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Background: Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study., Methods: This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA., Discussion: This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment., (© 2024. The Author(s).)

We consider how lived experience might actively inform policy design. Good policy design calls for analysis of problems, how they might be addressed, and likely outcomes. Policy scholars and practitioners have devised methods that bring rigor to policy design through problem framing, assessment of potential interventions, and prediction of outcomes of those interventions. This pursuit of analytical and predictive rigor has often given short shrift to the insights of people whose lives are affected by current challenges and who will be impacted by policy change. Our theory of change is that creative engagement with citizens can generate insights of high value to the process of policy design. We introduce the Tomorrow Party - a design method for generating novel stakeholder insights regarding desirable future states. We then discuss initial findings from a series of pilots. Those findings suggest the Tomorrow Party is a broadly applicable creative tool for advancing policy design., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objectives: To (i) develop a methodology for using historical and comparative perspectives to inform policy and (ii) provide evidence for antimicrobial-resistance (AMR) policymaking by drawing on lessons from climate change and tobacco control., Methods: Using a qualitative design, we systematically examined two other complex, large-scale policy issues-climate change and tobacco control-to identify what relevance to AMR can be learned from how these issues have evolved over time. During 2018-2020, we employed a five-stage approach to conducting an exploratory study involving a review of secondary historical analysis, identification of drivers of change, prioritisation of the identified drivers, scenario generation and elicitation of possible policy responses. We sought to disrupt more 'traditional' policy and research spaces to create an alternative where, stimulated by historical analysis, academics (including historians) and policymakers could come together to challenge norms and practices and think creatively about AMR policy design., Results: An iterative process of analysis and engagement resulted in lessons for AMR policy concerning persistent evidence gaps and uncertainty, the need for cross-sector involvement and a collective effort through global governance, the demand for new interventions through more investment in research and innovation, and recognising the dynamic relationship between social change and policy to change people's attitudes and behaviours are crucial towards tackling AMR., Conclusion: We draw on new methodological lessons around the pragmatism of future- and policy-oriented approaches incorporating robust historical and comparative analysis. The study demonstrates proof of concept and offers a reproducible method to advance further methodology, including transferrable policies that could tackle health problems, such as AMR., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The implementation of Personal Carbon Trading (PCT) holds promise in facilitating a noteworthy contribution towards the attainment of emissions reduction predicated on consumption patterns and consequently motivating lifestyle modifications. As individual consumption behaviors usually lead to continuous changes in carbon emissions, it is crucial to rethink PCT from a systematic perspective. This review employed a bibliometric analysis of 1423 papers related to PCT, highlighting the key themes of carbon emissions from energy consumption, climate change, and public opinion on policies in the context of PCT. Most of the existing PCT researches focus on theoretical assumptions and public attitudes, while the quantification of carbon emissions and simulation of PCT require further investigation. Furthermore, the concept of Tan Pu Hui is seldom addressed in PCT studies and case analyses. Moreover, there are limited PCT schemes worldwide that can be directly implemented in practice, leading to a scarcity of large-scale, high-participation case studies. To address these gaps, this review proposes a framework to clarify how PCT can stimulate individual emission reductions on the consumption side, comprising two phases, from motivation to behavior and behavior to target. Future endeavors should prioritize the enhancement of the systematic study of the theoretical foundation of PCT, encompassing carbon emissions accounting and policy design, the incorporation of cutting-edge technology, and the reinforcement of integrated policy practice. This review serves as a valuable reference for future research endeavors and policymaking efforts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Latin America and the Caribbean is one of the regions threatened most by natural events owing to the highly vulnerable circumstances of its urban centres. Consequently, its cities are occasionally affected by one or more disaster types, exposing problems of governance and public policy in relation to risk management. The aim of this research is to investigate the factors that influence the design of post-disaster policies. It hypothesises that in those countries with modes of governance characterised by greater articulation between State and non-State actors, the design of post-disaster policies tends to be more coherent. Methodologically, the study proposes a comparative analysis of post-disaster policies in three countries of the region affected by earthquakes: Haiti and Chile (in 2010) and Ecuador (in 2016). The findings show that co-governance in Chile resulted in optimal post-disaster policies, whereas hierarchical governance in the cases of Haiti and Ecuador led to unsuccessful and misdirected post-disaster policies, respectively., (© 2022 The Authors Disasters © 2022 ODI.)

The comparative study of health policy has focused mainly on the macro-structural dimensions of health systems and reforms that have sought to change these organizational arrangements. Thus, a great deal of attention has been paid to the multiple models of insurance against sickness risks and various modes of organizing and financing healthcare providers. However, little attention has been paid to policy tools and policy design in the health policy domain. This research gap largely impedes a focus on the micro (granular) dimension of health policy, although this is the level at which health policies impact reality and thus deliver progress toward the expected goals. Such a focus on the micro dimension could not only allow a finer-grained comparison of how health systems work but also shed light on how capable health policies are of achieving the expected outcomes. This paper fills this gap by presenting an analytical framework capable of illuminating the granular dimension of policy design (the instrumental delivery package) and shows the analytical relevance of the framework by applying it to the designs of maximum waiting time guarantee and vaccination mandate policies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Capano and Toth.)

