undertake our work as educationalists and researchers, the Reconciliation agenda has been pushed into schools and English teachers have been called on to share responsibility for facilitating the move towards a new national order. The recently introduced Australian Curriculum mandates that Aboriginal and Torres Strait Islander Histories and Cultures be embedded with “a strong” but “varying presence” into each learning area (Australian Curriculum, Assessment and Reporting Authority, 2013). In this paper we consider the tensions between policy and practice, when discourses external to education are recontextualised into the discipline of English. We do so by applying an analytical framework based on Bernstein’s (1990, 1996,2000) sociological theories about the structure of instructional and regulative discourses. Our findings suggest that the space to exert Reconciliatory agendas in the Australian Curriculum English is ambiguous and thus holds the potential to not only marginalise Indigenous knowledges but also to create tensions between policy and practice for non-Indigenous teachers of English.

The 1989 Comprehensive Plan of Action (CPA) and refugee policy in Southeast Asia : twenty years forward what has changed?

In 2012, the only South East Asian countries that have ratified the 1951 Convention relating to the Status of Refugees and the 1967 Protocol Relating to the Status of Refugees (hereafter referred to as the 1951 Convention and 1967 Protocol) is Philippines (signed 1954), Cambodia (signed 1995) and Timor Leste (signed 2001). Countries such as Indonesia, Malaysia and Thailand have annual asylum seeking populations from Myanmar, South Asia and Middle East, that are estimated to be at 15 000-20 000 per country (UNHCR 2012). The lack of a permanent and formal asylum processing process in these countries means that that asylum-seeking populations in the region are reliant on the local offices of the United Nations High Commission for Refugees based in the region to process their claims. These offices rely upon the good will of these governments to have a presence near detection camps and in capital cities to process claims of those who manage to reach the UNHCR representative office. The only burden sharing mechanism within the region primarily exists under the Bali Process on People Smuggling, Trafficking in Persons and Related Transnational Crime (the Bali Process), introduced in 2002. The Bali Process refers to an informal cooperative agreement amongst the states from the Asia-Pacific region, with Australia and Indonesia as the co-chairs, which discusses its namesake: primarily anti-people smuggling activities and migration protocols. There is no provision within this process to discuss the development of national asylum seeking legislation, processes for domestic processing of asylum claims or burden sharing in contrast to other regions such as Africa and South America (i.e. 2009 African Union Convention for the Protection and Assistance of the Internally Displaced, 1969 African Union Convention Governing the Specific Aspects of Refugee Problems in Africa and 1984 Cartagena Declaration on Refugees [Americas]) (PEF 2010: 19).

National security and pandemics

Pandemics are for the most part disease outbreaks that become widespread as a result of the spread of human-to-human infection. Beyond the debilitating, sometimes fatal, consequences for those directly affected, pandemics have a range of negative social, economic and political consequences. These tend to be greater where the pandemic is a novel pathogen, has a high mortality and/or hospitalization rate and is easily spread. According to Lee Jong-wook, former Director-General of the World Health Organization (WHO), pandemics do not respect international borders. Therefore, they have the potential to weaken many societies, political systems and economies simultaneously.

Teacher education targeting high-poverty schools : the National Exceptional Teachers for Disadvantaged Schools program

This paper examines the Exceptional Teachers for Disadvantaged Schools (ETDS) program and demonstrates how the outcomes from this teacher education model targeting high-poverty schools have been used to expand the model across other Australian universities. The paper outlines the parameters of ETDS and stresses the importance to the program of academic excellence, a modified teacher education curriculum, targeted practicums and a network of jurisdictional and school-based partnerships. The paper presents data from ETDS that demonstrates 90% of graduates have secured employed as teachers within high-poverty Australian schools. The paper concludes by outlining the impact of philanthropic funding (2 million dollars AUD) that will allow the expansion of the ETDS model into other teacher education universities across Australia.

