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The book "Women and Whitlam: Revisiting the Revolution" edited by Michelle Arrow is a collection of essays that explores the agenda for women during the Whitlam government in Australia. The book is divided into five sections, each focusing on different aspects such as political influence, the law, health and social policy, media, arts, and education, and the legacies of the era. The essays provide historical knowledge, personal stories, and inspiration for readers. The collection aims to shape the future by examining the past and highlighting what was achieved and what still needs to be done for women's equality and justice. The book also emphasizes the importance of diverse perspectives and voices, including Indigenous contributors, in the fight for lasting and meaningful change. [Extracted from the article]

This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up. [ABSTRACT FROM AUTHOR]

This article describes the development and dissemination of an evidence-based Policy Statement and Background Papers by the Australian Rehabilitation and Assistive Technology Association (ARATA). An experienced project team was engaged to conduct literature reviews and member consultations, develop resources and implement a targeted advocacy strategy that included a policy launch and meetings with government officials. The Policy Statement and Background Papers have enabled ARATA to represent the views of Assistive Technology (AT) Practitioners in consultations around the National Disability Insurance Scheme and other AT-related inquiries. In ARATA's experience, developing a policy statement and disseminating it through a targeted advocacy strategy is an effective way for a not-for-profit professional organisation to influence government policy. [ABSTRACT FROM AUTHOR]

Intergenerational care is a program where both the younger and older generations are receiving programmed care in an environment where activities and resources are shared between them. Anecdotally, an intergenerational care program takes on many forms. This paper presents a systematic literature review of intergenerational care models. Our findings are relevant to policy makers as the paper highlights the opportunities to create an age-friendly environment by introducing intergenerational models in Australia, where intergenerational care development is in its infancy. Future research will help articulate the personal, social, and economic value of intergenerational care. [ABSTRACT FROM AUTHOR]

Violence and abuse against people with intellectual disabilities are internationally recognised as a pervasive social problem. Recent years have seen the development and implementation of preventative strategies, yet only few of them have been rigorously evaluated. The present paper aims to identify preventative abuse strategies for people with intellectual disabilities and explore the evidence about their quality and effectiveness. A scoping review method was implemented, and a comprehensive search of 14 online databases identified six peer-reviewed articles, published between January 2007 and June 2019, that reported on evaluation of violence prevention strategies designed for adults with intellectual disabilities. Each program and its evaluation were critically and systematically reviewed. Overall, the analysis reveals the strategies' core elements, and highlights strengths and gaps in delivery and evaluation. More rigorous evaluation is required to establish the effectiveness of violence prevention strategies and to advance evidence-based practice in this field. IMPLICATIONS The social work profession has a critical role in the development, implementation, and evaluation of violence prevention strategies for adults with intellectual disabilities. Design of violence prevention strategies needs to be multifaceted, and embedded within the social and cultural environments of people with intellectual disabilities. Violence prevention strategies need to evolve from focusing solely on risk reduction to a broader approach encompassing the safety of adults with intellectual disabilities as part of their human rights. [ABSTRACT FROM AUTHOR]

Purpose: Substantial evidence supports assistive technology and environmental adaptations as key enablers to participation. In order to realise the potential of these interventions, they need to be both recognised in policy, and resourced in practice. This paper uses political theory to understand the complexities of assistive technology (AT) policy reform in Australia. AT research will not be influential in improving AT policy without consideration of political drivers. Method: Theories of policy formation are considered, with Kingdon's (2003) theory of multiple streams identified as a useful lens through which to understand government actions. This theory is applied to the case of current AT policy reformulation in Australia. Results: The convergence model of problem identification, policy formulation and political will is found to be an applicable construct with which to evaluate contemporary policy changes. This paper illustrates the cogency of this theory for the field of AT, in the case of Australia's recent disability and aged care reforms. Conclusions: Political theory provides a way of conceptualising the difficulties of consumers and AT practitioners experience in getting therapeutically valid solutions into public policy, and then getting policies prioritised and funded. It is suggested that AT practitioners must comprehend and consider political factors in working towards effective policies to support their practice. [ABSTRACT FROM AUTHOR]

Globally, population ageing is one of the most pressing social and policy issues faced today. Over the next two decades, Australian society will face dramatic increases in the proportion of the population aged 65 years and over, as the baby boomers move into older age and fertility levels remain low. Yet population ageing is not a surprising or new trend—demographic changes in the age profile of a population tend to occur incrementally rather than suddenly. As a demographer and geographer, Graeme Hugo drew attention to this trend in Australia’s population more than three decades ago. Throughout Graeme Hugo’s vast breadth of work over the past 40 years, there has been a consistent thread of demographic analysis and academic thought associated with the ageing of Australia’s population. This paper focuses on Hugo’s contributions to academic thought and policy on Australia’s ageing population and the challenges associated with this for both service delivery and health policy as Australian society moves into an unprecedented era of population ageing. [ABSTRACT FROM PUBLISHER]

