Joined–up Food Policy? The Trials of Governance,Public Policy and the Food System

To address the policy malfunctions of the recent past and present, UK food policy needs to link policy areas that in the past have been dealt with in a disparate manner, and to draw on a new ecological public health approach. This will need a shift within the dominant trade liberalization–national economic competitiveness paradigm that currently informs UK food policy, and the international levels of the EU and the WTO trade rules, and grants the large corporate players in the food system a favoured place at the policy–making tables. The contradictions of the food system have wrought crises that have engendered widespread institutional change at all levels of governance. Recent institutional reforms to UK food policy, such as the FSA and DEFRA, reflect a bounded approach to policy integration. Initiatives seeking a more integrated approach to food policy problems, such as the Social Exclusion Unit's access to shops report, and the Policy Commission on the Future of Food and Farming, can end up confined to a particular policy sector framed by particular interests—a process of "policy confinement". However, the UK can learn from the experience of Norway and Finland who have found their own routes to a more joined–up approach to public health and a sustainable food supply by, for example, introducing a national food policy council to provide integrated policy advice. Also, at the local and community levels in the UK, policy alternatives are being advanced in an ad hoc fashion by local food initiatives. More structural–level interventions at the regional and local governance levels are also needed to address the social dimensions of a sustainable food supply     

Public Participation in the New NHS: No Closer to Citizen Control?

Over the last decade support for increasing public participation in decisions regarding the planning and delivery of health services has become a familiar feature of the policy agenda for the UK National Health Service. This paper reviews current Labour policy towards public participation and reports on the response of primary care groups (PCGs) to recent Labour directives to make patient and public involvement an integral part of the way they work, presenting the findings of a survey conducted in one English health region. The experience of these PCGs suggests that, despite the diverse backgrounds of board members, there is marked consensus between local and central decision makers as to their understanding of public participation. Whilst academic debates have tended to conceptualize participation in dualist terms as a form of consumerism or of citizenship, the survey data suggest that in the context of local implementation public participation is framed within a new public management perspective which values it as an aid to organizational learning. The findings of this study highlight obstacles to securing effective public participation, including a lack of substantive guidance regarding policy implementation that produces uncertainty amongst local decision makers as to how best to proceed. The inherent limitations of public participation within the new public management paradigm suggest that democratic renewal, one of the goals of the government's modernization agenda, is unlikely to be achieved.     

Gender in/and/of Health Inequalities

The relationship between gender and health inequalities is potentially complicated, raising questions for health and social research, practice and policy. In this paper, I use two population health case studies – obesity and smoking – to explore the interplay between gender and socioeconomic position. The cases show that, on its own, neither dimension of inequality affords a comprehensive picture of these significant risks to public health. Furthermore, historical change in the socioeconomic and gendered distribution of these health risks suggests that gender is best considered as a dynamic and layered form of differentiation, rather than as a simple or stable dichotomy. A more nuanced approach to the analysis of gender and health has the potential to generate both more fruitful research and more effective health and social policy.     

Performing the state: the socio-political dimensions of performance measurement in policy and public services

ABSTRACT

This opening paper outlines the rise of public sector performance measurement and performance governance from New Public Management, its trajectory from an administrative tool for organisational monitoring and management, to its insertion into service performance and accountability, to a policy tool defining policy itself. Four key conceptual ways of approaching public sector performance measurement are outlined, and the significance of understanding performance measurement as a socio-technical policy instrument is argued. The paper thematically reviews the papers that follow and how they demonstrate new points of critical analysis in policy studies, including the multiple, mixed and sometimes contradictory purposes for performance measurement, the formation of performance measurement tools, the linkages of performance numbers and governance structures from macro to micro, and the reconfigured roles of professionals in public service delivery. The paper issues a clear challenge to policy researchers to take performance measurement more seriously in understanding the dynamics of policy performance, the achievement of policy objectives, the reframing of policy and the experience of citizens.     