The link between policy design choices and health is an important, yet understudied area of public health research. I investigate the impact of the generosity, inclusion, and autonomy of state paid sick leave laws on influenza-like-illness (ILI) rates and its components using data from the Centers for Disease Control and state-level paid sick leave statutes. I found that paid sick leave policies that include small firms and that allow for a larger number of medical uses have lower ILI rates, relative to states with less comprehensive policies. States with policies that had more generous accrual rates and that included a wide variety of worker types (temporary, part-time, students) increased the total number of reported medical cases, relative to states with less comprehensive policies. Policymakers contemplating paid sick leave policies should consider these design choices in their goals to incentivize health care utilization and to reduce contagion., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

The public acceptability of a policy is an important issue in democracies, in particular for anti-COVID-19 policies, which require the adherence of the population to be applicable and efficient. Discrete choice experiment (DCE) can help elicit preference ranking among various policies for the whole population and subgroups. Using a representative sample of the French population, we apply DCE methods to assess the acceptability of various anti-COVID-19 measures, separately and as a package. Owing to the methods, we determine the extent to which acceptability depends on personal characteristics: political orientation, health vulnerability, or age. The young population differs in terms of policy preferences and their claim for monetary compensation, suggesting a tailored policy for them. The paper provides key methodological tools based on microeconomic evaluation of individuals' preferences for improving the design of public health policies., Competing Interests: None., (© 2022 Published by Elsevier B.V.)

Background: Despite Uganda and other sub-Saharan African countries missing their maternal mortality ratio (MMR) targets for Millennium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions designed to reduce maternal deaths in Uganda and identified particular policy design issues that underpinned MDG 5 performance. We suggest a novel prescriptive and analytical (re)conceptualization of policy in terms of its fidelity to '3Cs' (coherence of design, comprehensiveness of coverage and consistency in application) that could have implications for future healthcare programming., Methods: We conducted a retrospective study. Sixteen Ugandan maternal health policy documents and 21 national programme performance reports were examined, and six key informant interviews conducted with national stakeholders managing maternal health programmes during the reference period 2000-2015. We applied the analytical framework of the 'three delay model' combined with a broader literature on 'policy mixing.', Results: Despite introducing fourteen separate policy instruments over 15 years with the goal of reducing maternal mortality, by the end of the MDG period in 2015, only 87.5% of the interventions for the three delays were covered with a notable lack of coherence and consistency evident among the instruments. The three delays persisted at the frontline with 70% of deaths by 2014 attributed to failures in referral policies while 67% of maternal deaths were due to inadequacies in healthcare facilities and trained personnel in the same period. By 2015, 37.3% of deaths were due to transportation issues., Conclusion: The piecemeal introduction of additional policy instruments frequently distorted existing synergies among policies resulting in persistence of the three delays and missed MDG 5 target. Future policy reforms should address the 'three delays' but also ensure fidelity of policy design to coherence, comprehensiveness and consistency., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

This paper assesses the financing gap faced by innovative start-ups in the European Union (EU) when they reach the scaling-up stage of their development. It draws on data collected through a seminar involving 117 experts representing start-ups and scale-ups, financial actors, academia, and EU policymakers and aimed at investigating the causes, consequences, and policy solutions of the scale-up gap in the EU. Besides highlighting supply-side deficiencies, the seminar also emphasised weaknesses in both the demand side of the scale-up gap and the EU ecosystem for high-growth entrepreneurship. The paper offers policy recommendations, highlighting the need for policy solutions involving private actors and specifically targeting scale-ups. The paper also calls for more robust research on measuring the scale-up financing gap and its economic impact to improve the policy response., (© 2022 The Authors.)

