Policy making

In assessments of the environmental impacts of waste management, life-cycle assessment (LCA) helps expanding the perspective beyond the waste management system. This is important, since the indirect environmental impacts caused by surrounding systems, such as energy and material production, often override the direct impacts of the waste management system itself. However, the applicability of LCA for waste management planning and policy-making is restricted by certain limitations, some of which are characteristics inherent to LCA methodology as such, and some of which are relevant specifically in the context of waste management. Several of them are relevant also for other types of systems analysis. We have identified and discussed such characteristics with regard to how they may restrict the applicability of LCA in the context of waste management. Efforts to improve LCA with regard to these aspects are also described. We also identify what other tools are available for investigating issues that cannot be adequately dealt with by traditional LCA models, and discuss whether LCA methodology should be expanded rather than complemented by other tools to increase its scope and applicability.

Leading biologists and clinicians interested in aging convened to discuss biomarkers of aging. The goals were to come to a consensus, construct an agenda for future research, and make appropriate recommendations to policy makers and the public-at-large. While there was not total agreement on all issues, they addressed a number of questions, among them whether biomarkers can be identified and used to measure the physiological age of any individual within a population, given emerging information about aging and new technological advances. The hurdles to establishing informative biomarkers include the biological variation between individuals that makes generalizations difficult; the overlapping of aging and disease processes; uncertainty regarding benign versus pathogenic age-related changes; the point at which a process begins to do damage to the organism, and, if so, when does it occur; and when to distinguish critical damage from noncritical damage. Finally, and significantly, it is...

Getting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to 'do' GRIPP, and the important features and challenges of this process within the African context. In-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective ...

In recent years a number of studies have attempted to rank drugs by a single measure of harmfulness as the basis for decisions about scheduling and classification. These efforts are fundamentally flawed, both conceptually and methodologically. The effort to provide a single measure masks the variety of non-comparable dimensions that are relevant, the fact that benefits are ignored for most, but not all, drugs and that the harms of a drug are not invariant to the policy regime chosen. Methodologically, the most prominent recent effort ignores drug interactions and mixes aggregate and individual harms inappropriately. Instead we suggest that multiple dimensions of harm need to be displayed to inform human judgments of what drugs should be scheduled. Harm is not usefully reducible to a single dimension, and even perfect rankings would not constitute a 'sufficient statistic' for determining scheduling decisions.a dd_3461 1886..1890

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.

We construct a set of indicators to measure the policy-making role of the European Union (European Council, Parliament, Commission, Court of Justice, etc.), in a selected number of policy domains. Our goal is to examine the division of prerogatives between European institutions and national ones, in light of the implications of normative models and in relation to the preferences of European citizens. Our data confirm that the extent and the intensity of policy-making by the ED have increased sharply over the last 30 years. Such increase has taken place, at different speeds, and to different degrees, across policy domains. In recent times the areas that have expanded most are the most remote from the EEC's original mission of establishing a free market zone with common external trade policy. We conjecture that the resulting allocation may be partly inconsistent with normative criteria concerning the assignment of policies at different government levels, as laid out in the theoretical literature.

This paper examines the public policy value of looking at gambling from a public health perspective. The manner in which social issues are framed will either expand or curtail public policy debates. The existing and traditional frames for gambling (e.g. gambling as a matter of individual freedom, gambling as a form of recreation) fail to consider research on the social and economic impacts of gambling. Because a public health frame offers a broad viewpoint of society, it encompasses a number of social and economic impacts not considered in traditional frames. However, the existing gambling frames enjoy varying degrees of cultural, economic, and political support and, as a result, creating a higher profile for a public health framework will encounter a number of barriers. Research can play a decisive role in overcoming these barriers, as it has in a number of related fields (e.g., tobacco use, addiction and product liability, the epidemiology of AIDS). The paper concludes that research that identifies and quantifies the public health factors of gambling will substantially contribute to a public shift toward a public health frame.