It is well established that social determinants are crucial to health outcomes. However, the link between how social determinants contribute to health inequalities for people with disability has often failed to be acknowledged. For example, Australian disability policy has paid little attention to social determinants of health, despite people with disability faring particularly badly on a range of outcomes. This paper identifies barriers to policy action on the social determinants of health for people with disability in Australia. Data obtained from interviews with key disability policy stakeholders are analysed using a micro, meso, macro level policy analysis framework. Our analysis identifies a "services drift" acting as an important barrier to policy action, where attention is focused on health service access rather than broader social determinants such as housing, employment and education. We also identify issues in how disability policy is made that hinders action on social determinants of health. The environments people live, work and interact in like their housing, employment and education, have been shown to be more important for good health than having access to health services, yet these areas are often neglected in policy for people with disability. Using interviewees with people involved in disability policy in Australia this article aims to explore why these areas are neglected in policy relative to the focus on access to health services. Reasons for focusing more on health services compared to other policy areas include people's attitudes towards disability such as thinking about it as a medical problem rather than a social problem. There are also issues with how disability policy is being made, such as a lack of consultation with people with disability, and a lack of co-ordination between government levels and departments. Identifying these policy barriers is an important step in finding ways to get more policy action on improving the environments people with disability live in. [ABSTRACT FROM AUTHOR]

Young people transitioning from out-of-home care, commonly called care leavers, are known to be a vulnerable group. Many experience poor outcomes leading them to become homeless or involved in the criminal justice system. Yet compared to most other Anglophone democracies, Australia lacks mandatory assistance for care leavers beyond 18 years of age. There are also major legislative, policy, and program differences between care leaver entitlements in the individual states and territories. This paper argues that the Commonwealth Government should introduce a nationally consistent extended care system that would require all jurisdictions to provide a minimum standard of support until at least 21 years of age. A uniform set of extended care standards is even more vital in the context of COVID-19. IMPLICATIONS Many Australian care leavers have poor life chances despite recent advances in the support programs provided by the states and territories. A nationally consistent extended care program is likely to progress improved opportunities and outcomes for care leavers. [ABSTRACT FROM AUTHOR]

As the speech-language pathology (SLP) profession matures and evolves, there will continue to be an ongoing need for practice change. Practice change has many drivers: consumer need; an advancing evidence base; clinical innovations; financial efficiency; local service needs; population change; government policy etc. If we are to continue to have a profession with a strong identity and the capacity to make meaningful contributions to the modern education and healthcare landscape, then practice change is a necessity. To achieve practice change we must step away from long-held traditional paradigms and service delivery models. We need a workforce that is ready, committed and willing to accept change. We need organisations that are willing and open to adopt new service models, and we must have the evidence base to support these new roles and responsibilities. Making change to ensure clinicians are working to full scope or considering extended scope models (when appropriate) is actively encouraged to help achieve a more client-centred, cost-effective health service. In this discussion paper, the benefits, issues and impacts of expanding scope of practice are discussed, and ways that individual clinicians, services, training institutions, and researchers can help support the future growth of our profession are highlighted. [ABSTRACT FROM AUTHOR]

Hepatitis C has long been a public health problem in Australia. 'Revolutionary' new drugs with the potential to cure hepatitis C have now emerged. The Australian government has invested heavily in them, and has an ambitious goal to eliminate hepatitis C by 2030. Numerous shifts in policy and practice are required if the elimination agenda is to be realised. This paper explores the significance of these shifts. We ask: what is the race to elimination doing with the subject? We argue that the race to elimination can be understood, simultaneously, as a product of posthuman forces, capable of being analysed using the theoretical tools made available via the posthuman turn; producing an intervention in what it means to be human; and generating a dilemma for people who use (or used) drugs, people with hepatitis C, and posthuman scholarship. In drawing out these issues, we aim to: trace the significant developments underway in hepatitis C medicine and raise awareness of them; encourage reflection on the consequences of these developments; and invite reflections on what might be lost when the human is remade by hepatitis C medicine. [ABSTRACT FROM AUTHOR]

This two-year (2016–2018) study aimed to identify what a good life is for Aboriginal people with disability in remote Central Australia and how service providers can support them to achieve a good life. This paper presents the findings that relate to barriers to delivering services for Aboriginal people with disability. In-depth interviews and focus groups were held with Aboriginal people with disability and their carers aged at least 18 years from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Lands and community organisations providing services there. The data were analysed using thematic analysis. There were 109 participants, of whom 47 were workers in service provider organisations and 62 were Aboriginal people. From the data, barriers to delivering services to support Aboriginal people to live a good life and solutions to overcome the barriers, were identified and described under the headings of environmental barriers and systemic issues. We discuss the policy implications of these findings with regard to addressing Indigenous disadvantage and how governments, service providers, communities, and Aboriginal people with disability and their families can work in partnership to address these barriers. Indigenous people with disability living in remote and very remote communities experience significant access and equity barriers to culturally responsive services that enable them to live a socially and culturally engaged life. Localised government and service provider disability policy approaches in Indigenous communities need to focus on both environmental and systemic issues. Greater investment in local remote communities is required to build the capacity of Indigenous families to support Aboriginal people with a disability to live a culturally and socially included life. [ABSTRACT FROM AUTHOR]