Introduction: The multi-disciplinary care offered to patients with multi-morbidities offers a powerful example of the practical challenges faced by the National Health Service's planned move to more closely integrated models of care., Purpose, Objective, and Contributions: The intention of this work was to identify the opportunities and obstacles presented by the current provision of integrated care and explore their implications for existing and future policy initiatives., Materials and Methods: We conducted a qualitative exploration of the experiences of senior managers, commissioners and clinicians, using a post-hoc content analysis to populate and present the results within the multi-componential Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework designed to understand integrated care., Results: A total of 13 senior medical directors, commissioners, and managers, and 15 clinicians from a range of care settings were interviewed. Relative factors within the six framework components were identified namely; issues around communication between settings (Service delivery), the importance of collaborative leadership (Leadership & governance); the need for high-level collaboration (Workforce), better directed financial incentives (Financing), the lack of software interoperability (Technologies and medical products) and constraints on sharing and utilising patient data (Information & Research)., Conclusions: The SELFIE framework has provided valuable insight into the challenges presented by inter-organisational and inter-professional working that will help guide the design and implementation of policies promoting integrated care. These may be mitigated by sharing the varied experiences and priorities that exist across primary and care settings, alongside improving communication and supporting collaborative leadership. There also appears a clear role for refocussing financial incentives to reward shared responsibility at all levels of service delivery., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Squires et al note that too many people use terms like 'context' imprecisely. The result (to avoid) is a catch-all term that lacks explanatory value and hinders the efforts of policy designers. Their list of 66 factors is a useful exercise to unpack what people mean when describing context. However, some problems will arise when the authors seek to move from research to practice. First, the list is too long to serve its purpose. Second, in many cases, it categorises rather than operationalises key terms. The result is the replacement of one vague term with a collection of others. Third, many categories describe what policy designers might need, rather than what they can reasonably expect to happen. In that context, wider studies of implementation and complex systems provide cautionary tales in which the outcomes of research become overwhelming rather than practical., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Since January 2020, the COVID-19 pandemic has caused millions of deaths and has posed a major public health threat worldwide. Such a massive and complex crisis requires quick and comprehensive policy responses. We developed an empirical dataset of policy mixes that included 4915 policies across 36 Chinese cities and investigated the relationships between the policy design choices and the COVID-19 pandemic response outcomes of a city. Using topic modeling and ordinary least squares regression analysis, we found considerable variation among cities in the compositions and design features of their policy mixes. Our analysis revealed that restriction measures did not significantly influence limiting the spread of the pandemic, but they were negatively correlated with the economic growth rate. By contrast, health protection measures greatly contributed to controlling viral spread. Intensive socioeconomic support reduced the occurrence of secondary disasters. The most effective policy strategy to deal with the COVID-19 pandemic appears to be a comprehensive policy design with a mix of restrictions, health protection measures, and socioeconomic support policies accompanied by a timely lockdown. Our empirical findings can help to improve pandemic policy design and contribute to generating broader lessons for how local governments should deal with similar crises in the future.

The SARS-Cov-2 has spread differently over space and time worldwide. By monitoring the contagion's time evolution, the November 3 2020 the Italian government introduced differentiated regime of restrictions among its regions. This experiment demonstrated that public health policies can be effectively designed by means of clustering. This paper proposes a fuzzy clustering model where spatial and temporal dimensions of the disease spread are optimally weighted. The resulting model is applied with the aim of identifying groups of Italian regions with similar contagion spread. We found that two groups of regions sharing similar patterns of COVID-19 spread over both space and time exist. Appropriate public health policies can be designed on the basis of this evidence., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

We draw on the Institutional Grammar Tool's rule types to empirically analyze the design of four major procedural regulatory instruments in the 27 member states of the European Union and the UK. They are: consultation, regulatory impact assessment, freedom of information, and the Ombudsman. By adopting the Institutional Grammar Tool as conceptual lens we end up with a single measurement template applicable to a variety of action situations. We derive measures that are conceptually robust and suitable for comparative analysis. With original data gathered on the official legal base in the 28 cases, we carry out principal components analysis. We identify design patterns across countries and instruments; the specialization of each instrument in terms of rule type; and the components that best explain cross-country variation. In the conclusions we argue that to reframe the design features of the four instruments in conceptual, theoretical categories is not simply a taxonomical exercise but it extends to the territory of comparative policy analysis, practice and reform., (© 2021 The Authors. Policy Studies Journal published by Wiley Periodicals LLC on behalf of Policy Studies Organization.)

During the COVID-19 emergency, cities around the world introduced measures to guarantee physical distancing that restricted access to urban parks and green areas, with potentially negative effects on citizens' health and wellbeing. This study aims at providing insights to manage access to urban green space in physical distancing times, when the risk of crowding should be avoided. Using the city of Trento (Italy) as a case study, the study simulates policy scenarios corresponding to different restrictions and assesses their effects on green space access and crowding. Policy scenarios are obtained by combining different distances that people are allowed to travel, different types of green areas available for public use (only urban parks or parks and schoolyards), and different target populations (all residents or only people with no private gardens). The results unveil the trade-off between access and crowding of green areas, and can be used to suggest policy interventions and regulations that can be adopted in an emergency. Particularly, the study shows that: i) The relationship between distance threshold and the percentage of people with access to green areas is non-linear, and this should be carefully considered when proposing travel restrictions; ii) Changing the maximum travel distance does not produce major effects on the number of crowded green areas, hence additional or alternative measures need to be adopted; iii) Off-the-shelf measures, such as opening schoolyards, are beneficial and can be implemented rapidly in an emergency. Finally, the study reveals "hotspots" of green space deprivation/overcrowding in the city that should be addressed by urban planning to ensure that green space continues to benefit citizens also during emergency conditions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Social entrepreneurship in social work is presented in the literature as an important practice considering its ability to provide long-term, innovative, and creative interventions for social problems. However, many doubt the ability of social workers to act as social entrepreneurs. This study examined action strategies adopted by social workers who established innovative services to address social problems. Data were collected from qualitative in-depth interviews conducted with 23 successful social work entrepreneurs. Research findings revealed seven action strategies that have the potential to promote successful social entrepreneurship in social work: (1) coalition building, (2) legislative advocacy, (3) media use, (4) legislative tools, (5) active use of social network: "street smarts," (6) development of a resource infrastructure, and (7) cultural norms and traditions. The study provides insight into the various ways to succeed in social work entrepreneurship; to identify opportunities in education and practice for entrepreneurship in social work; and to serve as an effective, innovative guide to address the complex social problems facing social workers., (© 2021 National Association of Social Workers.)

