Complex Policy Environment Research Articles

A comparison of the policy and institutional environment relevant to community-based primary health care in Ontario, Quebec and New Zealand

Introduction: Community-based primary health care (CBPHC) describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for CBPHC have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional path dependencies. This paper compares key features of the policy and institutional environments relevant to community-based primary health care in Ontario, Quebec and New Zealand. Theory/Methods: Drawing on existing literature and our collective expertise, we sought to identify the key organisational landscapes, service models, integrating mechanisms, and relevant policy developments within each jurisdiction. From these descriptions we develop a comparative analysis of enablers and facilitators. Results: Our analysis suggests that Ontario has the most significant institutional barriers to organisational integration and the fewest available policy levers, whilst New Zealand has the most conducive organisational landscape and strongest policy levers. Quebec has significant capacity for reform the structure of the health system, but reforms to date these have not incorporated primary health care. Conclusions: (comprising key findings) Our analysis suggests that two key conditions include the integration of relevant health and social sector organisations, and the range of policy levers available and used by governments. On both dimensions, the New Zealand environment appears to offer the largest scope, with Ontario’s environment significantly less conducive, with Quebec situated in between. Nevertheless, in each case there remain important institutional barriers to implementation of policies that promote CBPHC. Lessons Learned: Although New Zealand has more powerful policy levers, the effectiveness of levers is largely dependent on implementation strategies. Here the differences between New Zealand, Quebec and Ontario are less marked. Limitations: This research constitutes a preliminary, high-level understanding of the complex policy environments of three comparable policy and institutional environments. However, the degree to which the factors identified are key facilitators and inhibitors of CBPHC requires empirical investigation such that other significant policy and institutional constraints and enablers can be identified. Suggestions for Future Research: This research serves to inform the broader iCoach research collaboration, which investigates a range of specific local CBPHC initiatives and embedded practices that focus on older adults with complex conditions. Moving forward our research will focus on the analysis of key stakeholder interviews conducted within Ontario, Quebec and New Zealand to identify key institutional and policy settings that may enable and constrain the implementation and diffusion of these initiatives.

Working their way to school completion: a snapshot of School-based Apprenticeships and Traineeships for young Australians

This paper highlights troubling patterns within the Australian School-based Apprenticeships and Traineeships (SBATs) by analysing statistical data of 21,000 of 15–19 year old apprenticeship/traineeship learners engaged in Vocational Education and Training in School (VETiS). It confirms the alignment of social groups to certain qualification fields and levels and provides a compelling picture of the learner profile of SBAT including the type of occupations and qualifications being undertaken at school level. In a complex policy environment, where VET in Schools has been assigned the important task of preparing ‘workforce job-ready’ students for the ‘high skill and high earning roles our economy demands’, we argue that the SBAT pathway is not yet adequate to meet these high expectations. It is not an effective apprenticeship pathway as it potentially ‘locks-in’ already disadvantaged young people to precarious pathways, and reinforces the nature of an already highly gender-segregated Australian labour market. The paper helps to focus attention on endemic weaknesses in the Australian VET system that serve to entrench disadvantage in Australian society.

Do Markets Make Good Commissioners?: A Quasi-Experimental Analysis of Retail Electric Restructuring in Ohio

Empirical support for the purported benefits of retail electric deregulation is mixed at best. Prior studies that identify states as simply “retail deregulated” overlook complex policy environments in which deregulation is implemented by regulators with a high degree of discretion. Prior studies also rely on Energy Information Administration (EIA) data that does not account for core regulatory interventions that can take place during the process of implementing deregulation. Using robust time series household final bill survey data from the Public Utilities Commission of Ohio (PUCO), this paper provides a quasi-experimental analysis of the price impacts of retail electric restructuring in Ohio. The results suggest that residential electricity prices have increased following retail restructuring in all service territories in Ohio, with significant favorable welfare effects observed only in the Cincinnati area, where key policy implementation stages were not circumvented.

INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND

Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.

