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As market‐based responses to social care have grown in popularity across the world, the need for good stewardship of social care quasi‐markets is increasingly becoming a concern for governments. The market stewardship literature has focused almost exclusively on the role of government and central agencies. However, non‐government actors also play an important role in shaping quasi‐markets. We examine the market stewardship activities being conducted by non‐government actors in the Australian National Disability Insurance Scheme (NDIS), a large social care quasi‐market. Results show a wide range of non‐government actors are conducting both direct and indirect stewardship activities that are actively shaping the NDIS market. These include activities focused on both the participant side of the market such as advocacy and information provision and on the provider side such as connecting consumers with services, assisting providers with regulatory and administrative requirements and marketing for providers. We argue that for effective stewardship of the NDIS these activities need to be acknowledged and supported by central government. For this to occur we suggest development of a framework for distributed stewardship using principles of joined up government working. Such a framework could help inform stewardship actions across different personalisation quasi‐markets. [ABSTRACT FROM AUTHOR]

Previous research has indicated that administrative burdens are particularly high in personalised funding schemes such as the Australian National Disability Insurance Scheme (NDIS), because these schemes are predicated on very high levels of self‐advocacy. Administrative burdens tend to be inequitably distributed, thereby entrenching existing social inequalities. This is the first study to look at the lived experiences of administrative burden within the NDIS explicitly—and particularly those of women, who are underrepresented within the scheme. The research involved qualitative interviews with 30 women with disability who were either NDIS participants or had considered applying for the NDIS. We argue that like other marginalised groups, women with disability are experiencing significant administrative burdens within the NDIS, which are barriers to obtaining sufficient disability support. Based on this finding, we recommend the NDIS implement a gender strategy, as well as address burdensome administrative processes in general. [ABSTRACT FROM AUTHOR]

Background: There is a significant global lack of policy action on consumption of sustainable diets. Application of political science theories such as theories of the policy process can help in understanding policy inaction. Applying these theories could provide a more in-depth understanding of how various influences on the policy process shape decision making for consumption of sustainable diet policy.Methods: A systematic review to examine application of eight key political science theories of the policy process to research on consumption of sustainable diets was conducted.Results: The review identified no papers applying a theory of the policy process although 17 papers did mention or discuss influences on the policy process that are common elements within theories of the policy process. Most notably these elements were the influence of coalitions/networks, evidence use, narratives and framing, institutional and political system factors, and the importance of value and belief systems and socio-cultural norms. However, in most papers these influences were not examined in a detailed or in-depth way and often presented as suggestions for lack of policy action without the support of empirical data or application of any theory.Conclusions: Most research discussing policy inaction on the consumption of sustainable diets fails to utilise political science theories of the policy process, although a small number of papers include mention of or discussion of influences on the policy process. Application of political science theories could provide a more in-depth understanding of how different determinants might shape decision making at various points in the policy process. This could help identify key reasons for policy inaction on the consumption of sustainable diets and suggest possible ways to increase attention and action on the issue from policy decision makers. [ABSTRACT FROM AUTHOR]

Care systems worldwide regularly undergo reforms and adjustments in the hope of system improvements. In many ways this can align with calls for governments to be more 'adaptive' and 'agile' to changing care demands. However, such continued adaptations can create turbulence for the care sectors in question. In this article, we examine the large‐scale reform of the Australia National Disability Insurance Scheme and the impact of a series of adaptations on the disability care sector in Australia. We find that the disability sector in Australia is experiencing turbulence and a lack of clarity about the rules regarding the programme, resulting in increased administrative burden and financial pressures. Such turbulence has flow‐on effects on the level of care that is able to be accessed by people with disability in Australia. [ABSTRACT FROM AUTHOR]

Background: Care services in industrialized nations are increasingly moving towards individualized funding models, which aim to increase individuals' flexibility, choice and control over their services and supports. Recent research suggests that such schemes have the potential to exacerbate inequalities, however none has explored gendered dimensions of inequality. The Australian National Disability Insurance Scheme (NDIS) is a major individualized funding reform, and has a female participation rate of only 37%, despite women and girls making up half of the disability population. Methods: The objective of the study is to explore possible gendered barriers to applying for and receiving adequate support through the NDIS, and to suggest directions for future research. We report on semi-structured interviews with 30 women with disability and explore their experiences with the NDIS and their perspectives on challenges associated with being a woman seeking disability support in Australia. We analyse the results using thematic analysis. Results: Most women in our sample reported differences between the experiences of men and women seeking disability support in Australia. Commonly reported gendered barriers to women being able to access the right supports for their disability involve a) confidence, negotiation and self-advocacy, b) gendered discrimination in diagnosis and the medical system, which has implications for disability support access, and c) support for and recognition of caring roles. Conclusions: These results suggest that women are not receiving equitable treatment with regard to the NDIS, and that further research and policy reform are needed to ensure that women with disability are not further disadvantaged as a result of the move toward individualized funding models. [ABSTRACT FROM AUTHOR]

