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In Western Europe, as immigration flows increase – or at least become more salient – and austerity measures place welfare states under pressure, policy reforms that extend or restrict access to the welfare state for immigrants are highly contested. Much academic attention has been paid to restrictive or ‘welfare chauvinist’ policy reforms and the role played by far‐right parties and sympathisers in the policy‐making process. Yet, left‐wing parties, often considered the most susceptible to the ‘progressive's dilemma’ between open borders and strong welfare states, remain under‐researched. Using new data on immigrant welfare rights for 14 European countries from 1980 to 2018, and differentiating between social democrats, the greens and far‐left parties, we show that social democrats engage in both reforms that restrict as well as expand, but on average, they tend to be negatively associated with immigrant welfare rights. However, our evidence shows that context matters: We find that that social democrats are less likely to retrench immigrant welfare rights when they share power with the far left, and become more likely to retrench as unemployment rises.
During a crisis, the public expects the government to handle the situation. In parliamentary democracies, these expectations are directed to the cabinet and its ministers. Cabinet ministers are expected to be highly involved in policy making under their jurisdiction and in general. During periods of politics as usual, ministers differ in their policy involvement. This paper asks whether that changes during a crisis. Based on an analysis of cabinet ministers in Israel during the first wave of the COVID19 crisis, this paper finds that ministers’ policy involvement during a crisis is relatively low. Most ministers are little involved in issues outside their jurisdiction. Ministers less central to the crisis management are also little involved in issues under their jurisdiction. Ministers central to the crisis management are highly involved in introducing decisions on issues under their jurisdiction, but not necessarily in other aspects of policy making. These findings have implications for issues of accountability and trust.
This article explores the contribution that cultural memory studies can make to the debate about the role of ideas and the dynamics of ideational change in policy making. Cultural memory studies engage with the cultural dimensions of remembering, and analyse how shared images of the past are mediated and transferred across distance and time. Such research shows how the past may continue to influence the present by informing the frameworks through which groups and individuals interpret and give meaning to events and phenomena. Since policy makers operate within a cultural context, shared memories are likely also to affect the way they think about the nature and roots of policy issues and the appropriateness and feasibility of policy options. In this article, policy memory (the memory shared by policy makers about earlier policies) is identified as a subcategory of cultural memory. The role of cultural memory among policy makers is studied with reference to Dutch integration policies in two periods: the mid‐1990s and the early 2000s. On the basis of an in‐depth analysis of policy reports and parliamentary debates, references to the past and the role they play in the policy debate are identified. Different modes of dealing with the past are found in the two periods studied, reflecting the different political contexts in which the debates took place. In the 1990s, the memory of earlier policy was invoked in the mode of continuity – that is, policy change was legitimised (conceived) as part of a positive tradition. In the 2000s, memory was invoked in the mode of discontinuity. The same policies were reinterpreted in more negative terms and policy change legitimised by the perceived need to break with the past. Arguably, this reinterpretation of the past was a precondition for the shift in policy beliefs that took place around that time.
This introduction to the forum section on the Multiple Streams Framework (MSF) developed by John W. Kingdon argues that the conditions under which policy making takes place today increasingly resemble the assumptions upon which Kingdon built his lens. At the same time, while the framework is extremely successful with regard to citations and has been applied in various contexts that often differ remarkably from those for which the framework was originally developed, a systematic theoretical debate about the Multiple Streams Framework is still lacking. It is the intention to spark such a debate with this forum section.
This article analyses the role of organizations’ ideological affiliation in shaping information networks within civil society and in granting access to the political sphere. It investigates whether the Catholic and Leftist affiliation of organizations impacts in the city of Turin (Italy) and Kielce (Poland). Applying different social network analysis techniques, the article finds that in both cities there is a tendency towards preferring similar partners. However, while the influence of affiliation is relevant to predict the access to policy making in Turin, in Kielce, this influence is mediated by the actor’s centrality in the social sphere. In both cities, networks are characterized by the higher centrality of Catholic organizations, which also translate in a greater involvement in the political sphere. Twenty-five years after the end of the cold war, past-affiliation is still a strong predictor of political involvement and impacts on the shape of local governance structure.
The promise of algorithmic decision-making (ADM) lies in its capacity to support or replace human decision-making based on a superior ability to solve specific cognitive tasks. Applications have found their way into various domains of decision-making—and even find appeal in the realm of politics. Against the backdrop of widespread dissatisfaction with politicians in established democracies, there are even calls for replacing politicians with machines. Our discipline has hitherto remained surprisingly silent on these issues. The present article argues that it is important to have a clear grasp of when and how ADM is compatible with political decision-making. While algorithms may help decision-makers in the evidence-based selection of policy instruments to achieve pre-defined goals, bringing ADM to the heart of politics, where the guiding goals are set, is dangerous. Democratic politics, we argue, involves a kind of learning that is incompatible with the learning and optimization performed by algorithmic systems.
