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The conditional cash transfer programme (CCT) for poor families was terminated in Mexico in 2019. CCTs seek to fight poverty under a social investment logic by promoting the formation of human capital through the compliance of behavioural conditionalities. The programme – the first of its kind introduced at national level – accomplished several achievements and was maintained and developed by three successive federal administrations. As the backbone of anti-poverty policy for more than two decades, its achievements included delivering positive results to a significant proportion of the population; and triggering the expansion of social policy beyond social insurance. As a result, it was emulated by governments across the globe. A programme of these characteristics would have been expected to generate path dependency and policy stability, yet it was swiftly terminated with practically no opposition. This article applies a framework of historical institutionalism to analyse the feedback effects developed during the duration of the programme from the perspectives of beneficiaries, in order to contribute to the explanation of its termination. The research is based on qualitative empirical data from interviews with former beneficiaries. Our findings show that self-undermining mechanisms linked to a ‘hard’ design and implementation of conditionalities counterbalanced the self-reinforcing mechanisms derived from the benefits supplied by the programme, causing beneficiaries to become apathetic towards its continuity or termination. Conclusions yield theoretical insights that might serve to examine policy feedback in similar contexts, as well as lessons for policymakers regarding the design and implementation of social programmes.
Efforts to better understand what prevents institutions from changing to meet contemporary demands – or what facilitates the evolution of existing constructs to address new challenges – are of particular import and relevance to environmental governance. While the existing literature provides valuable conceptualisation and empirical evaluation of institutional stability and change, the lack of a consistent and holistic typology complicates the evaluation of institutions over time. In this article, we use a combined stability–change typology to assess the dominant modes of institutional change and stability over a multi-decadal timespan across three environmental governance systems – air quality governance in the US and China, and climate governance in the European Union. Across cases, we find that these modes are not mutually exclusive but can occur simultaneously, in concert or in conflict. We also find that observed patterns of change and stability are reflective of the social and political context in which systems operate, as well as the focus of the system itself (for example, localised air quality versus global climate change). Apart from providing a proof-of-concept analysis of institutional change and stability, our findings raise questions about the mechanisms underlying spatial and temporal patterns across identified modes. Indirectly, our findings also further highlight challenges to designing systems both resilient to exogenous stressors and capable of adapting to new situations. Our combined stability–change typology may help to advance understanding of whether and how such balancing has occurred in the past, thus facilitating future efforts to address contemporary challenges.
The aim of this article is to explore the types of health evidence that diverse actors find most persuasive in a complex policy system. The impact of evidence depends on many factors, including how it is presented and translated to audiences. If diverse actors are to address complex health challenges collectively, it helps if they can draw on evidence that is accessible and meaningful to all. We explore how this can be done through a case study of promoting healthy urban development in the United Kingdom. Based on 132 in-depth interviews with critical actors from across the urban development system, we examined the types of evidence actors find most helpful. While there was some variation by sector, actors revealed a strong preference for narratives with a strong emotional impact, supported by credible evidence. Urban development decision makers are persuaded by both qualitative and quantitative evidence, although there was a slight preference among the public sector for quantitative data. All actors valued evidence on the impact of the urban environment on population health outcomes and the associated costs of ill health. There was, however, a preference among private sector actors for evidence showing economic valuations of health that demonstrate a commercial advantage. Our findings make an important contribution to the evidence-based policy literature by identifying the types of health evidence that appeal to diverse actors in the urban development system. These insights can be used to design evidence that meets the requirements of all actors in a complex system.
Contemporary governments face dwindling resources and populations who feel disconnected from political systems. In response, both governments and scholars increasingly explore more participative governance approaches. Such efforts have coalesced around ‘co-creation’, a way of governing through collaboration between public and private actors, often including citizens. Increasingly, scholars emphasise ‘co-creation platforms’: devices that use reconfigurable structures and resources to facilitate multiple instances of co-creation. By creating platforms, advocates claim, governments can facilitate widespread co-creation without unfeasible costs. Some even encourage governments to adopt platform-creation as their way of governing – so-called ‘generative governance’. Yet, with governments being time- and cash-poor, they cannot participate in every such co-creation initiative themselves. To realise the promise of generative governance, platforms must enable governments to facilitate co-creation initiatives at arm’s length.
