Evidence for physical activity guidelines as a public health intervention: efficacy, effectiveness and harm – a critical policy sciences approach.

BACKGROUND: Evidence for the efficacy of physical activity in conferring health benefits is unequivocal, and this has led national governments to produce guideline recommendations for physical activity levels in their populations. AIM: To evaluate how far evidence for the efficacy, effectiveness and comparative effectiveness of current physical activity guideline recommendations as a public health intervention is considered in developing guideline recommendations, including a consideration of the extent to which, in comparison to alternatives, they may result in harm. METHODS: Utilising a critical policy sciences approach, national physical activity guideline recommendations in Australia, the UK and the USA, and those of the World Health Organisation, are examined, along with their stated underlying evidence bases, to analyse what evidence has been considered, how it has been interpreted, for what purpose, and with what outcomes. RESULTS: All current guidelines recommend 150 minutes moderate physical activity per week. However, efficacy evidence shows 60 minutes is sufficient to provide some health benefits. None of the guidelines consider effectiveness evidence nor potential effectiveness. No evidence could be found for the effectiveness of a recommendation of 150 minutes in improving population health, and none of the guidelines consider whether a recommendation at a lower but still sufficient level of efficacy (e.g. 60 minutes) would be a more effective public health intervention. CONCLUSIONS: Evidence considered in drawing up physical activity guidelines relates only to the efficacy of physical activity in conferring health benefits. The lack of effectiveness evidence, the failure to consider potential effectiveness, and related un-evidenced value judgements call into question the claim that the guidelines are evidence-based. Because neither effectiveness nor comparative effectiveness is considered, it is possible that current guidelines of 150 minutes may result in net harm to population health in comparison to the opportunity cost of recommendations at alternative levels

Representative bureaucracy and unconscious bias: Exploring the unconscious dimension of active representation

Representative bureaucracy theory explores the effects of representation on bureaucracies, but less attention has been paid to date as to how agents represent values or interests. Addressing this omission, this article highlights the unconscious dimension of active representation and, more specifically, the role of unconscious bias in representation. Unconscious bias has received limited attention to date in public administration, but has clear relevance for understanding how representation occurs at the individual level. This article proposes a framework for understanding unconscious bias. Drawing on Bourdieu's habitus, but making explicit its unconscious dimension, I argue that unconscious bias enhances our understanding of how active representation occurs in bureaucracies today. The article applies these insights to the case of unconscious gender bias as found in the Australian Public Service (APS) and concludes by exploring the methodological challenges involved in building a research agenda into tackling unconscious bias

From design to operations: a process management life-cycle performance measurement system for Public-Private Partnerships

YesPublic–Private Partnerships (PPPs) have become a critical vehicle for delivering infrastructure worldwide. Yet, the use of such a procurement strategy has received considerable criticism, as they have been prone to experiencing time/cost overruns and during their operation poorly managed. A key issue contributing to the poor performance of PPPs is the paucity of an effective and comprehensive performance measurement system. There has been a tendency for the performance of PPPs to be measured based on their ex-post criteria of time, cost and quality. Such criteria do not accommodate the complexities and lifecycle of an asset. In addressing this problem, the methodology of sequential triangulation is used to develop and examine the effectiveness of a ‘Process Management Life Cycle Performance Measurement System’. The research provides public authorities and private-sector entities embarking on PPPs with a robust mechanism to effectively measure, control and manage their projects’ life cycle performances, ensuring the assets are ‘future proofed’

Widening participation in nurse education; an integrative literature review

Background: Widening participation into higher education is espoused within educational policy in the UK, and internationally, as a mechanism to promote equality and social mobility. As nurse education is located within higher education it has a responsibility to promote widening participation within pre-registration educational programmes. It could also be argued that the profession has a responsibility to promote equality to ensure its’ workforce is as diverse as possible in order to best address the health needs of diverse populations. Objectives: To undertake an integrative review on published papers exploring Widening Participation in undergraduate, pre-registration nurse education in the UK Design: A six step integrative review methodology was utilised, reviewing papers 2013-2016; published in English. Data sources: Search of CINAHL, Education Source, MEDLINE, PsychINFO, SocINDEX, Science Direct, Business Scource Complete, ERIC, British Library ETOS, Teacher Reference Centre, Informit Health Collection and Informit Humanities and Social Science Collection which highlighted 449 citations; from these 14 papers met the review inclusion criteria. Review methods: Both empirical studies and editorials focusing upon widening participation in pre-registration nurse education in the UK (2013-2016) were included. Papers excluded were non UK papers or papers not focussed upon widening participation in pre-registration nursing education. Research papers included in the review were assessed for quality using appropriate critical appraisal tools Results: 14 papers were included in the review; these were analysed thematically identifying four themes; knowledge and identification of WP, pedagogy and WP, attrition and retention and career prospects. Conclusions: Whilst widening participation is a key issue for both nurse education and the wider profession there is a lack of conceptualisation and focus regarding mechanisms to both encourage and support a wider diversity of entrant. Whilst there are some studies, these focus on particular individual widening participation groups rather than a wider strategic focus across the student lifecycle

The business of death: a qualitative study of financial concerns of widowed older women

BACKGROUND: The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women’s experiences in the period soon after their husbands’ death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life. METHODS: This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis. RESULTS: Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband’s death. CONCLUSIONS: Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models

Competing and conflicting messages via online news media: potential impacts of claims that the Great Barrier Reef is dying

Coverage of issues by news media is known to impact on both public perceptions and policy development aimed at addressing the featured issues. We examine the potential impact of news media coverage regarding the health and potential future of the World heritage-listed Great Barrier Reef, which is under multiple pressures, both natural and anthropogenic. We draw on the extant literature regarding the impact of news media coverage of other complex issues, linking to relevant, albeit limited theoretical concepts that have been applied to previous media studies. We find that media coverage is predominately sensationalized and negative, with the potential to reinforce perceptions that mitigation attempts will be ineffective and thus likely to inhibit future policy development. We discuss the need for a review of existing science communication models and strategies to reduce the knowledge-practice gap between scientists and policy makers, together with proactive strategies to counter negative news coverage