When addressing complex societal problems, public regulation is increasingly complemented by private regulation. Extant literature has provided valuable insights into the effectiveness of such complex governance structures, with most empirical studies focusing on how public regulation influences private regulation. Conversely, the impact of private on public regulation is less well studied. Here, we investigate this impact with a focus on technological change as possible mechanism. Based on a case study of energy efficiency in buildings in Switzerland, we find evidence of a symbiotic interaction between public and private regulation that leads to ratcheting-up of regulatory stringency. We identify technological change as the mechanism linking private and public regulation. We discuss the relevance of our findings for governance literature and regulators., (© 2020 The Authors. Regulation & Governance Published by John Wiley & Sons Australia, Ltd.)

Background: Previous studies report a majority of the general public support euthanasia/assisted dying (EAD), while a majority of doctors are opposed. In considering policy decisions about EAD, some may discount the views of doctors because they take them to be based on personal values or tradition, rather than reasons that the general public might share. One way to explore this notion is to examine whether medical students' views change during their medical education. The objective of this study was to learn how New Zealand medical students view EAD and whether students at different year levels have different views., Methods: An on-line survey of undergraduate medical students was conducted asking whether they supported a law change to allow EAD. Quantitative data was analysed using unadjusted and multiple logistic regression. Thematic analysis was conducted with the qualitative data., Results: A total of 326 students replied to the survey. The overall response rate was 28%. 65% of 2nd year students were supportive of EAD, compared to 39% in 5th year. The odds of 5th year students supporting a law change compared to 2nd year was 0.30 (95% CI: 0.15-0.60). The predominant themes found in the qualitative results indicate that medical students support or oppose EAD for reasons similar to those found in the wider debate, and that their views are influenced by a range of factors. However, several at all year levels cited an aspect of medical school as having influenced their views. This was mentioned by participants who were supportive of, opposed to, or unsure about EAD, but it was the type of influence most often mentioned by those who were opposed., Conclusions: The quantitative findings show students at the end of 5th year were less likely to support EAD than students at the end of 2nd year. We suggest that this difference is most likely due to their time in medical education. This suggests that the lower support found among doctors is in part related to medical education and medical work rather than age, personality, or social context. The qualitative findings indicate that this is not related to a particular educational experience at Otago Medical School but a range.

While instruments to price congestion exist since the 1970s, less than a dozen cities around the world have a cordon or zone pricing scheme. Geneva, Switzerland, may be soon joining them. This paper builds on a detailed review of the existing schemes to identify a set of plausible design options for the Geneva congestion charge. In turn, it analyzes their acceptability, leveraging a large survey of residents of both Geneva and the surrounding areas of Switzerland and France. Our original approach combines a discrete choice experiment with randomized informational treatments. We consider an extensive set of attributes, such as perimeter, price and price modulation, use of revenues, and exemption levels and beneficiaries. The informational treatments address potential biased beliefs concerning the charge's expected effects on congestion and pollution. We find that public support depends crucially on the policy design. We identify an important demand for exemptions, which, albeit frequently used in the design of environmental taxation, is underexplored in the analysis of public support. This demand for exemptions is not motivated by efficiency reasons. It comes mostly by local residents, for local residents. Further, people show a marked preference for constant prices, even if efficiency would point to dynamic pricing based on external costs. Hence, we highlight a clear trade-off between efficiency and acceptability. However, we also show, causally, that this gap can in part be closed, with information provision. Analyzing heterogeneity, we show that preferences vary substantially with where people live and how they commute. Even so, we identify several designs that reach majority support., (© The Author(s) 2021.)

Effectiveness has been understood at three levels of analysis in the scholarly study of policy design. The first is at the systemic level indicating what entails effective formulation environments or spaces making them conducive to successful design. The second reflects more program level concerns, surrounding how policy tool portfolios or mixes can be effectively constructed to address complex policy objectives. The third is a more specific instrument level, focusing on what accounts for and constitutes the effectiveness of particular types of policy tools. Undergirding these three levels of analysis are comparative research concerns that concentrate on the capacities of government and political actors to devise and implement effective designs. This paper presents a systematic review of a largely scattered yet quickly burgeoning body of knowledge in the policy sciences, which broadly asks what capacities engender effectiveness at the multiple levels of policy design? The findings bring to light lessons about design effectiveness at the level of formulation spaces, policy mixes and policy programs. Further, this review points to a future research agenda for design studies that is sensitive to the relative orders of policy capacity, temporality and complementarities between the various dimensions of policy capacity., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

