Finland: Maintaining the fragile consensus

Peer reviewe

Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings

A comparative framework: how broadly applicable is a 'rigorous' critical junctures framework?

The paper tests Hogan and Doyle's (2007, 2008) framework for examining critical junctures. This framework sought to incorporate the concept of ideational change in understanding critical junctures. Until its development, frameworks utilized in identifying critical junctures were subjective, seeking only to identify crisis, and subsequent policy changes, arguing that one invariably led to the other, as both occurred around the same time. Hogan and Doyle (2007, 2008) hypothesized ideational change as an intermediating variable in their framework, determining if, and when, a crisis leads to radical policy change. Here we test this framework on cases similar to, but different from, those employed in developing the exemplar. This will enable us determine whether the framework's relegation of ideational change to a condition of crisis holds, or, if ideational change has more importance than is ascribed to it by this framework. This will also enable us determined if the framework itself is robust, and fit for the purposes it was designed to perform — identifying the nature of policy change

Local economic strategy development under Regional Development Agencies and Local Enterprise Partnerships: applying the lens of the multiple streams framework

Following the decision to abolish the Regional Development Agencies (RDAs) in England by the newly elected Coalition Government in 2010, Local Enterprise Partnerships (LEPs) were introduced to drive economic development at a local level. However, the limited Government prescription as to both the form and function of LEPs has contributed to a fundamental ambiguity as to their roles and ‘legitimate spheres’ of activity. In the context of this ambiguity, this paper uses the Multiple Streams Framework (Kingdon, 1995) to analyse the challenges faced by RDAs and LEPs in developing effective economic development strategies. The paper identifies the dimensions of strategic capability that LEPs must develop if they are to mature as effective agents of local economic development in England

Media coverage of climate change: an international comparison

We present an international comparison of broadsheet newspaper coverage of climate change. We employ two complementary theoretical lenses, multiple streams theory and institutional theory, to explore why climate change has become headline news in some countries but has received comparatively little coverage in others. The study utilises a worldwide sample across 41 different countries for the year 2008, covering 113 leading national broadsheet newspapers. A cross-sectional regression model is used to identify whether and how a range of contextual factors impact coverage of climate change. To a certain extent, a country’s direct exposure to climate change and the measures that have been taken to combat global warming influence the position of climate change on the media agenda. Crucially, however, we identify a number of contextual factors that impact climate change-related media coverage in different national contexts. In particular, we find a significantly positive relationship between regulatory quality and levels of media coverage. At the same time, unemployment trends are significantly negatively related to media attention to climate change. Gross domestic product per capita does not help to explain levels of climate change-related media coverage. In other words, climate change appears to have moved beyond simply being a ‘rich country issue’

SUPPORT Tools for evidence-informed health Policymaking (STP) 4: Using research evidence to clarify a problem

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers

Opportunistic decision-making in government: concept formation, variety and explanation

The notion of opportunism is too often used loosely in policy and administrative research on executive decision-making: its various meanings are too rarely clearly distinguished. To make it useful for explanation, this article presents fresh concept formation work, clarifying the concept to recognize different kinds and degrees of opportunism. To illustrate the use of the refined concept, the article examines key decisions by British cabinets and core executives between 1945 and 1990. It proposes that neo-Durkheimian institutional theory can help to explain why different kinds of opportunism are cultivated in differently ordered administrations, so providing new insight into decision-making.This work was supported by the Leverhulme Trust (grant number: F01374I

Policy ideas through the prism of knowledge regimes and framing

Policymakers are often confronted with problems that involve ambiguity and uncertainty (Zahariadis, 2003). In order to make sense of such problems and to identify possible solutions, they are on the lookout for policy ideas

Climate change adaptation in European river basins

This paper contains an assessment and standardized comparative analysis of the current water management regimes in four case-studies in three European river basins: the Hungarian part of the Upper Tisza, the Ukrainian part of the Upper Tisza (also called Zacarpathian Tisza), Alentejo Region (including the Alqueva Reservoir) in the Lower Guadiana in Portugal, and Rivierenland in the Netherlands. The analysis comprises several regime elements considered to be important in adaptive and integrated water management: agency, awareness raising and education, type of governance and cooperation structures, information management and—exchange, policy development and—implementation, risk management, and finances and cost recovery. This comparative analysis has an explorative character intended to identify general patterns in adaptive and integrated water management and to determine its role in coping with the impacts of climate change on floods and droughts. The results show that there is a strong interdependence of the elements within a water management regime, and as such this interdependence is a stabilizing factor in current management regimes. For example, this research provides evidence that a lack of joint/participative knowledge is an important obstacle for cooperation, or vice versa. We argue that there is a two-way relationship between information management and collaboration. Moreover, this research suggests that bottom-up governance is not a straightforward solution to water management problems in large-scale, complex, multiple-use systems, such as river basins. Instead, all the regimes being analyzed are in a process of finding a balance between bottom-up and top–down governance. Finally, this research shows that in a basin where one type of extreme is dominant—like droughts in the Alentejo (Portugal) and floods in Rivierenland (Netherlands)—the potential impacts of other extremes are somehow ignored or not perceived with the urgency they might deserv

How to engage across sectors: Lessons on leveraging agriculture for nutrition from the Brazilian school meal program

OBJECTIVE: To provide insights for nutrition and public health practitioners on how to engage with other sectors to achieve public health goals. Specifically, this study provides lessons from the example of integrating family farming and a nutrition into a legal framework in Brazil on how to successfully shift other sectors toward nutrition goals. METHODS: The study analyzed policy processes that led to a Brazilian law linking family farming with the National School Feeding Program. Main actors involved with the development of the law were interviewed and their narratives were analyzed using a well-established theoretical framework. RESULTS: The study provides five key lessons for promoting intersectorality. First, nutrition and health practitioners can afford to embrace bold ideas when working with other sectors. Second, they should engage with more powerful sectors (or subsectors) and position nutrition goals as providing solutions that meet the interests of these sector. Third is the need to focus on a common goal – which may not be explicitly nutrition-related – as the focus of the intersectoral action. Fourth, philosophical, political, and governance spaces are needed to bring together different sectors. Fifth, evidence on the success of the intersectoral approach increases the acceptance of the process. CONCLUSIONS: This study on policy processes shows how a convergence of factors enabled a link between family farming and school feeding in Brazil. It highlights that there are strategies to engage other sectors toward nutrition goals which provides benefits for all sectors involved. DESCRIPTORS: School Feeding. Sustainable Agriculture. Farmers Associations. Nutrition Programs and Policies. Food and Nutrition Security