With the rise in popularity of market‐based responses to social policy challenges, the stewardship of quasi‐markets or public service markets, is a key concern for governments worldwide. Debates about how to manage quasi‐markets have focussed on high‐level decision‐making processes. However local actors, in particular street level bureaucrats, are a key part of the complex work of managing quasi‐markets. We examine how street level bureaucrats act as local market stewards in a new quasi‐market for disability care, the Australian National Disability Insurance scheme. We find that the street level bureaucrats, known as local area coordinators, act as shapers of local markets but that their contributions are informal and often restricted by formal structures and processes. For example, we found evidence that the use of key performance indicators can disrupt effective local stewardship efforts towards a procedural approach. We conclude that introducing principles of the polycentric governance approach can improve connections between local market knowledge holders and central decision‐making agencies, thereby improving market stewardship and outcomes. [ABSTRACT FROM AUTHOR]

The outbreak of a pandemic provokes fear and risk of ill health for all individuals, however, these events pose even more of a threat to people with disability who often have poorer health outcomes because of underlying conditions, have difficulties in accessing health and other services, and typically fare worse once they are in the healthcare system. The growth of personalisation schemes in disability internationally is now exacerbating those risks and could lead to high morbidity and mortality if swift action is not taken. [ABSTRACT FROM AUTHOR]

This study focuses on the agency of governments engaged in implementation processes that take place over a number of years and through multiple stages. The long timeframes associated with staged implementation leave reforms vulnerable to the institutional effects that may ultimately derail policy aspirations. Governments engaged in staged implementation need to be able to plan longitudinally (foresight capacity) and analyse whether implementation processes are creating endogenous sources of institutional change and the likely impact of such change (reflective capacity). In this paper, we argue that being able to exercise foresight capacity and reflective capacity is necessary but not sufficient, if long‐term policy goals are to be realised. Governments must also be able to navigate the inconsistent objectives that arise across the different stages of an implementation process by modifying implementation approaches in ways that reduce the likelihood of unwanted implementation effects occurring—what we have labelled "mitigation capacity." [ABSTRACT FROM AUTHOR]

Personalisation schemes and associated markets for social care have been a growing trend in industrialised countries over recent decades. While there is no single approach to marketisation of social care and personalisation, often funds are devolved to clients of care services to be used to purchase services directly from market. Such arrangements are vulnerable to market failures and 'thin' markets, causing the need for stewardship of the social care markets. We present findings from a 2018 survey of 626 care service providers in the Australian National Disability Insurance Scheme market on their experience of market conditions. Over 46% of respondents listed 'addressing pricing' as their top action for addressing market problems. Qualitative findings show that central price setting is detached from service delivery realities, affecting service quality and capability building potential. We argue that devolution of price setting to, or at least flexibility and discretion at, the local level is likely to be a key to solving pricing dilemmas in personalisation schemes. [ABSTRACT FROM AUTHOR]

Background: The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform based on an international trend towards personalisation in social care. It aims to increase choice and control over services and supports for people who have or acquire a permanent disability, thereby boosting citizen empowerment and improving health and social outcomes.Methods: The research is a structured review of empirical evidence on the administration and outcomes of the NDIS to identify how social factors constrain or enable the ability of individuals to exercise choice within personalised care schemes.Results: We show how social determinants of health at the individual level can collide with the complexity of policy delivery systems to entrench health inequalities.Conclusion: Many social policy reforms internationally focus on improving empowerment through enabling choice and control. However, if administrative systems do not take account of existing structural inequities, then such schemes are likely to entrench or grow social inequality. Our research indicates that more attention must be given to the design of policy delivery systems for personalisation schemes to ensure health equity. [ABSTRACT FROM AUTHOR]

We explore personalized funding schemes and associated changes for accountability within new welfare governance reforms. Using the case of the Australian National Disability Insurance Scheme as hybrid institution, requiring mixed accountability arrangements, we examine the implications for broader discussions of accountability in personalized welfare arrangements. Methods used were semistructured interviews with government actors and disability service providers in Australia. In describing how accountability structures emerge, we argue that the way that layers fit together during implementation are often imperfect because of the conditions under which they arise. As a result, critical gaps can emerge in layered systems, which can put end users at risk. We demonstrate that theories on accountability in new public governance welfare reforms must also be informed by context and history informed qualitative analysis of case studies. [ABSTRACT FROM AUTHOR]

Aims: This paper examines the role of organizational structure within government(s) in attempts to implement intersectoral action for health in Danish municipalities. We discuss the implications of structural reorganization and the governance structures that are established in order to ensure coordination and integration between policy sectors. Methods: The paper is based on 49 interviews with civil servants from health and non-health sectors of 10 municipalities. Based on participants’ experiences, cases have been described and analyzed in an iterative process consulting the literature on Health in All Policies and joined-up government. Results: Continuous and frequent processes of reorganizing were widespread in the municipalities. However, they appeared to have little effect on policy change. The two most common governance structures established to transcend organizational boundaries were the central unit and the intersectoral committee. According to the experiences of participants, paradoxically both of these organizational solutions tend to reproduce the organizational problems they are intended to overcome. Even if structural reorganization may succeed in dissolving some sector boundaries, it will inevitably create new ones. Conclusions: It is time to dismiss the idea that intersectoral action for health can be achieved by means of a structural fix. Rather than rearranging organizational boundaries it may be more useful to seek to manage the silos which exist in any organization, e.g. by promoting awareness of their implications for public health action and by enhancing the boundary spanning skills of public health officers. [ABSTRACT FROM AUTHOR]

