Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

A pathway to a stronger research culture in health policy

A pathway to a stronger research culture in health policy Background: There are currently limited pathways into a career in health policy research in Australia, due in part to a serious absence of health policy research capability in Australian universities. Discussion: We define what we consider health policy research and education should comprise. We then examine what is currently on offer and propose ways to strengthen health policy research in Australia. Summary: This paper, which is part analysis and part commentary, is offered to provoke wider debate about how health policy research can be nurtured in Australia. Background nature of 'health policy' teaching, drawing on major texts A recent assessment of the capacity to conduct health serv- currently used in the teaching of policy and exploring the ices research in Australia noted that, although current implications of what we find for the development of workers were qualified and respected, structural limita- health policy as a teaching and research area. Second, we tions inhibited the discipline's influence in health system examine the ways in which health policy is currently reform [1]. Health policy research is in a similar position. taught at both undergraduate and postgraduate levels in In their discussion of the development of health services Australia. Third, we explore educational paths for the research capacity, Pirkis et al. (2005) list among impeding development of a sustainable field of health policy factors a lack of focus amongst researchers in this field [1]. researchers, and methods to locate this within Australian Often they must juggle other research interests and cope universities. We wish to provoke debate over the merits of with insecurity of tenure resulting from short-term such approaches to this problem and whether this will research contracts and dependence on grant based fund- indeed assist in the development of a strengthened ing. The same situation applies to health policy research, research culture in health policy in Australia. to which we add the lack of a clear educational and career path. Discussion What is health policy? Policy "... is the process by which governments, institu- In this commentary we explore the limited pathways into health policy research and how we might create new ones tions or organisations translate their political vision into and strengthen those that exist. First, we examine the programs and actions to deliver 'outcomes' – desired Page 1 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 changes in the real world" [2]. It can be a single statement ers, analysis for policy concentrates upon linking policy or a set of laws, regulations, or, more vaguely, guiding decisions to clear, evidence-based criteria [5]. As Brown- principles brought to manage a particular health issue or son et al. argue, 'when managers have complete informa- to resolve more fundamental problems. We take health tion, they behave rationally'[6]. Policy setting institutions policy to be an action plan that steers the direction of a such as the Australian Pharmaceutical Benefits Advisory social, professional and often government response to a Committee (PBAC) (which determines which drugs will health related issue. The job of health policy makers is to receive public subsidy on the basis of cost-effectiveness), find a way between competing needs (economic, political, are good examples of this rational model of policy analy- value-based and so forth) in order to define compromise sis [7]. The PBAC applies evidence from clinical trials and actions that can be taken in practice. cost effectiveness studies to recommend which prescribed medications should receive public funding support. The Consequently, 'health policy analysis' is the discovery technical recommendations from the PBAC are then con- through critical appraisal of the strengths and weaknesses sidered within the value-laden political process. Govern- of health policies or types of policy, including how they ment decides whether to accept the PBAC have been formulated and how they function in practice. recommendation. Here, therefore, politics and social val- Health policy analysis seeks to answer the questions: how ues operate subsequently to the technical policy develop- can existing health policy be improved, or how can new ment process. health policy best be developed to meet social, political, economic or legal ends in relation to a health problem, Analysis of policy by contrast recognises the messy dynam- taking heed of what has gone before? ics of political and social choice and stresses that conflict and argument are fundamental elements of policy-mak- What is the nature of health policy from an academic ing: 'politics is both inseparable from and preliminary to point of view? policy' [8,9]. The politicized or 'argumentative' approach We define academic health policy analysis as the study of gives more attention to uncovering the reasons why par- the decision-making that results in health policies, the ticular policies are adopted – often at the expense of tech- manner in which health and health service problems are nically more efficient alternatives. At their most extreme, conceptualized and enter public debate, and how alterna- these politicized approaches see choice as limited by an tive solutions to policy problems are formulated and iron cage of institutional structures [10]. In Gill Walt's implemented or ignored. Recent approaches to academic influential textbook, for example, policy is politics [11]. health policy tend to have swung between two poles: anal- She distinguishes between the content of health policy ysis for policy and analysis of policy [3,4]. We will examine and the processes and power relationships that create each of these in turn. agendas and enable (or block) implementation, arguing that power and process provide the proper domain for Analysis for policy focuses on the fit between a policy prob- health policy analysis. Blank and Burau's recent compara- lem and prescription, asking the question, 'what works?' It tive health policy textbook also emphasises process [12]. usually assumes a rationalistic model of the policy proc- Health policy is seen as 'those courses of action proposed ess. Policy-making is seen as a largely technical exercise: or taken by a government that impact on the financing the critical evaluation of alternative therapies, technolo- and/or provision of health services'. The core of policy gies, modes of organization and funding. The product of analysis thus becomes the study of conflicting interests as this analytical project is positive knowledge, preferably in they bear upon the process of making decisions about quantitative form, to provide evidence to policy develop- how to provide health services [12]. ers and decision-makers. This technical stream of policy analysis in health policy research and teaching sets out to There is a danger in these accounts that health policy will establish quantifiable measures of the most efficient and become just a local instance – 'adjectival policy' [13] – of (sometimes) most equitable ways that a society can invest generic public policy. However, even within the main- in health. stream of public policy, health has always been seen as posing a tougher, even intractable, set of constraints on The dominant academic disciplines (above all, econom- policy makers with a complexity of a different order to ics) engaged in analysis for policy have concentrated on education or social welfare [14]. The knowledge base – developing tools for the technical evaluation of policy ranging from the cultural and scientific weight of medical options. These approaches are rational – using techniques research to the information asymmetries between provid- such as cost-effectiveness analysis to quantify the effects of ers and recipients of health care – is one thing that differ- particular policy choices. While accepting that there is entiates the nature of decision making from other areas of rarely one correct answer and that final decisions will social policy [15]. often be influenced by the value positions of policymak- Page 2 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 These 'technical' and 'politicised' views of evidence and icy making in the context of the health system. We found policy-making are rarely as polarized as some theories that of the health and social science courses offered at the suggest. Sharp distinctions between the technical sphere 41 Australian universities 12 currently offer specific of evidence and a purely political zone of decision-mak- undergraduate