History and development of public health

This chapter and the others that follow have the study of population health as their focus, as opposed to a focus on individual care and treatment. Clearly, however, we are concerned with the way in which population health is influenced by biomedical theories and practices, and the way population health is funded, and is influenced by the importance placed on therapeutic medicine. The discussions that follow include a brief overview of the ancient history of public health, and the modern history of Western public health dating from 1850. This date signifies the beginnings of a more organised, collective effort to protect the public’s health. These discussions will help you further expand your definition of public health. You will have an entertaining journey through public health achievements, and less successful outcomes, by examining the historical developments that have led us to a modern understanding of public health. The ancient Greeks and Romans, for example, had public health measures to ensure the safety and health of their populations, for a range of social and economic reasons. Convicts arrived in Australia with many health problems, and were put to work to satisfy the needs of a fledgling colony. It is important to understand the historical journey of public health and the way it is critically analysed, as it provides a looking-glass onto the present and the future.

Achieving sustainable transportation system for Indian cities - problems and issues

This article aims at identifying the research issues and challenges that need to be addressed to achieve sustainable transportation system for Indian cities. The same is achieved by understanding the current system and trends of urbanization, motorization and modal shares in India; and their impact on mobility and safety (the two basic goals of transportation) as well as environment. Further, the article explores the efforts by the central and state governments in India to address the sustainability issues, and the problems and issues over and above the present efforts to achieve sustainability. The article concludes by summarizing the research issues with respect to planning/modelling, non-motorized transport, public transport, driver behaviour and road safety and traffic management. It is expected that these research issues will provide potential directions for carrying out further research aimed at achieving sustainable transport system for Indian cities.

Maintaining the "public good" nature of improved fish strains: dissemination of knowledge and materials

Many sources of information that discuss currents problems of food security point to the importance of farmed fish as an ideal food source that can be grown by poor farmers, (Asian Development Bank 2004). Furthermore, the development of improved strains of fish suitable for low-input aquaculture such as Tilapia, has demonstrated the feasibility of an approach that combines “cutting edge science” with accessible technology, as a means for improving the nutrition and livelihoods of both the urban poor and poor farmers in developing countries (Mair et al. 2002). However, the use of improved strains of fish as a means of reducing hunger and improving livelihoods has proved to be difficult to sustain, especially as a public good, when external (development) funding sources devoted to this area are minimal1. In addition, the more complicated problem of delivery of an aquaculture system, not just improved fish strains and the technology, can present difficulties and may go explicitly unrecognized (from Sissel Rogne, as cited by Silje Rem 2002). Thus, the involvement of private partners has featured prominently in the strategy for transferring to the public technology related to improved Tilapia strains. Partnering with the private sector in delivery schemes to the poor should take into account both the public goods aspect and the requirement that the traits selected for breeding “improved” strains meet the actual needs of the resource poor farmer. Other dissemination approaches involving the public sector may require a large investment in capacity building. However, the use of public sector institutions as delivery agents encourages the maintaining of the “public good” nature of the products.

Local solutions to local problems: A stormwater education collaborative

Currently completing its fifth year, the Coastal Waccamaw Stormwater Education Consortium (CWSEC) helps northeastern South Carolina communities meet National Pollutant Discharge Elimination System (NPDES) Phase II permit requirements for Minimum Control Measure 1 - Public Education and Outreach - and Minimum Control Measure 2 - Public Involvement. Coordinated by Coastal Carolina University, six regional organizations serve as core education providers to eight coastal localities including six towns and cities and two large counties. CWSEC recently finished a needs assessment to begin the process of strategizing for the second NPDES Phase II 5-year permit cycle in order to continue to develop and implement effective, results-oriented stormwater education and outreach programs to meet federal requirements and satisfy local environmental and economic needs. From its conception in May 2004, CWSEC set out to fulfill new federal Clean Water Act requirements associated with the NPDES Phase II Stormwater Program. Six small municipal separate storm sewer systems (MS4s) located within the Myrtle Beach Urbanized Area endorsed a coordinated approach to regional stormwater education, and participated in a needs assessment resulting in a Regional Stormwater Education Strategy and a Phased Education Work Plan. In 2005, CWSEC was formally established and the CWSEC’s Coordinator was hired. The Coordinator, who is also the Environmental Educator at Coastal Carolina University’s Waccamaw Watershed Academy, organizes six regional agencies who serve as core education providers for eight coastal communities. The six regional agencies working as core education providers to the member MS4s include Clemson Public Service and Carolina Clear Program, Coastal Carolina University’s Waccamaw Watershed Academy, Murrells Inlet 2020, North Inlet-Winyah Bay National Estuarine Research Reserve’s Coastal Training and Public Education Programs, South Carolina Sea Grant Consortium, and Winyah Rivers Foundation’s Waccamaw Riverkeeper®. CWSEC’s organizational structure results in a synergy among the education providers, achieving greater productivity than if each provider worked separately. The member small MS4s include City of Conway, City of North Myrtle Beach, City of Myrtle Beach, Georgetown County, Horry County, Town of Atlantic Beach, Town of Briarcliffe Acres, and Town of Surfside Beach. Each MS4 contributes a modest annual fee toward the salary of the Coordinator and operational costs. (PDF contains 3 pages)