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The abuse of older people, often perpetrated by family and friends, is a complex multidimensional social problem. In most Australian jurisdictions, responses are currently limited to either primary-level (information, education and referral) or tertiary-level statutory responses. Outside of Australia, Family Group Conferencing has partially addressed this secondary-level service gap by inviting the older person and their wider family system to identify and establish a family-led plan to address potential or actual risk of abuse. This paper presents the core processes of Family Group Conferencing, including the quality of the established evidence base for its use with older people. The limitations and caveats associated with this approach are explored, and a way forward is proposed to explore the utility and suitability of Family Group Conferencing for adults in Australia in response to some types and severities of abuse and mistreatment. The abuse of older people is complex and under-reported, and many older people choose to take no action as a large proportion of perpetrators are family members. Limited Australian responses focus on either primary prevention or tertiary-level statutory responses. Family Group Conferencing may enhance secondary-level service responses to abuse, mobilising the older person's protective networks, and reducing the risk of abuse. [ABSTRACT FROM AUTHOR]

This paper examines the experiences of a small group of socio-economically disadvantaged people and their attempts to access disability welfare under Australia's National Disability Insurance Scheme (NDIS). We interviewed 32 individuals with some form of disability who were potentially eligible to apply for the NDIS. Our research revealed that only a small proportion of a sample successfully applied to the NDIS, with our interviewees characterised as 'hard-to-reach' because of their socio-economic disadvantage, social isolation, and lack of adequate support. Reflecting on the many and varied experiences of this group, we consider our interviewees to be at risk of further marginalisation in the absence of effective measures to engage and support them. We recommend ways to bring the hard-to-reach group within the ambit of the NDIS, as well as possibilities for future research. This article reports on the experiences of people who have attempted to engage with Australia's national disability support scheme. Only a few people within our sample had successfully applied for support under the national scheme, with others either unaware of it or unsuccessful in their applications Many in our sample were effectively excluded from the scheme due to the complexities of disability, social exclusion, and financial hardship. Further research in this area is critical so that the problems faced by people in the hard-to-reach group, with respect to accessing the national disability support scheme, can be addressed. [ABSTRACT FROM AUTHOR]

Purpose:In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech pathology services in Australia. Submissions were sought from individuals and organisations. In this paper, submissions made by individuals with a history of childhood communication disorder were examined to explore their life experiences and the impact on their lives when the right to communicate could not be enacted. Method:There were 305 submissions to the Australian Government Senate Committee Inquiry, of which 288 were publically accessible. In this study, the submissions (n = 17) from children or adults with a history of communication disorder (including speech, language and stuttering), who provided personal accounts of their experiences, were analysed using an interpretative phenomenological approach. Result:Four themes emerged relating to: personal identity, life with communication disorder, the importance of help, and how life would be different without a communication disorder. Conclusions:This paper gives voice to children and adults with communication disorder. In listening to these voices, the impact of communication disorder on the right to communicate and on other human rights can be heard, and the need for a response is clear. However, the challenge is to determine how the voices of these individuals, and others like them, can be enabled to exert real influence on practice and policy so communication disorder will no longer be a barrier to attainment of their human rights. [ABSTRACT FROM PUBLISHER]

Australian community arts and mental health is described through its 40-year history with peaks of activity coinciding with federal labor governments and the establishment of four independent health promotion agencies from the late 1980s. The paper then takes a thematic approach to discussing the development of national approaches to supporting arts and health practice, data sources, current research and evaluation and advocacy challenges. The paper concludes by suggesting that under the current federal labor government arts and health may benefit from increasing recognition of the intrinsic benefits of arts participation and cultural rights. [ABSTRACT FROM AUTHOR]

Objective: The following mixed methods study aimed to decipher the factors influencing the psychological wellbeing of language brokers. Specifically, ethnic identity, attitudes towards brokering, family connectedness, and high intensity brokering situations were examined. Method: One hundred and twenty four individuals completed surveys in either paper pencil format or online. Six survey participants also volunteered to participate in semi‐structured interviews. Results: The quantitative results revealed ethnic identity and attitudes towards brokering positively correlated with psychological wellbeing, no support was found for family connectedness or for brokering in high intensity contexts. The moderating effects of ethnic identity, attitudes, and family connectedness on the relationship between high intensity brokering and wellbeing were not supported by the quantitative analysis. Emerging themes from the six interviews provided insight into familial relationships, community connection, and multicultural Australia with the sub‐themes of acceptance and non‐acceptance of diversity. Conclusion: These results support the current policies requiring health services and legal aid to provide free interpreters for individuals not fluent in English. Additionally, these results my assist in government bodies and policy makers providing additional support and resources to language brokers in the home setting and the community. [ABSTRACT FROM AUTHOR]

