Understanding factors impacting global priority of emergency care: a qualitative policy analysis

IntroductionThe high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped the priority of global emergency care and highlight potential responses by emergency care advocates.MethodsWe conducted semistructured interviews with key experts in global emergency care practice, public health, health policy and advocacy. We then applied a policy framework based on political ethnography and content analysis to code for underlying themes.ResultsWe identified problem definition, coalition building, paucity of data and positioning, as the main challenges faced by emergency care advocates. Problem definition remains the key issue, with divergent ideas on what emergency care is, should be and what solutions are to be prioritised. Proponents have struggled to portray the urgency of the issue in a way that commands action from decision-makers. The lack of data further limits their effectiveness. However, there is much reason for optimism given the network’s commitment to the issue, the emerging leadership and the existence of policy windows.ConclusionTo improve global priority for emergency care, proponents should take advantage of the emerging governance structure and build consensus on definitions, generate data-driven solutions, find strategic framings and engage with non-traditional allies.

Foreign Policy Entrepreneurs, Policy Windows, and “Pragmatic Engagement”: Reconsidering Insights of the Multiple Streams Framework and the Obama Administration's 2009 Policy Shift Toward Military-Run Myanmar

This article aims to contribute to the evolving dialogue between foreign policy analysis and public policy with reference to John Kingdon's multiple streams approach. It problematizes how one of the key concepts of MSA—policy windows—has been used in applications to foreign policy and suggests that policy windows may be more difficult to exploit than illustrations of successful foreign policy entrepreneurship indicate. Indeed, the article argues that policy windows can be either small or large; their size will likely differ not least because policy windows are situated within numerous contexts. With reference to instances of foreign policy redirection, the article highlights four such contexts: the placement and access of foreign policy entrepreneurs; the level of contestation surrounding a problematic but prevailing policy; geopolitical pressures; and ideas guiding foreign policy. The article moreover suggests that by contextualizing policy windows and considering also how contingency may affect policy windows, it seems possible to integrate insights from foreign policy analysis into current theorizing about foreign policy entrepreneurship drawing on the multiple streams framework. The empirical illustration examines the policy window that opened up for policy entrepreneurs to recast longstanding US policy toward military-run Myanmar as the Obama administration took office. Cet article a pour objectif de contribuer à l’évolution du dialogue entre Analyse de la politique étrangère et Politique publique en faisant référence à l'approche des courants multiples de John Kingdon. Il problématise la manière dont l'un des concepts clés de l'approche des courants multiples—celui de fenêtres politiques—a été utilisé dans des applications à la politique étrangère et suggère que les fenêtres politiques peuvent être plus difficiles à exploiter que les illustrations d'entreprise de politique étrangère réussie l'indiquent. En effet, cet article soutient que les fenêtres politiques peuvent être petites ou grandes ; leur taille sera susceptible de varier, notamment car elles interviennent dans de nombreux contextes. Il fait référence à des cas de réorientation de politique étrangère et met en évidence quatre de ces contextes : le placement et l'accès des entrepreneurs de politique étrangère, le niveau de contestation autour d'une politique problématique mais dominante, les pressions géopolitiques et les idées guidant la politique étrangère. Cet article suggère en outre qu'en contextualisant les fenêtres politiques et en prenant également en considération la façon dont la contingence peut affecter les fenêtres politiques, il semble possible d'intégrer les renseignements issus de l'analyse de la politique étrangère à la théorisation actuelle de l'entreprise de politique étrangère en s'inspirant du cadre des courants multiples. L'illustration empirique qu'il inclut est une observation de la fenêtre politique qui s'est ouverte aux entrepreneurs politiques pour remanier la politique américaine de longue date envers le Myanmar sous régime militaire lorsque l'administration Obama est entrée en fonction. El objetivo de este artículo es contribuir al diálogo en evolución entre el Análisis de la Política Exterior y la Política Pública con referencia al Enfoque de Corrientes Múltiples (MSA) de John Kingdon. El artículo problematiza la forma en que se ha utilizado uno de los conceptos clave del MSA (la ventana de oportunidad) en las aplicaciones a la política exterior y sugiere que las ventanas de oportunidad política pueden ser más difíciles de explotar de lo que indican los ejemplos ilustrativos de la política exterior empresarial. De hecho, el artículo sostiene que las ventanas de oportunidad política pueden ser pequeñas o grandes; su tamaño probablemente diferirá, entre otras cosas, ya que las ventanas de oportunidad se sitúan en numerosos contextos. Con referencia a los casos de reorientación de la política exterior, este artículo destaca cuatro de estos contextos: la ubicación y el acceso de los emprendedores de políticas exteriores; el nivel de impugnación que rodea a una política problemática pero predominante; las presiones geopolíticas y las ideas que guían la política exterior. Además, el artículo sugiere que al contextualizar las ventanas de oportunidad política y al considerar también cómo la contingencia puede afectar a las ventanas de oportunidad, parece posible integrar las ideas del análisis de la política exterior en la teorización actual sobre el esquema empresarial de la política exterior basándose en el marco de las corrientes múltiples. La ilustración empírica examina la ventana de oportunidad política que se abrió para que los emprendedores de políticas reformularan la antigua política de EE.UU. con respecto a cuando los militares gobernaron Birmania cuando la administración de Obama asumió el cargo.