Implementation of a nursing competency assessment system in public hospitals

Numerous problems are frequently observed when nursing competency assessment systems (NCAS) are implemented. How to effectively implement a nursing competency assessment system, according to academic and practical contributions, is poorly reported in the literature. The purpose of this paper is to present a set of recommendations for public hospitals and nursing management in order to facilitate the implementation of a NCAS. To achieve this objective we have revised the existing literature and conducted a Delphi study with nursing managers and human resource managers of the public hospitals of the Basque Health Service. The results are that the implementation of a NCAS requires a well-planned strategy that managers must consider before implementing any NCAS. This strategy must include, at minimum, the following aspects: communication, training, leadership, and content where the NCAS is concerned. The context of the organisations and the cultural dimensions may also influence the results of the application of the system.

Cooperative and market-based solutions to pollution abatement problems

This work concerns itself with the possibility of solutions, both cooperative and market based, to pollution abatement problems. In particular, we are interested in pollutant emissions in Southern California and possible solutions to the abatement problems enumerated in the 1990 Clean Air Act. A tradable pollution permit program has been implemented to reduce emissions, creating property rights associated with various pollutants.

Before we discuss the performance of market-based solutions to LA's pollution woes, we consider the existence of cooperative solutions. In Chapter 2, we examine pollutant emissions as a trans boundary public bad. We show that for a class of environments in which pollution moves in a bi-directional, acyclic manner, there exists a sustainable coalition structure and associated levels of emissions. We do so via a new core concept, one more appropriate to modeling cooperative emissions agreements (and potential defection from them) than the standard definitions.

However, this leaves the question of implementing pollution abatement programs unanswered. While the existence of a cost-effective permit market equilibrium has long been understood, the implementation of such programs has been difficult. The design of Los Angeles' REgional CLean Air Incentives Market (RECLAIM) alleviated some of the implementation problems, and in part exacerbated them. For example, it created two overlapping cycles of permits and two zones of permits for different geographic regions. While these design features create a market that allows some measure of regulatory control, they establish a very difficult trading environment with the potential for inefficiency arising from the transactions costs enumerated above and the illiquidity induced by the myriad assets and relatively few participants in this market.

It was with these concerns in mind that the ACE market (Automated Credit Exchange) was designed. The ACE market utilizes an iterated combined-value call market (CV Market). Before discussing the performance of the RECLAIM program in general and the ACE mechanism in particular, we test experimentally whether a portfolio trading mechanism can overcome market illiquidity. Chapter 3 experimentally demonstrates the ability of a portfolio trading mechanism to overcome portfolio rebalancing problems, thereby inducing sufficient liquidity for markets to fully equilibrate.

With experimental evidence in hand, we consider the CV Market's performance in the real world. We find that as the allocation of permits reduces to the level of historical emissions, prices are increasing. As of April of this year, prices are roughly equal to the cost of the Best Available Control Technology (BACT). This took longer than expected, due both to tendencies to mis-report emissions under the old regime, and abatement technology advances encouraged by the program. Vve also find that the ACE market provides liquidity where needed to encourage long-term planning on behalf of polluting facilities.

Policy entrepreneurship in the development of public sector strategy: the case of London health reform

The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter-related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entrepreneur and highlighting the translational processes of key actors in creating and aligning policy windows. We analyse the work in London of Professor Sir Ara Darzi as a policy entrepreneur. An important aspect of Darzi's approach was to align a number of important institutional networks to conjoin related problems. Our findings highlight how a policy entrepreneur not only opens policy windows but also yokes together a network to make policy agendas happen. Our contribution reveals the role of clinical leadership in health reform.