The main goal of palliative care is to relieve suffering. Opioids are an essential part of the pharmacological options required to address suffering by helping to relieve the pain and chronic breathlessness that may be experienced by someone with a life-limiting illness. This paper considers the recent history and current issues of the 'opioid crisis' providing recommendations to which regulatory and peak bodies can work with the Australian government, ensuring consistent adherence to WHO guidelines maintaining access to evidence based opioid management for palliative care patients whilst actively avoiding unintended suffering restricted access can cause. The recommendations are as follows: Review of the Palliative Care schedule of the Pharmaceutical Benefit Scheme Support of prescribers with current evidence, clinical practice guidelines and regulatory frameworks National opioid prescribing policies promoting linkages between palliative care and pain and addiction specialists. National real time monitoring of all opioid prescriptions Palliative care involvement in all opioids stewardship programs in acute services. Reform Medical Benefits Schedule to improve access for primary and other speciality practitioners to provide palliative care services. Compulsory palliative care education in undergraduate medical, nursing and allied health tertiary courses. Adequate, consistent stock of evidence based opioids for palliative care in community pharmacies and residential aged care facilities. These recommendations provide the regulatory guidance required to ensure persons with life limiting illness have continued access to safe and effective medication that can relieve suffering. [ABSTRACT FROM AUTHOR]

Trade agreements influence the distribution of money, goods, services and daily living conditions – the social determinants of health and health equity, which ultimately impacts differentially on health within and between countries. In order to advance health equity as a trade policy goal, greater understanding is needed of how different actors frame their interests in order to shape government priorities, thus helping to identify competing agendas across policy communities. This paper reports on a study of how policy actors framed their interests for the Trans Pacific Partnership agreement. We analysed 88 submissions made by industry actors, not for profit organisations, unions, researchers and individual citizens to the Australian government during treaty negotiations. We show that policy actors' ideas of the purpose of trade agreements are shaped by competing underlying assumptions of the role of the state, market and society. We identify three primary framings: a dominant neoliberal market frame, and counter frames for the public interest and state sovereignty. Our analysis highlights the potential enabling and constraining impact of policy frames for health equity. In particular, the current dominant market framing largely excludes the social determinants of health and health equity. We argue that advocacy needs to tackle head on the underlying assumptions of market framings in order to open up space for the social. We identify successful examples of health framing for equity as well as opportunities for engagement with 'non-traditional' allies on shared issues of concern. [ABSTRACT FROM AUTHOR]

As Leader of the Opposition in 1987, the current Prime Minister of Australia John Howard, stated unequivocally that he would dismantle Medicare at his first opportunity. By April 2000, the Health Minister in a Howard-led government proudly proclaimed to the Australian Parliament the Coalition was 'the best friend Medicare ever had'. Such a shift in ideology and policy position appears remarkable, overturning more than 60 years of conservative opposition to a universal, publicly funded, health care system. This paper traces the shift from the lead-up to the 1996 election until 2000, interrogating official policy texts to map how the Coalition reconfigured its own policy narrative about the Australian health care system. This paper argues that in order to understand contemporary reforms to the health care system, we must consider the way in which those reforms provide solutions to discursively, rather than objectively constructed, policy problems. [ABSTRACT FROM AUTHOR]

Based on a detailed reading of the six preceding papers, in conjunction with a reflection on the socio-political forces shaping lifestyles in the UK at the turn of the millennium, we come to four interrelated conclusions. First, sport and exercise science needs to move beyond evidence-based practice to evidence-based policy. Second, sport and exercise science needs to make health-enhancing physical activity a political issue at both national and local level. Third, transport, not health policy, may be the key to promoting health-enhancing physical activity. And, fourth, young people deserve our special attention. In reaching these four interrelated conclusions, we attempt both to shape evidence based policy and future research agendas in exercise science. To achieve an international perspective, we also present a short case note from Australia. [ABSTRACT FROM AUTHOR]

This paper explores the place of risk and risk management within contemporary Australian drug policy debates, focusing on the Howard Government's Tough on Drugs strategy. In exploring the conceptual bases of this strategy, this paper suggests that the characterisations of risk discernible in Australian debates have been dominated by a narrow group of 'expert' discourses leading to a range of gaps and omissions in the development of drugs policies. Furthermore the paper suggests that such omissions have significant implications for the development of harm reduction strategies within young drug using populations in Australia and elsewhere. In developing these arguments, the paper draws upon the work of Ulrich Beck and Anthony Giddens. Of particular interest is Beck's account of the tension between 'expert' and 'non-expert' risk assessments within contemporary risk management debates. In privileging more 'expert' risk knowledges, this paper suggests that Australian drug policies have ignored the range of 'non-expert' risk management strategies that exist within young drug using populations, and concludes that this ignorance of the culture and the context of young people's drug use further undermines the efficacy of health promotion efforts within these populations. [ABSTRACT FROM AUTHOR]

