Health Ombudsmen in Polycentric Regulatory Fields: England,New Zealand,and Australia

Health ombudsmen (health complaints commissioners), an unusual entity internationally, exist only in England, New Zealand, and the Australian states and territories. Established to respond to complaints from patients, the intention is to make health services and professionals more accountable to the public. Most cases are handled around the softer base of a regulatory pyramid, such as advice to complainants and requests to providers for an explanation and/or apology. Few cases escalate to investigations and prosecutions. Although the legal powers of some health ombudsmen to redress individual grievances have been strengthened, most lack the independent power to initiate an inquiry into systemic problems. To produce quality improvements, health ombudsmen need powers to require compliance from providers and to initiate inquiries. With the advent of new health sector regulators, health ombudsmen must negotiate their role and function within expanding networks of governance.     

Potential Health Outcome and Vulnerability Indicators of Climate Change for Australia: Evidence for Policy Development

There is a growing need to develop health‐related indicators for climate change to assist in policy, planning, and evaluation of preventive measures. To date, no environmental health indicators of climate change have been developed specifically for Australia. We conducted a review of the Australian literature relevant to climate change health impacts to find out which exposure–response relationships could be readily used as indicators. The bulk of the literature relates to direct health‐related outcomes of extreme heat, and indirect outcomes associated with air pollution and infectious disease agents. Based on this information, evidence‐based indicators were chosen using the modified Driving force‐Pressure‐State‐Exposure‐Effect‐Action framework. Three groups of health outcome indicators are proposed: direct heat related, air pollution related, and climate‐sensitive infectious diseases. Indicators of human vulnerability to these outcomes are also included. The potential usefulness of and barriers to their use are discussed in the context of relevance for policy makers.     

Making the Harder Yards: Environmental Policy Integration in Australia

Solutions to environmental problems such as climate change, biodiversity loss, and land and water resource degradation require long term integration of economic, social and environmental policies. This poses challenges to specialised, hierarchical public administration systems. The study reported here examined strategies, structures and processes to enable environmental policy integration in six Australian states and territories, and some federal arrangements. The study found that the most prominent success factors, barriers and gaps that affect environmental policy integration relate to leadership, long term embedding of environmental policy integration and implementation capacity. Factors deserving further research and policy attention include leadership, cultural change and capacity building; embedding sustainability in structures and processes; development of a long term evidence based approach; strengthening decentralised implementation arrangements; and evaluation of policy integration initiatives.     

Federalism,Physicians, and Public Policy: A Comparison of Health Care Reform in Canada and Brazil

Abstract

This article uses comparative historical analysis to explore physicians’ involvement in health care reform in Canada and Brazil. Drawing on historical institutionalism, the analysis stresses how, beyond partisanship, physicians build consensus around and promote specific policy ideas, and how federal institutions shape physicians’ mobilization. In both countries, physicians’ mobilization shaped the emergence of universal health care coverage, but in quite different ways, because of the differing federal institutions. Although the Brazilian medical lobby was far more heterogeneous than the Canadian profession, one faction was able to mobilize at the local level to pursue policy ideas favorable to universal health coverage.     

Changing Agendas in Australian Indigenous Policy: Federalism,Competing Principles and Generational Dynamics

This paper identifies two periods of punctuated change in the content and style of Australian Indigenous policy in the last fifty years. It also identifies a third period in which attention to Indigenous policy was heightened through the nationalisation of land issues already well‐established on the agendas of sub‐national jurisdictions. The paper relates all three periods to the changing federal institutions of Australian Indigenous policy, with the Commonwealth slowly exploring its post‐1967 role as a national government in Indigenous affairs. In later sections, the paper identifies some more conceptual bases of changing policy agendas, through ideas of the competing principles of equality, choice and guardianship and the generational moral dynamics of Indigenous affairs.     