The COVID-19 pandemic has forced governments to impose major restrictions on individual freedom in order to stop the spread of the virus. With the successful development of a vaccine, these restrictions are likely to become obsolete-on the condition that people get vaccinated. However, parts of the population have reservations against vaccination. While this is not a recent phenomenon, it might prove a critical one in the context of current attempts to manage the COVID-19 pandemic. Consequently, the task of designing policies suitable for attaining high levels of vaccination deserves enhanced attention. In this study, we use data from the Eurobarometer survey fielded in March 2019. They show that 39% of Europeans consider vaccines to cause the diseases which they should protect against, that 50% believe vaccines have serious side effects, that 32% think that vaccines weaken the immune system, and that 10% do not believe vaccines are tested rigorously before authorization. We find that-even when controlling for important individual-level factors-ideological extremism on both ends of the spectrum explains skepticism of vaccination. We conclude that policymakers must either politicize the issue or form broad alliances among parties and societal groups in order to increase trust in and public support for the vaccines in general and for vaccines against COVID-19 in particular, since the latter were developed in a very short time period and resulted-in particular in case of the AstraZeneca vaccine-in reservations because of the effectiveness and side effects of the new vaccines., Supplementary Information: The online version contains supplementary material available at 10.1007/s11077-021-09428-0., (© The Author(s) 2021.)

Background: The global policy discourse on sustainability and health has called for dietary transformations that require diverse, concerted actions from governments and institutions. In this article, we highlight the need to examine sociocultural influences on food practices as precursors to food policy decisions., Discussion: Sociocultural food practices relate to ideas and materials that give rise to food choices and food patterns of a group. We begin with a discussion of how individuals experience, interpret, negotiate, and symbolize the food world around them. We examine primarily the ideational pathways, such as identity, gender, religion, and cultural prohibitions, and their influence on food practices. We then provide guiding questions, frameworks, and a brief overview of food choice values to support policy planning and design. Lastly, we explore how sociocultural change for sustainable or healthy diets is already happening through food movements, food lifestyles, and traditional diets.

The continued spread of COVID-19 suggests a significant possibility of reimposing the lockdowns and stricter social distancing similar to the early phase of pandemic control. We present a dynamic model to quantify the impact of isolation for the contagion curves. The model is calibrated to the COVID-19 outbreak in Spain to study the effects of the isolation enforcement following the declaration of the state of alarm (14 March 2020). The simulations indicate that both the timing and the intensity of the isolation enforcement are crucial for the COVID-19 spread. For example, a 4-day earlier intervention for social distancing would have reduced the number of COVID-19 infected people by 67%. The model also informs us that the isolation enforcement does not delay the peak day of the epidemic but slows down its end. When relaxing social distancing, a reduction of the contagion probability (with the generalization of preventive actions, such as face mask wearing and hands sanitizing) is needed to overcome the effect of a rise in the number of interpersonal encounters. We report a threshold level for the contagion pace to avoid a second COVID-19 outbreak in Spain.

Forests increasingly will be used for carbon dioxide removal (CDR) as a natural climate solution, and the implementation of forest-based CDR presents a complex public policy challenge. In this paper, our goal is to review a range of policy tools in place to support use of forests for CDR and demonstrate how concepts from the policy design literature can inform our understanding of this domain. We explore how the utilization of different policy tools shapes our ability to use forests to mitigate and adapt to climate change and consider the challenges of policy mixes and integration, taking a close look at three areas of international forest policy, including the Kyoto Protocol's Clean Development Mechanism, Reducing Emissions from Deforestation and Forest Degradation (REDD+) and voluntary carbon offset markets. As it is our expertise, we then examine in detail the case of the USA as a country that lacks aggressive implementation of national climate policies but has potential to increase CDR through reforestation and existing forest management on both public and private land. For forest-based CDR to succeed, a wide array of policy tools will have to be implemented in a variety of contexts with an eye towards overcoming the challenges of policy design with regard to uncertainty in policy outcomes, policy coherence around managing forests for carbon simultaneously with other goals and integration across governance contexts and levels., Competing Interests: We declare we have no competing interests., (© 2020 The Author(s).)

Food reformulation policies aimed at reducing the risk of diet-related non-communicable diseases have been implemented in many countries. The degree of success of reformulation policies in changing the range of food options available to consumers has been a function of the design of these policies. Our objective was to review the different factors making the design and implementation of a food reformulation policy effective at improving populations' diets and health. In this narrative review, we present a logic model of the action of reformulation policies on consumer behaviour, dietary intake and population health. We set out how policy design could drive outcomes, and highlight the role for governments and public health agencies in promoting food reformulation that is effective in improving diet and health. The key drivers of success for reformulation policies include strong incentives, a tight implementation strategy, a focus on the overall nutritional quality of food products, rather than on individual nutrients, and effective monitoring and evaluation. Additionally, policies should mark the distinction between product reformulation and product differentiation, which have different nutrition and health outcomes.

