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Background: Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs.Methods: A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected.Results: The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement).Conclusions: The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated. [ABSTRACT FROM AUTHOR]

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This paper aims to illustrate the tension between public health and civil liberties through the case study of the UK government's emergency response to the Covid-19 pandemic. In the area of public health, this tension is predominantly approached by reference to two theories: liberalism and communitarianism. This paper studies these positions and how they are manifested in evidence-based policymaking by combining a study of public health policy with a study of public health ethics. The studies help demonstrate the UK government's framing of health policy relating to Covid-19 in terms of liberalism and communitarianism. The paper concludes that in the initial UK government response to Covid-19, the government discourse evoked communitarian values and framed its policies as being evidence-led and as prioritising public health. However, the policy measures themselves manifested liberal values: they had the underlying concern of not infringing excessively on civil liberties, and individuals were given autonomy of decision making within the measures that were taken. The article concluded that emergency times require a communitarian response based on preventative action. This article is the first to combine public health policy with public health ethics to demonstrate how values form a key part of decision making. [ABSTRACT FROM AUTHOR]

Support for informal dementia care at a local community level is not working for most carers today. Carers looking after a person with dementia have long lamented the absence of an empowered named support and an effectively actioned care plan. Drawing on literary writing and social research, we argue in this article that these challenges have existed since dementia emerged as a major condition in the West during the 1980s. Based on this historical context, we ask: Why has this issue persisted over the last four decades? How have healthcare politics and policy initiatives responded to these requests? And what can we learn from this for the current, COVID-19 exacerbated crisis of care? This article focuses on the English context, to discuss these ongoing challenges in the light of a series of policy papers, and to ask what is hampering the implementation of such policy initiatives. In England, local authorities are responsible for dementia support. This article focuses on the situation in a county in the Midlands where one of us (AB) has been lobbying local government for over a decade. The discussion contextualises the lived experience of dementia care within the situation exacerbated by the COVID-19 pandemic, ensuing politics of crises and persistent emphasis on cure over care. We find that the absence on two points centrally challenges care: a joined-up approach between health and social care and adequate information on available care support services, accessible through an empowered named contact. To enhance the lived experience of dementia care, consistent provision of individual named support and professional care support, as and when required, should become essential to local implementation of the care policy. [ABSTRACT FROM AUTHOR]

This paper provides a personal memoir of historical work at the Addiction Research Unit, in particular the genesis of the book Opium and the People. This topic had policy significance for US drug policy and a competing US study was funded. The development of the substance use history field is surveyed, and its expansion in recent times through a focused professional association and a critical mass of researchers in the area, covering a wide range of topics. The politics of using history in this area can be problematic. History now sits at the policy table more easily, but there is still a tendency for professionals in the field to use (and misuse) it, rather than calling on the interpretive and challenging approach they would obtain from professional historians. The paper calls for historians and others to move beyond a substance specific focus and to avoid the tendency for 'naive history' implicit in using only digitized industry archives as the sole source. [ABSTRACT FROM AUTHOR]

The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel. [ABSTRACT FROM AUTHOR]

Background and Aim: Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL). Design Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers. Setting: United Kingdom. Observations: For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles. Measurements Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks. Findings The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think‐tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both. Conclusion: A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross‐sector collaboration among policy opponents than proponents. [ABSTRACT FROM AUTHOR]

There is robust evidence that the places where people live have a profound influence on whether or not they are able to live healthy lives. This link between quality of place and well-being is now recognised by the UK's National Health Service (NHS) and is viewed as a key progenitor of pernicious health inequalities. Increasingly, it is also being recognised and reflected in UK national planning policy. Planning policy is weak, however, with few mandatory quality standards, and many of the new homes and places being built in the UK are of a poor quality. Unless there is an urgent effort to strengthen and co-ordinate national policy regarding public health, planning and housing, it is highly likely that the design and management of the built environment will continue to increase the already large health inequalities between rich and poor. In support of thinking anew about place-making as preventative public health, this paper reports insights and lessons arising from NHS England's Healthy New Towns project. [ABSTRACT FROM AUTHOR]

