Health Policy and the Politics of Evidence

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.     

Consensual partnering in Australia: A review and 1991 census profile

This paper is the first part of a two-part examination of consensual partnering in Australia. It reviews the Australian literature on consensual partnering, summarizing evidence of its proliferation since the mid-1960s and also the findings of investigations into its nature and the personal attributes that predispose some people more than others to adopt it. It then discusses the shortcomings of Australian census data as a source for studying consensual unions, before using data from the 1991 Census to present the first elements in a comprehensive profile of the cohabiting population. These cover the basic demography of consensual partnering: the ages, marital statuses and family type distributions of those involved. The second author contributed to this paper while a student of Graduate Studies in Demography, The Australian National University. Views expressed are those of the authors, and are not necessarily those of the Australian Bureau of Statistics.     

“Nyota Uhura is Not a White Girl”

This essay examines the online debate surrounding representation of the Black/African character of Lt. Uhura in the 2009 prequel film, Star Trek. Some fans, particularly those viewing the film from a gender/race intersection, applauded her portrayal, while others, including many “slashers” who espouse a homoerotic reading of classic Trek from an ostensible gender/sexuality standpoint, disapproved—especially of Uhura's romantic storyline. Virtual observation and appraisal of these discourses demonstrate the adaptability of Patricia Hill Collins' intersectionality framework to studies of media reception, especially in terms of hegemonic and interpersonal domains of power and cultural studies notions of articulation. Accordingly, the investigation finds the first fan faction's rhetorical efforts more authentically and pro-actively oppositional.     

Private companies' engagement in the labour market integration of refugees: An exploratory study of the city of Stuttgart,Germany

Private companies of all sizes may engage in the integration of refugees into the labour market. Taking the case study of the highly industrialised German city of Stuttgart, this study explores the motivation of (a) private large-scale international enterprises including (automotive and high-tech companies) and (b) family-owned small- to medium-sized companies (private social enterprises, suppliers to the automotive industries, architecture, and engineering companies) to do so. The research further explores the companies' challenges, opportunities and the lessons learned throughout the process. Utilising the principles of Grounded Theory, a qualitative case study approach is applied with in-depth interviews with private companies, civil society, public private partnerships and experts. The findings show that the arrival of a large number of refugees during 2015/2016 has increased the engagement of the companies, increased their cooperation with other sectors, and has correspondingly led to some innovative initiatives in refugees' labour market integration and policy advocacy. The call for the engagement of the private sector and the existence of employment-related policies such as tolerated work permits (Ausbildungsduldung/Beschäftigungsduldung) were essential to create sufficient incentives for private companies to engage in the training and employment of refugees. However, the insecure residence permits and bureaucratic procedures in the public sector mostly discouraged their engagement. Our research shows that the two company types had different possibilities, different approaches towards refugees and faced different challenges while engaging in refugee labour market integration.     

Openness in adoption: Challenging the narrative of historical progress

One significant change in adoption practice that has occurred over the last four decades is the shift away from an expectation of confidentiality towards an expectation of openness in adoption. Openness is typically conceived in terms of the level of contact between adoptive and birth families following adoption or the extent to which adoption is openly discussed within the adoptive family. While these shifts in practice have generated controversy, they are largely supported by research evidence and have become a feature of contemporary adoptive family life. As a result, the narrative that has emerged in relation to openness in adoption is one of historical progress. In this paper, I argue that the lived reality of adoption is less straightforward than this narrative suggests. An analysis of the social and cultural context in which adoption operates suggests instead that the persistent feature of adoption throughout this historical period of increasing openness can be more accurately described as a state of enduring ambiguity regarding the nature of post‐adoption relationships. The paper highlights the potentially damaging consequences of overlooking this aspect of adoptive family life and comments on the role of policy in shaping openness in adoption.     

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.     

Book review

New Zealand and the European Union edited by Matthew Gibbons. Auckland, Pearson Education. 2008. 172 p. NZ$52.99 (paperback). ISBN 0733993831.

Going bush. New Zealanders and nature in the twentieth century by Kirstie Ross. Auckland, Auckland University Press. 2008. 200 p. NZ$34.99 (paperback). ISBN 1869404246.

Globalisation and the wealth of nations by Brian Easton. Auckland, Auckland University Press. 2007. 248 p. NZ$50.00 (paperback). ISBN 9781869403775.     

Use of a conceptual model of societal drivers of ecological change in South Florida: Implications of an ecosystem management scenario

Human-dominated ecosystems such as in South Florida's Everglades region are greatly affected by societal actions and choices, and efforts to restore degraded ecosystems must take into account the societal drivers of ecosystem change. A conceptual model of societal-ecological interactions within the region illustrates connections between major societal drivers, such as water management and land use, and ecological stressors, such as loss of habitat and nutrient loading. Using the conceptual model as an initial guide for discussion, examination of a restoration scenario for the region shows that social and economic effects from activities proposed in a restoration scenario will likely affect most sectors of South Florida. Political effects from changing land and water management practices likely will be significant, as will the physical effects of changing water structures and management practices. Conceptual models such as this can aid in the initial stages of ecosystem restoration discussions and can assist in planning for subsequent social science evaluations of specific societal impacts of actual proposed governmental restoration alternatives. In crafting restoration scenarios, local, regional, and national decision makers can use conceptual models such as this to help broaden the early considerations of how possible future changes in societal drivers, including management choices, will change ecological stressors that affect ecosystem health.