units that focus on health policy. The ing risk creating an artificial analytical separation of rival health policy units that we identified are located across a black boxes of research/evidence and political decision- broad range of courses including the Bachelor of Biomed- making [16]. From its outset the journal Australia and New ical Sciences (Monash), Bachelor of Health Promotion Zealand Health Policy has recognized the need to combine (Griffith), Bachelor of Social Sciences (University of both, pointing to the significance – and neglect – of the Queensland) and the Bachelor of Environmental Health 'conflicts over values and policy choices', crucial to an (Flinders). However, the undergraduate degree in which understanding of policy developments in both countries health policy units are most commonly located is the [17]. Policy analysis, then, must explain how priorities are Bachelor of Health Science, which includes a health policy formed, and agendas filled; moving beyond both the unit at Deakin University, the University of Sydney, rationalist and political frames. Adelaide University, Flinders and the University of West- ern Sydney. Our own understanding of health policy analysis – and the technical disciplines needed for education and None of these courses, apart from the soon to be retired research in relation to it – accepts broad spectrum deci- Bachelor of Behavioural Health Sciences at the University sion-making that includes the manner in which policies of Sydney, offers more than one specifically health policy are developed, enter onto political and policy agendas oriented unit. and gain (or fail to achieve) sufficient political traction to be implemented. The development of skills for health Of the undergraduate units offered which specify health policy thus requires a curriculum that enables under- policy as a career path most do not teach specific health standing and the development of competence in relation policy units. For example, the Bachelor of Health Science/ to these policy processes. Social Work at Monash University, and the Bachelor of Health Sciences degrees from Queensland University of A rounded education in health policy analysis would Technology and the University of Western Australia, all include a grounding in the technical disciplines of evi- list employment in health policy as a degree exit point, dence assessment, including epidemiology and health but do not include modules which have a primary focus economics and evaluation – the basis of most analysis for on health policy [20-22]. Indeed, health policy is not policy. But it would need to move beyond the divisions offered as a major in any Australian undergraduate course. between evidence-based analysis for policy and the stress This limited undergraduate focus on health policy sets on context and decision-making processes of analysis of restrictions on the numbers of students able to take a policy. The most articulate exponents of systematic review health policy related honours project or a PhD project in and other evidence-based approaches have also argued a health policy related field and thus limits this as a path that policy-making must be seen as a drama in which lan- through which to develop health policy research. guage and rhetoric set the frame in which different approaches contend for power [18]. Policy analysis While some posit that health policy should not be taught should also draw on political science, sociology and polit- at an undergraduate level because it requires life experi- ical economy to gain 'a rounded understanding of what it ence and knowledge, we argue that this is not necessarily is to make and to suffer, to study and to critique, the pro- so, as demonstrated by the experience of policy teaching grams and policies by which officers of the state attempt in similar fields. A subject area with many similarities to to rule'[19]. health policy is social policy. Social policy, though not offered as an undergraduate degree at any university in Health policy education in Australia Australia, is offered as a major through various undergrad- We have stressed the diversity of approaches to the sys- uate courses, for example in the Bachelor of Social Sci- tematic study and research of health policy. There will ences at the University of Queensland [23]. The always be a variety of routes, and points in individuals' knowledge basis gained through a major in social policy careers at which a need for further training or education encourages students to undertake honours and from there will become apparent. We will look in turn at several of embark on a PhD or Masters by Research in social policy. these entry points, starting with undergraduate programs. Both health policy and social policy are frequently offered as either majors or discrete programmes within under- We systematically searched through each undergraduate graduate health or social sciences teaching at universities health or social science course in Australia for subjects in the United Kingdom or the United States, countries where the main component of the unit was a focus on pol- that arguably have a better developed health policy Page 3 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 research culture than Australia [24-27]. Undergraduate policy and analysis of policy approaches to health policy. environmental studies programs have always integrated This would provide health policy competence which scientific studies with more policy focused units of study. could be built upon through a PhD. As with our discus- sion of undergraduate health policy teaching above, it is This deficit in undergraduate teaching of health policy is important that health policy teaching at a postgraduate partly, but very patchily, remedied at the postgraduate level not be seen as a preserve of the health sciences, but level, with 21 Australian universities offering postgradu- included in postgraduate suites across the social sciences. ate units in health policy. Postgraduate health policy units are usually confined to individual units (or modules The marginal status of health policy at both an undergrad- within survey units) within public health, public policy or uate and postgraduate level limits students' exposure to (more rarely) health economics degrees. At present there the range of theories and methods necessary for serious are three postgraduate qualifications available in Australia research. A greater emphasis needs to be placed on health (through La Trobe, Sydney and Deakin) that are entirely policy teaching at all levels in order to attract students into devoted to health policy. These are confined to the Grad- the field. uate Certificate or Postgraduate Diploma level (although the University of Sydney degree will move to Master's level Pathways to a stronger research culture for health policy in 2008). The Centre for Health and Society at the Univer- Currently there are many entry points to health policy sity of Melbourne also offers a Masters in Social Health research. For example, in the health policy research centre (Health Policy). where we are based, two academics completed degrees in medicine, one has a degree in physiotherapy and two oth- Most of these programs are aimed at mature age students ers started with undergraduate degrees in history before with degrees in other disciplines, who have been working moving into health policy research. It is important to note in policy positions in government, or clinicians seeking that the many different pathways that currently lead to policy training. All of these postgraduate programmes academic research in health policy are not in and of them- offer a site for attracting students into a career in health selves a negative. On the contrary, the diversity of back- policy research and more needs to be done in order to grounds of current researchers allows for a wide variety of develop research in these programmes and encourage the influences to enrich health policy research. The current course participants to enter into research higher degrees in circuitous approach does however leave the development health policy. of health policy researchers to chance rather than design, meaning that there is no avenue in Australia for assuring Another area where health policy is included but underde- that there are adequate numbers of researchers emerging veloped at a postgraduate level is in Masters of Public in this field. For the remainder of this paper we explore Health programmes, which are now taught in 18 Austral- pathways for developing health policy researchers which ian universities. While some universities offer a small taste are the most direct, yet currently the most underdevel- of policy analysis in