Health, politics and policy

Stream convenors(s): Kevin White (Australian National University)
Complete list of papers

Other streams:       Australia's contribution to political studies    The disciplinary history of political science    Australasian politics    Political sociology    The politics of resistance and class    Women and politics    International politics    Political theory    Environmental policy and politics

Presenters:

PANELS

ABSTRACTS

Jenny M Lewis, Centre for the Study of Health and Society, Department of Political Science, University of Melbourne
Making connections and setting the agenda: Health policy networks and issues in Victoria
Networks of influence and networks around specific issues structure policy agendas and constrain policy making. This paper examines network structures of influence and networks around particular issues in health in Victoria. A snowballing method was used to generate a list of people who were regarded as influential in the health sector. 62 of the 115 people contacted completed forms nominating who they regarded as having influence and indicating whether they had ongoing contact with those nominated. Blockmodelling of these data generated eight blocks: a core block of influentials; one associated with acute care and other health services; one of public health academics; one associated with Monash University; one of people interested in particular communities or diseases; one with a consumer and legal focus; one of people who were peripheral but connected; and one of people who listed influentials only in their defined areas. On the basis of these nominations, 20 people were asked in interviews about the main current issues they were working on and who they were working with. Issue networks were then generated, highlighting the different configurations and structures that surround different policy issues in the health sector. The results were compared with the health sector information from the Victorian Agendas Study carried out in 1991-3. Substantial changes in who is seen to be influential and what the main issues are in health have occurred over the last decade.
Email: jmlewis@unimelb.edu.au

Kasumi Nishigaya, National Centre for Epidemiology and Population Health, Australian National University
Young women garment factory workers in post-UNTAC Cambodia: Export-orientation, decent work deficit and sexual health risk
Privatization and export-orientation characterize the structural adjustment processes of Post-UNTAC Cambodia. They have precipitated Cambodia's transition from a tranquil agrarian economy to a capitalist economy, rapidly restructuring the social relations in production and reproduction. Combined with the indigenous patterns of gender relations, they have serious implications for women's power base and health status. Propelled by the proliferation of direct and discreet commercial sex, the emergence and spread of HIV/AIDS epidemic coincides with the above structural adjustment processes. Yet, the government attention has mainly focused on public health interventions targeting the recognized 'risk groups' such as brothel-based sex workers, military and police. In a culture where women are expected to be 'virtuous virgins' till marriage, very little is known about the sexual health of young women in Cambodia. This paper examines the determinants of the sexual health risk experienced by young women workers in post-UNTAC Cambodia. Multiple research methods were executed in close collaboration with the Union Aid-Australia and ten former and current women workers. The results highlight that some women workers took up direct and discreet sex work in order to supplement their low factory income. Their decisions were mainly influenced by the market forces, very weak tripartite relations to improve labor conditions, and family expectations for daughters to earn cash. In order to enhance women workers' economic power base and hence to alleviate their sexual risk, the paper calls for a more inclusive policy approach by incorporating distributive elements into the current macroeconomic policy, protecting and promoting labour rights >and strengthening peer-based rights education.
Email: Kasumi.Nishigaya@anu.edu.au

Tim Tenbensel, Political Studies, University of Auckland
'Let the people decide': Will policy processes designed to facilitate 'direct' influence on policy outcomes by citizens and consumers deliver more legitimate policy?
For some time now, governments have routinely acknowledged that public policy processes suffer from legitimacy problems. These are the problems that stem from the power relationships that characterise policymaking institutions, particularly the constellation of interest groups and government agencies. In their attempts to address such problems, government agencies often sponsor more 'direct' policy process mechanisms. The aim of these mechanisms is to enable the wishes and preferences of citizens and/or consumers to be translated more directly and transparently into public policy outcomes. These mechanisms and the rationale supporting them are inspired by the theoretical traditions of public choice and participatory democracy. While these are apparently conflicting traditions, the similarities between them are highly significant. Both take as their starting point a fundamental scepticism towards the legitimacy of policymaking institutions. What happens, then, when agencies of the state adopt the language and techniques of these 'anti-institutional' approaches in order to bolster the legitimacy of institutional policy processes? To what extent can public faith in government be restored by the use of more direct policy process mechanisms? Using international examples of health policy decision-making as a starting point, this paper suggests some answers to these questions.
Email: t.tenbensel@auckland.ac.nz

Warren Talbot, School of Social Science and Policy, University of New South Wales
Inside, outside and offside: HIV/AIDS policy discourses in Australia, 1989
Australia's response to the HIV/AIDS epidemic has been praised for its success both in stemming the spread of the epidemic and providing a model for public health partnerships. The Australian approach was crystallised with the release of a Commonwealth Government White (Policy Information) Paper in August 1989. This paper is not primarily concerned with the veracity of those claims. Rather it examines the multiple policy discourses engaged in that policy process from the perspective of the writer, who was a policy insider at the time. The discussion questions the extent and manner in which the contributions of major players (community-based organizations, bureaucrats, clinicians and researchers) have subsequently been valorised in many accounts of the Australian response. The perspective offered is that of in insider, as a lobbyist for Australia's national NGO AIDS organization, but also as an appointed member of the drafting team for the White Paper. It is suggested that the 1989 Paper is best seen as the legitimisation, institutionalisation and justification for existing policies being adopted in many States and community groups. The spread of the virus had been substantially slowed five years prior to the White Paper. HIV's public health partnership, though, was cemented in the structured commitment of new resources that were delivered as a part of the four year Strategy. Individual actors played key roles.
Email: warren.talbot@student.unsw.edu.au

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