Space, place and (waiting) time: reflections on health policy and politics

AbstractHealth systems have repeatedly addressed concerns about efficiency and equity by employing trans-national comparisons to draw out the strengths and weaknesses of specific policy initiatives. This paper demonstrates the potential for explicit historical analysis of waiting times for hospital treatment to add value to spatial comparative methodologies. Waiting times and the size of the lists of waiting patients have become key operational indicators. In the United Kingdom, as National Health Service (NHS) financial pressures intensified from the 1970s, waiting times have become a topic for regular public and political debate. Various explanations for waiting times include the following: hospital consultants manipulate NHS waiting lists to maintain their private practice; there is under-investment in the NHS; and available (and adequate) resources are being used inefficiently. Other countries have also experienced ongoing tensions between the public and private delivery of universal health care in which national and trans-national comparisons of waiting times have been regularly used. The paper discusses the development of key UK policies, and provides a limited Canadian comparative perspective, to explore wider issues, including whether ‘waiting crises’ were consciously used by policymakers, especially those brought into government to implement new economic and managerial strategies, to diminish the autonomy and authority of the medical professional in the hospital environment.</jats:p

Doctors in Whitehall: medical advisers at the 60th anniversary of the NHS

• The government’s requirement for expert medical advice from the 1850s led to the development of a medical Civil Service, which reached its peak in size and authority in the 1970s. • The successive Whitehall efficiency reviews from 1979 onwards culminated in 1994 in the merger of the parallel reporting hierarchies, effectively reducing the Chief Medical Officer’s ability to call upon the support of medical civil servants, at a time of increasing new health threats such as AIDS and MRSA. • In the last ten years, the government has become more imaginative in its use of temporary specialist medical advisers (tsars) brought in from the NHS, in relaxing the formal Civil Service hierarchies, and quietly abandoning the statutory Standing Medical Advisory Committee (SMAC). • Historical examples show that when the government has failed to give adequate support to its Chief Medical Officers, the medical Civil Service has suffered from poor morale, experienced recruitment difficulties, and the ability to respond to health crises has been compromised. • Virtually none of the Whitehall and NHS reviews have considered their historical context. The current NHS review has been crudely timetabled to produce a politically favourable report in time for the 60th anniversary in July 2008. As with earlier reviews, it does not appear to be addressing more deep-seated issues such as the location and management of medical expertise. • The government needs to acknowledge that some of its tasks, such as protecting the public’s health, do not easily fit into fashionable Public Service Agreements or the ethos of New Public Management

The politics of health policy knowledge transfer: the evolution of the role of British health economics academic units

Economics is now central to health policy decision making, within government departments and the National Health Service. We examine how and why a health economics academic unit – the Centre for Health Economics (CHE) at the University of York, England – was created in 1983, funded and commissioned to provide research evidence to the British government, specifically the Department of Health and Social Security (DHSS) and its successors. Building on the knowledge transfer literature, we document the origins of this relationship and the different strategies deployed by successive governments and researchers. This paper demonstrates the value of historical methodologies such as oral history and textual analysis that highlight the limitations of existing knowledge transfer theories, by foregrounding the role of politics via the construction of individual relationships between academics and policy-makers.</jats:p

Beak shape and nest material use in birds

The evolution of behaviour can both influence, and be influenced by, morphology. Recent advances in methods and data availability have facilitated broad-scale investigations of physical form and behavioural function in many contexts, but the relationship between animal morphology and object manipulation—particularly objects used in construction—remains largely unknown. Here, we employ a new global database of nest materials used by 5924 species of birds together with phylogenetically informed random forest models to evaluate the link between beak shape and these nest-building materials. We find that beak morphology, together with species diet and access to materials, can predict nest-material use above chance and with high accuracy (68–97%). Much of this relationship, however, is driven by phylogenetic signal and sampling biases. We therefore conclude that while variation in nest material use is linked with that of beak shape across bird species, these correlations are modulated by the ecological context and evolutionary history of these species.This article is part of the theme issue ‘The evolutionary ecology of nests: a cross-taxon approach’

Anthropogenic nest material use in a global sample of birds

As humans increasingly modify the natural world, many animals have responded by changing their behaviour. Understanding and predicting the extent of these responses is a key step in conserving these species. For example, the tendency for some species of birds to incorporate anthropogenic items—particularly plastic material—into their nests is of increasing concern, as in some cases, this behaviour has harmful effects on adults, young and eggs. Studies of this phenomenon, however, have to date been largely limited in geographic and taxonomic scope. To investigate the global correlates of anthropogenic (including plastic) nest material use, we used Bayesian phylogenetic mixed models and a data set of recorded nest materials in 6147 species of birds. We find that, after controlling for research effort and proximity to human landscape modifications, anthropogenic nest material use is correlated with synanthropic (artificial) nesting locations, breeding environment and the number of different nest materials the species has been recorded to use. We also demonstrate that body mass, range size, conservation status and brain size do not explain variation in the recorded use of anthropogenic nest materials. These results indicate that anthropogenic materials are more likely to be included in nests when they are more readily available, as well as potentially by species that are more flexible in their nest material choice

Lessons from the History of British Health Policy

‘Health policy’ is a slippery concept. In Britain, since the establishment of the National Health Service, it has often come to be associated only with the NHS, but it has a longer running and wider history. Health policy both predates the NHS and goes beyond it. In this introduction we set the chapters in this report in context by exploring some of the issues that run through the history of health policy in Britain. We focus on five areas: (1.) What was or is ‘health policy’? (2.) Where was health policy made? (3.) Who were the policymakers? (4.) What were some of the persisting policy challenges? (5.) What are the politics of health policy