From policy borrowing to implementation : an illuminative evaluation of learning and teaching in higher education in Australia (2002 to 2008)

This study documents and theorises the consequences of the 2003 Australian Government Reform Package focussed on learning and teaching in Higher Education during the period 2002 to 2008. This is achieved through the perspective of program evaluation and the methodology of illuminative evaluation. The findings suggest that the three national initiatives of that time, Learning and Teaching Performance Fund (LTPF), Australian Learning and Teaching Council (ALTC), and Australian Universities Quality Agency (AUQA), were successful in repositioning learning and teaching as a core activity in universities. However, there were unintended consequences brought about by international policy borrowing, when the short-lived nature of LTPF suggests a legacy of quality compliance rather than one of quality enrichment.

Convergent Media Policy

This chapter considers the implications of convergence for media policy from three perspectives. First, it discusses what have been the traditional concerns of media policy, and the challenges it faces, from the perspectives of public interest theories, economic capture theories, and capitalist state theories. Second, it looks at what media convergence involves, and some of the dilemmas arising from convergent media policy including: (1) determining who is a media company; (2) regulatory parity between ‘old’ and ‘new’ media; (3) treatment of similar media content across different platforms; (4) distinguishing ‘big media’ from user-created content; and (5) maintaining a distinction between media regulation and censorship of personal communication. Finally, it discusses attempts to reform media policy in light of these changes, including Australian media policy reports from 2011-12 including the Convergence Review, the Finkelstein Review of News Media, and the Australian Law Reform Commission’s National Classification Scheme Review. It concludes by arguing that ‘public interest’ approaches to media policy continue to have validity, even as they grapple with the complex question of how to understand the concept of influence in a convergent media environment.

Experience indigenous culture in Arnhem Land, NT

A travel article about a journey to the Cobourg Peninsula, Arnhem Land. "NOW I know I'm back,'' says our guide David McMahon as the scent of wood smoke makes its way into the 4WD. For McMahon, being back means Kakadu and Arnhem Land, and ultimately our final destination in the Northern Territory's Cobourg Peninsula. In the north, one of the first things you need to adjust is your attitude to fire. The indigenous people have long worked with it. The rangers perform controlled burns. The animals have adapted and know how to escape the flames. The smoke trail leads us down the old Jim Jim Rd, our first stretch of dirt track since leaving Darwin. Our destination is the Venture North campsite at Garig Gunak Barlu National Park...

Palliative care phase : inter-rater reliability and acceptability in a national study

Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding. Aim: To test the reliability and acceptability of revised definitions of Palliative Care Phase. Design: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. Setting/participants: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. Results: A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians’ rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61–0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase. Conclusion: Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.

Understanding causal relationships between the built and social environment, health and associated behaviours and risk factors