Italy was the first large epicentre of the COVID-19 pandemic in the Western world. Since the country has not had any serious experience with this kind of disease in recent decades, its response has been indicative of a first reaction to an (un)known and (un)expected event. At the same time, the Italian experience is an emblematic case of how a lack of specific preparedness measures drives a country to deal with this kind of crisis through a process in which the existing characteristics of the policy and political system, with all their pros and cons, prevail. This means that the existing country characteristics that affects policy design, state capacity, institutional arrangements and political games forge the process and content of the response. Based on this observation, this paper analyses the policy dynamics of the first four months of management of the COVID-19 outbreak in Italy, focusing on how the health and economic responses were designed and implemented., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Aim: This article aims to explore how policymakers conceptualise a person suitable for disability income support (DIS) and how this compares across two settings - Australia and Canada. Methods: A constructivist grounded theory approach was used; 45 policymakers in Australia and Canada were interviewed between March 2012 and September 2013. All policymakers are or were influential in the design or assessment of DIS. Results: Results found that the policymakers in both jurisdictions define a suitable person as having as an 'ideal type' of disability with five features - visibility, diagnostic proof, permanency, recognition as a medical illness and perceived as externally caused. Many of the policymakers described how mental illnesses are not an 'ideal type' of disability for DIS by juxtaposing the features of mental illnesses against physical illnesses. As such, mental illnesses were labelled imperfect disabilities and physical illnesses as 'ideal type' for DIS. Conclusions: The rise of DIS recipients has divided the once protected 'deserving' category of the disabled into more ('ideal type' of disability) and less deserving (imperfect disability). Such conceptualisations are important because these categories can influence the allocation of welfare resources.

Despite an increasing number of people exposed to flood risks in Europe, flood risk perception remains low and effective flood risk management policies are rarely implemented. It becomes increasingly important to understand how local governments can design effective flood risk management policies to address flood risks. In this article, we study whether high flood exposure and flood risk perception correlate with the demand for a specific design of flood risk management policies. We take the ideal case of Switzerland and analyze flood risk management portfolios in 18 flood-prone municipalities along the Aare River. We introduce a novel combination of risk analysis and public policy data: we analyze correlations between recorded flood exposure data and survey data on flood risk perception and policy preferences for selected flood risk management measures. Our results indicate that local governments with high flood risk perception tend to prefer non-structural measures, such as spatial planning and ecological river restoration, to infrastructure measures. In contrast, flood exposure is neither linked to flood risk perception nor to policy preferences. We conclude that flood risk perception is key: it can decisively affect local governments' preferences to implement specific diversified policy portfolios including more preventive or integrated flood risk management measures. These findings imply that local governments in flood-prone areas should invest in raising their population's awareness capacity of flood risks and keep it high during periods without flooding., (© The Author(s) 2020.)

The high cost of drugs for hepatitis C limits access and adherence to treatment. In 2017, the Colombian health care system decided to design a strategy. It consisted of centralized purchasing, regulations, clinical practice guidelines, and direct observation of the treatment and follow-up of patients. The main objective of this study was to assess the centralized purchasing strategy in Colombia. The study design was a policy implementation assessment. We analyzed the change in prices, the clinical outcomes, and the opinions of stakeholders using data from the Ministry of Health. Additional information about effectiveness came from the Colombian Fund for High-Cost Diseases and semi-structured interviews of the stakeholders. The follow-up was from October, 2017 to October, 2018. The total number of patients reported in the cohort period was 1069. The number that finished 12 weeks of treatment, completed the follow-up for the case closure, and were considered cured through the end of October, 2018 was 563 (53%). The remainder, 506 patients (47%), are currently in treatment. A total of 543 of these treated patients (96%) were cured. After implementing this strategy, the drug prices decreased by more than 90% overall. Before implementation, the total direct cost was $100 102 171.75 dollars. Afterward, the cost was $8 378 747 dollars., Competing Interests: None of the authors have a conflict of interest., (© 2019 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.)

It is broadly accepted that health policy is crucially affected by contextual conditions. Yet, little is known about how the context limits the effectiveness of public health insurance (PHI) programs and the extent to which these limitations could be overcome. The objective of the paper is to address these issues on the basis of the examination of 17 PHI schemes introduced by federal and state governments in India since independence. Faced with the challenge of simultaneously expanding insurance coverage while containing costs, governments have overwhelmingly favored the latter. At the same time, governments have lacked the capacity to monitor performance, which has led providers to compromise quality in return for low payment rates. While there have been modest improvements in recent years, reform efforts have been hindered by contextual conditions that constrain the use of measures to control profiteering by for-profit agencies. The paper argues that system-wide data on the quality of providers (system-level operational capacity) and the ability of public agencies to monitor quality and link it with payment (organizational-level operational capacity) critically determined the program effectiveness. We demonstrate the interaction between contextual variables, program design elements, and policy capacity linking to performance, arguing for a broader approach to understand PHI performance. We extend the present frameworks on PHI effectiveness that have narrowly focused on the design of health financing functions without factoring unfavorable context and limited policy capacity in developing countries. The paper contributes to improving PHI performance operating in unfavorable contextual conditions in India and elsewhere., (© 2019 John Wiley & Sons, Ltd.)