Specialists, spinners and networkers: political appointees in Iceland

Theories of politicization trace attempts by politicians to stay in control of an increasingly complex policy environment to three main roots: changes in mass media, changes in the way party organizations are run and administrative reforms. Each has created new political vulnerabilities, calling for a stronger presence of trusted employees in the public sector to guard the interests of politicians and parties. Consideration for the quality of government, however, may require greater administrative autonomy than is compatible with conventional agency conceptions of administration. The present study uses the Icelandic case to shed light on how such trends and countertrends affect the overall level of politicization. Case selection is justified on the basis that politicization is expected to be present according to established theories in the field. The findings indicate that politicization is a clearly observable part of ongoing tension between political control and bureaucratic autonomy in Iceland. It is more easily observed at the apex of the administrative system than lower levels, and political appointments are but one of a set of tools available to maintain political control. It seems more appropriate to speak of contained politicization of political appointments than a major watershed.

Crisis on the Border: Specialized Capacity Building in Nonprofit Immigration Organizations

Traditional views of the nonprofit–government relationships suggest that while government may depend on nonprofit organizations to provide human services, nonprofits must also conform to government standards, monitoring, and regulation. In this paper, we argue that through specialized investments in capacity building, nonprofit providers can become irreplaceable to government funders. By developing a comparison case study of two organizations serving unaccompanied minor children who cross the U.S.–Mexico Border, we provide evidence of specialized capacity investments in a complex policy environment and discuss the implications of capacity building for both government and nonprofits.

Integrating Human Health into Environmental Impact Assessment: Review of Health Impact Assessment in Thailand

The objective of this paper is to review the integration of health impact assessment (HIA) into environmental health assessment (EIA) or EHIA, existing legal requirements for health risk analyses, and lessons learned for integrating HIA within EIA processes. The authors undertook literature searches for EHIA practices through academic publications, reports, and websites of pub-lic organizations and related agencies in Thailand. We examined and synthesized the HIA system development, regulations, and examples of integrated EHIA. In conclusion, the implementation of EHIA still faces many obstacles, especially in such com-plex sector policy environments. The uncertainties, lack of evidence base, and challenges in imple-menting EHIA within the prevailing political and cultural contexts constrain decision-making andremain under-developed. Methodologies and tools have to fit with the available data and resources. The EHIA evaluation requires analytical validity, relevance, stakeholder engagement, and public involvement. The review resulted in the following recommendations to increasing Thailand’s EHIA capacity: 1) develop tools and guidelines for implementation in each project types; 2) train EHIA experts and conduct EHIA courses to build capacity; 3) ensure meaningful participation of private sector and the public; 4) bring together all parties in the debate, and build consensus throughcommunity participation and the upholding of environmental justice including EHIA communication; and 5) work to ensure strong public participation and political engagement.

Affordable warmth: housing strategies for older people

Purpose – The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach – The authors consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through “desktop analysis”. The authors support this with qualitative data from Health and Wellbeing Boards (HWBs), health inequalities and environmental health from research comprising four longitudinal case studies in the Midlands and North of England over 18 months and semi-structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of HWB meetings observed. Findings – There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However, there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value – Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move towards sustainable, evidence based affordable warmth strategies for older people to protect and improve health.

The Building Story: Architecture and Inclusive Design in Remote Aboriginal Australian Communities

ABSTRACTInclusive design in architecture describes an approach that aims to encourage broad participation in design decisions. In Australian Aboriginal communities the practice of inclusive design is challenged by a complex policy environment, by language barriers, by cultural differences, by economic disadvantage, by time and by distance. The importance of inclusive design in Aboriginal communities is heightened because of these challenges. Here, architectural projects – regardless of the building typology – are not simply about new buildings. They carry with them the added burdens of addressing health, employment and equity in disadvantaged and often marginalized places. Through the experiences of a small Australian architectural practice working with Aboriginal people in Central Australia, this paper will look at established paradigms of designing with Aboriginal communities and posit the notion of ‘storytelling’ as a methodology of design practice and reconciliation.