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

This paper addresses policy change in Britain since 2010 across the three fields of domestic welfare, migration and asylum, and analyses the association between welfare, conditionality and control through the lens of civic stratification. Drawing on the work of Richard Munch and Mary Douglas, it moves beyond existing literature in this area to show that the more complex the classification in play, and the more severe its boundary implications, the more likely the emergence of contestable margins. Informed by Munch's 'battlefield' approach, it provides a discussion of contestable margins in each of the three policy fields and outlines the nature and source of challenges that emerge within the 'institutional battlefield'. A concluding section reflects on what is revealed by viewing welfare, migration and asylum within the same conceptual frame, identifying an emergent welfare paradigm that displays recurrent problems across all three fields. [ABSTRACT FROM AUTHOR]

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy. [ABSTRACT FROM AUTHOR]

There has been a succession of policy documents related to active travel published by the British government since the implementation of a National Cycle Network (NCN) in 1995. However, as the latest National Travel Survey (NTS) reveals, the number of journeys made by bike in the UK has remained steadfastly around only 2% (Department for Transport [DfT], 2018a). By using documentary analysis of the available official policy documents and statements, the aim of this paper is to make sense of the policies that have been published concerning active travel (AT) in England. This is done from a figurational sociological perspective. Three key themes emerge from the analysis: (1) the rhetorical, advisory level of the vast majority of the policies; (2) the reliance on a wide network of local authorities to implement AT policy; and (3) the focus placed on individuals to change their behaviour. Furthermore, the analysis reveals that despite a large number of policy publications from a range of government departments claiming to promote AT, little has actually changed in this time period in terms of a national agenda. Despite the successive policies, it seems there is little appetite on behalf of recent governments to make widespread infrastructural changes, where instead the focus has largely been on persuading the individual to seek more active modes of travel, increasingly for their own, individual 'health' gains. Highlights •The paper is based on documentary analysis of available official policy documents from UK government on active travel since 1996 • The findings reveal the largely rhetorical, advisory level of the vast majority of the policies, which contributes to a lack of overall success in promoting active travel • The lack of success is compounded further by a reliance on a wide network of local authorities to implement active travel policy, when most local authorities appear more concerned with transport issues related to motorised vehicles • The findings reveal that active travel policy has becoming increasingly focussed on health gains that might be made from increasing the number of trips made by bicycle • The overwhelming focus of the policy documents analysed, however, is on encouraging individuals to change their behaviour, a process regarded as 'healthism', and one most sociologists of health suggest is likely to fail as a result • We conclude by suggesting that if the government is serious about wanting to see a 'step change' in the way in which people travel, particularly over shorter distances, then there is a need to have a more forceful approach to implementing policy within local authorities at the same time as making more substantial infrastructure changes to encourage cycling [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to uncover perspectives on the COVID‐19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels. Method: Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank‐ordered phrases about different aspects of COVID‐19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents. Results: A four‐factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed. Conclusion: The four perspectives demonstrate plurality and nuance in views on COVID‐19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future. Patient or Public Contribution: The development of the statement set, which is rank‐ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID‐19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback. [ABSTRACT FROM AUTHOR]

Long-range temporal choices are built into contemporary policy-making, with policy decisions having consequences that play out across generations. Decisions are made on behalf of the public who are assumed to give much greater weight to their welfare than to the welfare of future generations. The paper investigates this assumption. It briefly discusses evidence from sociological and economic studies before reporting the findings of a British survey of people's intergenerational time preferences based on a representative sample of nearly 10,000 respondents. Questions focused on two sets of policies: (i) health policies to save lives and (ii) environmental policies to protect against floods that would severely damage homes, businesses and other infrastructure. For both sets of policies, participants were offered a choice of three policy options, each bringing greater or lesser benefits to their, their children's and their grandchildren's generations. For both saving lives and protecting against floods, only a minority selected the policy that most benefited their generation; the majority selected policies bringing equal or greater benefits to future generations. Our study raises questions about a core assumption of standard economic evaluation, pointing instead to concern for future generations as a value that many people hold in common. [ABSTRACT FROM AUTHOR]

