Understanding quality of life through Sen's capability framework : an application to people living with HIV/AIDS

It is nearly 30 years ago that the Acquired Immune Deficiency Syndrome (AIDS) epidemic officially started. In 2008 an estimated total of 33.4 million people lived worldwide with Human Immunodeficiency Virus (HIV), the virus that causes AIDS. Despite the fact that there is still no cure or vaccine for the HIV virus, important progress has been achieved in treatment for people living with HIV/AIDS (PLWHA) since the mid-1990s, when Highly-Active Antiretroviral Therapy (HAART) was introduced. HAART has proved successful in reducing AIDS-related morbidity and mortality and, therefore, prolonging the life expectancy of PLWHA. In Western democracies such as Australia, HIV/AIDS is considered as a chronic disease that can be managed by most people with the help of regular medical monitoring, adherence to treatment, and access to medical care. The substantial clinical changes observed since the introduction of HAART open a series of important questions regarding the quality of life of PLWHA. The current quality of life research on PLWHA consist primarily of health related quality of life studies (HRQOL), which investigate the subjective perceptions of PLWHA regarding the impact of their health status, disease, impairment, disability, or treatment primarily on their physical, mental/cognitive, and social functioning. This type of study has received several criticisms, for example the fact of confusing quality of life with perceived health. Another important limit of HRQOL studies is that they focus on PLWHA as patients or clinical cases, rather than as social actors with individual, social and economic rights experiencing freedoms and constraints to fulfil valued social roles and achieve desired social statuses. Lack of research on the experiences of PLWHA as social actors is regrettable because it would offer social scientists and social policy makers relevant information to identify health and social inequalities among PLWHA and to generate a broader and more insightful understanding of their quality of life. This thesis sets out to address these latter questions by introducing a complementary approach to the investigation of the quality of life of PLWHA known as the 'capability framework', which was founded by the economist and philosopher, Amartya Sen. This framework suggests that quality of life should be measured by focusing on people's capabilities, namely their real opportunities to lead the life that have reason to value. The thesis introduces the capability framework by discussing it in the wider debate around the concept of quality of life. It addresses the operationalisation of its core concept, capabilities, founding it in Sen's epistemological perspective, 'positional objectivity', which is interpreted as a constructivist approach. This is expanded by placing it in a more inclusive and developed constructivist framework, the phenomenological sociology of Alfred Schutz, which requires exploring and making explicit the model of social actor that underpins the operationalisation and measurement of any social science concept. Consequently, the psychological and sociological literature that has investigated the phenomenon of opportunities is reviewed to identify the cognitive, emotional, and meaning-making processes that underpin people's perception of opportunities. These analyses led to the development ofa threefold model of the main components of people's perception of opportunities and a fourfold model of experiences of opportunities. Both models are empirically tested through a mixed method investigation based on a concurrent nested strategy. The quantitative analysis operationalised the models through a secondary data analysis of the HIV Futures V Survey, an Australian nationwide survey of various clinical and social aspects of the lives of PLWHA. The qualitative analysis explored the factors affecting the perception of opportunities in 29 PLWHA of different socio economic background. The relevance of the results of both analyses to understand the quality of life of PLWHA is discussed against alternative measures and conceptualisations of quality of life

Project benefit management: a conceptual framework of target benefit formulation

Successful realization of project benefits is strongly associated with organizational performance. Formulating project target benefits is regarded as the first and critical step in the benefit management process. In this study, we drew upon relevant theories and conducted in-depth interviews with senior managers in Australia to develop a conceptual framework of project target benefit formulation and corresponding propositions. Our findings highlight the important role of project target benefits in funding decision-making and suggest seven criteria for their appraisal (strategic fit, target value, measurability, realism, target date, accountability and comprehensiveness) and four constructs which improve the formulated target benefits (a formal benefit formulation process, senior executive leadership, senior executive supports, and public service motivation). These findings extend the current literature on project benefit management by providing a holistic view on how project target benefits should be formulated and appraised