As part of the international trend towards personalisation, in 2013 Australia launched a major disability scheme aiming to give participants greater choice and control over services. The scheme aims to cover a wide diversity of disabilities, services and significant geographical area – resulting in a highly complex system of local overlapping markets. At four years into implementation a range of challenges have emerged. In this paper we firstly describe the Australian National Disability Insurance Scheme, then explore a range of implementation challenges it currently faces as a large-scale personalisation scheme. Based on these experiences we pose a range of questions for similar schemes internationally. [ABSTRACT FROM AUTHOR]

Personalized care and market-based approaches to public service provision have gained prominence in a range of Organisation for Economic Co-operation and Development countries. Australia has recently joined this trend, launching a complex and expansive programme of individualized care funding for disability through the National Disability Insurance Scheme. Public sector markets (i.e. where governments either directly fund a market by way of competitive tendering, or through personal budgets) have been embraced by actors at different points of the political spectrum and for a range of reasons, including efficacy and efficiency gains, empowerment of citizens and efforts to cater for diversity. Despite the growing dominance of public sector markets and individualized funding, many questions about the role and responsibility of governments in managing and regulating these markets remain unanswered. In this article we outline different roles governments might assume in the creation and management of public sector markets, based on the types of risks governments are willing to take responsibility for. We argue that to fulfil the social contract between government and citizens, governments need to ensure that markets are properly stewarded and embedded in broader social safety nets. This, we contend, can ensure citizens receive the gains of market models while being protected from market failures or market-produced inequities. [ABSTRACT FROM AUTHOR]

Background: Increasing attention is being given to political agenda setting for the social determinants of health. While designing policies that can improve the social determinants of health is critical, so too is ensuring these policies are appropriately administered and implemented. Many policies have the potential to entrench or even expand inequities during implementation. At present little attention has been given to this in the social determinants of health literature. There is an international trend in the personalisation of funding for care services, from the National Health Service in the England to the Brukerstyrt Personlig Assistanse in Norway. Part of this trend is the Australian National Disability Insurance Scheme (NDIS). The NDIS has the potential to secure gains in health for hundreds of thousands of Australians living with a disability. However, policies are only as good as their implementation. Methods: As part of a longitudinal study on the implementation of the Australian NDIS, we conducted a systematic document search of policy documents pertaining to the Scheme on the websites of government departments with auspice over the design and implementation of the scheme with the aim of examining issues of equity. Results and discussion: Scheme architects have argued that the NDIS has the potential to replace a piecemeal and fragmented set of state-determined services with an empowering model of user choice and control. However, without careful attention to both existing inequities and, diversity and difference across populations (e.g. different disability types and different localities), market based approaches such as the NDIS have the serious potential to entrench or even widen inequities. Conclusions: The research concluded that 'personalisation' approaches can widen inequities and inequalities unless careful consideration is given at both policy design and implementation stages. [ABSTRACT FROM AUTHOR]

Background: Internationally there has been a growth in the use of publicly funded service markets as a mechanism to deliver health and social services. This has accompanied the emergence of 'self-directed care' in a number of different policy areas including disability and aged care - often referred to as 'personalisation' (Giaimo and Manow, Comp. Pol Stud 32:967-1000, 1999; Needham, Public Money Manage 30:136-8, 2010; [Hood], [The Idea of Joined-up Government: A Historical Perspective], [2005]; Klijn and Koppenjan, Public Manage 2:437-54, 2000, Greener, Policy Polit 36:93-108, 2008). These reforms are underpinned by an idea that individuals should be placed in control of their own service needs, given funding directly by government and encouraged to exercise choice and control through purchasing their own services. A major challenge for governments in charge of these reforms is determining the best way to structure and govern emerging service markets markets. Given the growing international embrace of market-based reform mechanisms to provide essential services to citizens, finding ways to ensure they promote, and not diminish, people's health and wellbeing is vital.Methods: The Australian National Disability Insurance Scheme (NDIS) is Australia's first national approach to the use of personalised budgets. The program of research outlined in this paper brings together streams from a range of different studies in order to investigate the implementation of the NDIS longitudinally across different administrative levels of government, service providers and scheme participants.Conclusion: This programme of research will make a contribution to our understanding of the Australian scheme and how individualised funding operates within this context, but will also generate much needed evidence that will have relevance to other jurisdictions and help fill a gap in the evidence base. [ABSTRACT FROM AUTHOR]

Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocella's residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it. [ABSTRACT FROM AUTHOR]

This paper reports on first-year conservatoire students’ reflections on their one-to-one performance learning through a reflective journal. One-to-one lessons have been a central part of the education of performing musicians, although their place in the twenty-first-century conservatoire is not beyond challenge. Recent research has indicated that this model has potential for students to rely heavily on their teachers for feedback and that more reflective and autonomous learning might benefit their progress. Students’ journal responses revealed three main themes: the development of student autonomy; a sense of shared responsibility and collaboration; and increased clarity and confidence in the direction of their learning. The findings suggest that the journaling process can prompt an increased level of reflection and lead to more collaborative and autonomous learning in the one-to-one studio context. [ABSTRACT FROM AUTHOR]

Increasingly, researchers are arguing that there is a need to ‘act universally’ in order to address social and health inequalities. While, in theory, universal approaches to tackling inequalities are valuable, putting them into practice has proved to be much more difficult. Debates between universal and targeted approaches continue, both in the public health literature and social policy (a field with significant bearing on population health). These debates revolve around ideology and the intuitive appeal of targeting. In this paper, we explore how these ideologies and logics play out in the design and implementation of policy, using the Australian Social Inclusion Agenda as a case study. Based on our analysis, we suggest that a more dialogic approach to working with policy-makers is required in order to promote reflection on broader tendencies in the design and implementation of policies. [ABSTRACT FROM PUBLISHER]