introductory core units, in most pub- oped. We highlight three critical steps along the most lic health programs policy suffers in an already crowded direct pathway – the health policy 'streamed' undergradu- program. ate and honours student, the health policy PhD and the health policy postdoctoral fellowship and discuss other What of funding for health policy courses at a postgradu- alternative opportunities for the development of health ate level? The Commonwealth government's Public policy research. Health Education and Research Program (PHERP) has made contributions to policy a requirement for gaining its Undergraduate pathways support. The most recent evaluation of PHERP listed 'pol- As discussed, an area which currently has little focus on icy development and review' as one of the areas where health policy is undergraduate teaching. We feel that it interdisciplinary teaching and research should be fos- would be appropriate to introduce a specific health policy tered. It offers as a model the development of Health teaching stream at this level in order to promote interest Impact Assessment (HIA) techniques [28]. HIAs offer a in health policy as a research area for students who want valuable method for putting health concerns on public to progress toward a research career. agendas, but as a model for policy education and research they remain firmly in the analysis for policy category. The The lack of undergraduate training in health policy has a introduction and expansion of units such as these within significant effect on the development of a research culture postgraduate degree programmes is a good start in devel- in health policy. In the absence of a clear educational path oping a comprehensive understanding of health policy at few emerging academics can consider this a disciplinary a postgraduate level. We argue that these should evolve to focus for their research. It is thus important that health include health policy units that focus on both analysis for policy be developed as a discrete field of study within Page 4 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 undergraduate programmes across the health and social Another possibility is the inclusion of health policy as a sciences in order to lead a pool of potential researchers field of study within dual degrees. Health policy could be toward research in health policy. While this is not the only offered as a module in a dual degree which offers both a way to engage with potential health policy research work- health and a social science focus. The interdisciplinary ers, we see it as an obvious one which is currently under- approach offered by dual degrees such as these would developed. bring together the elements of sociology and political sci- ence with an understanding of the workings of the health As discussed above our search through the current health care system, thereby integrating both the analysis for policy policy offerings in Australia identified Bachelor of Health and analysis of policy approaches to health policy. Sciences degrees as the most common site for health pol- icy teaching to be located. The inclusion of a health policy Undergraduate programme options would offer students stream or major within a health sciences degree makes of health policy an experience from which they could some sense because those who enter into this degree have acquire the foundational knowledge and skill to take into a general, as yet undirected interest in the health system a health policy themed honours research project. Hon- which could be channelled into health policy research. ours is a significant year for developing research workers Even if a student were not to go into a research career in as it allows for the creation of an independent research health policy, engagement with health policy at an under- project through which students are able to learn and apply graduate level should provide them with a general intro- a set of research skills. It gives them a taste of what duction as to how policy decisions are made within the research in health policy may entail and enables academ- health system. This is especially important for students ics to identify and encourage the next generation of health who will follow a career as a health care practitioner as it policy researchers. We suggest the attributes listed in table may help develop a holistic understanding of the health 1, below, as appropriate for an honours student graduat- system. However this is not the only productive place in ing with competency in health policy: which to develop health policy research at an undergrad- uate level and health policy research as a field could be Honours to PhD more broadly developed were it to be encouraged as an A degree with first class honours or honours 2a in health policy will in most cases ensure that students are able to undergraduate field of study within social and political sciences. Teaching health policy in this context would conceptualise and carry out a supervised research project enhance the analysis of policy approach, which is currently at doctoral level. A solid background at undergraduate underdeveloped in health policy research [4]. and honours levels will make the transition to PhD more attractive as well as easier for the student. The benefits of a PhD are clear – the student can complete a research Table 1: Graduate Attributes for Honours Students Graduating with Competency in Health Policy. Knowledge of policy environments, including: understanding of the Australian health system, including knowledge of both Federal and State/Territory systems a basic understanding of comparative international health policy Knowledge of information and evidence, including: the ability to identify and effectively use appropriate research to understand and analyse health policy skills in evidence acquisition and analysis a basic and technical knowledge in health services evaluation a capacity to integrate qualitative and quantitative skills and information knowledge and understanding of the social and political determinants of health and health policy an understanding of the basic principles of health economics Knowledge of policy process, including: knowledge of both micro and macro level views of policy knowledge of the legal, value, political and ethical influences on policy awareness of the role of leadership in policy development and implementation Knowledge of the didactic analysis of policy, including: the ability to examine the congruence between values and intentions and actual policy the ability to understand and analyse aspirational policy and the importance of constructive new ideas practical knowledge of examples of policy failures and "real" policy Skills for effective engagement of policy stakeholders, including: knowledge and skills in advocacy and consultation the ability to appreciate the value and ethical aspects that influence stakeholder views and positions knowledge of the breadth of policy stakeholders and the diversity of their interests and influence Page 5 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 project that they have conceived, develop appropriate significant income needs such as a young family or mort- methodological and theoretical frameworks for analysis, gage repayments. and present findings in a manner acceptable to academic peers within a context of supervised learning. The mentor- It is important that following on from the postdoctoral ing of a good supervisor is integral to this process. research experience, opportunities are available for researchers in health policy to obtain permanent teaching At present, there is little opportunity for students to and research positions or long-term senior fellowships. engage with health policy through teaching at an under- The current fellowship and grant based funding available graduate level and an honours project. It is vital, at the to those finishing a postdoctoral position is usually avail- moment, therefore, that health policy academics actively able for a maximum of three years. This leads to a lack of seek to recruit the next generation of research workers job security for emerging research workers [31]. from other places. Potential sites for recruitment include health science, political science and social science hon- Summary ours, masters and professional doctorate programmes, This paper has sought to define the field of health policy where students have developed an interest in health pol- education and associated research and outline educa- icy and are looking to pursue this interest further. Another tional paths that can be developed in order to strengthen recruiting tactic would be to approach individuals in health policy as a research field. We