A Holistic Look at Agency Enforcement

The law review literature has long-recognized that effective enforcement is an essential component of effective regulation. Yet much of the literature focuses on one aspect of the enforcement challenge or another. For example, the underlying theory about optimal levels of enforcement has received considerable attention, as have topics such as the relative merits of using deterrence-based versus cooperation-based approaches and the use of citizen suits.The purpose of this article is to fill a gap in the law review literature by considering agencies’ enforcementand compliance promotion function holistically. In doing so, the article approaches the challenge from an “inside-out” perspective, a perspective that administrative law scholars have found to be lacking in the literature. The article proposes a three-layered conceptual framework for considering options for structuring the administrative agency enforcement and compliance promotion function. The first layer consists of five components of effective enforcement and compliance: norm clarity, norm achievability, verifiability, an appropriate mix of sanctions and rewards, and indicia of legitimacy. The second involves the inter-related character of these components and highlights the importance of fitting each into a particular enforcementand compliance regime so that agencies may gain synergistic benefits and consider the need to make difficult trade-offs. Third, and finally, our conceptual framework includes four contextual design issues that create additional challenges in determining the appropriate content of each of the five key components of effective enforcement and compliance: the hybrid character of contemporary governance efforts; the importance of “reality-checking” enforcement options through close attention to past performance as well as future challenges and opportunities; the dynamic character of environmental governance challenges; and the salience of possible design changes and the need to prioritize design improvements. The article suggests that it is important to consider all three layers in developing an effective enforcement and compliance promotion regime.The article tests our conceptual framework by including a case study of an ongoing Environmental Protection Agency (EPA) effort to reinvent its enforcement and compliance promotion program and by applying our framework to EPA’s initiative. This case study illustrates the value of our framework in evaluating regulatory design options for the enforcement and compliance promotion function

A Holistic Look at Agency Enforcement

The law review literature has long-recognized that effective enforcement is an essential component of effective regulation. Yet much of the literature focuses on one aspect of the enforcement challenge or another. For example, the underlying theory about optimal levels of enforcement has received considerable attention, as have topics such as the relative merits of using deterrence-based versus cooperation-based approaches and the use of citizen suits.The purpose of this article is to fill a gap in the law review literature by considering agencies’ enforcementand compliance promotion function holistically. In doing so, the article approaches the challenge from an “inside-out” perspective, a perspective that administrative law scholars have found to be lacking in the literature. The article proposes a three-layered conceptual framework for considering options for structuring the administrative agency enforcement and compliance promotion function. The first layer consists of five components of effective enforcement and compliance: norm clarity, norm achievability, verifiability, an appropriate mix of sanctions and rewards, and indicia of legitimacy. The second involves the inter-related character of these components and highlights the importance of fitting each into a particular enforcementand compliance regime so that agencies may gain synergistic benefits and consider the need to make difficult trade-offs. Third, and finally, our conceptual framework includes four contextual design issues that create additional challenges in determining the appropriate content of each of the five key components of effective enforcement and compliance: the hybrid character of contemporary governance efforts; the importance of “reality-checking” enforcement options through close attention to past performance as well as future challenges and opportunities; the dynamic character of environmental governance challenges; and the salience of possible design changes and the need to prioritize design improvements. The article suggests that it is important to consider all three layers in developing an effective enforcement and compliance promotion regime.The article tests our conceptual framework by including a case study of an ongoing Environmental Protection Agency (EPA) effort to reinvent its enforcement and compliance promotion program and by applying our framework to EPA’s initiative. This case study illustrates the value of our framework in evaluating regulatory design options for the enforcement and compliance promotion function

A Holistic View of Agency Enforcement

The law review literature has long recognized that effective enforcement is an essential component of effective regulation. Yet much of the literature focuses on one aspect of the enforcement challenge or another. For example, the underlying theory about optimal levels of enforcement has received considerable attention, as have topics such as the relative merits of using deterrence-based versus cooperation-based approaches and the use of citizen suits. The purpose of this Article is to consider agencies’ enforcement and compliance promotion function holistically. This Article proposes a three-layered conceptual framework for considering options for structuring the administrative agency enforcement and compliance promotion function. The first layer consists of five components of effective enforcement and compliance: norm clarity, norm achievability, verifiability, an appropriate mix of sanctions and rewards, and indicia of legitimacy. The second involves the interrelated character of these components and highlights the importance of fitting each into a particular enforcement and compliance regime so that agencies may gain synergistic benefits and consider the need to make difficult trade-offs. Third, and finally, our conceptual framework includes four contextual design issues that create additional challenges in determining the appropriate content of each of the five key components of effective enforcement and compliance: the hybrid character of contemporary governance efforts; the importance of “reality-checking” enforcement options through close attention to past performance as well as future challenges and opportunities; the dynamic character of environmental governance challenges; and the salience of possible design changes and the need to prioritize design improvements. This Article suggests that it is important to consider all three layers in developing an effective enforcement and compliance promotion regime. This Article tests our conceptual framework by including a case study of an ongoing Environmental Protection Agency (“EPA”) effort to transform its enforcement and compliance promotion program and by applying our framework to EPA’s initiative. This case study illustrates the value of our framework in evaluating regulatory design options for the enforcement and compliance promotion function