Phosphorus is an essential part of the world food web and a non-substitutable nutrient in all biological systems. Losses of phosphorus occur along the food-supply chain and cause environmental degradation and eutrophication. A key global challenge is to meet rising worldwide food demand while protecting water and environmental quality, and seeking to manage uncertainty around potential future phosphorus price or supply shocks. This paper presents a stakeholder-generated conceptual model of potential transformative change for implementing phosphorus sustainability on the island of Ireland via an 'All-Island Phosphorus Sustainability' workshop. Key transition pathways identified by stakeholders included: incentivising phosphorus recovery, developing collaborative networks to facilitate change, developing markets and value chains for recovered products; implementing data-informed practices on-farm to prevent losses and increase efficiencies, and harmonisation of technologies with end-user needs. A comparable model was previously produced for the North American region. We describe consensus and differences around key priorities between the two regions' conceptual models, and assess how the model produced for the island of Ireland can effect system-wide change and policy moving forward. Many of the transitional pathways and future aspirations presented in both models resonate globally and are highly pertinent to other jurisdictions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This article is an attempt to bridge the divide between academics and practitioners. Informed by both design theory and the reality of policy work, its focus is on 'problems'. From a practitioners' perspective, policy design is both an intellectual and political process, an inevitable oscillation between 'puzzling' and 'powering', in which 'messy' or unstructured problems are re-structured from problems as webs of 'undesirable situations' to problems as specific, time-and-space bound 'opportunities for improvement'. This requires a questioning habitus in practitioners of policy design. Using a socio-cognitive theory of problem processing, this paper shows how policy design is an iterative process of problem sensing, problem categorization, problem decomposition and problem definition. For each of these stages, appropriate rules-of-thumb for questioning and answering can be suggested that induce thought habits and styles for responsive and solid policy designs.

Infectious livestock disease problems are "biological pollution" problems. Prior work on biological pollution problems generally examines the efficient allocation of prevention and control efforts, but does not identify the specific externalities underpinning the design of efficiency-enhancing policy instruments. Prior analyses also focus on problems where those being damaged do not contribute to externalities. We examine a problem where the initial biological introduction harms the importer and then others are harmed by spread from this importer. Here, the externality is the spread of infection beyond the initial importer. This externality is influenced by the importer's private risk management choices, which provide impure public goods that reduce disease spillovers to others-making disease spread a "filterable externality." We derive efficient policy incentives to internalize filterable disease externalities given uncertainties about introduction and spread. We find efficiency requires incentivizing an importer's trade choices along with self-protection and abatement efforts, in contrast to prior work that targets trade alone. Perhaps surprisingly, we find these incentives increase with importers' private risk management incentives and with their ability to directly protect others. In cases where importers can spread infection to each other, we find filterable externalities may lead to multiple Nash equilibria.

In 2009, Denmark ratified the Convention on the Rights of Persons with Disabilities and thereby acknowledged that Denmark, through policies, plans and programmes, is to work for equal opportunities for persons with disabilities and promote Universal Design in the development of standards, guidelines and e.g. architectural policies. An architectural policy is an acknowledged tool for enhancing the quality of buildings and their surroundings. An important quality of architecture is the ability to include everybody, regardless of gender, sexuality, ethnicity, culture or disability. In 1994, 2004 and again in 2014, Denmark published a national architectural policy. Inclusion as an architectural quality was included, but the focus and terminology changed with every new policy. Based on a desk study about architectural policies, this paper presents how Universal Design is included in Danish municipal architectural policies. On a local level, 34 of 98 Danish municipalities have formulated an architectural policy. None of the architectural policies applies Universal Design, but a few operate with the concept of accessibility, primarily focusing on accessibility for all. This paper discusses how the absence of Universal Design in the architectural policies can be interpreted and how Universal Design can be introduced into future policies.

Just over 10 years ago, we conducted a culture study of the Computer Science Department at the flagship University of Illinois at Urbana-Champaign, one of the top five computing departments in the country. The study found that while the department placed an emphasis on research, it did so in a way that, in conjunction with a lack of communication and transparency, devalued teaching and mentoring, and negatively impacted the professional development, education, and sense of belonging of the students. As one part of a multi-phase case study spanning over a decade, this manuscript presents preliminary findings from our latest work at the university. We detail early comparisons between data gathered at the Department of Computer Science at the University of Illinois at Urbana-Champaign in 2005 and our most recent pilot case study, a follow-up research project completed in 2016. Though we have not yet completed the full data collection, we find it worthwhile to reflect on the pilot case study data we have collected thus far. Our data reveals improvements in the perceptions of undergraduate teaching quality and undergraduate peer mentoring networks. However, we also found evidence of continuing feelings of isolation, incidents of bias, policy opacity, and uneven policy implementation that are areas of concern, particularly with respect to historically underrepresented groups. We discuss these preliminary follow-up findings, offer research and methodological reflections, and share next steps for applied research that aims to create positive cultural change in computing.