While, however, research suggests that governments can be successful platform-users, we know little about how successfully they can forge platforms to encourage co-creation among others. Consequently, we conducted a nested case study of the creation and use of one novel platform: London Borough of Culture. Theorised through literatures on platforms, and co-creation’s drivers and inhibitors, our findings affirm that platforms can facilitate co-creation. However, they also uncover how platforms fashioned by politically-led organisations become entangled in political dynamics that inhibit co-creation. Two contributions follow: first, platforms made by politically-led bodies enable, but simultaneously constrain, others’ co-creation; second, drivers and inhibitors of co-creation can be strategically shaped by interventions (for example, platforms) to maximise the chances of that co-creation succeeding.
Background:
Pharmacists have important roles in consumers’ access to medicines and healthcare. Pharmacy policy advocates have recognised that evidence is important but often insufficient for policy change to support expanded roles of pharmacists, but there has been minimal exploration of why this is the case.
Aims and objectives:
To characterise, classify, and describe the types of knowledge that were considered and used in these two pharmacy policy issues in Australia: codeine up-scheduling and pharmacist-administered vaccinations.
Methods:
Using documentary data and semi-structured interviews, we identified the research-based, practical, and political knowledge used in these policy processes, drawing on Head’s ‘three lenses of evidence-based policy’. We used a ‘programmatic approach’ to analyse how evidence is used in policymaking, where the use and framing of evidence is considered in light of policy actors’ institutional roles and goals.
Findings:
Practical knowledge demonstrating pharmacists’ ability to conduct clinical activities and political knowledge of institutional processes and acceptability were used for both issues; however, research evidence was more identifiable in up-scheduling. Evidence was prioritised and used differently depending on stakeholders’ goals.
Discussion and conclusions:
Our analysis offers insights for the Australian pharmacy sector advocating for policies to benefit individual and public health. Although medicines regulation and pharmacy practice are phenomena that exist globally, institutional and policymaking contexts differ by country. The pharmacy sector needs to consider these contexts to effectively engage policymakers and optimise evidence use in developing and implementing desired policies.
Background:
It is widely recognised that policymakers use research deemed relevant, yet little is understood about ways to enhance perceived relevance of research evidence. Observing policymakers’ access of research online provides a pragmatic way to investigate predictors of relevance.
Aims and objectives:
This study investigates a range of relevance indicators including committee assignments, public statements, issue prevalence, or the policymaker’s name or district.
Methods:
In a series of four rapid-cycle randomised control trials (RCTs), the present work systematically explores science communication strategies by studying indicators of perceived relevance. State legislators, state staffers, and federal staffers were emailed fact sheets on issues of COVID (Trial 1, N = 3403), exploitation (Trial 2, N = 6846), police violence (Trial 3, N = 3488), and domestic violence (Trial 4, N = 3888).
Findings:
Across these trials, personalising the subject line to the legislator’s name or district and targeting recipients based on committee assignment consistently improved engagement. Mentions of subject matter in public statements was inconsistently associated, and state-level prevalence of the issue was largely not associated with email engagement behaviour.
Discussion and conclusions:
Together, these results indicate a benefit of targeting legislators based on committee assignments and of personalising the subject line with legislator information. This work further operationalises practical indicators of personal relevance and demonstrates a novel method of how to test science communication strategies among policymakers. Building enduring capacity for testing science communication will improve tactics to cut through the noise during times of political crisis.
Background:
The emergency response to the COVID-19 pandemic has required a rapid acceleration of policy decision making, and raised a wide range of ethical issues worldwide, ranging from vaccine prioritisation, welfare and public health ‘trade-offs’, inequalities in policy impacts, and the legitimacy of scientific expertise.
