Planning, implementation and effectiveness in Indigenous health reform

The Planning, Implementation and Effectiveness in Indigenous Health Reform (PIE) project, funded by the Lowitja Institute and the Australian Research Council, carried out by the University of Melbourne, arose from concerns by Aboriginal and Torres Strait Islander people that despite the importance of participation and investment in collaborative governance, little research focused on capturing current practice and identifying best practice is being done. The advent of the National Indigenous Reform Agreement (NIRA) and the Indigenous Health National Partnership Agreements (IHNPAs) has led to further development/application of collaborative approaches to governance through committees and forums at national, State and regional levels. The activities associated with these committees and forums are referred to throughout this report as collaborative governance. This report focuses on building the evidence base around best practice based on case studies of collaborative governance in relation to the NIRA. A policy brief highlighting the policy recommendations of this report is also available

A longing just to be: British Muslim negotiations of belonging and identity in the multicultural 'Real'

© 2015 Dr. Camille La BrooyThis thesis explores how young Muslims in Britain are negotiating belonging and difference in light of the so-called ‘failure’ of multiculturalism in Europe, a fate that has been linked to their supposed failed integration. It has been suggested that the continued existence of radically different practices by Muslims highlights an ‘illiberality’ about multiculturalism, since the latter is alleged to license these practices. The thesis presents findings of content and critical discourse analyses of 503 articles from national newspapers in Britain examining the media’s representations of Muslims around the period of the London bombings, together with interviews undertaken with 40 British Muslim youths – 30 in 2008 and 10 in 2015. It is argued that while Muslim ‘differences’ are recognised, their negative representation signifies that there exist limits to what can be tolerated in multicultural states. It is argued that the alleged failure of multiculturalism is a reflection of multiculturalism’s inherent liberality rather than illiberality. The fact that (perceived) radical difference beyond the spaces allotted by liberalism cannot be tolerated represents the failure of multiculturalism

What is the role of consensus statements in a risk society?

This paper explores the role of consensus statements in a risk society. It uses Beck’s theory of risk to show that scientists have employed consensus statements in order to re-establish faith in science. Through analysing the goals of participants in consensus fora and comparing them to the fora processes, this paper considers how consensus statements and guidelines in public health can be viewed as remedies for the decline in expert trust experienced in the current risk society. To collect data, 25 interviews were undertaken with consensus panel participants from the USA, UK and Australia. Interviewees were from peak national agencies/commissioning agencies and were categorised as policymaker, practitioner and consumer stakeholders. Participants made recommendations for improving consensus processes in order to mitigate perceptions of risk. These were: (1) clearly stated goals; (2) robust, evidence-based and transparent processes of methodological development and participation/deliberation/decision-making; (3) diverse stakeholder representation, including increased consumer participation; (4) transparency about conflicts of interest; and, (5) robust, carefully worded recommendations. Poor-quality consensus statements can further entrench scepticism about the scientific enterprise. While consensus statements can be seen as a tool for moderating perceptions of risk, policymakers and scientists must ensure the integrity, strength and transparency of their research methods. This has the potential to facilitate policy, improve scientific accountability to the public and legitimise processes. While fostering greater trust is not a primary objective for scientists, an increase in legitimacy of process can be an important unintended consequence of improved quality consensus statements and an important antidote to the risk society

First Nations’ Perspectives in Law-Making About Voluntary Assisted Dying

Voluntary assisted dying laws have now been enacted in all six Australian states. While there is an emerging body of literature examining various aspects of regulation, there has been scant consideration of what these reforms mean for First Nations’ people, and to what extent their experiences have been considered in the process of developing legislation. This article provides a critical analysis of how Indigenous perspectives both contributed to, and were engaged with, during the law reform processes in Victoria and Western Australia, the first two States to grapple with this topic. Findings reveal the sophistication in how Indigenous organisations and individuals engaged with this issue and highlight the critical importance of not universalising Indigenous perspectives. Significantly, there was much greater engagement with Indigenous views in Western Australia than in Victoria. We conclude by considering how Indigenous voices can meaningfully influence Australian law reform processes

Does more equitable governance lead to more equitable health care?: a case study based on the implementation of health reform in Aboriginal health Australia

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity

Can depressed patients make a decision to request voluntary assisted dying?

Depressive symptoms, including those as part of a major depressive disorder, are common at the end of life. A number of psychiatrists consider that a diagnosis of major depression precludes the capacity to make a decision to request voluntary assisted dying (VAD), although this is not a unanimous view. This paper uses a case of a patient in which two different psychiatric opinions were formed regarding her capacity to make the decision to request VAD. The difference of view can be related to whether major depression was diagnosed and the association made between depression and the capacity to request VAD. The view that an absence of major depression is required in order to establish the capacity to request VAD is potentially at odds with the legal definition and not necessarily in keeping with the patient’s experience at the end of life