Since 1979, the Portuguese health care system has been based on a National Health Service structure that is expected to promote equity, efficiency, quality, accountability and the devolution of power. In this article, we analyse the content and impact of policies designed to reform the system between 1979 and 2002. This article differs from previous studies in that it uses a stage-based framework to evaluate the policy-making process and the impact of health care reform throughout different political cycles. We show that the NHS model has never been fully implemented and that many policies have diverted the system from its original objectives. Different governments have endorsed a progressive split between financing and provision and the institution of 'new public management' rules in public providers. We conclude that most policies put forward by Social Democratic governments have aimed at influencing demand, while Socialist governments have targeted the supply side. These policies have led to increases in health expenditure that have been comparatively more cost-shared by the State under Socialist governments. We show some overriding trends, namely as follows: despite huge improvements in health outcomes, the system is nonetheless lasting to meet its goals, particularly in terms of the equity of access and utilisation; accountability problems, inadequacies in the use of operational reforming tools (such as resource allocation mechanisms) and a lack of mechanisms to promote efficient behaviour, are all associated with cost containment problems. Structural reforms have been undertaken since 2002 and these have offered some potential for improving accountability and efficiency. Nonetheless, the success of these reforms calls for certain conditions that do not seem to have been fulfilled. Copyright # 2005 John Wiley & Sons, Ltd. Keywords health care reform; impact analysis; NHS evaluation; Portugal quently attributed most importance to equity objectives. This was reinforced by successive legislation [1], which also attributed to the Portuguese health care system the objectives of promoting efficiency, quality, accountability and the devolution of power (with cost containment as an intermediate objective) [1,2]. However, in reality, the Portuguese NHS has never conformed to the general characteristics of the Beveridge model, mainly because of an incomplete transition from the previous fragmented social insurance system. Although universality

(1) Background: Our aim was to conduct objective, baseline food environment audits of two major western Sydney public hospitals and compare them to recently revised state nutritional guidelines. (2) Methods: A cross-sectional assessment was conducted (June-July2017) across 14 fixed food outlets and 70 vending machines in two hospitals using an audit tool designed to assess the guideline's key food environment parameters of availability, placement, and promotion of 'Everyday' (healthy) and 'Occasional' (less healthy) products. (3) Results: Availability: Overall, Everyday products made up 51% and 44% of all products available at the two hospitals. Only 1/14 (7%) fixed outlets and 16/70 (23%) vending machines met the guideline's availability benchmarks of ≥75% Everyday food and beverages. Proportion of Everyday products differed among different types of food outlets (café, cafeteria, convenience stores). Placement: On average, food outlets did not meet recommendations of limiting Occasional products in prominent positions, with checkout areas and countertops displaying over 60% Occasional items. Promotion: Over two-thirds of meal deals at both hospitals included Occasional products. (4) Conclusion: Baseline audit results show that substantial improvements in availability, placement, and promotion can be made at these public hospitals to meet the nutrition guidelines. Audits of other NSW hospitals using the developed tool are needed to investigate similarities and differences in food environment between sites. These findings highlight the need for ongoing tracking to inform whether the revised guidelines are leading to improved food environments in health facilities.

BACKGROUND The compliance of hospital staff with guidelines for the active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in Israel has not been determined. OBJECTIVES To evaluate the compliance of hospital staff with guidelines for the active surveillance of MRSA and assess its impact on the incidence of nosocomial MRSA bacteremia. METHODS We assessed compliance with MRSA surveillance guidelines by assessing adherence to the screening protocol and reviewing medical and nursing charts of patients colonized with MRSA, and observed hand hygiene opportunities among health care workers and colonized patients. Rates of nosocomial MRSA bacteremia and of adherence with hand hygiene among overall hospital staff were obtained from archived data for the period 2001-2010. RESULTS Only 32.4% of eligible patients were screened for MRSA carriage on admission, and 69.9% of MRSA carriers did not receive any eradication treatment. The mean rate of adherence to glove use among nur...