Background: Consumer and carer participation in mental health service development and evaluation has widespread nominal support. However, genuine and consistent participation remains elusive due to systemic barriers. Aims: This paper explores barriers to reform for mental health services from the perspectives of consumers and carers actively engaged in advocating for improvements in the mental health system. Method: Qualitative research with two mental health systemic advocacy organisations analysed 17 strategic communication documents and nine interviews to examine barriers to reform and participation identified by consumer and carer advocates and staff. Results: A number of individual-level barriers were described, however advocates gave more focus to systemic barriers, for which five themes emerged. These reflected lack of awareness, limited participation opportunities, slow progress for change, policy issues and mental health culture including stigma. Conclusions: Findings highlight systemic barriers to participation for consumer and carer advocates as a whole and the influence of these barriers on the individual experiences of those engaged in advocacy and representation work. Participants also emphasised the need for leadership to overcome some of these obstacles and move towards genuine consumer and carer participation and reform. Findings are discussed in the context of power within mental health systems. [ABSTRACT FROM AUTHOR]

Young adults, aged 18-30 years, are disproportionally mentioned in sexually transmissible infection surveillance data both in Australia and internationally. This contributes to categorising young adults as an ‘at risk’ group in health policy. How young adults are framed in policy, and what informs this, have direct implications for policy priorities and responses, including the development of health promotion programmes. In this paper, we provide a case study of Australia’s National Strategies for Blood Borne Viruses and Sexually Transmissible Infections from 2005 to 2017. We identify how ‘young adults’ as a population are masked by, and subsumed within, the broader category of ‘young people’ within these strategies. As a result, young adults become framed by default as a ‘risk category’ that requires education to correct its deficits, regardless of personal experience. For health promotion to advocate, mediate and enable better sexual health outcomes, a policy environment is needed that reflects the changing social and cultural contexts and sexual independence that young adults experience. Sexual health policies should reflect the complexity and opportunities of young adulthood if we are to offer an enabling policy environment for innovative and nuanced health promotion strategies, including adult appropriate health education. [ABSTRACT FROM AUTHOR]

Public health efforts to lift childhood vaccination rates can be supported or undermined by media representations of parents. Polarising representations neglect the large range of ‘middle-ground’ positions people occupy, potentially alienating parents. In recent years, Australian public health actors have tried to better engage journalists to avoid this. As these efforts have unfolded, the main national immunisation policy lever has become more punitive. This paper examines whether Australian newspaper representations of parents have changed, by comparing 153 newspaper articles from two periods: 1997-1998 (prior to the development of a public health lobby targeting the media; when the first national childhood immunisation policy was introduced) and; 2015-2016 (5 years after advocacy groups began working with the media; and when the national policy took a punitive turn). We analyse patterns and shifts (between 1997-1998 and 2015-2016) in the portrayal of parents as complacent, alternative, hesitant and as choosing. Australian newspaper portrayals of parents are broadly aligned with the policy targets of the day. In 2015-2016, there was less negative representation of parents who occupy the ‘middle-ground’ between vaccine acceptance and rejection. However, coverage of alternative parents (vaccine objectors) intensified in quantity and negativity. Concurrently, there were new (minority) portrayals of vaccine objectors as invisible, and as victims being denied choice. This signals that reporting may simultaneously align with national policy targets and destabilise public health efforts to avoid polarising misrepresentations of parents, characterisations likely to undermine trust in public health. Rather than ‘blame the media’, this analysis illuminates conflicts within public health. [ABSTRACT FROM AUTHOR]

In the past decades, public health has increasingly addressed what has been called the children's obesity 'epidemic', most notably through large-scale initiatives promoting physical activity. Through a discourse analysis the current paper critically examines such efforts in Canadian and Australian public health. Public health websites in Canada and Australia were examined for information concerning children's health, physical activity and obesity and explored for how these issues were represented in the discourse. Bacchi's (2009) 'What's the problem represented to be?' approach to discourse analysis guided our interrogation of the taken-for-granted assumptions underlying Canadian and Australian public health discourse, the ideological and political influences involved in its construction, and the knowledge base upon which it rests. The article calls for critical reflection on how children's physical and leisure activities are being advanced. [ABSTRACT FROM AUTHOR]

In most developed countries, competent patients have the legal right to refuse any medical treatment; Advance Care Planning mechanisms extend this right to non-competent patients. However, some groups, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people, risk their wishes not being respected if they lose capacity, more than others. Little is known about medical practitioners' knowledge of, or attitudes to, the law in this area, especially in relation to LGBTI people, or how the law influences their decision-making. An Australian postal survey explored knowledge and attitudes of medical specialists to legal issues relating to withdrawing/ withholding life-sustaining treatment from adults without capacity. One scenario (the focus of this paper) asked which of four plausible substitute decision-makers, including a same-sex partner, had the legal authority to make such decisions. The overall response rate was 32% (867/2702). Less than one-third of respondents correctly identified the same-sex partner as the legally authorised decision-maker. LGBTI people face multiple obstacles to having their end-of-life wishes respected. Where healthcare providers are also ignorant of the partner's legal right to make such decisions, the problem is compounded. Improved legal education for clinicians and promotion of educational resources for members of the LGBTI community is needed. [ABSTRACT FROM AUTHOR]