Introduction: The finding that there is a social gradient in health has prompted considerable interest in public health circles. Recent influential works describing health inequities and their causes do not always argue cogently for a policy framework that would drive the most appropriate solutions differentially across the social gradient This paper aims to develop a practice heuristic for proportionate universalism. Methods: Through a review the proposed heuristic integrates evidence from welfare state and policy research, the literature on universal and targeted policy frameworks, and a multi-level governance approach that adopts the principle of subsidiarity. Results: The proposed heuristic provides a more-grained analysis of different policy approaches, integral for operationalizing the concept of proportionate universalism. Conclusion: The proposed framework would allow governments at all levels, social policy developers and bureaucrats, public health professionals and activists to consider the appropriateness of distinctive policy objectives across distinctive population needs within universal welfare state principles. [ABSTRACT FROM AUTHOR]

Background: Inequalities in the distribution of the social determinants of health are now a widely recognised problem, seen as requiring immediate and significant action (CSDH. Closing the Gap in a Generation. Geneva: WHO; 2008; Marmot M. Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalitites inEngland Post-2010. London; 2010). Despite recommendations for action on the social determinants of health dating back to the 1980s, inequalities in many countries continue to grow. In this paper we provide an analysis of recommendations from major social determinants of health reports using the concept of 'system leverage points'. Increasingly, powerful and effective action on the social determinants of health is conceptualised as that which targets government action on the non-health issues which drive health outcomes. Methods: Recommendations for action from 6 major national reports on the social determinants of health were sourced. Recommendations from each report were coded against two frameworks: Johnston et al's recently developed Intervention Level Framework (ILF) and Meadow's seminal '12 places to intervene in a system' (Johnston LM, Matteson CL, Finegood DT. Systems Science and Obesity Policy: A Novel Framework forAnalyzing and Rethinking Population- Level Planning. American journal of public health. 2014;(0):e1-e9; Meadows D. Thinking in Systems. USA: Sustainability Institute; 1999) (N = 166). Results: Our analysis found several major changes over time to the types of recommendations being made, including a shift towards paradigmatic change and away from individual interventions. Results from Meadow's framework revealed a number of potentially powerful system intervention points that are currently underutilised in public health thinking regarding action on the social determinants of health. Conclusion: When viewed through a systems lens, it is evident that the power of an intervention comes not from where it is targeted, but rather how it works to create change within the system. This means that efforts targeted at government policy can have only limited effectiveness if they are aimed at changing relatively weak leverage points. Our analysis raises further (and more nuanced) questions about what effective action on the social determinants of health looks like. [ABSTRACT FROM AUTHOR]

Background: Inequalities in the distribution of the social determinants of health are now a widely recognised problem, seen as requiring immediate and significant action (CSDH. Closing the Gap in a Generation. Geneva: WHO; 2008; Marmot M. Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalitites inEngland Post-2010. London; 2010). Despite recommendations for action on the social determinants of health dating back to the 1980s, inequalities in many countries continue to grow. In this paper we provide an analysis of recommendations from major social determinants of health reports using the concept of ‘system leverage points’. Increasingly, powerful and effective action on the social determinants of health is conceptualised as that which targets government action on the non-health issues which drive health outcomes. Methods: Recommendations for action from 6 major national reports on the social determinants of health were sourced. Recommendations from each report were coded against two frameworks: Johnston et al’s recently developed Intervention Level Framework (ILF) and Meadow’s seminal ‘12 places to intervene in a system’ (Johnston LM, Matteson CL, Finegood DT. Systems Science and Obesity Policy: A Novel Framework forAnalyzing and Rethinking Population- Level Planning. American journal of public health. 2014;(0):e1-e9; Meadows D. Thinking in Systems. USA: Sustainability Institute; 1999) (N = 166). Results: Our analysis found several major changes over time to the types of recommendations being made, including a shift towards paradigmatic change and away from individual interventions. Results from Meadow’s framework revealed a number of potentially powerful system intervention points that are currently underutilised in public health thinking regarding action on the social determinants of health. Conclusion: When viewed through a systems lens, it is evident that the power of an intervention comes not from where it is targeted, but rather how it works to create change within the system. This means that efforts targeted at government policy can have only limited effectiveness if they are aimed at changing relatively weak leverage points. Our analysis raises further (and more nuanced) questions about what effective action on the social determinants of health looks like. [ABSTRACT FROM AUTHOR]

It is now well documented that many of the key drivers of health reside in our everyday living conditions. In the last two decades, public health has urged political action on these critical social determinants of health (SDH). As noted by the World Health Organisation, encouraging action in this area is challenging. Recent research has argued that public health researchers need to gain a deeper understanding of the complex and changing rationalities of policymaking. This, it seems, is the crucial next step for social determinants of health research. In this paper, we turn our attention to the practitioners of ‘the art of government’, in order to gain insight into how to secure upstream change for the SDH. Through interviews with policy actors (including politicians, senior government advisors, senior public servants and experienced policy lobbyists) the research sought to understand the nature of government and policymaking, as it pertains to action on the SDH. Through exploring the policy process, we examine how SDH discourses, evidence and strategies align with existing policy processes in the Australian context. Participants indicated that approaches to securing change that are based on linear conceptualisations of the policy process (as often found in public health) may be seen as ‘out of touch’ with the messy reality of policymaking. Rather, a more dialogic approach that embraces philosophical and moral reasoning (alongside evidence) may be more effective. Based on our findings, we recommend that SDH advocates develop a deeper awareness of the political and policy structures and the discursive conventions they seek to influence within specific settings. [ABSTRACT FROM AUTHOR]