Being a Good Senior Manager in Indigenous Community Governance: Working with Public Purpose and Private Benefit

This article seeks to understand the role of being a senior manager in Indigenous community governance, particularly though not exclusively in remote Aboriginal communities. It argues against the tendency of would‐be reformers of Indigenous community governance to focus on the competence and ethical qualities of those who occupy these roles and asks instead how can isolated managerialism in Indigenous community governance be overcome? The article begins with an overview of Ralph Folds' analysis of relations between Pintupi settlements and the larger Australian polity. While taking much from Folds' analysis, the article argues that ultimately he relies too heavily on the idea of antithetical worldviews across the settlement interface, on a problematic distinction between the official and private uses of publicly allocated resources and on too idealist a view of the Australian state. The article argues that the state's allocation of public resources inevitably involves a flow of private benefits and that public purposes and private benefits are not different phenomena, but rather different perspectives on state action. In contrast to Folds' idealism about the state, the article outlines a more thoroughly realist or materialist analysis of being a good senior manager in Indigenous community governance. In its concluding section, the article makes some suggestions for overcoming isolated managerialism in Indigenous community governance oganisations.     

Evidence and Contestation in the Indigenous Policy Domain: Voice,Ideology and Institutional Inequality

There is a tension in the evidence‐based policy paradigm as it concerns Aboriginal and Torres Strait Islander people, particularly with regard to their standing as evidence providers. Aboriginal people in Australia have primarily been seen as a ‘problem to be solved’ and racialised views of Aboriginal competence have allowed for past policy, now recognised as harmful, to be justified as being ‘for their own good’. This article considers some of the complexities of the evidence‐based policy paradigm as it applies to the Indigenous policy domain, arguing that in such a turbulent field the use of evidence is inevitably ideological and selective. The article concludes that, in light of persistent institutional inequalities, including Aboriginal and Torres Strait Islander voices and perspectives in genuine dialogue about policy is the only way to navigate this difficult terrain with any chance of success.     

Policy on innovation in Australia: Divergence in definitions,problems, and solutions

Innovation has joined the mainstream in many nations as governments search for new ways to tackle challenging societal and economic problems. But Australia is seen to be lagging on innovation policy. Is this related to how governments define innovation? What do they regard as the problem they are addressing? What proposed solutions follow from this? This paper examines how Australian governments have defined innovation over four decades, signalling their policy intentions about how to make the nation more innovative. Definitions of innovation are analysed using 79 Australian (national level) policy documents published from 1976 to 2019. Close reading of these documents suggests two main definitions: innovation as technology, and innovation as culture. Topic modelling uncovers more differentiated themes, shows how definitions change over time, and demonstrates an association between definitions and political parties in government. The divergent approaches suggest a lack of coherence and continuity to policy on innovation in Australia.

Points for practitioners

• Innovation has expanded and broadened in its definition and governments and policymakers have paid increasing attention to it.
• In Australia, there are two main definitions of innovation used in policy—one related to technology and one related to culture.
• The technology view of innovation can be further divided into a focus on businesses or a focus on research and development (R&D).
• Different innovation definitions, problems, and solutions dominate at different times, with Coalition governments tending to favour business and technology over culture, and Labor governments doing the opposite.
• There are divergent approaches to policy on innovation in Australia which suggest a lack of coherence and consistency in policy over the long term.

     

Environmental Policy, New Federalism and New Privatism: Policy Conflicts in the Coastal Zone

Public policies developed under the New Federalism of the 1970s and the new privatism of the 1980s have produced a variety of policy problems for states. This is particularly true in the area of environmental policy. This paper looks at environmental policymaking in the coastal zone giving particular attention to the conflicts between the desire to protect renewable resources and the need for economic growth in the coastal zone. These conflicts are illustrated by an examination of comprehensive land use planning in Oregon and the federal government's proposal to develop seabed mining on the Gorda Ridge.     