This paper describes the political origins of the National Treatment Outcomes Research Study (NTORS) and the outputs and impacts of the study. NTORS was designed to meet the request of the Health Secretary and of a Government Task Force for evidence about the effectiveness of the national addiction treatment services. NTORS was a prospective cohort study which investigated outcomes over a 5-year period of drug users admitted to four major treatment modalities: in-patient treatment, residential rehabilitation, methadone reduction and methadone maintenance programmes. The study investigated treatments delivered under day-to-day operating conditions. Outcomes showed substantial reductions in illicit drug use and reduced injecting risk behaviours. These changes were accompanied by improved psychological and physical health and by reductions in criminal behaviour. However, not all outcomes were so positive. There was a continuing mortality rate in the cohort of about 1% per year, and many clients continued to drink heavily throughout the 5-year follow-up. NTORS findings informed and influenced UK addiction treatment policy both at the time and subsequently. The findings were influential in supporting an immediate increase in funding for treatment, and Government Ministers have repeatedly cited NTORS as evidence of the effectiveness of addiction treatment. One finding that received political attention was that of the cost savings provided by treatment through reductions in crime. This important finding led to an unanticipated consequence of NTORS; namely, the greater focus on crime reduction that has increasingly been promoted as a political and social priority for drug misuse treatment. [ABSTRACT FROM AUTHOR]

Key actors engaged in debate on obesity in Australia and the UK subscribe to radically different narratives about the nature, extent and even existence of this public health problem. Yet there is a common thread to these clashing narratives: evidence. All are emphatic that their story is 'evidence-based'. In this paper, I seek to examine this state of affairs by looking at how actors think about, use and interpret evidence across a range of sites of policy debate on this issue. In doing so, I contribute to academic inquiry about the place of evidence in democratic deliberation. Firstly, I find that there is a high degree of consensus among actors who promote differing interpretations of the issue on what evidence means and entails in the abstract. Secondly, I find that the differing narratives on obesity are underpinned by different interpretations of the evidence, but that internal inconsistencies affect each of these competing narratives as well. As such, I argue that policy actors should not be seen just as strategically marshalling convenient evidence to support a preconceived cause. Overall, I suggest that these findings have mixed implications for democratic deliberation on the issue, enhancing the deliberative side of the equation but undermining the democratic. I then point to ways in which the goals of evidence-based and democratic policymaking on this issue may be further reconciled. [ABSTRACT FROM AUTHOR]

Introduction: With the rapid growth of urbanization globally and in the UK, increasing attention is now being directed towards urban green spaces (UGS). The appeal of UGS to policymakers lies in their capacity to address multiple policy objectives, including improving physical and mental wellbeing, mitigating noncommunicable diseases (NCDs), combating climate change through carbon sequestration, providing climate adaptation measures, and enhancing biodiversity. Method: This narrative review gives an overview of the current literature and UK policy relating to urban green and blue spaces, with a particular focus on the use of UGS to increase physical activity levels. Results: UGS have a profound impact on public health, with evidence indicating their positive effect on both physical and psychological health. Thirty‐eight percent of adults in the UK do not live within 15 minutes of UGS, so policy makers at national and international level are aiming to address this gap. One reason for the health benefits of UGS is associated increased physical activity, a vital component needed to address the burden of non‐communicable disease. To effectively harness UGS to promote physical activity various factors must be considered; proximity and diversity of urban green spaces, and the presence of suitable infrastructure features. Tailoring UGS to meet the needs and preferences of different population demographics is essential, as is ensuring safety, and addressing barriers to access particularly for lower socio‐economic groups. The careful planning of UGS must avoid potential gentrification effects and displacement of vulnerable communities, whilst utilising the equigenic nature of UGS. Conclusions: To create a brighter future and capitalize on the potential of UGS, a collaborative approach is needed, involving communities, local governments, and national authorities. Primary‐care professionals, represented by organizations like the Royal College of General Practitioners (RCGP), can play a crucial role in advocating for UGS and physical activity, promoting their use, and providing guidance and support. [ABSTRACT FROM AUTHOR]

Leaving the European Union (so-called ‘Brexit’) is a ‘critical moment’ for health policy reform which can pave the way to different pathways, including, a ‘critical juncture’. Given that Brexit cannot be undone without a second referendum, it opens up opportunities to elude European constraints for reform along the lines of equity, employment rights and patient choice. Brexit deepens the financial crisis of the National Health Service (NHS) by increasing hiring costs and imposing new transaction costs to accommodate patient cross-border mobility and international public health needs. Given the weak sustainability of the NHS, it could lead to major system reform. [ABSTRACT FROM AUTHOR]