Objective: Integrated care has been identified as means of managing the demands on the healthcare budget while improving access to and quality of services. It is particularly pertinent to rural health services, which face limited access to specialist and support services. This paper explores the capacity of three rural communities in South Australia to deliver integrated mental health support for older people. Methods: Thirty-one interviews were conducted with local health and social service providers from mental health, community health, general practice, residential aged care, private practice, NGOs and local government as part of a larger action research project on service integration. Results: Participants highlighted differences in service delivery between the communities related to size of the community and access to services. Three structural barriers to delivery of integrated care were identified. These are as follows: fragmentation of governmental responsibility, the current funding climate, and centralisation and standardisation of service delivery. Conclusion: We conclude that despite a focus upon integrated care in mental health policy, many features of current service delivery undermine the flexibility and informal relationships that typically underpin integration in rural communities. [ABSTRACT FROM AUTHOR]

Nurse leadership capability that is constructed, nurtured and supported from pre-registration level into the mature career stages intuitively appears to offer benefit for all health stakeholders. Literature suggests such effective nurse leadership impacts positively on not only the quality of clinical care, but also the working environment in which nursing is conducted. Yet a coordinated strategic impetus to develop this leadership capability throughout the nursing profession in Australia remains elusive to quantify. Australia produces many outstanding nurse leaders despite this apparent lack of stra-tegic direction, and yet perhaps due to this lack of cohesive direction nursing leadership is arguably not embedded within and across the culture of the profession; or within health organizations generally. This paper seeks to critically explore the recent literature on nursing leadership in Australia, and to highlight the necessity to strengthen leadership capability across the stratified layers of the nursing workforce. [ABSTRACT FROM AUTHOR]

This paper analyses the substantial financial subsidy, alongside other regulatory changes, introduced to support private health insurance in Australia at the end of the 1990s. The concept of policy layering is developed and refined theoretically in terms of changes in policy paradigms in order to chart a lengthy period of tense layering in Australian health-care politics between private and public health insurance and the bipartisan convergence on a universalism plus choice policy paradigm during the 1990s. This is the key dynamic underlying the Coalition's support of private health insurance after 1996 rather than a neo-liberal ambition to dismantle the health-care state and return to a predominately privately financed health-care system with a residual, public safety net. [ABSTRACT FROM AUTHOR]

In this paper we report on the findings from six focus groups conducted with Australian medical students. The focus groups discussed students' perceptions of conflicts of interest and the influence of commercial values in health care and medical education. Our research revealed that students were aware of a number of structural influences that affected the medical education they received and that had the potential to shape their attitudes and practices as they progressed in becoming a doctor. We found that the pressures of educational workload and anticipated career trajectories tended to have an individualising effect that limited the perceived possibility of collective action and response to structural influences. We interpreted these findings through the lens of neoliberal governmentality to articulate the way commercial interests are negotiated and normalised by medical students. Based on these findings, we suggest that medical education should not only explicitly alert students to effects of political and commercial influences on the healthcare system, but also encourage the collective agency of students and strategies that do not place unrealistic expectations on individuals to effect structural change. [ABSTRACT FROM AUTHOR]

Since the introduction of Medicare in 1984, the proportion of the Australian population with private health insurance has declined considerably. Insurance for health care consumption is compulsory for the public health sector but optional for the private health sector. In this paper, we explore a number of important issues in the demand for private health insurance in Australia. The socio-economic variables which influence demand are examined using a binary logit model. A number of simulations are performed to highlight the influence and relative importance of various characteristics such as age, income, health status and geographical location on demand. A number of important policy issues in the private health insurance market are highlighted. First, evidence is provided of adverse selection in the private health insurance pool, second, the notion of the wealthy uninsured is refuted, and finally it is confirmed that there are significant interstate differences in the demand for private health insurance. [ABSTRACT FROM AUTHOR]

This paper starts from the premise that embodied knowledge is critical to understanding health policy implementation. We explore this notion through a qualitative investigation of the way that knowledge has functioned in the implementation of an Australian mental health policy, Partners in Recovery (PIR). Analysis uses the theoretical lens of interpretive policy analysis and the 'embodied, inscribed, enacted' knowledge schema developed by Freeman and Sturdy [(2014a). Introduction: Knowledge in policy – embodied, inscribed, enacted. In R. Freeman & S. Sturdy (Eds.), Knowledge in policy: Embodied, inscribed, enacted (pp. 1–19). Bristol: Policy Press]. Our analysis reveals a policy problem centred around difficulties of coordination where the inscribed solution lies in individuals who must implement the PIR program in local areas. Our interviews with PIR consortium members and stakeholders show that this implementation happens through the enactment of embodied knowledge. However this implementation is not straightforward and we point to difficulties arising from the centrality of embodied processes in implementation, related to the localisation of systems knowledge in individuals and structural devaluation of certain types of knowledge over others. [ABSTRACT FROM AUTHOR]

The paper presents an historical critical policy analysis of deinstitutionalisation and the introduction of neoliberal forms of governance in mental health policy. It focuses particularly on a major period of policy reform in the 1980s and 1990s in Victoria, Australia. Many of the particularities of the Victorian experience can be generally observed with deinstitutionalisation throughout the world. In particular, the policy discourse of rights and entitlements, consumer choice and empowerment, at times stood in tension with the service void created by the transition from large, stand-alone psychiatric institutions, to dispersed forms of service provision outside the hospital. Further, certain policy features could be seen to perpetuate patterns of coercion, abuse and neglect. This article offers a number of potential lessons for mental health law, policy and practice today, which is poised for further advances of neoliberal governance, including through the policy of personalised services, individualised disability funding and human rights-based reform. [ABSTRACT FROM AUTHOR]