Equity in music education in Finland

This article illustrates how a social innovation, Figurenotes, has contributed and can contribute, through conceptual change, to the advancement of equity in Basic Education in the Arts (BEA), Finland’s publicly funded system of extracurricular music education. BEA has traditionally been characterised by structures and pedagogical practices–such as the use of Western standard music notation–that influence the accessibility of music studies. The theoretical framework for this interview study consists of change-theoretical concepts: namely, social innovation, multiple streams, and policy windows. The findings are presented at two levels. First, the innovation process of Figurenotes is described to explain social innovation development. Second, three different strands of discourse on the concept of special music education expose the educational policy change generated by this innovation. The findings suggest that the use of Figurenotes has raised awareness of inequity in the institutional agenda and has encouraged this problem to be addressed through the public policy process. The opening of this policy window is critically discussed in relation to the establishment of the field of special music education, and in relation to inclusion and equity policies as well as exclusion.

Tracking Progress from Policy Development to Implementation: A Case Study on Adoption of Mandatory Regulation for Nutrition Labelling in Malaysia

Mandatory nutrition labelling, introduced in Malaysia in 2003, received a “medium implementation” rating from public health experts when previously benchmarked against international best practices by our group. The rating prompted this qualitative case study to explore barriers and facilitators during the policy process. Methods incorporated semi-structured interviews supplemented with cited documents and historical mapping of local and international directions up to 2017. Case participants held senior positions in the Federal government (n = 6), food industry (n = 3) and civil society representations (n = 3). Historical mapping revealed that international directions stimulated policy processes in Malaysia but policy inertia caused implementation gaps. Barriers hindering policy processes included lack of resources, governance complexity, lack of monitoring, technical challenges, policy characteristics linked to costing, lack of sustained efforts in policy advocacy, implementer characteristics and/or industry resistance, including corporate political activities (e.g., lobbying, policy substitution). Facilitators to the policy processes were resource maximization, leadership, stakeholder partnerships or support, policy windows and industry engagement or support. Progressing policy implementation required stronger leadership, resources, inter-ministerial coordination, advocacy partnerships and an accountability monitoring system. This study provides insights for national and global policy entrepreneurs when formulating strategies towards fostering healthy food environments.

The Structure of Nursing Legislation in Iran from the Perspective of Nursing Policymakers: A Qualitative Study

Background: Nursing can and is directly affected by the legislation structure and its associated governance. So, nursing regulators and indeed practitioners must be aware of their own legislative framework. This content analysis was conducted to define the structure of nursing legislation in Iran. Method: A qualitative design using a content analysis approach was used using semi-structures interviews with nursing policymakers(n=15). Result: This content analysis revealed three categories: Competent authorities, Advancing the profession of nursing and COVID-19 as an opportunity window for nursing policymaking.Conclusion: There is an essential need to enactment an Iranian Nursing Practice Act through competent authorities. However, to achieve this goal nursing policy makers must be able to convince members of the Parliament about the contribution of this legislation regarding public safety. Furthermore, this will not be achieved except with diplomacy and capitalizing on any policy windows. Notably, the profound impact of the COVID-19 outbreak may provide just such a policy window.

Voluntary sector peak bodies during the COVID-19 crisis: a case study of Philanthropy Australia

The Australian philanthropic sector’s peak (or umbrella) membership body, Philanthropy Australia, has played a significant role in shaping sector responses to COVID-19 and influencing government policy initiatives regarding the voluntary sector. This research note explores four key actions taken by Philanthropy Australia, with a particular focus on policy advocacy. It highlights how ‘policy windows’ provide opportunities for voluntary sector peak bodies to demonstrate policy entrepreneurship, secure desirable policy outcomes and show their value to members, government and other stakeholders. ‘Bad times’ require new and innovative policy responses, and this research note provides insights into how voluntary sector peak bodies can shape policy and practice responses to major crises.

Eliciting public values on health inequalities: missing evidence for policy windows?

Background: There is a widening health divide in the UK despite health inequalities being a longstanding subject of policy and research. New types of evidence are needed.Key points for discussion: Knowledge of public values for non-health policies and their associated (non-)health outcomes is currently missing from decision-making processes. Eliciting public values using stated preference techniques can provide insights on what the general public would be willing to give up for different distributions of (non-)health outcomes and the policies that can achieve them. To understand the role this evidence could have in decision-making processes, Kingdon’s multiple streams analysis (MSA) is used as a policy lens to explore how evidence of public values could affect policy processes for ways to tackle health inequalities.Conclusions and implications: This paper outlines how evidence of public values could be elicited through the use of stated preference techniques and suggests this could facilitate the creation of policy windows for tackling health inequalities. Additionally, Kingdon’s MSA helps make explicit six crosscutting issues when generating this new form of evidence. This suggests the need to explore reasons for public values and how decision makers would use such evidence. With an awareness of these issues, evidence on public values has the potential to support upstream policies to tackle health inequalities.<br />Key messages<br /><ul><li>UK health inequalities are widening despite being a longstanding subject of policy and research;</li><br /><li>We are missing evidence of public values for non-health policies and their (non-)health outcomes;</li><br /><li>Kingdon’s MSA is used to consider the role this evidence could have in decision-making processes;</li><br /><li>This evidence could facilitate the creation of policy windows for tackling health inequalities.</li></ul>