Can scientists and policy makers work together?

This paper addresses a fundamental question in evidence based policy making--can scientists and policy makers work together? It first provides a scenario outlining the different mentalities and imperatives of scientists and policy makers, and then discusses various issues and solutions relating to whether and how scientists and policy makers can work together. Scientists and policy makers have different goals, attitudes toward information, languages, perception of time, and career paths. Important issues affecting their working together include lack of mutual trust and respect, different views on the production and use of evidence, different accountabilities, and whether there should be a link between science and policy. The suggested solutions include providing new incentives to encourage scientists and policy makers to work together, using knowledge brokers (translational scientists), making organisational changes, defining research in a broader sense, re-defining the starting point for knowledge transfer, expanding the accountability horizon, and finally, acknowledging the complexity of policy making. It is hoped that further discussion and debate on the partnership idea, the need for incentives, recognising the incompatibility problems, the role of civil society, and other related themes will lead to new opportunities for further advancing evidence based policy and practice.

Improving services for people with a psychotic disorder and problematic substance use: a multifaceted approach to project evaluation

OBJECTIVE

The objective of this study was to conduct a multifaceted formative evaluation of the Central Sydney Area Health Service (CSAHS) Psychosis and Substance Use Project.

METHOD

Four evaluative methods were used: (i) description and interpretation of the Project's documented processes and outcomes; (ii) a benchmark comparison of the Project processes and outcomes against three of the 11 National Standards for Mental Health Services; (iii) a survey of the Project's key stakeholders; and (iv) interviews with 12 purposefully sampled key informants.

RESULTS

The Project achieved its aim to develop a strategy to improve services for people with comorbid psychosis and problematic substance use. Three of the five Project objectives were fully achieved: examination of current clinical services, development of a clinical services plan, and development of a staff education programme. The Project partially achieved two objectives: development of an information system, and a research agenda. The Project and CSAHS performed well when measured against three of the National Mental Health Standards. Project participants perceived the Project to have been successful and worth continuing, identified some shortcomings and made recommendations for the second phase.

CONCLUSIONS

The participatory approach to the Project and the evaluation was successful. With some improvements the Project is worth continuing into a second phase. A multifaceted approach and qualitative research methods are useful for formative evaluation of health service programmes.

Divisions of population health: quantum leap forward or rearranging the deckchairs?

OBJECTIVES

To describe the reasons for the formation of divisions of population health in NSW, their functional units, how they might be evaluated, and some future challenges; to stimulate critical appraisal of the divisions.

METHODS

Personal observation; review of documentation and organisational charts.

RESULTS

Area health services (AHSs) were established in NSW in 1986; there are now 17. Divisions of population health attempt to overcome the marginalisation and fragmentation that often characterise population health workers within AHSs. Divisions aim to strengthen an AHS's capacity to meet its legislated responsibility to protect and promote the health of the local population. Each of the 13 divisions established since 1994 contains a different mix of services. Public health, health promotion and health services planning units are most commonly included in divisions. Formal evaluations of organisational structures are not common in health services. Evaluations of divisions of population health should focus on their success at creating organisational structures and processes which are conducive to the implementation of population health strategies; improving health outcomes; and improving the personal, social and environmental preconditions for health.

CONCLUSIONS

Establishing divisions of population health has highlighted the lack of evidence regarding the effectiveness of different organisational structures for delivering population health services.

IMPLICATIONS

Greater effort is needed to evaluate existing organisational structures and to develop and implement optimal structures for population health services.

Industrial atmospheric pollution, historical land use patterns and mortality

BACKGROUND

The measurement of atmospheric pollution for epidemiological studies is problematic. This study presents a new proxy measure of atmospheric pollution of industrial origin and uses it to determine, at electoral ward level, the relationship between atmospheric pollution and all-cause mortality.

METHODS

All-cause Standardized Mortality Ratios (SMR), all ages, and for persons under 65 years for the period 1984-1988, proportions of land in each ward utilized by industrial works (the proxy for atmospheric pollution) and levels of socioeconomic deprivation of the ward residents were compared in 104 electoral wards.

RESULTS

The all-age SMR in the 22 wards containing the largest proportions of industrial land (113) was 9.7 per cent higher than the SMR (103) in the 60 wards with no industrial land. The under 65 years SMR in the 22 highly industrialized wards (120) was 22.4 per cent higher than the SMR (98) in the wards with no industrial land. After matching the levels of deprivation, the all-age SMR in the 15 wards containing over 10 per cent industrial land (116) was significantly higher than the SMR in 15 wards containing no industrial land (108); corresponding figures for the under 65 years SMR were 135 and 118.

CONCLUSIONS

A greater proportion of industrial land in a ward is associated with a higher mortality of the ward residents, even after controlling for the level of socio-economic deprivation of the residents. The association between deprivation and mortality is stronger than the association between atmospheric pollution and mortality. There is an urgent need for better measures of atmospheric pollution which are usable in epidemiological studies.

An outcomes approach to population health at the local level in NSW: practical problems and potential solutions

While a health outcomes approach has the potential to improve the health status of Australians as well as health service efficiency, such a policy will be successful only if practice at the local level follows suit. This paper briefly reviews the health outcomes approach and describes how the Central Sydney Area Health Service has established a Needs Assessment & Health Outcomes Unit to help improve health outcomes. The paper discusses issues in working with population health outcomes at the local level, such as the usefulness and limitations of routinely collected data for planning and managing health services, problems of small area data, gaps in the documentation of national health goals and targets, problems of attribution of improved outcomes to specific interventions, and definition of responsibilities for action at the local level. It offers some potential solutions relevant at the local level.

Estimating suicide risk among attempted suicides: I. The development of new clinical scales

A discriminant function analysis was carried out to separate a sample of 75 suicides from a sample of 146 attempted suicides, on which comprehensive clinical and social data were recorded on an identical schedule. Two sets of discriminating items (with 18 and 6 variables) correctly classified 91 per cent and 83 per cent of the two samples in their respective groups. The results provide a basis for examining the usefulness of these variables as predictors of future suicide in people who have attempted suicide.

The accuracy of officially reported suicide statistics for purposes of epidemiological research

Suicide is underreported for a number of reasons and the reliability of the official rates is subject to error from variation in defining and reporting cases--the kind of inaccuracies encountered when ascertaining cases in studies of mortality from any cause. Nevertheless, the evidence from studies designed to see whether these sources of error invalidate the differences reported between cultural and social groups indicate that they are randomised, at least to an extent that allows epidemiologists to compare rates between countries and districts within them, between demographic groups, and over time.

An Ultrasound technique for the measurement of tardive dyskinesia

A simple and portable ultrasound system, using a transducer attached to a pair of spectacles, to measure disorders of facial movement is described and applied to the measurement of tardive dyskinesia. Product-moment coefficients of correlation for the split-half and test-retest assessments of reliability in 20 patients were 0.96 and 0.93 respectively. Concurrent validity was confirmed by assessing the consistency between ultrasound scores and time-sampled scores based on video films (Pearson r = 0.86). Serial measurements of tardive dyskinesia over five months revealed striking individual consistency.