This paper explores teachers' and students' perceptions of one-to-one pedagogy, in the context of tertiary vocal and instrumental tuition. Teachers and students at one Australian conservatoire participated in interviews and focus groups that explored their experiences and perceptions on the nature, value, effectiveness and challenges of one-to-one learning and teaching. Four key themes emerged: customising teaching to the learner, the teacher- student relationship, negotiating issues of student dependency versus self-sufficiency, and situating one-to-one in a broader institutional context. Aside from an undisputed view that one-to-one is essential to students' learning and development, findings indicate diverse perceptions, including discrepancies between intentions of teachers and their pedagogical practice, and between teacher practice and student expectations. By drawing on voices 'from the inside' to characterise one-to-one practice, the study contributes to evidencebased research about learning and teaching in the conservatoire environment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Non-communicable disease (NCD) incidence and prevalence is of central concern to most nations, along with international agencies such as the UN, OECD, IMF and World Bank. As a result, the search has begun for ‘causes of the cause’ behind health risks and behaviours responsible for the major NCDs. As part of this effort, researchers are turning their attention to charting the temporal nature of societal changes that might be associated with the rapid rise in NCDs. From this, the experience of time and its allocation are increasingly understood to be key individual and societal resources for health (7–9). The interdisciplinary study outlined in this paper will produce a systematic analysis of the behavioural health dimensions, or ‘health time economies’ (quantity and quality of time necessary for the practice of health behaviours), that have accompanied labour market transitions of the last 30 years - the period in which so many NCDs have risen sharply. Methods/Design: The study takes a mixed-methods approach to capture and explain the relationships between work time and health behaviours. It combines: longitudinal analysis of temporal organisation of work in Australia, with the goal of establishing associations between labour timescapes and health behavioursand health time economies; an in-depth qualitative investigation of employee experiences of the perceived impact of their labour timescapes on ‘health time economies’; and, a stakeholder analysis, will uncover whether, how and why (or why not) stakeholders consider health an important dimension- of work and industrial relations policy, and what efforts are being made to mitigate health impacts of work. Discussion: The study posits that time is a key mechanism through which particular forms of labour market policies impact health. The labour market flexibility agenda appears to be operating as a time re-distributive device: it has supported the removal of regulations that governed ‘the when’ of working time and removed limits over the amount of working time, thus extending by many hours the notion of the ‘standard’ working week and forcing employees to adapt their shared or social times as well as their time for health. [ABSTRACT FROM AUTHOR]

The partnerships approach has been part of a broader transition in public health focus from service-delivery to a community-based paradigm. In particular, the focus on communities and community-level action has meant that not-for-profit organisations (also referred to as 'community-based organisations') have been targeted for partnerships to promote health. However, limited attention has been given within the public health literature to describing and understanding the not-for-profit sector, its functions or the challenges it faces in creating social change and community action. To assist in building this understanding, we have developed a typology of Australian not-for-profit organisations. The typology outlines four 'ideal types' of not-for-profit organisations, distinguishable through their differing relationships with community groups and government. We then discuss how these four types of organisations are likely to contribute to health. In using this heuristic device, researchers and practitioners can gain a better understanding of not-for-profit organisations and the challenges they face. This understanding can form the basis of more respectful partnerships between public health and not-for-profit organisations. [ABSTRACT FROM AUTHOR]

Health promotion professionals often work with community organisations and voluntary associations, including churches and church-affiliated organisations, to reduce health inequities within communities. How voluntary and church-affiliated organisations form intersectoral relationships and partnerships, and the challenges they face in doing so, has been well researched. However, there is a need to investigate further the extent to which local churches collaborate or form partnerships with other actors, such as government, peak bodies and welfare organisations. This paper reports a Victorian-based mapping exercise of partnerships and funding involving document analysis of the annual reports from 126 organisations and 35 interviews conducted with church-affiliated organisations and local churches. The discussion begins with the exploration of the nature of, and the reason why churches partner with other sectors. The paper also examines funding sources and partnership pathways that churches access to undertake the activities and programs they conduct. Interview themes highlight the value to churches of the sharing of expertise and resources, the provision of support to communities, a shared ethos of social justice and the empowerment of vulnerable populations. The findings about the extent to which local churches are involved in partnerships across society, and the extent of public and private funds they draw on to provide resources and assistance to local communities, indicate that churches are now a key player not just in welfare provision but also in health promotion activities. The findings contribute to the understanding of church activities in relation to health promotion and will assist organisations who may be potential partners to consider their collaborative efforts in the health promotion field. [ABSTRACT FROM AUTHOR]