The Vulnerable Persons Resettlement Scheme (VPRS) comprised the UK government's primary response to persons forcibly displaced by the Syrian civil war. Recipients were granted immediate recourse to public funds and a locally-based 12-month integration support plan, designed at the discretion of practitioners. Drawing on forty in-depth interviews with refugees and practitioners in two areas with contrasting local approaches, this article explores the tensions that emerged when broader central government policies (distinct from the VPRS), intersected with resettlement support in recipients' lives. Two current welfare reforms are identified and evaluated as having impacted resettled families' housing experiences: firstly; the Two-Child Limit and secondly; the Benefit Cap. The article demonstrates how the financial precarity produced by both policies undermined local practitioners' resettlement support. In doing so, the article challenges dominant policy narratives of exceptionality, locating those resettled within the routinised systems of precarity and conditionality embedded in the welfare system. [ABSTRACT FROM AUTHOR]

Background: Countries around the world are putting in place sugar reformulation targets for packaged foods to reduce excess sugar consumption. The Australian government released its voluntary sugar reformulation targets for nine food categories in 2020. We estimated the potential impact of these targets on household sugar purchases and examined differences by income. For comparison, we also modelled the potential impact of the UK sugar reduction targets on per capita sugar purchases as the UK has one of the most comprehensive sugar reduction strategies in the world. Methods: Grocery purchase data from a nationally representative consumer panel (n=7,188) in Australia was linked with a large database (FoodSwitch) with product-specific sugar content information for packaged foods (n=25,261); both datasets were collected in 2018. Potential reductions in per capita sugar purchases were calculated overall and by food category. Differences in sugar reduction across income level were assessed by analysis of variance. Results: In 2018, the total sugar acquired from packaged food and beverage purchases consumed at-home was 56.1 g/day per capita. Australia's voluntary reformulation targets for sugar covered 2,471/25,261 (9.8%) unique products in the FoodSwitch dataset. Under the scenario that all food companies adhered to the voluntary targets, sugar purchases were estimated to be reduced by 0.9 g/day per capita, which represents a 1.5% reduction in sugar purchased from packaged foods. However, if Australia adopted the UK targets, over twice as many products would be covered (n=4,667), and this would result in a more than four times greater reduction in sugar purchases (4.1 g/day per capita). It was also estimated that if all food companies complied with Australia's voluntary sugar targets, reductions to sugar would be slightly greater in low-income households compared with high-income households by 0.3 g/day (95%CI 0.2 - 0.4 g/day, p<0.001). Conclusions: Sugar-reduction policies have the potential to substantially reduce population sugar consumption and may help to reduce health inequalities related to excess sugar consumption. However, the current reformulation targets in Australia are estimated to achieve only a small reduction to sugar intakes, particularly in comparison to the UK's sugar reduction program. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has had a major impact globally, with older people living in aged care homes suffering high death rates.Objectives: We aimed to compare the impact of initial government policies on this vulnerable older population between the UK and Australia during the first wave of attack.Methods: We searched websites of governments in the UK and Australia and media outlets. We examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing) and the effects of these initial policies on the mortality rates in the aged care homes during the first wave of attack of COVID-19.Results: We found that both countries had prioritized resources to hospitals over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than in Australia as on 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality rate in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1000), as well as the better community viral testing regime in Australia.Conclusion: In conclusion, the public health policy in Australia aimed towards earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives being saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector. [ABSTRACT FROM AUTHOR]

Background Parallels have been drawn between the 'Great Depression' of the 1930s and the more recent 'Great Recession' that followed the 2007/8 financial crisis. Austerity was the common policy response by UK governments in both time periods. This article examines health inequalities at a local level in the 1930s, through a historical case study. Methods Local and national historical archives, Medical Officer for Health reports, and secondary sources were examined from 1930 to 1939 to obtain data on inequalities in health (infant mortality rates, stillbirths and neonatal mortality rates, 1935 and crude overall mortality rates, 1936) and ward-level deprivation (over-crowding rates, 1935) in Stockton-on-Tees, North-East England. Results There were high geographical inequalities in overcrowding and health in Stockton-on-Tees in the 1930s. Rates of overall mortality, in particular, were higher in those wards with higher levels of overcrowding. Conclusions There were geographical inequalities in health in the 1930s and the most deprived areas had the worst overall mortality rates. The areas with the worst housing conditions and health outcomes in the 1930s remain so today - health inequality is extant over time across different periods of austerity. [ABSTRACT FROM AUTHOR]