Identifying policy frames through semantic network analysis: an examination of nuclear energy policy across six countries

This study uses semantic network analysis to investigate nuclear energy policy frames in six countries: USA, UK, Germany, France, Japan, and South Korea. It is suggested that semantic network analysis represents a useful tool to investigate policy frames in complex policy environments. The discourse of top-level decision-makers is analyzed to highlight similarities and differences in policy frames and to identify the key policy arguments in the integrated network of all six countries. In total, 14 major policy arguments are identified, which relate to the three major frames of energy security, clean energy, and nuclear safety, along with the meta-issue of economic growth. There are differences in the degree of emphasis on each of the frames in the six countries, and Germany can be seen to have diverged the most following the Fukushima accident, as the emphasis is on clean energy, to the exclusion of the other frames. In contrast, both the USA and Japan have framed the issues primarily in terms of nuclear safety and energy security, while the UK and France have stressed the economic growth frame, and Korea has prioritized nuclear safety.

Malaysia's National Higher Education Research Institute (IPPTN): narrowing the research-policy gap in a dynamic higher education system

Policy decision-making in Malaysia has long used an approach based on intuition, ideology, or conventional wisdom. But as Malaysian society matures within an increasingly complex policy environment, a move toward an evidence-based approach to public policy-making is called for. This paper discusses the experience of the National Higher Education Research Institute (IPPTN) in its attempts at linking research to higher education policy formulation. The main aim is to understand the perspectives of the IPPTN researchers regarding the use and impact of higher education research on policy-making, and the challenges they experienced. The findings provide insights into the future of evidence-based higher education policy-making in Malaysia and the IPPTN's capacity and capability for evidence-based policy research.

Australian alcohol policy 2001-2013 and implications for public health.

BackgroundDespite a complex and multi-faceted alcohol policy environment in Australia, there are few comprehensive reviews of national and state alcohol policies that assess their effectiveness and research support. In mapping the Australian alcohol policy domain and evaluating policy interventions in each of the core policy areas, this article provides a useful resource for researchers. The implications for protecting public health emanating from this mapping and evaluation of alcohol policy are also discussed.MethodsThis review considered data from: published primary research; alcohol legislation, strategies and alcohol-related press releases for all levels and jurisdictions of Australian government; international publications by prominent non-governmental organisations; and relevant grey literature. These were organised and evaluated using the established framework offered by Thomas Babor and colleagues.ResultsFindings indicated great variability in alcohol initiatives across Australia, many of which do not reflect what is currently considered to be evidence-based best practice.ConclusionsResearch showing increasing alcohol-related harms despite steady levels of consumption suggests a need to pursue alcohol policy initiatives that are supported by evidence of harm-reduction. Future initiatives should aim to increase existing alcohol controls in line with suggested best practice in order to protect public health in Australia.

Living and Learning at the Intersection: Student Homelessness and Complex Policy Environments

In urban districts, homeless and highly mobile students are an important contributor to achievement disparities—and their numbers are rising. To date there has been little inquiry into how broader education and housing policies shape the schooling experiences of homeless and highly mobile families. Using semi-structured interviews with 132 key community stakeholders (parents, school social workers, other school staff, and community/service personnel) in one urban area, this study explored how families living at the policy intersection of the McKinney-Vento Homeless Assistance Act and federal rehousing policies, such as the HEARTH Act, experience the schooling process. These policies have important impacts on students; the McKinney-Vento Act provides them with a range of supports while recent federal policies such as the HEARTH Act are shifting where and how they are living. Taking a policy perspective and drawing insights from Lin’s network theory of social capital, the findings suggest that these policies both independently and concomitantly shape families’ life opportunities. Implications for schools, communities, and scholars are addressed.

Health policy evolution in Lao People's Democratic Republic: context, processes and agency.

During the last 20 years Lao People’s Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally.

Culturally Responsive Instructional Leadership: A Conceptual Exploration with Principals of Three New Zealand Mainstream Schools

Principals of many New Zealand (NZ) mainstream schools navigate a complex intercultural educational policy environment to address the academic challenges of M?ori and Pasifika students. This inquiry sought to explore the concept of culturally responsive instructional leadership by studying the knowledge, actions, motives, perceptions, and challenges of White principals in a primary school, an intermediate school, and a high school in NZ. The emergent conceptual definition of culturally responsive instructional leadership includes those purposeful, well-intentioned, creative, and collaborative actions that a principal takes to enhance the academic engagement and achievement of minority-culture students.