invite comment on career streams that might feed into masters and postgrad- these ideas and encourage academics across Australia to uate programmes in health policy, and from this to a PhD find a place for health policy in their undergraduate and in health policy. Internships in health policy research cen- postgraduate curricula and to be innovative in their tres could be offered, and visits arranged by health policy recruitment, development and mentoring of future health academics to postgraduate programmes. Active collabora- policy research workers. tion between health policy academics, public servants and practitioners would also be useful. Competing interests All authors currently work in health policy research and Postdoctoral research teaching. JSM was recently in receipt of an NHMRC Whatever tangled routes lead developing research workers Capacity Building Postdoctoral Fellowship in Health Pol- toward a health policy research focus, a relevant and well icy. structured postdoctoral experience is necessary to consol- idate postgraduate training. It has recently been argued Authors' contributions that expanded postdoctoral research fellowship programs JSM conceived of the theme for this article and completed are essential if we are to replace the estimated third to half the research relating to the current teaching of health pol- of all Australian academics reaching retirement age over icy, devised the pathway and prepared the manuscript for the next decade [29]. Postdoctoral research fellowships publication. JG assisted in the development of the ideas provide the best means for mentoring younger researchers expressed in the article, wrote the section defining health in a discipline [29]. policy and assisted in the preparation of the manuscript draft. SL assisted in the development of the ideas In order for a postdoctoral experience to be as productive expressed in the article and helped to prepare the manu- as possible it should include a mix of autonomous and script draft. All authors read and approved the final man- team based research and be based around a strong men- uscript. toring relationship with an academic established in health policy research. A survey of 7,600 US postdoctoral Acknowledgements The authors wish to thank the staff and associates of the Australian Health researchers conducted in 2005 found that researchers Policy Institute for advice on the development of a definition of health pol- were "... more likely to be happy with their jobs and to icy. publish copiously when they receive a lot of structured training and advice from mentors" [30]. A drawback of References the long period of mentoring involved in a postdoctoral 1. Pirkis J, Goldfeld S, Peacock S, Dodson S, Haas M, Cumming J, Hall J, position could be that researchers are less willing to enter Boultan A: Assessing the capacity of the health services research community in Australia and New Zealand. Aust New onto this path because of the limited salaries available Zealand Health Policy 2005, 2(1):4-4. compared with what they might receive in industry. Post- 2. United Kingdom Cabinet Office: Professional policy making for doctoral fellowships are funded low on the academic sal- the twenty first century. [http://www.civilservant.org.uk/profpol th icymaking.pdf]. (accessed 17 April, 2007) ary scale, at either level A or B. It is important that 3. Lin V, Gibson B: Introduction. In Evidence-based Health Policy: Prob- postdoctoral fellowship salaries allow for a comfortable lems and possibilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:xxi. standard of living, especially as most postdoctoral 4. Lewis JM: Health Policy and Politics: networks, ideas and power East Haw- researchers will be at a stage in their lives where they have thorn: IP Communications; 2005:2-3. Page 6 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 5. Mitton C, Donaldson C: Tools of the Trade: a comparative anal- 31. Akerlind G: Postdoctoral researchers: roles functions and ysis of approaches to priority setting in healthcare. Health Serv career prospects. Higher Education Research and Development 2005, Manage Res 2003, 16(2):96-105. 24(1):21-40. 6. Brownson R, Baker E, Leet T, Gillespie K: Evidence-based Public Health New York: Oxford University Press; 2003:163. 7. Aroni R, de Boer R, Harvey K: The Viagra Affair: Evidence as the terrain for competing partners. In Evidence-based Health Policy: Problems and possibilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:97-109. 8. Fox D: The politics and policy of population health: A com- parative perspective. In European Health and Welfare Policies Edited by: Abreu L. Brno: The Compostela Group of Universities & PhoenixTN; 2004:526. 9. Lewis JM: Evidence-based Policy: A Technocratic Wish in a Political World. In Evidence-based Health Policy: Problems and possi- bilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:250-259. 10. Tuohy C: Accidental logics: The dynamics of change in the health care arena in the United States, Britain, and Canada New York: Oxford Uni- versity Press; 1999:11-12. 11. Walt G: Health Policy: An Introduction to Process and Power London, New Jersey and Johannesburg: Zed Books and Witwatersrand Uni- versity Press; 1994:1-3. 12. Blank R, Burau V: Comparative Health Policy Basingstoke and New York: Palgrave; 2004:16. 13. Colebatch H: Policy 2nd edition. Buckingham: Open University Press; 2002:96. 14. Heidenheimer A, Heclo H, Adams C: Comparative Public Policy 2nd edi- tion. New York: St Martins Press;; 1983:52-56. 15. Palmer G, Short S: Health Care and Public Policy: An Australian Analysis Melbourne: Macmillan; 2000:26-27. 16. Lin V: Competing rationalities. In Evidence-based Health Policy: Problems and possibilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:10-11. 17. Duckett SJ: Australian and New Zealand Health Policy: a new journal. Aust New Zealand Health Policy 2004, 1(1):1-1. 18. Greenhalgh T, Russell J: Reframing Evidence Synthesis as Rhe- torical Action in the Policy Making Drama. Healthcare Policy 2005, 1(1):31-39. 19. Moran M, Rein M, Goodin R: The public and its policies. In Oxford Handbook of Public Policy Edited by: Moran M, Rein M, Goodin R. Oxford: Oxford University Press; 2006:3. 20. Monash University: Medicine, nursing and health sciences. th [http://www.monash.edu.au/pubs/ugrad/med.html]. (accessed 8 June, 2006) 21. Monash University: What will I study? [http:// www.med.monash.edu.au/healthsciences/curriculum.html]. (accessed th 8 June, 2006) 22. Monash University: Bachelor of Biomedical Science. [http:// www.monash.edu.au/pubs/handbooks/undergrad/med-19.html]. th (accessed 8 June, 2006) 23. University of Queensland: Policy in the Bachelor of Social Sci- ence. [http://www.uq.edu.au/study/ th plan.html?acad_plan=POLICX2032]. (accessed 8 June, 2006) 24. University of Edinburgh: Centre for International Public Health Policy, Undergraduate Study. [http://www.health.ed.ac.uk/ nd CIPHP/undergraduate/]. (accessed 2 July, 2007) 25. Pennsylvania State University: Health Policy and Administration. [http://www.psu.edu/bulletins/bluebook/major/h_p_a.htm]. (accessed 2nd July, 2007) 26. Ithaca College, New York: B.A. in Health Policy. [http://www.ith Publish with Bio Med Central and every aca.edu/catalogs/undergrad/cat03/05hshp-09.shtml#P1022_76619]. scientist can read your work free of charge nd (accessed 2 July, 2007) 27. Warwick University: Health and Social Studies, B.A.(Hons) in "BioMed Central will be the most significant development for Health and Social Policy. [http://www2.warwick.ac.uk/study/cll/ disseminating the results of biomedical researc h in our lifetime." courses/undergraduate_degrees/twoplustwo/healthandsocial/]. Sir Paul Nurse, Cancer Research UK nd (accessed 2 July, 2007) 28. Australian Government, Department of Health and Ageing: Strength- Your research papers will be: ening Workforce Capacity for Public Health. The Public Health Education available free of charge to the entire biomedical community and Research Program Review 2005 Canberra: Commonwealth of Aus- tralia; 2005:37-38. peer reviewed and published immediately upon acceptance th 29. Nile R: Passing the baton. The Australian :29. 26 April, 2006 cited in PubMed and archived on PubMed Central 30. Brainard J: Postdoctoral researchers value structured training over pay, survey says. The Chronicle of Higher Education 2005, yours — you keep the copyright 51(32):21. BioMedcentral Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 7 of 7 (page number not for citation purposes) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australia and New Zealand Health Policy Springer Journals

A pathway to a stronger research culture in health policy

Download PDF
7 pages

Loading next page...