Social Security in Hungary: A Balance Sheet after Twelve Years

The social and political transformation in Hungary contributed to the development of a democratic political system and to the establishment of the rule of law and a market economy. The process was accompanied by a series of economic and social problems. The paper first reviews the social policy orientation of the three free consecutive governments elected since the transition. None of them has had a clear political profile: they have constituted mixed and unclear welfare regimes. None of them has sketched a clear welfare policy except perhaps the current government. In its case central redistribution is consistently biased in favour of the middle and upper strata at the expense of the poor. Instead of a consensual plan defining priorities, decisions and reforms in the last ten years have been motivated by political interests, at hoc ideas, and authoritarian rulings. The paper next shows what reform meant in the case of the different instruments and various fields of social policy, namely unemployment, health, pensions, family benefits and social assistance. It concludes that while both the inherited and the newly created systems had contributed to alleviate the shocks of the transition, yet there never was enough political will to give sufficient or adequate help to those needing it. As a consequence of the "reforms" public expenditures have been significantly reduced. The welfare gap between East and West has thereby grown. The consequence is that the country has become gravely divided, and that poverty is greater and deeper than it might have been under a different set of policies.     

关于我国发展城市公共卫生事业的若干思考

健康不仅是城市人与社会发挥功能的前提条件,也是城市人与社会全面、协调、可持续发展的一种社会财富。要大力发展城市公共卫生事业就必须加强对城市公共卫生事业发展的经济支持和社会政策支持,同时还要积极推进社区卫生服务体系,进而通过发展公共卫生事业来促进城市社会公平。     

Older People and the Health–Social Care Boundary in the UK: Half a Century of Hidden Policy Conflict

The boundary between health and social care services has been an important focus of both social research and policy reform in many western and northern European countries. In the UK there is a history of particularly sharp divisions between the centrally funded NHS and locally run social services. A consequence for older people, especially those with less acute or "intermediate" needs, is that they may be rationed out, ignored, or treated inappropriately on either side of the boundary. This paper seeks to go beyond explanations in terms of financial, administrative and professional divisions by using now-available public records to show how the boundary between health and social care was set in stone in the immediate postwar years and resulted in a constant battle between the two services over the needs they would meet. The first part of the paper examines a largely hidden history of health and social care policy. The second part examines the new NHS Plan and the extent to which it is likely to resolve the problem of the boundary.     

A Social-symbiotic Approach? EU Industrial Policy and the Pharmaceutical Industry in the EU

The purpose of this paper is to develop the debate about a symbiotic approach to industrial policy with respect to the pharmaceutical industry in the EU. The EU has an increasingly important role to play in European markets but it seems, at best, to be following a fragmented industrial strategy. There is a real and growing danger that this strategy becomes worse for everyone than no strategy at all. Thus the EU can either go for a comprehensive and comprehensible strategy or let the industry fend for itself amongst disparate health care systems amongst member states. Alternatively it can continue to stumble along with a pastiche of policies. There are signs of some debate about a more holistic approach to industry. In the European Union for example DG (Directorate General) V and DG III produced a communication arguing that “the [European Union] Community policy in favour of the pharmaceutical industry must take notice of [the] twofold context of public health and social security” (Com(93)718:3). This paper identifies current fragments of EU pharmaceutical industrial policy and indicates what a social-symbiotic approach is. Whether or not the industry in the EU continues to decline with respect to the industry elsewhere Asia and America in particular, the sick people of the EU will still need medication: a symbiotic approach to industrial policy can help stem the relative decline in the EU and indeed could reverse it.     

Public Policy and the Effects of Media Violence on Children

Policymakers and the public have been concerned about the effects of media violence on children for decades. Scientific psychological research can be an important source of information for policy, as the goal of science is to separate facts from opinions. This article reviews children's exposure to media violence, describes theories that explain the effects media violence could have, summarizes the research on the effects of media violence exposure, and describes several moderators that can enhance or mitigate those effects. These scientific findings provide useful information for public policy, yet there are many barriers to their use, including misunderstandings of how causality is determined in scientific and public health circles and how large the effects are. Finally, the implications for public policy are discussed, including what has and has not worked in the United States, what other countries and the international community are doing, and where opportunities for new approaches for effective policies may exist.     