European policymakers have recently become increasingly committed to using Impact Assessment (IA) to inform policy decisions. Welcoming this development, the public health community has not yet paid sufficient attention to conceptual concerns about IA or to corporate efforts to shape the way in which IA is used. This essay is a thematic analysis of literature concerning IA and associated tools and a related assessment of the European Union's (EU) new 'integrated'IA tool. Eight key concerns regarding IA are identified from ...

Background: Despite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way. Proposals: We propose a minimum dataset as the basis of a functional health information system in countries where health information is lacking. This would involve continuous monitoring of cause-specific mortality through routine civil registration, regular documentation of exposure to leading risk factors, and monitoring effective coverage of key preventive and curative interventions in the health sector. Consideration must be given as to how these minimum data requirements can be effectively integrated within national health information systems, what methods and tools are needed, and ensuring that ethical and political issues are addressed. A more strategic approach to health information systems in sub-Saharan African countries, along these lines, is essential if epidemiological changes are to be tracked effectively for the benefit of local health planners and policy makers. Conclusion: African countries have a unique opportunity to capitalize on modern information and communications technology in order to achieve this. Methodological standards need to be established and political momentum fostered so that the African continent's health status can be reliably tracked. This will greatly strengthen the evidence base for health policies and facilitate the effective delivery of services.

T]he focus shifts the locus of change from the individual to the environment in which the individual resides. Such a shift can provide crucial insight into realistic expectations related to health behaviors and the utilization of health services. By examining environmental or contextual factors, researchers can collect data to guide the design of effective health programs uniquely tailored to the needs of the communities.

Objective: To develop a comprehensive conceptual framework of tobacco industry tactics in four countries in South East Asia for the purpose of: (1) generating consensus on key areas of importance and feasibility for regional and cross country tobacco industry monitoring and surveillance; (2) developing measures to track and monitor the effects of the tobacco industry and to design counterstrategies; and (3) building capacity to improve tobacco control planning in the participating countries. Design: A structured conceptualisation methodology known as concept mapping was used. The process included brainstorming, sorting and rating of statements describing industry activities. Statistical analyses used multidimensional scaling and cluster analysis. Interpretation of the maps was participatory, using regional tobacco control researchers, practitioners, and policy makers during a face to face meeting. Participants: 31 participants in this study come from the four countries represented in the project along with six people from the Johns Hopkins Blomberg School of Public Health. Conclusions: The map shows eight clusters of industry activities within the four countries. These were arranged into four general sectors: economics, politics, public relations and deception. For project design purposes, the map indicates areas of importance and feasibility for monitoring tobacco industry activities and serves as a basis for an initial discussion about action planning. Furthermore, the development of the map used a consensus building process across different stakeholders or stakeholder agencies and is critical when developing regional, cross border strategies for tracking and surveillance.

In the United States, the common interest often is conceived as a by-product of the pluralist, interest-groupdriven democratic process. Special interests dominate in many political arenas. Consequently, we have lost the language, vocabulary, and ability to talk about the common interest. The way to reverse this trend is to develop and practice with new tools that allow us to articulate what we mean by the common interest in specific contexts. In this article, we leveraged the literature on procedural, substantive, and pragmatic decision making to illustrate how they work together to demonstrate whether and how the common interest was served in three case studies of Healthy Forests Restoration Act implementation on the Apache-Sitgreaves National Forest in Arizona. In two of the cases we found that the common interest was mostly served, while in the third case it was not. Our results raise questions about the ability of procedural criteria or substantive criteria alone to determine effectiveness in decision making. When evaluated together they provide a more complete understanding of how the common interest is or is not served.

Wastewater constitutes an alternative water source for the irrigation sector. To fully benefit from it, and reduce possible adverse effects on public health and the environment, we need to look at the regulation of the practice. A prerequisite for this is an institutional analysis, and the points to consider are the institutional mandates. We used the city of Hyderabad, India, as a case study. There, irrigation with wastewater is not supported or recognized, but it happens in practice. It takes place in an indirect and unplanned way. Institutions fail at enforcing regulations, and little attention is given to formalization of the practice. With this article, we aim to untangle the institutional setup, and by doing so, identify the constraints surrounding development of a formal practice. Ultimately, we aim at contributing to the discussion on the agricultural use of wastewater.