This paper articulates the disproportionate policy perspective and uses it to mount four challenges for the new policy design orientation. First, in contrast to the new policy design thinking, disproportionate policy options may be systematically designed, and at times, successfully implemented. Second, in contrast to the new policy design thinking, there are certain conditions under which policymakers may tend to develop effective response, with cost considerations becoming only secondary in importance if at all (read, policy overreaction), or cost-conscious response, with effectiveness considerations becoming only secondary in importance if at all (read, policy underreaction). Third, in contrast to the new policy design thinking, disproportionate policy options may be designed for purposes other than implementation (e.g., to be used as signaling devices or as context-setters). Fourth, in contrast to new policy design thinking, there are certain conditions under which the emotional arena of policy may be equally, if not more, important than the substantive one. The paper concludes that so far the literature on new policy design has not responded to the emergence of the disproportionate policy perspective, but a robust research agenda awaits those answering this paper's call for action., (© Springer Science+Business Media New York 2016.)

Few studies have examined the association between the New Cooperative Medical Scheme (NCMS) policy design and its achievement of providing financial protection to rural residents. This study collected data on NCMS policy design and health care spending from 25 counties and rural households in their catchment areas. It shows that on average, NCMS has a growing but small effect on the reduction of catastrophic medical payment (CMP) incidence. If outpatient spending can be reimbursed from an NCMS pooled account, the incidence of CMP before a reimbursement and that after a reimbursement will be reduced. Higher nominal reimbursement rate for inpatient spending at provincial hospitals is correlated with higher incidence of CMP before a reimbursement. Higher ceiling for annual reimbursement from NCMS is associated with lower incidence of CMP after a reimbursement. Thus, NCMS policy design can be improved to strengthen its effects on the reduction of CMP incidence., (© 2015 APJPH.)

The importance of designing suitable participatory governance processes is generally acknowledged. However, less emphasis has been put on how decision-makers design such processes, and how they learn about doing so. While the policy learning literature has tended to focus on the substance of policy, little research is available on learning about the design of governance. Here, we explore different approaches to learning among German policymakers engaged in implementing the European Floods Directive. We draw on official planning documents and expert interviews with state-level policymakers to focus on learning about the procedural aspects of designing and conducting participatory flood risk management planning. Drawing on the policy learning and evidence-based governance literatures, we conceptualise six types of instrumental 'governance learning' according to sources of learning (endogenous and exogenous) and modes of learning (serial and parallel). We empirically apply this typology in the context of diverse participatory flood risk management planning processes currently unfolding across the German federal states. We find that during the first Floods Directive planning cycle, policymakers have tended to rely on prior experience in their own federal states with planning under the Water Framework Directive to inform the design and carrying out of participatory processes. In contrast, policymakers only sporadically look to experiences from other jurisdictions as a deliberate learning strategy. We argue that there is scope for more coordinated and systematic learning on designing effective governance, and that the latter might benefit from more openness to experimentation and learning on the part of policymakers.

Through 3 broad and interconnected streams of thought, resilience thinking has influenced the science of ecology and natural resource management by generating new multidisciplinary approaches to environmental problem solving. Resilience science, adaptive management (AM), and ecological policy design (EPD) contributed to an internationally unified paradigm built around the realization that change is inevitable and that science and management must approach the world with this assumption, rather than one of stability. Resilience thinking treats actions as experiments to be learned from, rather than intellectual propositions to be defended or mistakes to be ignored. It asks what is novel and innovative and strives to capture the overall behavior of a system, rather than seeking static, precise outcomes from discrete action steps. Understanding the foundations of resilience thinking is an important building block for developing more holistic and adaptive approaches to conservation. We conducted a comprehensive review of the history of resilience thinking because resilience thinking provides a working context upon which more effective, synergistic, and systems-based conservation action can be taken in light of rapid and unpredictable change. Together, resilience science, AM, and EPD bridge the gaps between systems analysis, ecology, and resource management to provide an interdisciplinary approach to solving wicked problems., (© 2014 Society for Conservation Biology.)

More often than not, system dynamics model-based public policy analysis is limited to testing parameter changes instead of designing and testing new stock-and-flow policy structures. That is problematic because improvements in behaviour require improvements in structure. This paper considers how the public policy implementation literature could improve the operational thinking skills required for designing policy structure for public sector models. A familiar model of a public health problem is used to illustrate the recommended approach. And an instructional training strategy is offered for teaching and learning to think operationally during the policy-design stage of modelling. Copyright © 2010 John Wiley & Sons, Ltd., (Copyright © 2010 John Wiley & Sons, Ltd.)