Health promotion practice requires partnerships with different sectors of society and at all levels of government to achieve health equity as the prerequisites for health include domains that exist outside of the health sphere. Therefore existing partnerships for health need to be strengthened and the potential for new partnerships must be considered in order to address health holistically. The literature base exploring the church as a partner and setting for health promotion is predominantly from the US and therefore there is a need for research exploring the opportunities and challenges of partnering with churches in the Australian context. This paper presents an historical overview of the involvement of churches and church affiliated organisations in health and welfare in Australia recognising that while some of the values, practices and beliefs of churches may have considerable synergies with health promotion, others may be sources of contention or difference. [ABSTRACT FROM AUTHOR]

Social exclusion and social inclusion have been popular policy themes in the UK and Europe, and made more modest appearances in countries such as Canada and New Zealand, for over a decade. In 2007, the Australian Government became the latest country in this trend of structuring social policy around issues of exclusion, launching its ‘Social Inclusion Agenda’ (SIA). The SIA aims to increase social and economic participation through a reorientation of social services and increased attention to issues of equity. At the same time, there has been international consensus on the importance of the social determinants of health (such as education, income and gender) for individuals and populations. The SIA has the potential to make a substantive contribution to the social determinants of health and hence the health and wellbeing of the population. However, much will depend on the extent to which international discourses of inclusion, exclusion, structural inequality and third way politics are taken up, adapted or discarded in the Australian context. At this formative stage of the SIA's development, the public health community is in a unique position to contribute to the development and direction of the SIA to secure the potential health gains it offers. This article outlines the formulation of social inclusion policy in Australia, and discusses the potential promises and pitfalls of a social inclusion approach. Our examination of the Australian experience of social inclusion policy provides an opportunity to reflect on the relationship between social inclusion and health internationally. [ABSTRACT FROM PUBLISHER]

Background: In this paper we present the research design and methods of a study that seeks to capture local level responses to an Australian national social policy initiative, aimed at reducing inequalities in the social determinants of health. Methods/Design: The study takes a policy-to-practice approach and combines policy and stakeholder interviewing with a comparative case study analysis of two not-for-profit organisations involved in the delivery of federal government policy. Discussion: Before the health impacts of broad-scale policies, such as the one described in this study, can be assessed at the population level, we need to understand the implementation process. This is consistent with current thinking in political science and social policy, which has emphasised the importance of investigating how, and if, policies are translated into operational realities. [ABSTRACT FROM AUTHOR]

Increasingly the health and welfare needs of individuals and communities are being met by third sector, or not-for-profit, organizations. Since the 1980s third sector organizations have been subject to significant, sector-wide changes, such as the development of contractual funding and an increasing need to collaborate with governments and other sectors. In particular, the processes of 'professionalization' and 'bureaucratization' have received significant attention and are now well documented in third sector literature. These processes are often understood to create barriers between organizations and their community groups and neutralize alternative forms of service provision. In this article we provide a case study of an Australian third sector organization undergoing professionalization. The case study draws on ethnographic and qualitative interviews with staff and volunteers at a health-based third sector organization involved in service provision to marginalized community groups. We examine how professionalization alters organizational spaces and dynamics and conclude that professionalized third sector spaces may still be 'community' spaces where individuals may give and receive care and services. Moreover, we suggest that these community spaces hold potential for resisting the neutralizing effects of contracting. [ABSTRACT FROM AUTHOR]

The limit for hazardous levels is 200 2.5 PM in the ACT.[1] Let that sink in, we are nearly 10 times above the highest "hazardous" readings and as I type Canberra has the poorest air quality in the world. Given both the extent and the lack of preparedness of our communities, the long-running health implications of current events are likely to be severe. 8 Lindell J. (2019) Poor air quality has uneven impact across Canberra, health researcher says. [Extracted from the article]

Background: Researchers and policymakers are increasingly concerned that personalisation schemes in social and health care might be worsening social and health inequities. This has been found internationally, where better outcomes from such schemes have been found amongst those who have higher education and more household income.Method: This study looks at one of the world's largest personalisation schemes, the Australian National Disability Insurance Scheme. Using publicly available data we examine the allocation and utilisation of NDIS funds according to social gradient.Results: We find that the rate at which people with disability 'spend' or effectively use their disability care funds follows a social gradient. That is, those in areas of higher socioeconomic disadvantage are not spending as much of their allocated budgets on care services across the year compared to people in areas of higher socioeconomic advantage. This represents a clear issue of equity in the use of public money to people with disability in Australia.Conclusion: We argue that this points to the need to provide targeted supports for the use of disability care funds in areas of higher socioeconomic disadvantage. Without effective supports for fund use, the NDIS and other personalisation schemes may be positioned to worsen existing social inequalities. [ABSTRACT FROM AUTHOR]

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]

Background: Personalisation is a growing international policy paradigm that aims to create both improved outcomes for individuals, and reduce fiscal pressures on government, by giving greater choice and control to citizens accessing social services. In personalisation schemes, individuals purchase services from a 'service market' using individual budgets or vouchers given to them by governments. Personalisation schemes have grown in areas such as disability and aged care across Europe, the UK and Australia. There is a wealth of evidence in public health and health care that demonstrates that practically all forms of social services, programs and interventions produce unequal benefit depending on socio-economic position. Research has found that skills required to successfully negotiate service systems leads to disproportionate benefit to the 'middle class. With an unprecedented emphasis on individual skills, personalisation has even greater potential to widen and entrench social inequalities. Despite the increase in numbers of people now accessing services through such schemes, there has been no examination of how different social groups benefit from these schemes, how this widens and entrenches social inequities, and – in turn – what can be done to mitigate this. Methods: This article presents a meta-review of the evidence on personalisation and inequality. A qualitative meta-analysis was undertaking of existing research into personalisation schemes in social services to identify whether and how such schemes are impacting different socio-economic groups. Results: No research was identified which seeks to understand the impact of personalisation schemes on inequality. However, a number of 'proxies' for social class were identified, such as education, income, and employment, which had a bearing on outcome. We provide a theoretical framework for understanding why this is occurring, using concepts drawn from Bourdieu. Conclusion: Personalisation schemes are likely to be entrenching, and potentially expanding, social inequalities. More attention needs to be given to this aspect of personal budgets by policymakers and researchers. [ABSTRACT FROM AUTHOR]