To examine policy processes and industry opposition surrounding the first US healthy checkout ordinances (HCO), which mandate nutritional standards for foods and beverages displayed in grocery checkout areas.
Design:
Qualitative case study comparison using Kingdon’s Multiple Streams Framework, triangulating city records, advocacy materials and key informant interviews.
Setting:
Local governments of Berkeley and Perris, California, USA.
Participants:
Informants, identified from documents and snowball sampling, included community-based organisation members/local advocates (Berkeley n 6; Perris n 1), staff from national nongovernmental organisations providing assistance (Berkeley n 2; Perris n 2), city councilmembers (Berkeley n 2; Perris n 2), city commissioner (Berkeley n 1) and city staff (Perris n 2).
Results:
We described and compared each city’s HCO enactment process. In both, prior commitments to community-led food environment reforms enabled advocates to garner financial and technical support for early coalition building. Berkeley used soda tax proceeds for a youth-led citizen science project to formulate an enforceable HCO and assess public support. These experiences fostered political commitment to define applicable stores, checkout areas and nutritional standards. Campaigns emphasised protecting children and parents from predatory marketing and impulse buying. Berkeley’s campaign quietly and cautiously engaged mostly independent retailers, attracting limited industry attention; Perris engaged all retailers and after enactment faced open opposition from a chain store and trade associations. Perris’ amended HCO included concessions allowing unhealthy items at many endcaps and long checkout lanes.
Conclusions:
HCO enactment may be facilitated by prior food policy experience, community capacity, early coalition building, careful policy design and framing and anticipating and managing industry opposition.
Mental health policies and plans (MHPPs) are powerful tools developed to facilitate real-world changes in mental-health-related prevention, promotion and treatment. This study examined barriers and facilitators to MHPP implementation across the WHO European region. Key informants from 53 countries were contacted and 25 provided in-depth qualitative interviews on MHPP existence, implementation, and evaluation related barriers and facilitators of implementation. We analyzed data via qualitative framework analysis approach aligned with the WHO Comprehensive Mental Health Action Plan 2013–2030. Reported facilitators included active involvement of key stakeholders, ongoing mental healthcare reform, bottom-up approach to implementation, sufficient funding, favorable political receptivity and strong monitoring. Barriers encompassed insufficient funding, workforce shortages, adequate training in psychiatry, missing or insufficient infrastructure in terms of both physical structures and technology for data collection, low political receptivity, stigma and bureaucratic obstables. While notable progress has been made in the development of mental health plans in the European region, substantial gaps remain in information systems, research capacity, and systematic evaluation frameworks on mental health and development of appropriate evaluation plans. Strengthening these components is essential to ensure the effective and sustainable implementation of MHPPs throughout the region.
Health technology assessment (HTA) for medical devices (MDs) is essential for adoption decisions, but the sector’s particularities studied here defy regulatory frameworks. In Brazil, the National Policy for Health Technology Management (PNGTS) provides guidelines for HTA, but the reimbursement of MDs in the Brazilian National Health System (SUS) still faces challenges. This study aimed to identify and validate relevant domains and attributes for HTA of MDs in the SUS, considering the perspectives of various stakeholders.
Objectives
To analyze and validate the essential domains and attributes for conducting HTA studies focused on the reimbursement of MDs in the SUS.
Methods
A baseline systematic review was performed, which was followed by two additional stages: a survey with 115 participants and a Delphi panel with 33 experts. Likert scales were used to assess the importance of the domains and attributes, along with open questions to collect suggestions and comments.
Results
The domains “clinical benefits,” “evidence ecosystem,” and “budget impact” were considered fundamental. “Social participation” showed high variability in response, indicating the need for greater engagement and clarity in participation mechanisms. The inclusion of the “public policy” domain emphasizes the importance of aligning government policies with population needs.
Conclusions
This study reinforced the relevance of a multidisciplinary and participatory approach in HTA for MDs, with a focus on clinical outcomes, real-world evidence, and continuous monitoring. Overcoming the identified challenges, such as information gaps and the need for robust methods, is crucial for improving the reimbursement of MDs in the SUS.
