Folate fortification : a case study of public health policy-making

Introducing Evidence Based Health Policy: Problems and Possibilities, Section 1: What is the Problem?, 1: Competing Rationalities: Evidence based Health Policy, 2: Beyond Two Communities, Section 2: What does Evidence Mean?, 3: Evidence based Medicine - The Medical Profession and Health Policy, 4: Mind The Gap: Assessing the Quality of Evidence for Public Health Problems, 5: Health Policy and Normative Analysis: Ethics, Evidence and Politics, 6: What is New in Health Information? Evidence for Health Consumers and Policy Making, 7: From Evidence based Medicine to Evidence based Public Health, Section 3: Policy Case Studies, 8: The Viagra Affair: Evidence as the Terrain for Competing Partners, 9: Folate Fortification: A Case Study of Public Health Policy-Making in a Food Regulation Setting, 10: The Supply and Safety of Blood and Blood Products - Evidence, Risk and Policy, 11: The Development of Nurse Practitioner Policy, 12: Creating Healthy Public Policy for Oral Health: How was the Evidence Used?, 13: Regulation of Traditional Chinese Medicine in Victoria, 14: The Victorian Primary Health Care Reforms: A Case Study of Evidence-based Policy Making, 15: Evidence-based Practice in the Australian Drug Policy Community, 16: Challenging the Evidence - Women's Health Policy in Australia, 17: Evidence and Aboriginal Health Policy, 18: The Limits to Technical Rationality in the Health Inequalities Policy Process, 19: Evidence-based policy: A Technocratic Wish in a Political World, Section 4: Is the transfer of evidence into policy possible?, 20: The Community Model of Research Transfer, 21: Getting Research Transfer into Policy and Practice in Maternity Care, 22: Improving the Research and Policy Partnership: An Agenda for Research Transfer and Governance, 23: Framing and Taming 'Wicked' Problems

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Creative tensions? Creativity and basic skills in recent educational policy.

Recently, in response to sustained criticism about the standards driven curriculum, UK government agencies have been promoting creativity in schools. In this article we explore how creativity is being defined in current national educational policy statements; how these definitions relate to other theoretical work on creativity, and the implications for the curriculum and pedagogies.

Dancing with death : risk, health promotion and injecting drug users

The thesis investigated ambivalent attitudes towards death in injecting drug users, factors that may lead to such ambivalent attitudes and implications for health promotion campaigns. It was found that this relationship with death was principally attributable to government drug policy in Australia.

The sociology of Pierre Bourdieu and researching education policy

Bourdieu did not write anything explicitly about education policy. Despite this neglect, we agree with van Zanten that his theoretical concepts and methodological approaches can contribute to researching and understanding educational policy in the context of globalisation and the economising of it. In applying Bourdieu's theory and methodology to research in education policy, we focus on developing his work to understand what we call 'cross-field effects' and for exploring the emergence of a 'global education policy field'. These concepts are derived from some of our recent research concerning globalisation and mediatisation of education policy. The paper considers three separate issues. The first deals with Bourdieu' s primary 'thinking tools', namely practice, habitus,capitals and fields and their application to policy studies. The second and third sections consider two additions to Bourdieu's thinking tools, as a way to reconceptualise the functioning of policy if considered as a social field. More specifically, the second section develops an argument around cross-field effects, as a way to group together, research and describe policy effects. The third section develops an argument about an emergent global education policy field, and considers ways that such a field affects national education policy fields.

Benzodiazepine and pharmaceutical opioid misuse and their relationship to crime : an examination of illicit prescription drug markets in Melbourne, Hobart and Darwin : Victorian report

This report presents the findings of the major research project 'benzodiazepine and pharmaceutical opioid misuse and their relationship to crime', and is an examination of illicit prescription drug markets in Melbourne.

New scalar politics : implications for education policy

This paper argues that globalisation has implications for research and theory in the social sciences, demanding that the social no longer be seen as homologous with nation, but also linked to postnational or global fields. This situation has theoretical and methodological implications for comparative education specifically focused on education policy, which traditionally has taken the nation-state as the unit of analysis, and also worked with 'methodological nationalism'. The paper argues that globalisation has witnessed a rescaling of educational politics and policymaking and relocated some political authority to an emergent global education policy field, with implications for the functioning of national political authority and national education policy fields. This rescaling and this reworking of political authority are illustrated through two cases: the first is concerned with the impact of a globalised policy discourse of the ‘knowledge economy’ proselytised by the OECD and its impact in Australian policy developments; the second is concerned explicitly with the constitution of a global education policy field as a commensurate space of equivalence, as evidenced in the OECD’s PISA and educational indicators work and their increasing global coverage. The paper indicatively utilises Bourdieu’s ‘thinking tools’ to understand the emergent global education policy field and suggest these are very useful for doing comparative education policy analysis.