 
/lp/springer-journals/a-pathway-to-a-stronger-research-culture-in-health-policy-ynlyFGMFjV

References (18)

Publisher
Springer Journals
Copyright
Copyright © 2007 by Smith-Merry et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; Public Health; Social Policy
ISSN
1743-8462
eISSN
1743-8462
DOI
10.1186/1743-8462-4-19
pmid
17927814
Publisher site
See Article on Publisher Site

Abstract

Background: There are currently limited pathways into a career in health policy research in Australia, due in part to a serious absence of health policy research capability in Australian universities. Discussion: We define what we consider health policy research and education should comprise. We then examine what is currently on offer and propose ways to strengthen health policy research in Australia. Summary: This paper, which is part analysis and part commentary, is offered to provoke wider debate about how health policy research can be nurtured in Australia. Background nature of 'health policy' teaching, drawing on major texts A recent assessment of the capacity to conduct health serv- currently used in the teaching of policy and exploring the ices research in Australia noted that, although current implications of what we find for the development of workers were qualified and respected, structural limita- health policy as a teaching and research area. Second, we tions inhibited the discipline's influence in health system examine the ways in which health policy is currently reform [1]. Health policy research is in a similar position. taught at both undergraduate and postgraduate levels in In their discussion of the development of health services Australia. Third, we explore educational paths for the research capacity, Pirkis et al. (2005) list among impeding development of a sustainable field of health policy factors a lack of focus amongst researchers in this field [1]. researchers, and methods to locate this within Australian Often they must juggle other research interests and cope universities. We wish to provoke debate over the merits of with insecurity of tenure resulting from short-term such approaches to this problem and whether this will research contracts and dependence on grant based fund- indeed assist in the development of a strengthened ing. The same situation applies to health policy research, research culture in health policy in Australia. to which we add the lack of a clear educational and career path. Discussion What is health policy? Policy "... is the process by which governments, institu- In this commentary we explore the limited pathways into health policy research and how we might create new ones tions or organisations translate their political vision into and strengthen those that exist. First, we examine the programs and actions to deliver 'outcomes' – desired Page 1 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 changes in the real world" [2]. It can be a single statement ers, analysis for policy concentrates upon linking policy or a set of laws, regulations, or, more vaguely, guiding decisions to clear, evidence-based criteria [5]. As Brown- principles brought to manage a particular health issue or son et al. argue, 'when managers have complete informa- to resolve more fundamental problems. We take health tion, they behave rationally'[6]. Policy setting institutions policy to be an action plan that steers the direction of a such as the Australian Pharmaceutical Benefits Advisory social, professional and often government response to a Committee (PBAC) (which determines which drugs will health related issue. The job of health policy makers is to receive public subsidy on the basis of cost-effectiveness), find a way between competing needs (economic, political, are good examples of this rational model of policy analy- value-based and so forth) in order to define compromise sis [7]. The PBAC applies evidence from clinical trials and actions that can be taken in practice. cost effectiveness studies to recommend which prescribed medications should receive public funding support. The Consequently, 'health policy analysis' is the discovery technical recommendations from the PBAC are then con- through critical appraisal of the strengths and weaknesses sidered within the value-laden political process. Govern- of health policies or types of policy, including how they ment decides whether to accept the PBAC have been formulated and how they function in practice. recommendation. Here, therefore, politics and social val- Health policy analysis seeks to answer the questions: how ues operate subsequently to the technical policy develop- can existing health policy be improved, or how can new ment process. health policy best be developed to meet social, political, economic or legal ends in relation to a health problem, Analysis of policy by contrast recognises the messy dynam- taking heed of what has gone before? ics of political and social choice and stresses that conflict and argument are fundamental elements of policy-mak- What is the nature of health policy from an academic ing: 'politics is both inseparable from and preliminary to point of view? policy' [8,9]. The politicized or 'argumentative' approach We define academic health policy analysis as the study of gives more attention to uncovering the reasons why par- the decision-making that results in health policies, the ticular policies are adopted – often at the expense of tech- manner in which health and health service problems are nically more efficient alternatives. At their most extreme, conceptualized and enter public debate, and how alterna- these politicized approaches see choice as limited by an tive solutions to policy problems are formulated and iron cage of institutional structures [10]. In Gill Walt's implemented or ignored. Recent approaches to academic influential textbook, for example, policy is politics [11]. health policy tend to have swung between two poles: anal- She distinguishes between the content of health policy ysis for policy and analysis of policy [3,4]. We will examine and the processes and power relationships that create each of these in turn. agendas and enable (or block) implementation, arguing that power and process provide the proper domain for Analysis for policy focuses on the fit between a policy prob- health policy analysis. Blank and Burau's recent compara- lem and prescription, asking the question, 'what works?' It tive health policy textbook also emphasises process [12]. usually assumes a rationalistic model of the policy proc- Health policy is seen as 'those courses of action proposed ess. Policy-making is seen as a largely technical exercise: or taken by a government that impact on the financing the critical evaluation of alternative therapies, technolo- and/or provision of health services'. The core of policy gies, modes of organization and funding. The product of analysis thus becomes the study of conflicting interests as this analytical project is positive knowledge, preferably in they bear upon the process of making decisions about quantitative form, to provide evidence to policy develop- how to provide health services [12]. ers and decision-makers. This technical stream of policy analysis in health policy research and teaching sets out to There is a danger in these accounts that health policy will establish quantifiable measures of the most efficient and become just a local instance – 'adjectival policy' [13] – of (sometimes) most equitable ways that a society can invest generic public policy. However, even within the main- in health. stream of public policy, health has always been seen as posing a tougher, even intractable, set of constraints on The dominant academic disciplines (above all, econom- policy makers with a complexity of a different order to ics) engaged in analysis for policy have concentrated on education or social welfare [14]. The knowledge base – developing tools for the technical evaluation of policy ranging from the cultural and scientific weight of medical options. These approaches are rational – using techniques research to the information asymmetries between provid- such as cost-effectiveness analysis to quantify the effects of ers and recipients of health care – is one thing that differ- particular policy choices. While accepting that there is entiates the nature of decision making from other areas of rarely one correct answer and that final decisions will social policy [15]. often be influenced by the value positions of policymak- Page 2 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 These 'technical' and 'politicised' views of evidence and icy making in the context of the health system. We found policy-making are rarely as polarized as some theories that of the health and social science courses offered at the suggest. Sharp