Neo-Liberalism, Policy Incoherence and Discourse Coalitions Influencing Non-Communicable Disease Strategy; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

Lencucha and Thow have highlighted the way in which neo-liberalism is enshrined within institutional mechanisms and conditions the policy environment to shape public policy on non-communicable diseases (NCDs). They critique the strong (but important) focus of public health policy research on corporate interests and influence over NCD policy, and point toward neo-liberal policy paradigms shaping the relationship between the state, market and society as an area for critique and further exploration. They also importantly underline the way in which the neo-liberal policy paradigm shapes the supply of unhealthy goods and argue that health advocates have not engaged enough with supply side issues in critiques of policy debates on NCDs. This is an important consideration especially in the Asia-Pacific where trade and agricultural policies have markedly shaped production and what is being produced within countries. In this commentary, I reflect upon how neoliberalism shapes intersectoral action across trade, development and health within and across institutions. I also consider scope for international civil society to engage in advocacy on NCDs, especially where elusive ‘discourse coalitions’ influenced by neoliberalism may exist, rather than coordinated ‘advocacy coalitions.

Editorial: Public Mental Health Policy, Mental Health Promotion, and Interventions Which Focus on the Social Determinants of Mental Health

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Alcohol education for Australian schools: What are the most effective programs?

A scientific approach to understanding what works and what does not, by using the best available evidence, can lead to policy and implementation decisions that are more effective in achieving desired outcomes. A systematic review was undertaken to assist schools to effectively utilise the evidence in order to decide on appropriate school alcohol education programs. A systematic review is a method of assessing whether a program is effective or not by collating all the research on a specific question and looking at the whole body of evidence together. Within each program type, the available studies were examined in detail by two researchers and assessed for both the quality of the research and the outcomes for students. Three programs, CLIMATE Schools (Australia), Project ALERT (USA) and All Stars (USA) had enough evidence to support their general use in schools. Four programs showed some evidence of good outcomes and may be suitable for use by some schools where those outcomes are high priority (Life Skills Program, SHAHRP, Unplugged EU-DAP, and Life Skills Training) especially if outcomes are monitored within the school. One program showed no evidence of positive effect (DARE) and two showed negative outcomes (such as increases in drinking) (Peer Acceleration Social Network (Project TND) and Take Charge of Your Life) and are not recommended for use in Australian schools. The remaining 29 programs showed inconclusive results (i.e. those with poor quality research, inconsistent effects, or only one available study) and are also not recommended for schools until further research is conducted. Common elements of effective programs included: accurate evidence based information about alcohol; a focus on social norms; an interactive presentation style; clear, achievable and measureable goals and objectives; teacher training and support; and a whole of school approach

Consumer and non-government organisations' representation and advocacy for change: a case study of South Australia across the 2000-2005 period

Auckland, N

Social participation, housing and people with a psychiatric disability

Maroochydore, QL

Power asymmetries, policy incoherence and noncommunicable disease control - a qualitative study of policy actor views

Noncommunicable diseases (NCDs) kill 40 million people each year and are the cause of 70% of global deaths annually. Proximal risk factors include tobacco use, physical inactivity, the harmful use of alcohol and consumption of unhealthy food, which are shaped by the social and economic conditions of daily life, known as the social and commercial determinants of health. It is well recognised within the global health community that policy coherence across all levels of government at the national and international level is required to address NCDs. To date, however, there has been little coherence between health and trade policy, which directly affects access to unhealthy or healthy commodities. This paper explores policy actors' views of the challenges in achieving coordinated and coherent NCD policy across health and trade sectors. Drawing on interviews (n = 18) with key policy actors and using a policy framework that focuses on ideas, power and the 'deep core' of neoliberalism, we identify the role of competing frames, power asymmetries and interests in constraining policy coherence. We also find differences between NCD risk factor domains. Tobacco control was highlighted as one area of generally successful coherence internationally. In contrast, alcohol and nutrition were identified as areas with little coherence. Industry power, the role of evidence, presence of absence of a treaty, the extent of coordinated advocacy and leadership by intergovernmental organisations were key factors influencing coherence. In light of these constraints, the role of advocacy by non-governmental organisations was highlighted as the key for much-needed policy change

What policies and policy processes are needed to ensure that people with psychiatric disabilities have access to appropriate housing?

This paper uses data from a South Australian case study of a period of mental health reform (2000-2005) to answer the question of how different policy networks set agenda and implement policy to ensure that people with psychiatric disabilities have access to appropriate housing. Qualitative methods were used, including interviews (n = 31) and focus groups (n = 8) with non-government organisations (NGOs), consumers and carers and professionals from health, disability and housing sectors, and participant observation with South Australian NGOs (n = 52). These data were supported by a thematic analysis of national and State (i.e. South Australian) policies in mental health and housing sectors. The research indicated that, despite a number of 'inter-sectoral projects' and regional networks, the health and housing sectors were essentially separate policy systems with little integration. It also concluded that the absence of strategic integration across sectors leads to inadequate housing for people with a psychiatric disability. Research participants considered the need for better collaboration secondary to the need for additional housing and support resources and political commitment to such resources. A number of barriers and enablers to policy agenda setting and collaboration were identified. The paper concludes with a discussion of policy and policy processes which will support housing outcomes for people with psychiatric disability.Australia Inter-sectoral Policy Reform Collaboration Psychiatric disability Mental illness Supported accommodation Housing

Mental health and the right to health

Sydne