The lived experience of flexible education : theory, policy and practice

The range of rationales that underpin conceptions of flexible education, and the re-making over time of the official meaning of flexibility in national education policy, have led to the point where flexibility might be found, or be required, in nearly every aspect of Australian higher education. This paper seeks to identify those rationales and the development of public policy rhetoric that have framed the development of the meaning of flexible education over time in an Australian context. By considering the intersection of theoretical and policy perspectives on flexible education with the realities of teaching and learning practice in the discipline context of engineering, this paper proposes the essential importance of individual context and agency in the making of real meaning from, and creating practical boundaries around, the otherwise tenuous definitions of flexibility often offered by institutional policy.

Harm reduction as anarchist practice : a user’s guide to capitalism and addiction in North America

In spite of its origins as an illegal, clandestine, grassroots activity that took place either outside or in defiant opposition to state and legal authority, there is growing evidence to suggest that harm reduction in North America has become sanitized and depoliticized in its institutionalization as public health policy. Harm reduction remains the most contested and controversial aspect of drug policy on both sides of the Canada–US border, yet the institutionalization of harm reduction in each national context demonstrates a series of stark contrasts. Drawing from regional case study examples in Canada and the US, this article historically traces and politically re-maps the uneasy relationship between the autonomous political origins of harm reduction, contemporary public health policy, and the adoption of the biomedical model for addiction research and treatment in North America. Situated within a broader theoretical interrogation of the etiology of addiction, this study culminates in a politically engaged critique of traditional addiction research and drug/service user autonomy. Arguing that the founding philosophy and spirit of the harm reduction movement represents a fundamentally anarchist-inspired form of practice, this article concludes by considering tactics for reclaiming and re-politicizing the future of harm reduction in North America.

Internet content regulation, public drug websites and the growth in hidden Internet services

Governments have traditionally censored drug-related information, both in traditional media and, in recent years, in online media. We explore Internet content regulation from a drug-policy perspective by describing the likely impacts of censoring drug websites and the parallel growth in hidden Internet services. Australia proposes a compulsory Internet filtering regime that would block websites that ‘depict, express or otherwise deal with matters of… drug misuse or addiction’ and/or ‘promote, incite or instruct in matters of crime’. In this article, we present findings from a mixed-methods study of online drug discussion. Our research found that websites dealing with drugs, that would likely be blocked by the filter, in fact contributed positively to harm reduction. Such sites helped people access more comprehensive and relevant information than was available elsewhere. Blocking these websites would likely drive drug discussion underground at a time when corporate-controlled ‘walled gardens’ (e.g. Facebook) and proprietary operating systems on mobile devices may also limit open drug discussion. At the same time, hidden Internet services, such as Silk Road, have emerged that are not affected by Internet filtering. The inability for any government to regulate Tor websites and the crypto-currency Bitcoin poses a unique challenge to drug prohibition policies.
Read More: http://informahealthcare.com/doi/full/10.3109/09687637.2012.745828

Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services?

INTRODUCTION AND AIM: To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. DESIGN AND METHODS: Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. RESULTS: Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. DISCUSSION AND CONCLUSION: Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2015;00:000-000].

"Não compre, plante"? A tipificação penal das situações de cultivo de Canábis pelo Tribunal de Justiça de São Paulo