distinctions between the technical sphere 41 Australian universities 12 currently offer specific of evidence and a purely political zone of decision-mak- undergraduate units that focus on health policy. The ing risk creating an artificial analytical separation of rival health policy units that we identified are located across a black boxes of research/evidence and political decision- broad range of courses including the Bachelor of Biomed- making [16]. From its outset the journal Australia and New ical Sciences (Monash), Bachelor of Health Promotion Zealand Health Policy has recognized the need to combine (Griffith), Bachelor of Social Sciences (University of both, pointing to the significance – and neglect – of the Queensland) and the Bachelor of Environmental Health 'conflicts over values and policy choices', crucial to an (Flinders). However, the undergraduate degree in which understanding of policy developments in both countries health policy units are most commonly located is the [17]. Policy analysis, then, must explain how priorities are Bachelor of Health Science, which includes a health policy formed, and agendas filled; moving beyond both the unit at Deakin University, the University of Sydney, rationalist and political frames. Adelaide University, Flinders and the University of West- ern Sydney. Our own understanding of health policy analysis – and the technical disciplines needed for education and None of these courses, apart from the soon to be retired research in relation to it – accepts broad spectrum deci- Bachelor of Behavioural Health Sciences at the University sion-making that includes the manner in which policies of Sydney, offers more than one specifically health policy are developed, enter onto political and policy agendas oriented unit. and gain (or fail to achieve) sufficient political traction to be implemented. The development of skills for health Of the undergraduate units offered which specify health policy thus requires a curriculum that enables under- policy as a career path most do not teach specific health standing and the development of competence in relation policy units. For example, the Bachelor of Health Science/ to these policy processes. Social Work at Monash University, and the Bachelor of Health Sciences degrees from Queensland University of A rounded education in health policy analysis would Technology and the University of Western Australia, all include a grounding in the technical disciplines of evi- list employment in health policy as a degree exit point, dence assessment, including epidemiology and health but do not include modules which have a primary focus economics and evaluation – the basis of most analysis for on health policy [20-22]. Indeed, health policy is not policy. But it would need to move beyond the divisions offered as a major in any Australian undergraduate course. between evidence-based analysis for policy and the stress This limited undergraduate focus on health policy sets on context and decision-making processes of analysis of restrictions on the numbers of students able to take a policy. The most articulate exponents of systematic review health policy related honours project or a PhD project in and other evidence-based approaches have also argued a health policy related field and thus limits this as a path that policy-making must be seen as a drama in which lan- through which to develop health policy research. guage and rhetoric set the frame in which different approaches contend for power [18]. Policy analysis While some posit that health policy should not be taught should also draw on political science, sociology and polit- at an undergraduate level because it requires life experi- ical economy to gain 'a rounded understanding of what it ence and knowledge, we argue that this is not necessarily is to make and to suffer, to study and to critique, the pro- so, as demonstrated by the experience of policy teaching grams and policies by which officers of the state attempt in similar fields. A subject area with many similarities to to rule'[19]. health policy is social policy. Social policy, though not offered as an undergraduate degree at any university in Health policy education in Australia Australia, is offered as a major through various undergrad- We have stressed the diversity of approaches to the sys- uate courses, for example in the Bachelor of Social Sci- tematic study and research of health policy. There will ences at the University of Queensland [23]. The always be a variety of routes, and points in individuals' knowledge basis gained through a major in social policy careers at which a need for further training or education encourages students to undertake honours and from there will become apparent. We will look in turn at several of embark on a PhD or Masters by Research in social policy. these entry points, starting with undergraduate programs. Both health policy and social policy are frequently offered as either majors or discrete programmes within under- We systematically searched through each undergraduate graduate health or social sciences teaching at universities health or social science course in Australia for subjects in the United Kingdom or the United States, countries where the main component of the unit was a focus on pol- that arguably have a better developed health policy Page 3 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 research culture than Australia [24-27]. Undergraduate policy and analysis of policy approaches to health policy. environmental studies programs have always integrated This would provide health policy competence which scientific studies with more policy focused units of study. could be built upon through a PhD. As with our discus- sion of undergraduate health policy teaching above, it is This deficit in undergraduate teaching of health policy is important that health policy teaching at a postgraduate partly, but very patchily, remedied at the postgraduate level not be seen as a preserve of the health sciences, but level, with 21 Australian universities offering postgradu- included in postgraduate suites across the social sciences. ate units in health policy. Postgraduate health policy units are usually confined to individual units (or modules The marginal status of health policy at both an undergrad- within survey units) within public health, public policy or uate and postgraduate level limits students' exposure to (more rarely) health economics degrees. At present there the range of theories and methods necessary for serious are three postgraduate qualifications available in Australia research. A greater emphasis needs to be placed on health (through La Trobe, Sydney and Deakin) that are entirely policy teaching at all levels in order to attract students into devoted to health policy. These are confined to the Grad- the field. uate Certificate or Postgraduate Diploma level (although the University of Sydney degree will move to Master's level Pathways to a stronger research culture for health policy in 2008). The Centre for Health and Society at the Univer- Currently there are many entry points to health policy sity of Melbourne also offers a Masters in Social Health research. For example, in the health policy research centre (Health Policy). where we are based, two academics completed degrees in medicine, one has a degree in physiotherapy and two oth- Most of these programs are aimed at mature age students ers started with undergraduate degrees in history before with degrees in other disciplines, who have been working moving into health policy research. It is important to note in policy positions in government, or clinicians seeking that the many different pathways that currently lead to policy training. All of these postgraduate programmes academic research in health policy are not in and of them- offer a site for attracting students into a career in health selves a negative. On the contrary, the diversity of back- policy research and more needs to be done in order to grounds of current researchers allows for a wide variety of develop research in these programmes and encourage the influences to enrich health policy research. The current course participants to enter into research higher degrees in circuitous approach does however leave the development health policy. of health policy researchers to chance rather than design, meaning that there is no avenue in Australia for assuring Another area where health policy is included but underde- that there are adequate numbers of researchers emerging veloped at a postgraduate level is in Masters of Public in this field. For the remainder of this paper we explore Health programmes, which are now taught in 18 Austral- pathways for developing health policy researchers which ian universities. While some universities