Today, over-consumption, pollution and resource depletion threaten sustainability. Waste management policies frequently fail to reduce consumption, prevent pollution, conserve resources and foster sustainable products. However, waste policies are changing to focus on lifecycle impacts of products from the cradle to the grave by extending the responsibilities of stakeholders to post-consumer management. Product stewardship and extended producer responsibility are two policies in use, with radically different results when compared for one consumer product, refrigerators. North America has enacted product stewardship policies that fail to require producers to take physical or financial responsibility for recycling or for environmentally sound disposal, so that releases of ozone depleting substances routinely occur, which contribute to the expanding the ozone hole. Conversely, Europe's Waste Electrical and Electronic Equipment (WEEE) Directive requires extended producer responsibili...

We analyze longitudinal data from a demographic surveillance area (DSA) in KwaZulu-Natal to examine the impact of parental death on children’s outcomes. The results show significant differences in the impact of mothers’ and fathers’ deaths. The loss of a child’s mother is a strong predictor of poor schooling outcomes. Maternal orphans are significantly less likely to be enrolled in school and have completed significantly fewer years of schooling, conditional on age, than children whose mothers are alive. Less money is spent on maternal orphans’ educations, on average, conditional on enrollment. Moreover, children whose mothers have died appear to be at an educational disadvantage when compared with non-orphaned children with whom they live. We use the timing of mothers’ deaths relative to children’s educational shortfalls to argue that mothers’ deaths have a causal effect on children’s educations. The loss of a child’s father is a significant correlate of poor household socioeconomi...

Background: After decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting. From 1994From to 1999 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance.

Reductionism in rural development policymaking can have serious practical ramifications for human life and well-being. Ecosystem Health and Sustainable Livelihoods (SL) are two approaches that have been assisting development practitioners to avoid reductionism and to take complexity seriously. Both of these approaches have primarily been applied at relatively small scales, and the application of SL at policy level has been largely in terms of the substance of policyconsidering the impacts of policy on livelihoods. Nevertheless, we argue that they offer insights for policy processes, as well. Drawing on these insights we outline factors that should be considered in an ecosystem approach to policy process. This is an approach that would be characterized by a set of nested deliberation and decision-making processes, by a method of problem definition, analysis and solution seeking that is iterative and based on negotiation among multiple stakeholders, and by careful attention to the cross-scale aspects of decision-making processes and the flow of information.

Background: Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Methods: Policy analysis using document review and qualitative data from 10 in-depth interviews with facility incharges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. Results: The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. Conclusions: OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government's role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.

Foreign Direct Investment (FDI) as an important driver of growth. It is an important source of non debt financial resources for country for economic development. Besides it is a means of achieving technical knowhow and employment generation of employment. However, many are of the view that FDI is a big threat to sovereignty of host and domestic business houses. Faster exploitation of natural resources for profit may deprive host from such resources in long run. Midst of debate on pros and cons of FDI, world economy has observed a phenomenal change in volume and pattern of FDI. There is clearly an intense global competition of FDI. India is not behind this global race of attracting foreign investment. India emerged as an attractive FDI destination in services but has failed to evolve a manufacturing hub which has greater economic benefit. FDI though one of the important sources of financing the economic development, but not is not a solution for poverty eradication, unemployment and other economic ills. India needs a massive investment to achieve the goals of vision 20-20. Policy makers need to ensure transparency and consistency in policy making along with comprehensive long term development strategy.