Failure of governments across the world to address climate change has fuelled social movements focused on climate-related policy and action. Research analysing these movements has focused mainly on the types of strategies employed including blockades and occupations, marches and petitions, divestment, boycotts and litigation as well as how groups are framing climate change as a problem. What has been largely missed are the ways these groups are framing the change they want to see, that is their demands to governments. Not all demands and actions have the same potential to create the changes needed to mitigate climate change. Used in public health and health promotion, the systems science Intervention Level Framework (ILF) is a tool that can help analyse to what extent different demands have the leverage to create change in a system. We use the ILF to analyse 131 demands from 35 different climate-related advocacy groups in Australia. Results show demands are more focused on lower system leverage points, such as stopping particular projects, rather than on more impactful leverage points, such as the governance structures that determine climate-related policy and decision-making mechanisms. Further, the results highlight the lack of attention on public health related topics of transport and food systems. This paper shows how a systems science framework used in health promotion, the ILF, could enable climate advocacy groups to more effectively target demands to achieve more impactful outcomes from governments, corporations and the public. [ABSTRACT FROM AUTHOR]

As governments worldwide turn to personalised budgets and market‐based solutions for the distribution of care services, the care sector is challenged to adapt to new ways of working. The Australian National Disability Insurance Scheme (NDIS) is an example of a personalised funding scheme that began full implementation in July 2016. It is presented as providing greater choice and control for people with lifelong disability in Australia. It is argued that the changes to the disability care sector that result from the NDIS will have profound impacts for the care sector and also the quality of care and well‐being of individuals with a disability. Once established, the NDIS will join similar schemes in the UK and Europe as one of the most extensive public service markets in the world in terms of numbers of clients, geographical spread, and potential for service innovation. This paper reports on a network analysis of service provider adaptation in two locations—providing early insight into the implementation challenges facing the NDIS and the reconstruction of the disability service market. It demonstrates that organisations are facing challenges in adapting to the new market context and seek advice about adaptation from a stratified set of sources. [ABSTRACT FROM AUTHOR]

While social and public policy studies recognize the diversity of actors and processes occurring in the implementation of policy and the organization of public service delivery, analysis of the role of value pluralism in implementation remains underdeveloped. This article contributes to a more nuanced understanding of the relationship between value pluralism and organizational responses to value conflict by exploring the effect of politics on the value choices of senior public servants involved in the design and implementation of Australia's National Disability Insurance Scheme. Our analysis shows that politics may play an essential role in facilitating implementation of a complex social policy that contains a number of incommensurable values because successful politics allows these incommensurable values to co‐exist and adaption to take place, thereby avoiding organizational dysfunction. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Crossing boundaries, hitting barriers," by Adina Payton and Mary Lou Zoback.

Background: Previous research on employee well-being for those who have experienced social and economic disadvantage and those with previous or existing mental health conditions has focused mainly on programmatic interventions. The purpose of this research was to examine how organisational structures and processes (such as policies and culture) influence well-being of employees from these types of backgrounds.Methods: A case study ethnographic approach which included in-depth qualitative analysis of 93 semi-structured interviews of employees, staff, and managers, together with participant observation of four social enterprises employing young people.Results: The data revealed that young people were provided a combination of training, varied work tasks, psychosocial support, and encouragement to cultivate relationships among peers and management staff. This was enabled through the following elements: structure and space; funding, finance and industry orientation; organisational culture; policy and process; and fostering local service networks.. The findings further illustrate how organisational structures at these workplaces promoted an inclusive workplace environment in which participants self-reported a decrease in anxiety and depression, increased self-esteem, increased self-confidence and increased physical activity.Conclusions: Replicating these types of organisational structures, processes, and culture requires consideration of complex systems perspectives on implementation fidelity which has implications for policy, practice and future research. [ABSTRACT FROM AUTHOR]

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly. [ABSTRACT FROM AUTHOR]

In this article, we describe the sources of funding cited, and topics of research associated with that funding, in Australian disability research. We conducted a systematic search for publicly available peer-reviewed papers reporting the findings of Australian disability research studies focused on Australia in the 2018–2020 period. Papers identified were analyzed according to research topic, participant group, study methodology, and funding sources acknowledged. In total, 1,241 relevant papers were identified. Of these, 582 papers (47%) reported at least one funding source. Government sources accounted for most funding identified (n = 487), followed by university sector (n = 112), nongovernment organizations (n = 99) and for-profit organization funding (n = 17). The most funding went to intellectual disability (22%), autism (15%), and psychosocial disability (12%). Only 16 (1.3%) papers citing funding sources reported their research was conducted in partnership with people with disability. Research funding influences the priorities of disability research, how it is conducted, and its outputs. Funding therefore shapes the information available to build evidence-based systems of service and support for and with people with disability. It is essential that research funding policies are considered in relation to broader disability policy goals and the research priorities of the disability community. [ABSTRACT FROM AUTHOR]