Home modification or adaptation is an important global issue, especially for older people living with disabilities in ordinary housing of varying ages, and pre-dating concerns about accessibility in design. Comparisons of research from five developed nations identify common themes: variation in integrated service development; public and private financial investment; deferred health costs; workforce expansion and training; and the value of the user perspective. Further discussion identifies the importance of retrofitting alongside new build, and argues for sustainable housing that recognizes population aging but also issues of climate change and the need for more inclusive design of housing for all ages. [ABSTRACT FROM AUTHOR]

While an adverse childhood experience (ACE)-informed approach to child protection and welfare has become influential in USA, it has had markedly less influence in UK, this despite growth in adoption of ACE research as a basis for understanding population needs and aligning service delivery amongst policymakers and other professional groups. In this article, we note the development of ACE research and draw out implications for social work with children and families. We argue that current organisational and practice preoccupations, drawing on the example of the Signs of Safety programme, together with antipathy to ACEs in some quarters of the social work academy, have the effect of reifying a short-term and occluded view of the developing child's needs so as to obstruct the systemic analysis and changes necessary to ensure that the child welfare system is redesigned to meet such needs. This suggests that post-Kempe era child welfare services are no longer conceptually or systemically adequate to protect children beyond immediate safety outcomes and consequently we need to reimagine their future. [ABSTRACT FROM AUTHOR]

Context: This research examines the development of vaccination policy in Britain, the United States, and Australia to begin to understand the different forms of coercion that industrialized states utilize to achieve vaccination compliance from the majority of their citizens. Methods: This research applies a comparative-historical analysis of the three countries listed, using a combination of primary and secondary documents. Findings: The different degrees of compulsion in the vaccination policies of Britain, the United States, and Australia is explained through an analysis of the path-dependent ways that each nation adapted coercion in response to civil society resistance. Each nation has moved up and down a continuum of coercion searching for a policy that balances overcoming passive noncompliance without engendering active resistance. Arriving at different balancing points between these two objectives, the three nations have now institutionalized policies with different degrees of coercion. Conclusions: This research shows that vaccination policy is not just created top-down by the state, but through an ongoing interactive process with citizens and civil society. Furthermore, as vaccination is a "wicked problem" that faces ongoing civil society resistance, states will need to perpetually adapt the coerciveness of their policies into the foreseeable future. [ABSTRACT FROM AUTHOR]

