National review of maternity services 2008: women influencing change

<p>Abstract</p> <p>Background</p> <p>In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth.</p> <p>Methods</p> <p>A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women.</p> <p>Results</p> <p>Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors' traditional authority is questioned by strong consumer organisations and informed consumers.</p> <p>Conclusions</p> <p>Unified consumer influence advocating a move away from obstetric -led maternity care for all pregnant women appears to be synergistic with the ethos of corporate governance and a neoliberal approach to maternity service policy. The silent voice of one consumer group (women happy with their obstetric-led care) in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint.</p

When public action undermines public health: A critical examination of antifluoridationist literature

Background: The addition of the chemical fluorine to the water supply, called water fluoridation, reduces dental caries by making teeth more resistant to demineralisation and more likely to remineralise when initially decayed. This process has been implemented in more than 30 countries around the world, is cost-effective and has been shown to be efficacious in preventing decay across a person's lifespan. However, attempts to expand this major public health achievement in line with Australia's National Oral Health Plan 2004–2013 are almost universally met with considerable resistance from opponents of water fluoridation, who engage in coordinated campaigns to portray water fluoridation as ineffective and highly dangerous. Discussion: Water fluoridation opponents employ multiple techniques to try and undermine the scientifically established effectiveness of water fluoridation. The materials they use are often based on Internet resources or published books that present a highly misleading picture of water fluoridation. These materials are used to sway public and political opinion to the detriment of public health. Despite an extensive body of literature, both studies and results within studies are often selectively reported, giving a biased portrayal of water fluoridation effectiveness. Positive findings are downplayed or trivialised and the population implications of these findings misinterpreted. Ecological comparisons are sometimes used to support spurious conclusions. Opponents of water fluoridation frequently repeat that water fluoridation is associated with adverse health effects and studies are selectively picked from the extensive literature to convey only claimed adverse findings related to water fluoridation. Techniques such as "the big lie" and innuendo are used to associate water fluoridation with health and environmental disasters, without factual support. Half-truths are presented, fallacious statements reiterated, and attempts are made to bamboozle the public with a large list of claims and quotes often with little scientific basis. Ultimately, attempts are made to discredit and slander scientists and various health organisations that support water fluoridation. Summary: Water fluoridation is an important public health initiative that has been found to be safe and effective. Nonetheless, the implementation of water fluoridation is still regularly interrupted by a relatively small group of individuals who use misinformation and rhetoric to induce doubts in the minds of the public and government officials. It is important that public health officials are aware of these tactics so that they can better counter their negative effectJason M Armfiel

“Milbulgali Bagili”: A systematic scoping review of the history of Aboriginal and Torres Strait Islander advocacy 1940‐1970

Issue addressed: Health promotion, the process of enabling people to increase control over their health, implies advocacy and empowerment on behalf of others. This does not account for the phenomena whereby Aboriginal and Torres Strait Islander people have advocated to strengthen the determinants of their own and their communities' health. This paper provides a systematic scoping review of the published literature that documents Aboriginal and Torres Strait Islander advocacy to improve community empowerment during the time 1940-1970. The objectives of the review were to establish: 1. The extent to which Aboriginal and Torres Strait Islander advocacy has been documented; 2. The extent to which the literature is written from an Aboriginal and Torres Strait Islander perspective; 3. The extent to which local community-level advocacy has been documented; and 4. How advocacy occurred. Methods: The Informit database was systematically searched, publications selected against inclusion criteria, and themes synthesised to map key concepts, types of evidence and gaps in research. Results: Based on this systematic search, 30 papers were found. The four key themes identified were: individual advocates, black organisations, international solidarity and black and white people working together. Conclusions: Despite the many gaps in the literature, there is documented evidence of considerable outcomes from advocacy. So what?: The concept of advocacy and indeed, health promotion itself, may need to be decolonised, and that the concept of “everyday resistance” may more accurately encompass the diverse repertoire of actions which took place between agents of resistance and agents of dominant power</p

Non-medical prescribing in Australasia and the UK: the case of podiatry

Background: the last decade has witnessed a rapid transformation in the role boundaries of the allied healthprofessions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategyof health care ‘modernisation’ has encompassed calls for the redrawing of professional boundaries and identities,linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domainof medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped tomeet the challenges posed by changing demographic, social and political contexts. The prescribing of medicinesby non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects thesechanges.Methods: using a range of key primary documentary sources derived from published material in the publicdomain and unpublished material in private possession, this paper traces the development of contemporary UKand Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sourcesinclude material from legislative, health policy, regulatory and professional bodies (including both State and Federalsources in Australia).Results: tracing a chronological, comparative, socio-historical account of the emergence and development of‘prescribing’ in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reformson the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled withdemands for workforce flexibility and role transfer within a climate of demographic, economic and social changehas enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply,administration and prescription of medicines.Conclusion: as a challenge to medical dominance, these changes, although driven by wider healthcare policy,have met with resistance. As anticipated in the theory of medical dominance, inter-professional jurisdictionaldisputes centred on the right to access, administer, supply and prescribe medicines act as obstacles to workforcechange. Nevertheless, the broader policy agenda continues to ensure workforce redesign in which podiatry hasassumed wider roles and responsibilities in prescribing