Participation in an ensemble is a significant aspect of tertiary music experience. Learning and assessment practices within ensembles have rarely been investigated in Australia and the perceptions of staff and students as to how they learn and are assessed within ensembles remain largely unexplored. This paper reports on part of a larger project that investigated learning and assessment practices within ensembles at an Australian Conservatorium of Music. Ensembles contribute to approximately 25% of student work in each semester, and the assessment contributes to a final grade for the semester. Using a case study methodology, four music ensembles were studied. The data generated were coded into themes including assessment practices and processes; collaborative learning practices; the development of the professional musician; and communication and transparency between participants and the institution. Findings revealed that both staff and student participants in this study perceived ensemble participation to be valuable to the development of a professional musician, but that assessment procedures did not always support this goal. Institutional demands were found to be an inhibiting factor in the assessment of ensembles, and both students and teachers had problems with current assessment procedures, resulting in confusion and lack of transparency about how ensembles are assessed. Approaches to the development of the professional musician became a dominant discussion point and a substantial finding of the research. By examining dominant and subjugated knowledge in this domain, institutional power relations were interrogated, existing practices were challenged, and assessment practices rethought. [ABSTRACT FROM PUBLISHER]

There is debate within the health promoting school (HPS) movement on whether schools should monitor health behaviour outcomes as part of an evaluation or rely more on process type measures, such as changes to school policies and the physical and social environment which yield information about (in) effective implementation. The debate is often framed around ideological considerations of the role of schools and there is little empirical work on how these indicators of effective implementation can influence change at a policy and practice level in real world settings. Information has potentially powerful effects in motivating a change process, but this will vary according to the type of information and the type of organizational culture into which it is presented. The current predominant model relies on process data, policy and environmental audit monitoring and benchmarking approaches, and there is little evidence of whether this engages school communities. Theoretical assertions on the importance of monitoring data to motivate change need to be empirically tested and, in doing so, we can learn which types of data influence adoption of HPS in which types of school and policy contexts. [ABSTRACT FROM AUTHOR]

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such ‘regulatory interventions’ between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as ‘obesogenic environments’, and the deployment of ‘protecting kids’, ‘industry demonization’ and ‘economic costs’ frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The ‘productive power’ and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from ‘nanny-state’ intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict ‘evidence-based’ policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity. [ABSTRACT FROM AUTHOR]

Church-based health promotion has increasingly gained attention in strategies to address health disparities. In Australia, we have limited understanding of the role of local churches in health promotion and without this, how they might be involved in meaningful partnerships to tackle public health challenges. The objective of this qualitative study was to explore how churches are involved in health promotion in the state of Victoria. The research involved in-depth interviews with ministers from 30 churches in urban and rural Victoria, and case studies with 10 of these churches to enable further exploration. These case studies, conducted in 2010, included interviews with church staff, focus groups with volunteers, participant observation and document analysis. Analysis was iterative, utilising open, axial and thematic coding. Three different expressions of church - traditional, new modern and emerging - were identified and found to differentiate the levels and types of health promotion activity. Case studies illustrate the different expressions of how church mission influences health promotion activity. The traditional churches were involved particularly in disease screening and health education activities with their own, predominantly older congregation members. The new modern churches tended to have the material and human resources to be harnessed in health promotion activities involving congregation members and others. Emerging churches, in contrast, engaged in broad health-promoting activities, including disease prevention, lifestyle activities and socio-ecological approaches at a community level. These research findings highlight the opportunities and challenges of engaging with local churches in health promotion efforts and public health programmes to address health inequities. [ABSTRACT FROM AUTHOR]

The Mycobacterium tuberculosis complex CFP-10/ESAT-6 family proteins play essential but poorly defined roles in tuberculosis pathogenesis. In this article we report the results of detailed spectroscopic studies of several members of the CFP-10/ESAT-6 family. This work shows that the CFP-10/ESAT-6 related proteins, Rv0287 and Rv0288, form a tight 1:1 complex, which is predominantly helical in structure and is predicted to closely resemble the complex formed by CFP-10 and ESAT-6. In addition, the Rv0287·Rv0288 complex was found to be significantly more stable to both chemical and temperature induced denaturation than CFP-10ESAT-6. This approach demonstrated that neither Rv0287·Rv0288 nor the CFP-10ESAT-6 complexes are destabilized at low pH (4.5), indicating that even in low pH environments, such as the mature phagosome, both Rv0287·Rv0288 and CFP-10ESAT-6 undoubtedly function as complexes rather than individual proteins. Analysis of the structure of the CFP-10·ESAT-6 complex and optimized amino acid sequence alignments of M. tuberculosis CFP-10/ESAT-6 family proteins revealed that residues involved in the intramolecular contacts between helices are conserved across the CFP-10/ESAT-6 family, but not those involved in primarily intermolecular contacts. This analysis identified the molecular basis for the specificity and stability of complex formation between CFP-10/ESAT-6 family proteins, and indicates that the formation of functional complexes with key roles in pathogenesis will be limited to genome partners, or very closely related family members, such as Rv0287/Rv0288 and Rv3019c/Rv3020c. [ABSTRACT FROM AUTHOR]