Health technology assessment of medical devices (HTA-MDs) presents unique challenges compared to pharmaceuticals. Total MD expenditure continues to grow in Europe, and countries typically conduct their own HTA-MDs evaluations, with varying institutionalization arrangements. European Union’s (EU’s) HTA Regulation aims to establish collaborative clinical assessments across Member States, potentially expediting the path from EU safety certification of MDs to pricing and reimbursement decisions. This study aims to identify emergent configurations among institutionalizations of HTA-MDs in the EU, European Economic Area (EEA), and European Free Trade Association (EFTA) countries.
Methods
Publicly available data were cross-sectionally collected for EU, EEA, and EFTA countries until August 2024 to allow a cross-country analysis of HTA-MDs institutionalizations. Countries were included if they had at least one publicly mandated body for HTA-MDs. Data sources were scientific databases, institutional websites, and HTA bodies’ documentation. A framework of 16 elements, qualitatively describing the institutionalization of HTA-MDs, was developed based on a document review and used as a dataset for agglomerative hierarchical cluster analysis to identify patterns of HTA-MDs institutionalization.
Results
The 21 included countries formed three clusters: Cluster 1 featured regulatory-focused, legally bound HTA-MDs systems with mandatory assessments determining reimbursement decisions; Cluster 2 was characterized by regulatory functions, external expert collaboration, formal prioritization processes, and organized Horizon Scanning; Cluster 3 showed recommendatory functions, nonmandatory assessments, and limited impact on reimbursement decisions.
Conclusions
HTA-MDs institutionalizations could benefit from implementing prioritization processes of evaluations, establishing networks of collaborative assessment centers, and ensuring links between evaluations and reimbursement decisions.
As Ethiopia advances towards efficient resource utilization and UHC through strategic health purchasing, the institutionalization of HTA will play a critical role. This study aims to identify key stakeholders, analyze the political economy surrounding HTA and priority setting in Ethiopia, and assess existing skills and capacities for a robust and sustainable HTA system.
Methods
We employed a mixed-method approach, combining 16 key informant interviews, 24 document reviews, and a cross-sectional survey (n=65) to assess national HTA capacity. We employed the Walt and Gilson policy analysis triangle framework, alongside Campos and Reich’s framework, to evaluate the context, process, content, and actors influencing HTA institutionalization, and to explore the complex interplay of institutions, positions, power, and interests among various stakeholders.
Results
While there is a general commitment to implementing HTA across various government agencies and stakeholder groups, the institutionalization process faces several challenges, involving multiple agencies with overlapping mandates, raises bureaucratic challenges and potential conflicts, risking horizontal fragmentation as agencies compete for authority, budget, and influence. The involvement of other key stakeholders, such as professional associations, patients, and the public, is notably lacking. Challenges such as limited HTA expertise, high professional turnover, and gaps in specific HTA knowledge areas persist, with capacity-building efforts often failing to address organizational needs effectively.
Conclusions
The complexity of HTA institutionalization in Ethiopia underscores the necessity of managing intricate inter-agency dynamics, establishing a robust legal framework for an inclusive and transparent HTA process, building local capacity, and securing sustainable, domestically aligned funding.
The various global refugee and migration events of the last few years underscore the need for advancing anticipatory strategies in migration policy. The struggle to manage large inflows (or outflows) highlights the demand for proactive measures based on a sense of the future. Anticipatory methods, ranging from predictive models to foresight techniques, emerge as valuable tools for policymakers. These methods, now bolstered by advancements in technology and leveraging nontraditional data sources, can offer a pathway to develop more precise, responsive, and forward-thinking policies.
This paper seeks to map out the rapidly evolving domain of anticipatory methods in the realm of migration policy, capturing the trend toward integrating quantitative and qualitative methodologies and harnessing novel tools and data. It introduces a new taxonomy designed to organize these methods into three core categories: Experience-based, Exploration-based, and Expertise-based. This classification aims to guide policymakers in selecting the most suitable methods for specific contexts or questions, thereby enhancing migration policies.
A substantial international body of evidence links housing to health outcomes. In 2021, the World Health Organisation (WHO) evaluated a small selection of policies from its six geographic regions and found that, in Australia as in the rest of the world, existing healthy housing measures fall short of the systemic response required to address health impacts and inequities. This paper takes the novel step of applying Bacchi’s (2009) ‘What is the Problem Represented to Be?’ approach to a wide-ranging thematic analysis of over 300 Australian policies across the domains of health and housing and related policy areas. In so doing, it offers an overview of existing healthy housing policy as well as illuminating the conceptual understandings and priorities of policy makers, shedding light on the policy paradigms that see housing under-utilised as a preventive health and health equity measure.