offer a small taste are the most direct, yet currently the most underdevel- of policy analysis in introductory core units, in most pub- oped. We highlight three critical steps along the most lic health programs policy suffers in an already crowded direct pathway – the health policy 'streamed' undergradu- program. ate and honours student, the health policy PhD and the health policy postdoctoral fellowship and discuss other What of funding for health policy courses at a postgradu- alternative opportunities for the development of health ate level? The Commonwealth government's Public policy research. Health Education and Research Program (PHERP) has made contributions to policy a requirement for gaining its Undergraduate pathways support. The most recent evaluation of PHERP listed 'pol- As discussed, an area which currently has little focus on icy development and review' as one of the areas where health policy is undergraduate teaching. We feel that it interdisciplinary teaching and research should be fos- would be appropriate to introduce a specific health policy tered. It offers as a model the development of Health teaching stream at this level in order to promote interest Impact Assessment (HIA) techniques [28]. HIAs offer a in health policy as a research area for students who want valuable method for putting health concerns on public to progress toward a research career. agendas, but as a model for policy education and research they remain firmly in the analysis for policy category. The The lack of undergraduate training in health policy has a introduction and expansion of units such as these within significant effect on the development of a research culture postgraduate degree programmes is a good start in devel- in health policy. In the absence of a clear educational path oping a comprehensive understanding of health policy at few emerging academics can consider this a disciplinary a postgraduate level. We argue that these should evolve to focus for their research. It is thus important that health include health policy units that focus on both analysis for policy be developed as a discrete field of study within Page 4 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 undergraduate programmes across the health and social Another possibility is the inclusion of health policy as a sciences in order to lead a pool of potential researchers field of study within dual degrees. Health policy could be toward research in health policy. While this is not the only offered as a module in a dual degree which offers both a way to engage with potential health policy research work- health and a social science focus. The interdisciplinary ers, we see it as an obvious one which is currently under- approach offered by dual degrees such as these would developed. bring together the elements of sociology and political sci- ence with an understanding of the workings of the health As discussed above our search through the current health care system, thereby integrating both the analysis for policy policy offerings in Australia identified Bachelor of Health and analysis of policy approaches to health policy. Sciences degrees as the most common site for health pol- icy teaching to be located. The inclusion of a health policy Undergraduate programme options would offer students stream or major within a health sciences degree makes of health policy an experience from which they could some sense because those who enter into this degree have acquire the foundational knowledge and skill to take into a general, as yet undirected interest in the health system a health policy themed honours research project. Hon- which could be channelled into health policy research. ours is a significant year for developing research workers Even if a student were not to go into a research career in as it allows for the creation of an independent research health policy, engagement with health policy at an under- project through which students are able to learn and apply graduate level should provide them with a general intro- a set of research skills. It gives them a taste of what duction as to how policy decisions are made within the research in health policy may entail and enables academ- health system. This is especially important for students ics to identify and encourage the next generation of health who will follow a career as a health care practitioner as it policy researchers. We suggest the attributes listed in table may help develop a holistic understanding of the health 1, below, as appropriate for an honours student graduat- system. However this is not the only productive place in ing with competency in health policy: which to develop health policy research at an undergrad- uate level and health policy research as a field could be Honours to PhD more broadly developed were it to be encouraged as an A degree with first class honours or honours 2a in health policy will in most cases ensure that students are able to undergraduate field of study within social and political sciences. Teaching health policy in this context would conceptualise and carry out a supervised research project enhance the analysis of policy approach, which is currently at doctoral level. A solid background at undergraduate underdeveloped in health policy research [4]. and honours levels will make the transition to PhD more attractive as well as easier for the student. The benefits of a PhD are clear – the student can complete a research Table 1: Graduate Attributes for Honours Students Graduating with Competency in Health Policy. Knowledge of policy environments, including: understanding of the Australian health system, including knowledge of both Federal and State/Territory systems a basic understanding of comparative international health policy Knowledge of information and evidence, including: the ability to identify and effectively use appropriate research to understand and analyse health policy skills in evidence acquisition and analysis a basic and technical knowledge in health services evaluation a capacity to integrate qualitative and quantitative skills and information knowledge and understanding of the social and political determinants of health and health policy an understanding of the basic principles of health economics Knowledge of policy process, including: knowledge of both micro and macro level views of policy knowledge of the legal, value, political and ethical influences on policy awareness of the role of leadership in policy development and implementation Knowledge of the didactic analysis of policy, including: the ability to examine the congruence between values and intentions and actual policy the ability to understand and analyse aspirational policy and the importance of constructive new ideas practical knowledge of examples of policy failures and "real" policy Skills for effective engagement of policy stakeholders, including: knowledge and skills in advocacy and consultation the ability to appreciate the value and ethical aspects that influence stakeholder views and positions knowledge of the breadth of policy stakeholders and the diversity of their interests and influence Page 5 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 project that they have conceived, develop appropriate significant income needs such as a young family or mort- methodological and theoretical frameworks for analysis, gage repayments. and present findings in a manner acceptable to academic peers within a context of supervised learning. The mentor- It is important that following on from the postdoctoral ing of a good supervisor is integral to this process. research experience, opportunities are available for researchers in health policy to obtain permanent teaching At present, there is little opportunity for students to and research positions or long-term senior fellowships. engage with health policy through teaching at an under- The current fellowship and grant based funding available graduate level and an honours project. It is vital, at the to those finishing a postdoctoral position is usually avail- moment, therefore, that health policy academics actively able for a maximum of three years. This leads to a lack of seek to recruit the next generation of research workers job security for emerging research workers [31]. from other places. Potential sites for recruitment include health science, political science and social science hon- Summary ours, masters and professional doctorate programmes, This paper has sought to define the field of health policy where students have developed an interest in health pol- education and associated research and outline educa- icy and are looking to pursue this interest further. Another tional paths that can be developed in order to strengthen recruiting tactic would be to approach individuals in health