Basis Reduction Algorithms and Subset Sum Problems

This thesis investigates a new approach to lattice basis reduction suggested by M. Seysen. Seysen's algorithm attempts to globally reduce a lattice basis, whereas the Lenstra, Lenstra, Lovasz (LLL) family of reduction algorithms concentrates on local reductions. We show that Seysen's algorithm is well suited for reducing certain classes of lattice bases, and often requires much less time in practice than the LLL algorithm. We also demonstrate how Seysen's algorithm for basis reduction may be applied to subset sum problems. Seysen's technique, used in combination with the LLL algorithm, and other heuristics, enables us to solve a much larger class of subset sum problems than was previously possible.

Police accountability in Ireland: an analysis of the problems posed by the legal, constitutional and political dimensions and how they might be addressed

The concept of police accountability is not susceptible to a universal or concise definition. In the context of this thesis it is treated as embracing two fundamental components. First, it entails an arrangement whereby an individual, a minority and the whole community have the opportunity to participate meaningfully in the formulation of the principles and policies governing police operations. Second, it presupposes that those who have suffered as victims of unacceptable police behaviour should have an effective remedy. These ingredients, however, cannot operate in a vacuum. They must find an accommodation with the equally vital requirement that the burden of accountability should not be so demanding that the delivery of an effective police service is fatally impaired. While much of the current debate on police accountability in Britain and the USA revolves around the issue of where the balance should be struck in this accommodation, Ireland lacks the very foundation for such a debate as it suffers from a serious deficit in research and writing on police generally. This thesis aims to fill that gap by laying the foundations for an informed debate on police accountability and related aspects of police in Ireland. Broadly speaking the thesis contains three major interrelated components. The first is concerned with the concept of police in Ireland and the legal, constitutional and political context in which it operates. This reveals that although the Garda Siochana is established as a national force the legal prescriptions concerning its role and governance are very vague. Although a similar legislative format in Britain, and elsewhere, have been interpreted as conferring operational autonomy on the police it has not stopped successive Irish governments from exercising close control over the police. The second component analyses the structure and operation of the traditional police accountability mechanisms in Ireland; namely the law and the democratic process. It concludes that some basic aspects of the peculiar legal, constitutional and political structures of policing seriously undermine their capacity to deliver effective police accountability. In the case of the law, for example, the status of, and the broad discretion vested in, each individual member of the force ensure that the traditional legal actions cannot always provide redress where individuals or collective groups feel victimised. In the case of the democratic process the integration of the police into the excessively centralised system of executive government, coupled with the refusal of the Minister for Justice to accept responsibility for operational matters, project a barrier between the police and their accountability to the public. The third component details proposals on how the current structures of police accountability in Ireland can be strengthened without interfering with the fundamentals of the law, the democratic process or the legal and constitutional status of the police. The key elements in these proposals are the establishment of an independent administrative procedure for handling citizen complaints against the police and the establishment of a network of local police-community liaison councils throughout the country coupled with a centralised parliamentary committee on the police. While these proposals are analysed from the perspective of maximising the degree of police accountability to the public they also take into account the need to ensure that the police capacity to deliver an effective police service is not unduly impaired as a result.

Public-public partnerships (PUPs) in water

Water operators need to be efficient, accountable, honest public institutions providing a universal service. Many water services however lack the institutional strength, the human resources, the technical expertise and equipment, or the financial or managerial capacity to provide these services. They need support to develop these capacities. The vast majority of water operators in the world are in the public sector – 90% of all major cities are served by such bodies. This means that the largest pool of experience and expertise, and the great majority of examples of good practice and sound institutions, are to be found in existing public sector water operators. Because they are public sector, however, they do not have any natural commercial incentive to provide international support. Their incentive stems from solidarity, not profit. Since 1990, however, the policies of donors and development banks have focussed on the private companies and their incentives. The vast resources of the public sector have been overlooked, even blocked by pro-private policies. Out of sight of these global policy-makers, however, a growing number of public sector water companies have been engaged, in a great variety of ways, in helping others develop the capacity to be effective and accountable public services. These supportive arrangements are now called 'public-public partnerships' (PUPs). A public-public partnership (PUP) is simply a collaboration between two or more public authorities or organisations, based on solidarity, to improve the capacity and effectiveness of one partner in providing public water or sanitation services. They have been described as: “a peer relationship forged around common values and objectives, which exclude profit-seeking”.1 Neither partner expects a commercial profit, directly or indirectly. This makes PUPs very different from the public–private partnerships (PPPs) which have been promoted by the international financial institutions (IFIs) like the World Bank. The problems of PPPs have been examined in a number of reports. A great advantage of PUPs is that they avoid the risks of such partnerships: transaction costs, contract failure, renegotiation, the complexities of regulation, commercial opportunism, monopoly pricing, commercial secrecy, currency risk, and lack of public legitimacy.2 PUPs are not merely an abstract concept. The list in the annexe to this paper includes over 130 PUPs in around 70 countries. This means that far more countries have hosted PUPs than host PPPs in water – according to a report from PPIAF in December 2008, there are only 44 countries with private participation in water. These PUPs cover a period of over 20 years, and been used in all regions of the world. The earliest date to the 1980s, when the Yokohama Waterworks Bureau first started partnerships to help train staff in other Asian countries. Many of the PUP projects have been initiated in the last few years, a result of the growing recognition of PUPs as a tool for achieving improvements in public water management. This paper attempts to provide an overview of the typical objectives of PUPs; the different forms of PUPs and partners involved; a series of case studies of actual PUPs; and an examination of the recent WOPs initiative. It then offers recommendations for future development of PUPs.

