Constructing the public in roadmapping the transition to a bioeconomy : A case study from the Netherlands

In recent years there has been increasing attention to the transition toward a bioeconomy. From comparable transitions toward sustainability, we know that transitions require integral, inclusive approaches toward developing a long-term strategy, focusing not only on technological innovation, but also on involving the public. This is not easy. Public engagement encompasses diverse forms of public and civil society participation, and it is crucial to understand the specificities of these interactions and their effects on potential transition pathways. We present a conceptual-analytical paper where the focus lies on understanding sense-making practices in the construction of publics in the bioeconomy. Using a case-study approach, this article describes five partialities of the constructed public in the bioeconomy and analyzes the orchestration, productive dimensions and effects of these constructions. Our analysis offers a new perspective on, and appreciation of, the partiality of different forms of public participation, and varying degrees in which possibilities of system change in the bioeconomy transition are inclusive or exclusive toward differentially constructed publics. This offers an alternative, constructive way of exploring actor dynamics and politics in system change. We aim to contribute to a more nuanced and integral interpretation of public engagement in sustainability transitions, which is relevant to actors from academia, policy, industry and other spheres relevant to the bioeconomy transition.</p

Performance of community health workers:situating their intermediary position within complex adaptive health systems

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community healthworkers (CHWs) in low- a nd middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate.The assessment combines evidence from the international literature on CHW programmes with research outcomes from the 5-year REACHOUT consortium, undertaking implementation research to improve CHW performance in six contexts(two in Asia and four in Africa). A conceptual framework on CHW performance, which explicitly conceptualizes the interface role of CHWs, is presented. Various categories of factors influencing CHW performance are distinguished in the framework: the context, the health system and intervention hardware and the health system and intervention software.Hardware elements of CHW interventions comprise the supervision systems, training, accountability and communication structures, incentives, supplies and logistics. Software elements relate to the ideas, interests, relationships, power, values and norms of the health system actors. They influence CHWs’ feelings of connectedness, familiarity, self-fulfilment and serving the same goals and CHWs’ perceptions of support received, respect, competence, honesty, fairness and recognition.The framework shines a spotlight on the need for programmes to pay more attention to ideas, interests, relationships,power, values and norms of CHWs, communities, health professionals and other actors in the health system, if CHW performance is to improv

Exploring adaptation and agency of mothers caring for disabled children inan urban settlement in South Africa: A qualitative study

Mothers of disabled children who are living in poverty face multiple interlinked disadvantages in relation togender, care, disability, and poverty. Yet, their experiences have been largely neglected in academic literature.This study explores how mothers from a poor urban settlement in South Africa manoeuvre, adapt, act and reactin such a difficult context, and how they maintain or improve their own and their family's wellbeing. Ourqualitative research with 30 mothers shows women's adaptation and agency in the trade-offs they make. Fuelledby social discrimination and abuse, mothers prefer to focus solely on the child, its care and the household inorder to keep themselves and their child safe. Despite providing certain benefits that mothers value, thesepreferences perpetuate or indeed worsen their position in society, as they reinforce traditional gender structuresand render them invisible to policymakers. This poses serious challenges for women's empowerment and gender-sensitive poverty-reduction policies

Research and innovation as a catalyst for food system transformation

Background: Food systems are associated with severe and persistent problems worldwide. Governance approaches aiming to foster sustainable transformation of food systems face several challenges due to the complex nature of food systems. Scope and approach: In this commentary we argue that addressing these governance challenges requires the development and adoption of novel research and innovation (R&I) approaches that will provide evidence to inform food system transformation and will serve as catalysts for change. We first elaborate on the complexity of food systems (transformation) and stress the need to move beyond traditional linear R&I approaches to be able to respond to persistent problems that affect food systems. Though integrated transdisciplinary approaches are promising, current R&I systems do not sufficiently support such endeavors. As such, we argue, we need strategies that trigger a double transformation - of food systems and of their R&I systems. Key Findings and Conclusions: Seizing the opportunities to transform R&I systems has implications for how research is done - pointing to the need for competence development among researchers, policy makers and society in general - and requires specific governance interventions that stimulate a systemic approach. Such interventions should foster transdisciplinary and transformative research agendas that stimulate portfolios of projects that will reinforce one another, and stimulate innovative experiments to shape conditions for systemic change. In short, a thorough rethinking of the role of R&I as well as how it is funded is a crucial step towards the development of the integrative policies that are necessary to engender systemic change - in the food system and beyond

Evaluating the 'return on patient engagement initiatives' in medicines research and development: A literature review

Search strategy and inclusion criteria. We undertook a scoping literature review using a systematic search, including academic and grey literature with a focus on evaluation approaches or outcomes associated with patient engagement. No date limits were applied other than a cut-off of publications after July 2018. Data extraction and synthesis. Data were extracted from 91 publications, coded and thematically analysed. Main results. A total of 18 benefits and 5 costs of patient engagement were identified, mapped with 28 possible indicators for their evaluation. Several quantitative and qualitative methods were found for evaluation of benefits and costs of patient engagement. Discussion and conclusions. Currently available indicators and methods are of some use in measuring impact but are not sufficient to understand the pathway to impact, nor whether interaction between researchers and patients leads to change. We suggest that the impacts of patient engagement can best be determined not by applying single indicators, but a coherent set of measures

Ensuring societal considerations are met when translating science into policy for sustainable food system transformation

Background: A food system transformation is needed to address food and nutrition security, minimise impacts on planetary health, reduce climate change emissions, and contribute to equity, diversity, and the Sustainable Development Goals

Introduction

Health systems have long been considered key determinants of well-being within modern societies, a valuable resource which has faced a series of reform initiatives throughout the past decades. These reforms have been used to manage the cost of development, measure the tenability of health systems in globalizing economies and promote the increasing importance of health problems related to lifestyle and living conditions, yet they have failed to provide a true resolution to the persistent economical and logistical problems facing modern-day health systems. This rich, interdisciplinary work explores the hypothesis that many of these problems cannot be adequately addressed without structural changes to our health systems, and examines the embedded features of our health systems that underlie contemporary challenges as well as how, and under what conditions, our health systems can be made more sustainable. Combining and building upon theoretical approaches from transition and innovation studies for analysing health system deficits, Toward Sustainable Transitions in Healthcare Systems raises fundamental questions about how new research, new needs and exogenous trends are transforming current health systems. Providing an original and substantial analysis of the complex structural features of the health innovation system, this book will be of interest to students and practitioners of the politics of health, social epidemiology, medical sociology and those with an interest in transition theory