policy as a research field. We invite comment on career streams that might feed into masters and postgrad- these ideas and encourage academics across Australia to uate programmes in health policy, and from this to a PhD find a place for health policy in their undergraduate and in health policy. Internships in health policy research cen- postgraduate curricula and to be innovative in their tres could be offered, and visits arranged by health policy recruitment, development and mentoring of future health academics to postgraduate programmes. Active collabora- policy research workers. tion between health policy academics, public servants and practitioners would also be useful. Competing interests All authors currently work in health policy research and Postdoctoral research teaching. JSM was recently in receipt of an NHMRC Whatever tangled routes lead developing research workers Capacity Building Postdoctoral Fellowship in Health Pol- toward a health policy research focus, a relevant and well icy. structured postdoctoral experience is necessary to consol- idate postgraduate training. It has recently been argued Authors' contributions that expanded postdoctoral research fellowship programs JSM conceived of the theme for this article and completed are essential if we are to replace the estimated third to half the research relating to the current teaching of health pol- of all Australian academics reaching retirement age over icy, devised the pathway and prepared the manuscript for the next decade [29]. Postdoctoral research fellowships publication. JG assisted in the development of the ideas provide the best means for mentoring younger researchers expressed in the article, wrote the section defining health in a discipline [29]. policy and assisted in the preparation of the manuscript draft. SL assisted in the development of the ideas In order for a postdoctoral experience to be as productive expressed in the article and helped to prepare the manu- as possible it should include a mix of autonomous and script draft. All authors read and approved the final man- team based research and be based around a strong men- uscript. toring relationship with an academic established in health policy research. A survey of 7,600 US postdoctoral Acknowledgements The authors wish to thank the staff and associates of the Australian Health researchers conducted in 2005 found that researchers Policy Institute for advice on the development of a definition of health pol- were "... more likely to be happy with their jobs and to icy. publish copiously when they receive a lot of structured training and advice from mentors" [30]. A drawback of References the long period of mentoring involved in a postdoctoral 1. Pirkis J, Goldfeld S, Peacock S, Dodson S, Haas M, Cumming J, Hall J, position could be that researchers are less willing to enter Boultan A: Assessing the capacity of the health services research community in Australia and New Zealand. Aust New onto this path because of the limited salaries available Zealand Health Policy 2005, 2(1):4-4. compared with what they might receive in industry. Post- 2. United Kingdom Cabinet Office: Professional policy making for doctoral fellowships are funded low on the academic sal- the twenty first century. [http://www.civilservant.org.uk/profpol th icymaking.pdf]. (accessed 17 April, 2007) ary scale, at either level A or B. It is important that 3. Lin V, Gibson B: Introduction. In Evidence-based Health Policy: Prob- postdoctoral fellowship salaries allow for a comfortable lems and possibilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:xxi. standard of living, especially as most postdoctoral 4. Lewis JM: Health Policy and Politics: networks, ideas and power East Haw- researchers will be at a stage in their lives where they have thorn: IP Communications; 2005:2-3. Page 6 of 7 (page number not for citation purposes) Australia and New Zealand Health Policy 2007, 4:19 http://www.anzhealthpolicy.com/content/4/1/19 5. Mitton C, Donaldson C: Tools of the Trade: a comparative anal- 31. Akerlind G: Postdoctoral researchers: roles functions and ysis of approaches to priority setting in healthcare. Health Serv career prospects. Higher Education Research and Development 2005, Manage Res 2003, 16(2):96-105. 24(1):21-40. 6. Brownson R, Baker E, Leet T, Gillespie K: Evidence-based Public Health New York: Oxford University Press; 2003:163. 7. Aroni R, de Boer R, Harvey K: The Viagra Affair: Evidence as the terrain for competing partners. In Evidence-based Health Policy: Problems and possibilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:97-109. 8. Fox D: The politics and policy of population health: A com- parative perspective. In European Health and Welfare Policies Edited by: Abreu L. Brno: The Compostela Group of Universities & PhoenixTN; 2004:526. 9. Lewis JM: Evidence-based Policy: A Technocratic Wish in a Political World. In Evidence-based Health Policy: Problems and possi- bilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:250-259. 10. Tuohy C: Accidental logics: The dynamics of change in the health care arena in the United States, Britain, and Canada New York: Oxford Uni- versity Press; 1999:11-12. 11. Walt G: Health Policy: An Introduction to Process and Power London, New Jersey and Johannesburg: Zed Books and Witwatersrand Uni- versity Press; 1994:1-3. 12. Blank R, Burau V: Comparative Health Policy Basingstoke and New York: Palgrave; 2004:16. 13. Colebatch H: Policy 2nd edition. Buckingham: Open University Press; 2002:96. 14. Heidenheimer A, Heclo H, Adams C: Comparative Public Policy 2nd edi- tion. New York: St Martins Press;; 1983:52-56. 15. Palmer G, Short S: Health Care and Public Policy: An Australian Analysis Melbourne: Macmillan; 2000:26-27. 16. Lin V: Competing rationalities. In Evidence-based Health Policy: Problems and possibilities Edited by: Lin V, Gibson B. Melbourne: Oxford University Press; 2003:10-11. 17. Duckett SJ: Australian and New Zealand Health Policy: a new journal. Aust New Zealand Health Policy 2004, 1(1):1-1. 18. Greenhalgh T, Russell J: Reframing Evidence Synthesis as Rhe- torical Action in the Policy Making Drama. Healthcare Policy 2005, 1(1):31-39. 19. Moran M, Rein M, Goodin R: The public and its policies. In Oxford Handbook of Public Policy Edited by: Moran M, Rein M, Goodin R. Oxford: Oxford University Press; 2006:3. 20. Monash University: Medicine, nursing and health sciences. th [http://www.monash.edu.au/pubs/ugrad/med.html]. (accessed 8 June, 2006) 21. Monash University: What will I study? [http:// www.med.monash.edu.au/healthsciences/curriculum.html]. (accessed th 8 June, 2006) 22. Monash University: Bachelor of Biomedical Science. [http:// www.monash.edu.au/pubs/handbooks/undergrad/med-19.html]. th (accessed 8 June, 2006) 23. University of Queensland: Policy in the Bachelor of Social Sci- ence. [http://www.uq.edu.au/study/ th plan.html?acad_plan=POLICX2032]. (accessed 8 June, 2006) 24. University of Edinburgh: Centre for International Public Health Policy, Undergraduate Study. [http://www.health.ed.ac.uk/ nd CIPHP/undergraduate/]. (accessed 2 July, 2007) 25. Pennsylvania State University: Health Policy and Administration. [http://www.psu.edu/bulletins/bluebook/major/h_p_a.htm]. (accessed 2nd July, 2007) 26. Ithaca College, New York: B.A. in Health Policy. [http://www.ith Publish with Bio Med Central and every aca.edu/catalogs/undergrad/cat03/05hshp-09.shtml#P1022_76619]. scientist can read your work free of charge nd (accessed 2 July, 2007) 27. Warwick University: Health and Social Studies, B.A.(Hons) in "BioMed Central will be the most significant development for Health and Social Policy. [http://www2.warwick.ac.uk/study/cll/ disseminating the results of biomedical researc h in our lifetime." courses/undergraduate_degrees/twoplustwo/healthandsocial/]. Sir Paul Nurse, Cancer Research UK nd (accessed 2 July, 2007) 28. Australian Government, Department of Health and Ageing: Strength- Your research papers will be: ening Workforce Capacity for Public Health. The Public Health Education available free of charge to the entire biomedical community and Research Program Review 2005 Canberra: Commonwealth of Aus- tralia; 2005:37-38. peer reviewed and published immediately upon acceptance th 29. Nile R: Passing the baton. The Australian :29. 26 April, 2006 cited in PubMed and archived on PubMed Central 30. Brainard J: Postdoctoral researchers value structured training over pay, survey says. The Chronicle of Higher Education 2005, yours — you keep the copyright 51(32):21. BioMedcentral Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 7 of 7 (page number not for citation purposes)

Journal

Australia and New Zealand Health Policy – Springer Journals

Published: Oct 10, 2007

There are no references for this article.