Response to the coronavirus disease (COVID-19) pandemic revealed gaps in medical supply quality and personnel training and familiarity in San Francisco County, prompting the reexamination of county disaster supply caches and emergency medical services (EMS) system decompression protocols. Project RESPOND (Rapid Emergency Supplies for Prehospital Operations in Disaster) was developed to bridge the gap in patient care infrastructure during short- or no-warning disasters and enhance EMS system offloading by introducing a novel capacity for the safe treatment and discharge of patients with minor injuries from the scene of an event. This design, while scaled to the needs of a unique metropolitan population, can be used as a template for the reimagining of disaster response policy and development of disaster supply caches.
Based on 4 codesign cases and 15 designer interviews, this article presents how territorial design serves as a catalyst for shared values in community living. Examining user experience and design goals, it reveals how ethological and political values shape territories and the design process. Participants explore new work methodologies, redefine collective activities and navigate in tensions, power issues and political dimensions. The codesign space transforms political interactions, shifting from controversy to conception, offering a new experience and perspective on territorial discussions.
Ethiopia’s commitment to achieving universal health coverage (UHC) requires an efficient and equitable health priority-setting practice. The Ministry of Health aims to institutionalize health technology assessment (HTA) to support evidence-based decision making. This commentary highlights key considerations for successful formulation, adoption, and implementation of HTA policies and practices in Ethiopia, based on a review of international evidence and published normative principles and guidelines. Stakeholder engagement, transparent policymaking, sustainable financing, workforce education, and political economy analysis and power dynamics are critical factors that need to be considered when developing a national HTA roadmap and implementation strategy. To ensure ownership and sustainability of HTA, effective stakeholder engagement and transparency are crucial. Regulatory embedding and sustainable financing ensure legitimacy and continuity of HTA production, and workforce education and training are essential for conducting and interpreting HTA. Political economy analysis helps identify opportunities and constraints for effective HTA implementation. By addressing these considerations, Ethiopia can establish a well-designed HTA system to inform evidence-based and equitable resource allocation toward achieving UHC and improving health outcomes.
Mental health policies and plans (MHPPs) are important policy instruments and powerful tools to facilitate development of mental health systems and services across the world. We aimed to map and analyse methods and tools used to assess the extent, process and impact of implementing MHPPs. We systematically searched peer-reviewed and grey literature across seven scientific databases. We extracted and analysed the data on a) the characteristics of included studies (e.g., policy areas, region of origin, income setting) and b) the methodology and evaluation tools applied to assess the extent and process of implementation. We included 48 studies in the analyses. Twenty-six of these studies employed only qualitative methods (e.g., semi-structured interviews, focus group discussions, desk review, stakeholder consultations); 12 studies used quantitative methods (e.g., trend analysis, survey) and 10 used mixed-methods approaches. Generally, methods and tools used for assessment were described poorly with less than half of the studies providing partial or full details about them. Only three studies provided assessment of full policies. There is a lack of rigorous research to assess implementation MHPPs. Assessments of the implementation of entire MHPPs are almost non-existent. Strategies to assess the implementation of MHPPs should be an integral part of MHPPs.
The objective of the present policy analysis was to understand how a disinvestment approach to the process of health technology assessment (HTA), applied to the field of medical devices, might help Italian policymakers to properly spend the resources in healthcare.
Methods
Previous international and national experiences in disinvestment for medical devices were reviewed. Precious insights for the rational expenditure of the resources were derived by assessing the evidence available.
Results
The disinvestment of ineffective or inappropriate technologies or interventions with an inadequate value-for-money ratio has become a growing priority for National Health Systems. Different international disinvestment experiences of medical devices were identified and described through a rapid review. Although most of them have a strong theoretical framework, their practical application remains difficult. In Italy, there are no examples of large and complex HTA-based disinvestment practices, but their importance is becoming increasingly acknowledged, especially given the need to prioritize the funds provided by Recovery and Resilience Plan.
Conclusions
Anchoring decisions on health technologies without reassessing the current technological landscape through a robust HTA model might expose to the risk of not ensuring the best employment of the resources available. Thus, it is necessary to develop a strong HTA ecosystem in Italy through adequate consultation with stakeholders to enable a data-driven and evidence-based prioritization of resources toward choices characterized by high value for both patients and society as a whole.
Climate change threatens archaeological sites and cultural landscapes globally. While to date, awareness and action around cultural heritage and climate change adaptation planning has focused on Europe and North America, in this article, the authors address adaptation policy and measures for heritage sites in low- and middle-income countries. Using a review of national adaptation plans, expert survey and five case studies, results show the varied climate change adaptation responses across four continents, their strengths and weaknesses, and the barriers to be addressed to ensure better integration of cultural heritage in climate change adaptation planning.