One new policy: A variety of applications—The implementation processes of a new mental health policy in Sweden

The increase in mental ill health at a global level is widely acknowledged. This trend has led to the development of new policy frameworks that focus on public mental health. This study aimed to explore the implementation process regarding regional and local responses to national policy, proposing a substantially enhanced understanding of mental health within the Swedish welfare system. To explore the implementation process, a multiple case study was conducted using snowball sampling. In all, 18 key informants were interviewed. The results revealed that the informants adopted an experimental implementation process in which policy learning could take place. Contextual factors were essential for how a broad policy approach could be translated into practice. The broad policy not only made it possible for local needs to be addressed, but it also allowed for variations in focus position within the country as a whole. There seemed to be no consensus among the informants as to the origin or solution to the problem. Essentially, the question of whether public mental health issues should be dealt with at a structural or individual level remained unresolved. The Swedish case could be understood as an illustrative example of how one country attempts to handle a major problem despite insufficient information to direct the initiative towards a certain direction.     

Telecommunications infrastructure in Australia

This paper considers Australia’s approach to telecommunications infrastructure from the perspectives of the policy official and the public administration scholar. From the official’s perspective, the approach has been successful in stimulating private sector investment in many markets. This has been achieved by promoting open competition and where necessary establishing a government business enterprise as a transitional measure to build and operate a next-generation National Broadband Network (NBN) to provide high-speed fixed-line broadband to all Australian premises by 2020. From the academic perspective, however, the approach reveals the shifting balances between political objectives and market challenges. This paper consists of three main parts. The first is an introduction by a former senior public servant turned public administration scholar. The second is from a policy official and provides an overview of the Australian telecommunications market, starting with some historical context, the deregulation in the 1990s and the privatisation of the former government-owned telecommunications incumbent, Telstra. The third is from a public administration scholar and provides a short complementary critique of Australia’s communications policy. The paper discusses, from different perspectives, the policy settings that have been adopted to support infrastructure competition and investment in the Australian telecommunications market, including the development of the NBN.     

Environmental Psychology and Sustainable Development: Expansion, Maturation, and Challenges

In this summary article, some advances of, the potential for, and challenges faced by environmental psychology as a contributor to sustainability science are outlined. In its first 40 years, it has evolved from a discipline primarily—but never solely—concerned with proximate architecture to one that adds concern with larger-scale issues, particularly sustainability. This growth of interest has in turn led to increased interest within it in public policy, technology, cooperation with other disciplines, multilevel analyses of problems, the ingestion of new ideas, and concern with the health of the biotic and ecological world. Some challenges are that the central proponents of "sustainability science" itself have not acknowledged environmental psychology as a potential contributor, the field is comparatively young, that it needs to explore biotic and ecological issues more, needs to help discriminate facts from nonfacts about environmental problems, and needs to warn sustainability science about the daunting task of overcoming environmental numbness and self-interest in individuals. Nevertheless, there is hope: sustainability scientists, including environmental psychologists, may be Adam Smith's "invisible hand."     

Food Safety and Consumers: Constructions of Choice and Risk

This paper argues that food safety did not arise as a "new" obsession at the end of the twentieth century, but has been an intermittent object of public and policy concern over the last two hundred years in the UK. However, the nature of food policy has shifted over that period, from an orientation towards protecting a largely ignorant public from fraud, through controlling the risks potentially arising from negligence in food–handling, to informing rational consumers to enable them to "choose" the right foods. Most recently, the public have had a nominally more active role in food policy, as citizens consulted on the content of the policy agenda. Drawing on histories of food policy in the UK and social science research on consumers, this paper explores the links between the changing risks and publics addressed by British food policy.     

Consultation,for a Change? Engaging Users and Communities in the Policy Process

The process of consultation has become integral to the development, implementation and evaluation of a raft of UK health and social policies. However, the current bewildering patchwork of area–based initiatives means that, in many localities, it is impossible to evaluate the outcomes of particular targeted initiatives, let alone make sense of local planning consultations, Best Value reviews and (multi–agency) service reviews which run concurrently. The cumulative effects of this consultation "overload" threaten to swamp both local authorities and their service users. Consul–tation is itself a crucial yet deeply problematic process. There is an official view which holds that an "old" model of consultation—often tokenistic and unrepresentative—is being replaced with a "new" one. This paper examines and challenges that view in relation to the key policy areas of housing, social services and policing. It also pays particular attention to, and problematizes, the notion of "hard–to–reach groups", which is so dominant in the discourse of consultation. The paper argues that developing appropriate tools and recognizing that consultation is a process—not an event—are essential starting points in addressing these problems. The next step is to reconcile the principles of both evidence–based policy and user–led services into a strategic (and "joined–up") framework. But, when all this is accomplished, we still need to question the political and fiscal contexts in which policy–making takes place and within which the process of consultation is itself bounded.     