The European Union (EU) is a rules-based international organisation with an exceptionally dense legal system. Likewise, the ways in which EU law has effects in domestic law are determined by (constitutional) law. The legal rights and obligations entailed for state and 'third sector' entities, companies and human beings of some 45 years of membership have had significant effects on domestic health law across the United Kingdom, even though health per se is a national competence. That said, the EU's relationships with national legal orders are also determined by the politically possible. We therefore sketch the key legal questions for UK health law, and health law in each of the 'devolveds', in two possible immediate post-Brexit futures. By immediate future, we mean after 29 March 2019, the date on which the Article 50 TEU notification period ends. It will not be possible to answer these legal questions until the politics have crystallised into legal texts, which is not the case at the time we write. We go on to argue that the ways in which UK health law, policy and practice are currently determined by the UK's membership of the EU, coupled with the short time frame within which the future EU-UK relationship must be determined, mean that law may be expected to be less of a determinant in immediate post-Brexit futures than it is at present. Our principal conclusion is that the uncertainties that surround the process of Brexit mean that at a level of specific policy and practice, such as in areas of health law, we might expect a period of 'a-legality', where the legal position of actors does not necessarily determine or explain their actions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To compare drug recovery outcomes in commissioning areas included in a ‘payment by results’ scheme with all other areas. Design: Observational and data linkage study of the National Drug Treatment Monitoring System, Office for National Statistics mortality database and Police National Computer criminal records, for 2 years before and after introduction of the scheme. Pre–post controlled comparison compared outcomes in participating versus non‐participating areas following adjustment for drug use, functioning and drug treatment status. Setting: Drug services in England providing publicly funded, structured treatment. Participants: Adults in treatment (between 2010 and 2014): 154 175 (10 716 in participating areas, 143 459 non‐participating) treatment journeys in the 2 years before and 148 941 (10 012 participating, 138 929 non‐participating) after the introduction of the scheme. Intervention: Scheme participation, with payment to treatment providers based on patient outcomes versus all other areas. Measurements: Rate of treatment initiation; waiting time (> or < 3 weeks); treatment completion; and re‐presentation; substance use; injecting; housing status; fatal overdose; and acquisitive crime. Findings: In participating areas, there were relative decreases in rates of: treatment initiation [difference‐in‐differences odds ratio (DID OR) = 0.17, 95% confidence interval (CI) = 0.14, 0.21]; treatment completion (DID OR = 0.60, 95% CI = 0.53, 0.67); and treatment completion without re‐presentation (DID OR = 0.63, 95% CI = 0.52, 0.77) compared with non‐participating areas. Within treatment, relative abstinence (DID OR = 1.50, 95% CI = 1.30, 1.72) and non‐injecting (DID OR = 1.32, 95% CI = 1.10, 1.59) rates were improved in participating areas. No significant changes in mortality, recorded crime or housing status were associated with the scheme. Conclusion: Drug addiction recovery services in England that are commissioned on a payment‐by‐results basis tend to have lower rates of treatment initiation and completion but higher rates of in‐treatment abstinence and non‐injecting than other services. [ABSTRACT FROM AUTHOR]

Health policy instruments such as the public financing of health technologies (e.g., new drugs, vaccines) entail consequences in multiple domains. Fundamentally, public health policies aim at increasing the uptake of effective and efficient interventions and at subsequently leading to better health benefits (e.g., premature mortality and morbidity averted). In addition, public health policies can provide non-health benefits in addition to the sole well-being of populations and beyond the health sector. For instance, public policies such as social and health insurance programs can prevent illness-related impoverishment and procure financial risk protection. Furthermore, public policies can improve the distribution of health in the population and promote the equalization of health among individuals. Extended cost-effectiveness analysis was developed to address health policy assessment, specifically to evaluate the health and financial consequences of public policies in four domains: (1) the health gains; (2) the financial risk protection benefits; (3) the total costs to the policy makers; and (4) the distributional benefits. Here, we present a tutorial that describes both the intent of extended cost-effectiveness analysis and its keys to allow easy implementation for health policy assessment. [ABSTRACT FROM AUTHOR]

This article uses a case study of financial sector policy making in East Asia in the post 2000 period to examine and help to resolve questions surrounding the origins of the phenomenon of ‘dynamics without change’ in public policy making; that is, the appearance of policy activity and alteration without affecting the overall nature and orientation of policy outputs or outcomes. This is a phenomenon which has challenged existing notions of policy dynamics which associate enhanced policy activity with fundamental changes in outputs and outcomes and is an issue which has concerned policy studies since Robert Alford’s seminal study of British health policy dynamics first noted the phenomenon in the mid-1970s. The article develops and extends the ideas put forward by Rayneret al. (2001, Privileging the sub-sector: critical sub-sectors and sectoral relationships in forest policy-making,Forest Policy and Economics, 2 (3–4), 319–332) that ‘critical subsectors’ or subsets of actors within a subsystem which control whether or not fundamental change occurs. Evidence from recent developments in the Asian financial sector is put forward supporting the argument that the uneven structuration and non-reciprocal nature of the relationships existing between components of a policy subsystem explain that policy’s propensity for change and stability. The discussion moves the general analysis of policy change, policy subsystems and their role in policy change forward from the existing orthodoxy of ‘dynamics with change’ and provides the foundation for a new research programme analysing intra-sectoral policy dynamics in an empirically robust manner. [ABSTRACT FROM PUBLISHER]

The article offers information on the efforts of the Centre of Excellence for Information Sharing and its associated challenges. Topics discussed include information on the Regional health information exchange for improving the health care using information sharing and policies for the education in Great Britain; discussions on the issues related to the data protection; and the discussion of information governance and big data in health.