A Lei nº 11.343 de 23 de agosto de 2006 (Lei de Drogas) instituiu o Sistema Nacional de Políticas Públicas sobre Drogas e criou as diretrizes para a política de drogas brasileira. Dentre o conjunto de medidas trazidas pela lei em seu dispositivo criminal está a criação de um tipo penal específico de cultivo de plantas para produção de drogas para consumo pessoal (art. 28, §1º). O plantio para consumo recebe o mesmo tratamento jurídico-penal que o porte para consumo (art. 28), sendo previstas sanções alternativas à privação de liberdade. O §2º do art. 28 da Lei de Drogas estabelece os critérios que as autoridades competentes do sistema de justiça criminal deverão considerar na tipificação penal das situações de cultivo. Este trabalho se debruça sobre a tipificação penal de situações de cultivo de canábis em acórdãos do Tribunal de Justiça de São Paulo. A problemática de pesquisa aqui desenvolvida discute especificamente quais são os argumentos e como eles são apresentados nas decisões para justificar a determinação de que uma situação de cultivo é para fins de tráfico ou de consumo pessoal. O trabalho busca identificar como os critérios do §2º do art. 28 da Lei de Drogas são apresentados na fundamentação de decisões judiciais em que se discute na esfera criminal se uma situação de cultivo é para “consumo pessoal” ou “destinada a terceiros”. Uma pergunta central norteia a pesquisa realizada: quais os elementos e de que forma eles são utilizados nas decisões analisadas para tipificação do plantio para consumo pessoal (art. 28, §1º, da Lei de Drogas) e do plantio destinado a fornecer drogas a terceiros (art. 33, §1º, II)? Para enfrentar a problemática de pesquisa utilizamos a ferramenta de busca de acórdãos disponibilizada no sítio eletrônico do Tribunal de Justiça de São Paulo. Foram analisados 135 acórdãos do TJSP que enfrentam diretamente a controvérsia relativa à tipificação penal de situações de cultivo de canábis. Os acórdãos foram proferidos entre os anos de 1998 e 2014 e foram selecionados segundo os critérios especificados no capítulo metodológico da dissertação. Os resultados quantitativos da pesquisa dizem respeito às informações gerais dos processos, elementos de prova mencionados nos acórdãos, características das situações de cultivo e fundamentação da tipificação penal. A discussão qualitativa sobre os resultados da pesquisa é promovida em quatro frentes: (i) interpretação e valoração da quantidade de drogas; (ii) antecedentes criminais, circunstâncias da prisão e do agente; (iii) materiais de venda e outros elementos relevantes na tipificação penal; e (iv) características do conjunto probatório. As questões discutidas nestas frentes circunscrevem o problema de pesquisa e é a partir delas que é feita a análise apresentada neste trabalho. Esperamos conseguir contribuir para melhor compreensão (i) da determinação da finalidade do cultivo e (ii) das implicações jurídicas que decorrem da opção legislativa pela não utilização de critérios quantitativos na definição dos crimes de tráfico de drogas e plantio para consumo.

A intervenção do poder judiciário no acesso a medicamentos no Rio Grande do Norte: uma análise sob a ótica das políticas nacionais de medicamento e de assistência farmacêutica

The present study aimed to evaluate the inclusion of the principles of the National Medicines Policy - PNM and the Pharmaceutical assistance - PNAF in the prosecution of lawsuits involving medicines. To fulfill this necessity , data collection was performed on the website by the Tribunal Rio Grande do Norte - TJ RN ( Rio Grande do Norte Court) , in 2012 . It was obtained 115 judgments, which were analyzed in order to generate Monitoring Indicators from lawsuits and conduct content analysis proposed by Bardin (2006). The results showed that : a) 100 % of the decisions were favorable to the author , b) 76 % of decisions were requests by the trade name of the drug , c) only one drug (eculizumabe) had not granted by ANVISA , d) 36 % of drugs were present in the list of standard medicines in SUS , 16 % of primary care block and 20 % of specialized component , e) 76 % of the decisions presented the request of at least 01 non-standard medicine. With regard to decentralization of PNM and PNAF we observed a commitment to this principle at judicial decisions, to see that municipalities and states are often forced to buy medicines of responsibility from another federal entity or other tertiary units as CACONs and UNACONS. The content analysis revealed that the argument from the judges used when you utter their decisions was that the right to health is recognized by Brazilian law as a fundamental right and should be guaranteed by the State for all its citizens. So, health is more than budgetary constraints of federal entities, which are severally liable for lawsuits , regardless the medication requested belongs or not to a particular block of a pharmaceutical assistance funding. Given these data, it is observed that there are gaps in the judgment when it comes to the insertion of the words and principles of PNM and PNAF, creating then the need for greater dialogue between the executive and judicial, so that they may consider relevant the effectiveness and application of such principles to minimize the negative consequences of the phenomenon of health judicialisation. Keywords: Judicialisation, Medicines, Public Policy, Pharmaceutical Care

Multilateral rules on competition policy: an overview of the debate

Includes bibliography

Establishing social statistical databases for evidenced-based social policy formulation in the Caribbean

Includes bibliography