Australia's history is not often considered to be an indicator of any person's health status. However, as health professionals we are taught the importance of taking and listening to our client's detailed history to assist us in our comprehension of the issues impacting upon their lives. This skill base is an important one in that it makes available valuable information that assists the health professional to be discerning of intimate and specific circumstances that could contribute to health related problems not previously diagnosed. It is a vital screening tool. I would like to advocate that history taking, that being Australia's colonial, political, social and economic histories be a course of action undertaken by all health professionals working with Aboriginal and Torres Strait Islander peoples. Health researchers of recent years have been able to clearly illustrate that there is a powerful relationship between health status and individuals or collectives; social, political and economic circumstances (Marmot, 2011; Marmot & Wilkinson, 2001; Saggers & Gray, 2007). This way of knowing how health can be affected through such social health determinants is an important health competency (Anderson, 2007; Marmot, 2011). As such this paper delivers a timeline of specific historical and political events, contributing to current social health determinants that are undermining Indigenous Australians health and well-being. This has been undertaken because most Australians including Indigenous Australians have not benefited from a balanced and well informed historical account of the past 200 and something years. The implication of this lack of knowing unfortunately has left its effect on the way health service providers have delivered health to Indigenous children, mothers, fathers, and their communities. Indigenous Australians view the way forward in improving health outcomes, as active partners in their health service delivery. This partnership requires health professionals to listen to their clients, with respect and a decolonising gaze. [ABSTRACT FROM AUTHOR]

The aim of this paper is to investigate how Australian Opioid Replacement Therapy (ORT) policy influences access to ORT treatment, including the resources required for implementation. In doing so, we also compare the accessibility of ORT treatment in Australia (AU) with ORT in the United Kingdom (UK) and United States (US). A review of government data and policy that influence service delivery was undertaken. When comparing across AU, the UK, and the US, we found several differences. To improve access to treatment in Australia more general practitioners need to provide ORT. Additionally, criteria for quality care, a centralised intake system, a national ORT treatment outcome measure, and a shift towards a recovery focus are recommended. [ABSTRACT FROM AUTHOR]

Disparities in access to health care also extend to the end-of-life care. Despite the general principle that palliative care is equitably available for all in need, it remains underutilised by certain groups in the community. Ethnic minorities, older people and patients with non-cancer diseases are found to be at a greatest risk for underutilisation of palliative care. Barriers to access palliative care by these groups in the community are complex and often overlapping. To overcome these barriers, there is a need to take action on many fronts. This paper discusses these barriers and provides an overview of the strategies that have been implemented to address these issues. [ABSTRACT FROM AUTHOR]

The creation of a curriculum blueprint appropriate to the development of a professional nurse who is practice-ready for the current and future context of health service delivery must take account of the extant context as well as an unpredictable and sometimes ambiguous future. The curriculum renewal process itself ought to challenge existing long held ideals, practices, and sacred cows within the health and higher education sectors. There is much to consider and importantly curriculum developers need to be mindful of reform within the health sector and health workforce education, as well as the concomitant vision and requirements of the nursing profession. Curriculum must develop more than discipline knowledge and skills: it must provide an infrastructure for generic abilities both social and intellectual in order to better prepare students for the registered nurse role. This paper discusses a number of forces that are essential to consider in curriculum development in undergraduate nursing education. [ABSTRACT FROM AUTHOR]

Like other countries, Australia is looking to reforms in the primary health care sector to meet the growing demand for care. Expansion of the role of practice nurses (PNs) is one way in which this demand may be met. To date the Federal Australian government has played a significant role in encouraging growth in the PN workforce. If PNs tend to be GP directed, with little autonomy, care must be taken to consider whether to expand existing scopes of practice. In contrast, if PNs rely on their own independent clinical judgment and skill, this would support potential expansions to the scope of the PN role. Understanding these issues is important to inform the development of future workforce policy. This paper examines the structural policy dimensions within which these changes are occurring, and makes recommendations for future research on PNs. [ABSTRACT FROM AUTHOR]

Following the introduction of the first National Mental Health Plan in 1992 consumer participation was and continues to be identifi ed as a key component of the reform of Australia's mental health services. One strategy to achieve participation has been the creation of the role of consumer and carer consultants (CCCs) who have been employed in public mental health services since the early 1990s. Despite over two decades of service by CCCs there seems to be little consensus between the CCCs and mental health professionals regarding the roles and function of these positions. This qualitative study sought to explore the question of 'what is the role of consultants?' from the perspective of CCCs, focusing in particular on the formation of CCCs' role identity. Four themes were identifi ed, namely: role motivation; role preparation; role practice/focus; and role ambiguity/confl ict. This paper explores these themes and their implications, and fi nally makes recommendations regarding clinical practice. [ABSTRACT FROM AUTHOR]