Introduction: Built environment interventions designed to reduce non-communicable diseases and health inequity, complement urban planning agendas focused on creating more ‘liveable’, compact, pedestrian-friendly, less automobile dependent and more socially inclusive cities.However, what constitutes a ‘liveable’ community is not well defined. Moreover, there appears to be a gap between the concept and delivery of ‘liveable’ communities. The recently funded NHMRC Centre of Research Excellence (CRE) in Healthy Liveable Communities established in early 2014, has defined ‘liveability’ from a social determinants of health perspective. Using purpose-designed multilevel longitudinal data sets, it addresses five themes that address key evidence-base gaps for building healthy and liveable communities. The CRE in Healthy Liveable Communities seeks to generate and exchange new knowledge about: 1) measurement of policy-relevant built environment features associated with leading non-communicable disease risk factors (physical activity, obesity) and health outcomes (cardiovascular disease, diabetes) and mental health; 2) causal relationships and thresholds for built environment interventions using data from longitudinal studies and natural experiments; 3) thresholds for built environment interventions; 4) economic benefits of built environment interventions designed to influence health and wellbeing outcomes; and 5) factors, tools, and interventions that facilitate the translation of research into policy and practice. This evidence is critical to inform future policy and practice in health, land use, and transport planning. Moreover, to ensure policy-relevance and facilitate research translation, the CRE in Healthy Liveable Communities builds upon ongoing, and has established new, multi-sector collaborations with national and state policy-makers and practitioners. The symposium will commence with a brief introduction to embed the research within an Australian health and urban planning context, as well as providing an overall outline of the CRE in Healthy Liveable Communities, its structure and team. Next, an overview of the five research themes will be presented. Following these presentations, the Discussant will consider the implications of the research and opportunities for translation and knowledge exchange. Theme 2 will establish whether and to what extent the neighbourhood environment (built and social) is causally related to physical and mental health and associated behaviours and risk factors. In particular, research conducted as part of this theme will use data from large-scale, longitudinal-multilevel studies (HABITAT, RESIDE, AusDiab) to examine relationships that meet causality criteria via statistical methods such as longitudinal mixed-effect and fixed-effect models, multilevel and structural equation models; analyse data on residential preferences to investigate confounding due to neighbourhood self-selection and to use measurement and analysis tools such as propensity score matching and ‘within-person’ change modelling to address confounding; analyse data about individual-level factors that might confound, mediate or modify relationships between the neighbourhood environment and health and well-being (e.g., psychosocial factors, knowledge, perceptions, attitudes, functional status), and; analyse data on both objective neighbourhood characteristics and residents’ perceptions of these objective features to more accurately assess the relative contribution of objective and perceptual factors to outcomes such as health and well-being, physical activity, active transport, obesity, and sedentary behaviour. At the completion of the Theme 2, we will have demonstrated and applied statistical methods appropriate for determining causality and generated evidence about causal relationships between the neighbourhood environment, health, and related outcomes. This will provide planners and policy makers with a more robust (valid and reliable) basis on which to design healthy communities.

Work Health and Safety Law and Policy

The third edition of Work Health and Safety Law and Policy continues to provide a plain English approach to explaining and analysing the law which regulates work health and safety in Australia. Providing broad coverage, this book focuses on the role that legal regulation plays in preventing work-related injury and disease, as well as the way in which the law contributes to rehabilitating and compensating injured and ill workers. This third edition focuses on the national model Work Health and Safety Bill 2009. The provisions of the model Bill are outlined, along with court decisions and other documentation that help interpret the provisions in new legislation enacting the model Bill. There is also a chapter in the book examining the national model Work Health and Safety Regulations 2011, and model codes of practice. The book includes three chapters on common law, statutory workers’ compensation provisions and rehabilitation. Tables summarising the key legal provisions of the major Australian Commonwealth, State and Territory workers’ compensation statutes have been updated and give quick and easy reference to points of legislation.

Harmonising occupational health and safety regulation in Australia: The first report of the national OHS review

The Australian government had set up a major National Review into Model Occupational Health and Safety Laws (National OHS Review) to examine the Occupational health and safety (OHS) statutes in Australia to identify areas of best practice, common practice and inconsistency and to make recommendations for a model OHS Act. The article analyses the first report of the review panel.

Investigating the interplay between transport, land use and the environment : a review of the literature

Integration of land use and transport decisions to achieve sustainable travel behavior has been considered an integral element for sustainable urban development. However, before the popularity of urban sustainability concept, land use and transport interaction had been scrutinized as strictly separate entities in the urban planning and development domains. Fortunately today the concept of sustainability has been pushed to the forefront of policy-making and politics as the world wakes up to the impacts of climate change and the effects of the rapid urbanization and modern urban lifestyles. The paper therefore aims to highlight the importance of the interplay between transport, land use and the environment. This review paper provides evidence from the literature including the Transport, Land Use and the Environment Special Issue contributions and global best practice cases to showcase new empirical approaches and investigations from different parts of the world that contribute to the wealth of knowledge in exploring the interplay between transport, land use and the environment thoroughly.