Power,Powerlessness and Petroleum: Indigenous Environmental Claims and the Limits of Transnational Law

Environmental disasters, particularly oil spills, increasingly involve a complex intermingling of the national, international and often the transnational. Traditional responses to seeking remediation have pursued the legal path of class action suits against multinational corporations. This article examines one such historic case, Aguinda v. Texaco, Inc., in which residents of Ecuador's Amazonian rainforest brought suit against Texaco in US federal courts through the legal opening provided by the Alien Tort Claims Act of 1789. Dominant analyses of this case have centered on the failed promise of this law to serve as a human rights tool and view this failure in terms of the sovereigntist limitations on an emerging cosmopolitan order. Against these analyses, this article offers an alternative approach that shifts the focus from the limitations of the law towards a perspective on power. Bringing to bear political science's power debate to develop this perspective on power, the article highlights what analytical tools from this debate are translatable or which are not for understanding the power relations of the Aguinda case. Through this exercise, this article aims to prod a reconsideration of dominant theories of power, developed in a frame of the nation-state, and to provoke their redevelopment to better engage with the complex and dynamic flows of power in cases of environmental justice and politics across borders.     

Worlds,Families, Regimes: Country Clusters in European and OECD Area Public Policy

This article focuses on the notion that the policies and politics of states and nations constitute distinct worlds or clusters. We begin by examining the concept of clustering as it has emerged in the literature on policy regimes and families of nations. We then address a series of empirical questions: whether distinct worlds persist in an era of policy convergence and globalisation, whether policy antecedents cluster in the same ways as policy outcomes and whether the enlargement of the EU has led to an increase in the number of worlds constituting the wider European polity. Our main conclusions are that country clustering is, if anything, more pronounced than in the past, that it is, in large part, structurally determined and that the EU now contains a quite distinct post-Communist family of nations.     

A Concurrent Analysis of Three Institutions that Transform Health Technology‐Based Ventures: Economic Policy,Capital Investment,and Market Approval

Drawing on institutional theory, this article articulates qualitative insights from a program of research on Canadian health technology‐based ventures to examine the rules that characterize economic policy, capital investment, and regulatory approval as well as the way these institutions enable and constrain the development of ventures at an early stage. Our findings clarify how economic policy integrates these ventures into the entrepreneurial domain, how capital investment configures them for economic value extraction, and how regulatory approval fully releases their market value. These findings help to revisit current policy modernization initiatives by calling attention to the convergence among the three institutions. Rather than operating solely as a source of constraints, these institutions provide a highly integrated market‐oriented space for health technology‐based entrepreneurial activities to unfold.     

Trade, Harmonization, and Domestic Autonomy in Environmental Policy

This article evaluates the environmental criticisms of free trade that have been such an important part of the critique of globalization. The first section briefly surveys the range of criticisms environmentalists have brought against the new economic order. The second section examines the available literature on the race to the bottom, one of the key concerns. The third section analyzes the World Trade Organization trade rules and how they have been interpreted by dispute resolution panels involving environmental issues. The fourth section turns to the specific rules of the North American Free Trade Agreement and examines several case studies of environmental issues in that region. The final section provides a summary evaluation of the environmental criticisms. The article argues that the environmental criticisms are exaggerated. Trade agreements leave far more room for domestic environmental measures than is frequently argued. The political globalization of the environmental movement has helped counter the threat to environmental policy created by the economic and trade aspects of globalization. Environmentalists do need to be careful about how they advance this critique of globalization, however, because their arguments risk becoming a self-fulfilling prophecy.     

Repealing Federal Oversight of State Health Policy: Lessons from the Boren Amendment

The Boren Amendment is frequently cited as an example where judicial involvement markedly shaped the implementation of federal legislation. Unlike other controversial health policies, Boren was eventually rescinded by Congress. Results indicate that the Amendment was repealed because changing socioeconomic, political, and programmatic conditions combined with policy‐oriented learning to facilitate a shift in policy venue away from the judiciary toward the President and Congress. This is because during the devolutionary climate of the mid‐to‐late 1990s, both the executive and legislature proved more conducive to the policy image promulgated by state officials that the Amendment unnecessarily restricted state discretion, than the policy image promulgated by providers that without the Amendment, low reimbursement levels would compromise access and quality. Data for this analysis derive from archival documents, secondary sources, and 101 interviews with state and federal experts.