The rise of the active health care consumer in the United Kingdom requires a reformulation not only of the traditional relationship between patients and doctors, but also of the macro-politics of health which reflect and service that relationship. Market and democratic themes have supplied an ideological impetus to the pressures for change. The well-publicised problems of medical self-regulation have given them practical political expression. However, the response from the policy community still reflects the dominant partners within it, medicine and the state. What neither partner has recognised is that the functionality of the policy community has been undermined by the different and issuebased challenges to the traditional patient-doctor relationship. As a result, the state is likely to remain the lead player in an increasingly unstable politics of health where consumerist issues are on the policy agenda, but patient groups are still excluded from the policy community. r

The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

Tourism in China has rapidly developed since the adoption of open-door economic reform policy in 1978. There is still little understanding about the role played by the Chinese government in the development of tourism. This paper represents a "rst attempt to identify the roles played by the Chinese government in developing its international inbound tourism. The period examined is from 1978, a turning point for China's development, to the present. Generally, the Chinese government has played the following roles: Operator } involving ownership and provision of the infrastructure for tourism development and operation of tourism business activities; Regulator } formulating and implementing regulations to control tourism business; Investment stimulator } stimulating tourism investment through the provision of "nancial incentives; Promoter } spending money on the promotion of tourism in the international market; Coordinator } coordinating activities of di!erent government departments with respect to tourism; and Educator } establishing a system of tourism education institutions and providing tourism education and training programs. Analysis of the policies and government roles in China was examined systematically in terms of demands, decisions, outputs and impacts for each of the three historical periods identi"ed, namely 1978}1985, 1986}1991 and 1992 to the present. The framework adopted for examining the policies in terms of demands, decisions, etc. represents the speci"c policy issue components of the tourism policymaking process suggested by Hall's model (1994). Based on China's experiences, some implications of the governmental roles for other developing countries are suggested.

The paper puts forward a workable rural development strategy. It shows on which principles, which historical realities and which statistical facts such a strategy should be based. It looks at what the government is doing to promote rural development and suggests ways in which current policies could be improved, expanded and refined. The paper starts by reviewing the statistical literature on rural poverty to demonstrate how desperate the situation is and how urgent the need for action. In order to provide a greater sense of process and of detail the paper then looks at some of the dynamics that have shaped and are shaping different parts of rural South Africa. In this section the paper covers agricultural transformation, changing labour markets, rural differentiation, patterns of urbanisation, levels of education, institutional changes and gender discrimination. In the third part of the paper government programmes such as land reform, agricultural development policies, integrated rural development programmes, the education policy and the welfare policy are reviewed. We offer constructive criticisms and ways to add to these policies in order to make our vision of rural development a reality. We also suggest that government should focus more attention on strengthening the organisational capacity of rural people.

Design has an increasing role in the development of public services and policies. The implementation of policies is now considered a matter of design, especially in the field of public services. Moreover, design has been slowly entering the process of policymaking. Meanwhile, policy scientists’ promoters of Policy Design have started to analyse design discipline’s approaches on the design of policies. Among design activities, prototyping has been recognised as a valuable instrument for policy, also aligned with the new experimental approach in the public sector. However, it is still unclear how prototyping could intersect formal administrative and bureaucratic structures, including their traditional processes for policy analysis and experimentation. This research identifies frameworks for prototyping drawing on relevant authors in design-related disciplines in Europe. Then it characterises these diverse perspectives and suggests the benefits of design prototyping for policy analysis...

In the last decade, the regeneration of derelict or underused sites, fully or partly located in urban areas (or so called "brownfields"), has become more common, since free developable land (or so called "greenfields") has more and more become a scare and, hence, more expensive resource, especially in densely populated areas. Although the regeneration of brownfield sites can offer development potentials, the complexity of these sites requires considerable efforts to successfully complete their revitalization projects and the proper selection of promising sites is a pre-requisite to efficiently allocate the limited financial resources. The identification and analysis of success factors for brownfield sites regeneration can support investors and decision makers in selecting those sites which are the most advantageous for successful regeneration. The objective of this paper is to present the Timbre Brownfield Prioritization Tool (TBPT), developed as a web-based solu...