Nurses and midwives play a key role in providing universal maternal, child and family health services in Australia. However, the Australian federation of states and territories has resulted in policy frameworks that differ across jurisdictions and services that are fragmented across disciplines and sectors. This paper reports the findings of a study that reviewed and synthesised current Australian service policy or frameworks for maternity and child health services in order to identify the degree of commonality across jurisdictions and the compatibility with international research on child development. Key maternity and child health service policy documents in each jurisdiction were sourced. The findings indicate that current policies were in line with international research and policy directions, emphasising prevention and early intervention, continuity of care, collaboration and integrated services. The congruence of policies suggests the time is right to consider the introduction of a national approach to universal maternal, child health services. [ABSTRACT FROM AUTHOR]

The Mental Health Coordinating Council (MHCC) welcomes the opportunity to contribute to this special edition on the Australian mental health service system. This paper discusses the experiences of the non-government community-managed mental health sector. The mental health sector in Australia consists of a complex and increasingly fragmented mix of public/government, private for-profit and not-for-profit non-government community-managed organization (NGO/CMO) service providers with multiple layers of commonwealth and state/territory government policy, planning, and funding levers. The development of the community-managed mental health sector in Australia has been defined by both organic and government funded strategic growth at different points in its history. Despite strong evidence for the effectiveness of recovery-oriented approaches and the clear role of the community sector in promoting and applying the recovery principles and supporting social inclusion for mental health consumers and carers, the dilemma for the sector in the large majority of the eight Australian states and territories lies in its struggle to fully take its place as an integral and contributing part of the mental health system in its own right. [ABSTRACT FROM AUTHOR]

Tobacco-related conditions contribute significantly to the health gap between Indigenous and non-Indigenous Australians. Smoking rates in Australia's Indigenous population has failed to decline even though smoking rates in Australia have declined in general. In some Indigenous communities, smoking rates remain very high. This paper outlines a project to investigate appropriate strategies to assist Indigenous smokers to quit and the important role nurses can play. [ABSTRACT FROM AUTHOR]

Clients with co-occurring substance use and mental health disorders are not well served in traditional health care systems where specialist services offer segregated interventions and the client is left to negotiate required treatment across both systems. In recent years, policy change guiding the treatment of dual diagnosis in the United States, United Kingdom, Australia and elsewhere has triggered the development of diverse models of treatment, each of which function at different points on a continuum from serial to fully integrated care. This paper outlines key models and provides examples, while considering their potential for appropriately addressing the needs of this client group. Consideration is given to the benefits of an interaction between stepped care and the chosen model, as a means of enhancing care efficiency while retaining the focus on positive outcomes. [ABSTRACT FROM AUTHOR]

In Australia, fluoridation was first endorsed as an effective, safe and equitable means of improving population oral health over fifty years ago. However, recent opposition to attempts to introduce the measure in several regional Victorian towns has demonstrated that it remains a highly controversial health policy. This paper investigates the history of the Victorian fluoridation debate within a national and international context. It finds that although the evidence concerning fluoridation has advanced considerably, the essential arguments put forward by proponents and opponents have remained largely unchanged over that time. Protagonists incorporate the same scientific evidence yet come to polarised and unshakeable conclusions. I argue that the concept of deep structure ideation is a useful means to understand how this occurs. Furthermore, analysis of the ideas and social processes that determine a partisan position in the fluoridation debate makes this an important case study for approaching other durable scientific controversies. [ABSTRACT FROM AUTHOR]

This critical ethnographic study aimed to understand policy and documentation in relationship to guiding nursing practice in delivering a palliative approach to residents of an aged care unit of a Multi-purpose Service (MPS). A thematic analysis was undertaken that searched the text for cultural determinants of practice, and similarities and differences between the data sets. Where discrepancies occurred, key informants were revisited and questioned regarding anomalies. Using a critical lens this interpreted data formed the substantive findings of this research. The Guidelines for a Palliative Approach in Residential Aged Care (RAC) were not known or understood by management or nurses employed in this MPS. This paper supports the need for research to be conducted into evaluating the Guidelines as the current premise of this research is that policy is rhetoric not reality in providing a planned trajectory of care for residents and their family members. [ABSTRACT FROM AUTHOR]

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Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country. [ABSTRACT FROM AUTHOR]

International efforts to control female genital surgery (also referred to as female genital mutilation) have mainly targeted countries where the practice is culturally sanctioned. Women in these countries belong to a mainstream culture and are supported by their communities through the process of debate and change. In displaced communities, particularly among migrants and refugees living in Western countries, women from these communities are the visible minority, and the focus and implementation of legislation and health policy addressing female genital surgery risks creating or increasing inequities in access to reproductive health. This paper reviews health policy on female genital surgery in Australia. We relate the frequency of genital cosmetic surgery in the wider population to procedures such as re-infibulation following childbirth, requested by African women; this latter procedure is illegal and currently unavailable in most public hospitals. Data are presented to highlight the effects of these and other political and legal inconsistencies on the reproductive health of women from displaced communities. [ABSTRACT FROM AUTHOR]