Russia's energy relations in Europe and the Far East: towards a social structurationist approach to energy policy formation

In this article, we examine the formation of Russia's energy policies vis-a-vis Europe and the Far East. As energy policy is a very complex field, we propose a new structurationist analytical model to deal with that complexity. Our model highlights the practices by which actors acquire information of their policy environments, which are conceptualised as structures enabling and constraining their actions. These practices involve intentions, interests and schemata. In our case analyses — the Nord Stream pipeline project and the Sakhalin Island's energy politics — we find that profit interests, as part of a wider business frame, most centrally guide Russian actors. The often-hyped energy superpower frame is found to be ambiguous. It generally does not bring the intentions of Russian actors together well, even if such a frame resonates with some of Russia's European customers. Energy security frames are found to be prevalent among Russia's customers and are highly differentiated. Environmental frames are mostly instrumentally deployed. Russian energy actors are capable of displaying collective intentionality, but are incapable of fully controlling the various dimensions of the complex policy environment.

A New Paradigm for Adaptive Management

Uncertainty is a pervasive feature in natural resource management. Adaptive management, an approach that focuses on identifying critical uncertainties to be reduced via diagnostic management experiments, is one favored approach for tackling this reality. While adaptive management is identified as a key method in the environmental management toolbox, there remains a lack of clarity over when its use is appropriate or feasible. Its implementation is often viewed as suitable only in a limited set of circumstances. Here we restructure some of the ideas supporting this view, and show why much of the pessimism around AM may be unwarranted. We present a new framework for deciding when AM is appropriate, feasible, and subsequently successful. We thus present a new paradigm for adaptive management that shows that there are no categorical limitations to its appropriate use, the boundaries of application being defined by problem conception and the resources available to managers. In doing so we also separate adaptive management as a management tool, from the burden of failures that result from the complex policy, social, and institutional environment within which management occurs.

Promoting Competition: European Union and the Global Competition Order

Global developments such as economic interdependence and the proliferation of national and regional competition regimes have created a complex international competition policy environment. The European Commission’s DG Competition has responded to these developments by making the international dimension of competition policy a priority since the late 1980s. It advocated for the establishment of a binding multilateral competition framework at the WTO, pursued bilateral cooperation agreements, extraterritorially applied its competition rules, and tried to export its competition policy model to its neighbors. This paper examines DG Competition’s objectives and strategies in internationalizing the EU’s competition policy, and evaluates the success of these strategies in furthering the EU’s goals in this area. The findings suggest that among all of the strategies it has tried, the DG has had most success with exporting the EU’s competition regime to other countries; however, this strategy may have reached its limits, and needs to be supplemented by multilateral efforts.

The Regulatory Challenge of Food Allergens

Food allergy is an important public health issue worldwide. Allergic consumers must avoid eating foods that could provoke potentially life-threatening reactions, and successful avoidance depends on having complete and accurate information on food labels. Regulatory agencies support allergic consumers by working with industry to ensure that all food allergens that are intended to be present in a food are declared on the label and that effective controls are used to prevent the presence of unintended allergens. These regulatory activities take place in a complex legal and policy environment both domestically and internationally. Protecting allergic consumers in this complex environment requires effective use of public health data and risk assessments.

MANAGING PUBLIC CONSULTATION: A CONCEPTUAL FRAMEWORK AND EMPIRICAL FINDINGS FROM BELGIAN CASE STUDIES

This article addresses the question of how governments can set up and manage, in an increasingly complex policy environment, processes of public consultation that lead to good outcomes. Drawing upon insights of democratic theory and literature on network and interactive governance, the article discusses the organization and outcomes of public consultation processes. The analysis of four Belgian cases shows that the absence of open process rules does not prevent good outcomes. Second, the level of managerial autonomy is positively correlated with the intensity of process design and management. Third, cases with intensive process design and management have better overall results. These findings question some normative assumptions in the literature, positing the need for open process rules regarding entrance, scope of discussion, and interaction. Intensive process design and management with rules properly accommodating the policy situation is possibly a better means of achieving good results than rule openness. These findings challenge the need for legislation stipulating in detail who needs to be consulted, about what, and how.