Finance for water and sanitation as a public service

Drawing on empirical evidence gathered through the PSIRU database, this contribution aims at addressing the potential of public finance to enhance the provision of water supply and sanitation as a public service. It highlights the problems associated with (and the disappointing results obtained from) resort to Private Sector Participation and private finance, both historically and in the last 15-20 years, in developed and developing countries. It also addresses the advantages of using public finance as a more cost-effective and equitable instrument to achieve developmental objectives such as the expansion of service coverage and development of water and sanitation infrastructure. The potential of public operations in maximising developmental impact from the social, economic and environmental points of view is then explored referring to specific examples from a variety of countries and regions. These include the in-house restructuring of public operations to enhance transparency, accountability and effectiveness, as well as the use of Public-Public Partnerships (PUPs) to build capacity. Attention is devoted to the specific financial requirements of expanding sewerage services at global level to achieve MDGs or broader developmental goals. These requirements are revisited in light of a regional breakdown of coverage gaps, available resources and development aid flows. These findings challenge the established view among international and bilateral agencies that expanding sewerage services in developing countries is excessively costly and should be abandoned as a priority because unaffordable. This contribution draws on a number of PSIRU Reports, and particularly the following. - http://www.psiru.org/reports/2008-03-W-sewers.pdf - http://boell-latinoamerica.org/download_es/agua08_privatizacion_LA_2007.pdf - http://boell-latinoamerica.org/download_es/agua08_agua_un_servicio_publico.pdf - http://www.psiru.org/reports/2006-03-W-investment.pdf All PSIRU Reports are accessible at http://www.psiru.org/publicationsindex.asp.

New public management of Higher education, Foucault and power

The theory of New Public Management (NPM) suggest that one of the features of advanced liberal rule is the tendency to define social, economic and political issues as problems to be solved through management. This paper argues that the restructuring of Higher Education (HE) in many Western countries since the 1980s has involved a shift from an emphasis on administration and policy to one of its efficient management. Utilising Foucault’s concept of governmentality rather than the liberal discourse of management as a politically neutral technology, managerialism can be seen as a newly emergent and increasingly rationalised disciplinary regime of governmentalising practices in advanced liberalism. As such the contemporary University as an institution governed by NPM can be demonstrated to have emerged not as the direct outcome of democratic policies that have rationalised its activities (so that the emancipatory aims of personal development, an educated workforce and of true research can be fully realised), nor can it be understood as the instrument through which individuals or self-realising classes are defeated through the calculations of the state acting on behalf of economic interests, rather it can be seen as the contingent and intractable outcome of the complex power/knowledge relations of advanced liberalism. I analyse the interlocking of the ‘tutor-subject’ and ‘student-subject’ as a local enacting of policy discourse informed by the NPM of HE that reshapes subjectivity and retunes the relationship between tutor and student. I put forward suggestions for how resistance to these new modes of disciplinary subjectification can be enacted.

Public religions and civil society: the case of London Methodism

Amendments to secularization theory have brought the issue of public religions to the fore in recent years. In particular, the work of Casanova and Beyer has maintained the importance of functional differentiation whilst pointing to the flow of religious discourses across social boundaries. These issues, however, have received little ethnographic attention, such that many of the problems associated with theories of differentiation and globalization have not been engaged in a sustained manner. Research within black majority London Methodist congregations is drawn upon to suggest ways in which these theories can be reconsidered. Three related issues are focused upon: the continued importance of the nation-state (including national stratifications); the importance of a practical approach to religion, such that discourses are understood as ‘practical discourses’; and the importance of not privileging religion by reifying it in functional terms. These considerations have ramifications not only for secularization theory, but the general field of the sociological study of religion.