Knit Your Own Without a Pattern: Health Promotion Specialists in an Internal Market

The reforms of the National Health Service in England have given an emphasis to "strategic" approaches to health and health care, in that, ideally, purchasing decisions will be made on the basis of evidence from various forms of "needs assessment". Alongside these reforms a strategic approach to the promotion of health has been set out in the "Health of the Nation" (DoH 1992). However, although the promotion of health is high on the policy agenda, the occupational group of health promotion specialists, whose prime function it is to devise, develop and implement health promotion strategies, have been ignored. Drawing on qualitative interview data with these specialists in both provider and purchasing settings in England this paper argues that thus far the reforms have actually hindered the development of a strategic approach to the promotion of health by health promotion specialists. Three main reasons for this are suggested; a confusion over the most appropriate institutional location for health promotion specialists; a lack of clarity by key actors as to the role and function of health promotion specialists; and the emergence of a model of effectiveness and efficiency which is largely antithetical to the philosophy and practice of health promotion.     

我国公共医疗卫生政策中的政府角色分析

公共医疗卫生政策关系老百姓的切身利益,近些年来的一系列的天价医疗费事件和医疗改革的成效讨论早已就是人们关注的焦点。本文从当前的热点人手,着重从政策过程角度提出了我国政府在公共医疗卫生政策中的角色定位。     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

Gender and Health Inequalities: What Are They and What Can We Do About Them?

The subject of gender and health inequalities is contested territory in health policy, research and practice. Yet there is a dominant approach which I describe as a form of technocratic rationality. Its application imposes significant limitations because it represents the problem of gender and health in terms of measurable sex differences in relation to health service access and health outcomes. In doing so, it fails to address and explain the social dynamics that generate the problem. I propose an alternative approach that originates in Australian women's health policies of the 1980s. These emphasised the inequalities between men's and women's participation in mainstream health policy, planning, management and delivery of services, and women's concomitant marginalisation. Recent sociological study offers support for this perspective suggesting that the endogenous organisational dynamics (or logics) within public health institutions provide a better way of understanding what the problem of gender inequalities in health is, and how we might fix it.     

Cost and Stakeholder Views: A combined approach to evaluating services

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 5NH Summary This paper focuses on the decision-making process at a strategiclevel in the context of implementing a ‘community care’policy for older people with mental health problems. It is basedon the findings of an evaluative study of the implementationof one district health authority's strategy for the decentralizationof its mental health services for older people. The study wasan attempt to develop an evaluative approach which acknowledgedthe importance of cost, but also the need to include the viewsof the several ‘interested parties’, not least thosewho used the service. The reconciliation of what might be seenas the conflicting interests of the wider public for a carefulutilization of resources with the individual's needs for anaccessible and responsive service represents a major challengefor planners, managers and practitioners within the public sector.This paper argues the need for dialogue as the basis for partnershipbetween those with a primarily financial focus to their workand those more intimately concerned with individual needs.     

Help or hindrance? Social policy and the ‘social determinants of health’

In recent years, public health research has become increasingly focused on issues of social inequality and social disadvantage. This is because social issues, such as poor housing and unemployment, have been found to impact health significantly, and are now referred to as ‘the social determinants of health‘. As a result of this shift, public health is now principally concerned with what are historically considered to be social policy issues. This paper discusses the confluence of public health and social policy; it examines the opportunities and risks posed by this convergence for those working in social policy seeking to reduce poverty and inequality. We argue that, while much can be gained in the two fields by working more closely together, there remain fundamental differences in perspectives and approaches. In order to maximise benefits, these points of difference need to be thought through sooner rather than later.