Aims and objectives:
This paper explores the legacy of the pandemic for future science-advice-policy relationships by investigating how the UK government’s engagement with ethical advice is organised institutionally. We provide an analysis of some key ethical moments in the UK Government response to the pandemic, and institutions and national frameworks which exist to provide ethical advice on policy strategies.
Methods:
We draw on literature review, documentary analysis of scientific advisory group reports, and a stakeholder workshop with government ethics advisors and researchers in England.
Findings:
We identify how particular types of ethical advice and expertise are sought to support decision making. Contrary to a prominent assumption in the extensive literature on ‘governing by expertise’, ethical decisions in times of crisis are highly contingent.
Discussion and conclusions:
The paper raises an important set of questions for how best to equip policymakers to navigate decisions about values in situations characterised by knowledge deficits, complexity and uncertainty. We conclude that a clearer pathway is needed between advisory institutions and decision makers to ensure ethically-informed debate.
Background:
Research impact is at least partly generated through collaborative interactions, yet the associations between knowledge production and impact are far more complex than relatively simple linear models generally describe.
Aims and objectives:
In this case study, we focus on a community-university partnership and try to answer the question, ‘What are the conditions that facilitate or hinder successful collaborative interactions aimed towards solving a shared challenge between partners from different organisations?’
Methods:
A set of four co-creation sessions with diverse stakeholders was organised with the aim of tackling the nuisance caused by youth in a specific deprived neighbourhood in Belgium. The sessions were video-recorded, transcribed verbatim, and analysed following a Grounded Theory (GT) approach to develop theoretical understandings of the process of knowledge production and research impact.
Findings:
Roles and mandates of individual stakeholder representatives determine (and hinder) their access to (confidential) information, but also their visibility and accessibility towards youth as end users. Achieving positive outcomes through collaboration was perceived by stakeholders as slowly evolving towards small successes, and was facilitated by being able to accept failure, working in a climate of trust, developing a shared identity, managing expectations, informally sharing information, and being able to connect with youth.
Discussion and conclusions:
We reflect on the importance of overcoming organisational asymmetries in collaborative interactions through installing feedback loops, and through the particular roles of boundary organisations, boundary objects, and practical tools that can help steer iterative collaborative interactions towards positive impact.
Background:
Meetings are essential events for the production of a policy. Yet they are largely taken for granted in policy studies: they are perceived as tools for achieving predefined tasks and used as a means of studying other topics, such as public participation.
Aims and objectives:
I aim to study meetings themselves and to develop the concept of meeting in brackets, which helps understand how meetings produce the policy to which they relate. I focus on a Belgian mental health policy supporting a shift from hospital to community mental healthcare.
Methods:
Qualitative methods, including direct observation of 77 meetings and interviews, were combined over an eight-year period in order to comprehensively understand the relationship between meetings and policy production.
Findings:
The Belgian mental health policy gradually emerged from meetings that took place at international, national and local levels. As a result of references made by the participants to previous meetings or to the resulting documents, these meetings gradually formed a web, outside of which the Belgian mental health policy cannot be understood.
Discussion and conclusions:
The concept of meeting in brackets led to define meetings as communicative events framed by decisions about meeting structure, which I call bracketing decisions. These decisions facilitate a form of communication described as reflexive. Reflexive communication in turn leads to a collective creation: a unique vision of the policy under discussion. Such unique visions are gradually assembled as meetings succeed each other, thus forming a web of meetings which is inherent to policy production.
Background:
Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces.
Aims and objectives:
This study investigated key factors affecting municipal officials’ policymaking for obesity and related health disparities.
Methods:
Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021.
Findings:
Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviours, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take; limitations based on the scope of government; challenges with intergovernmental collaboration or across government levels; ability of policymakers and government employees to understand the problem; and the challenge of framing health disparities given the social-political context.
Discussion and conclusion:
Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.
