Adding the past to the policy mix: an historical approach to the issue of access to general practice in England

Historical perspectives can be embedded into policy initiatives through a process of ‘past-proofing’—ensuring new policies take the study of the past into consideration. We describe how this was done in a project looking at patient access to general practice in the NHS. We argue that current preoccupations with timeliness which have led to the marginalisation of other dimensions of access are connected to a broader process of neo-liberal reform since the 1970s. This reflection can support a reframing of the terms of current debates on a major issue in British health care. It has wider implications for the policy relevance of history.     

Criminalising commercial surrogacy in Canada and Australia: the political construction of ‘national consensus’

This article examines the language used to justify a criminal prohibition on commercial surrogacy in Canada and Australia. I demonstrate that legislators in each country framed commercial surrogacy as an area over which there was national ‘consensus’ because of uniquely Canadian and Australian values. This was an effective political strategy, but for different reasons in each country: in Canada, because it fit with frames surrounding healthcare and anti-commercialisation, and in Australia, because the distinction between ‘altruistic’ and ‘commercial’ surrogacy mapped onto broader themes of altruism in Australian society. This suggests that the political use of national frames is especially successful when it taps into pre-existing narratives of what constitutes unacceptable behaviour in a given polity, and when it is attached to criminal prohibitions.     

Developing Geostatistical Space–Time Models to Predict Outpatient Treatment Burdens from Incomplete National Data

Basic health system data such as the number of patients utilizing different health facilities and the types of illness for which they are being treated are critical for managing service provision. These data requirements are generally addressed with some form of national Health Management Information System (HMIS), which coordinates the routine collection and compilation of data from national health facilities. HMIS in most developing countries are characterized by widespread underreporting. Here we present a method to adjust incomplete data to allow prediction of national outpatient treatment burdens. We demonstrate this method with the example of outpatient treatments for malaria within the Kenyan HMIS. Three alternative modeling frameworks were developed and tested in which space–time geostatistical prediction algorithms were used to predict the monthly tally of treatments for presumed malaria cases (MC) at facilities where such records were missing. Models were compared by a cross-validation exercise and the model found to most accurately predict MC incorporated available data on the total number of patients visiting each facility each month. A space–time stochastic simulation framework to accompany this model was developed and tested in order to provide estimates of both local and regional prediction uncertainty. The level of accuracy provided by the predictive model, and the accompanying estimates of uncertainty around the predictions, demonstrate how this tool can mitigate the uncertainties caused by missing data, substantially enhancing the utility of existing HMIS data to health-service decision makers.     

Adventures in happy land

Abstract

Interpretation proved to be a key to the successful outcome of three overseas aid projects in Asia and the Pacific. In Vanuatu, interpretation games were used to interest and involve local villagers in writing a management plan to protected a recently protected Pacific Kauri (Agathis macrophylla.) forest. The rapid establishment of national parks in Indonesia required staff to be trained in a variety of disciplines including interpretation. Park interpretation manuals were also written. Small scale tourism ventures in Fiji, where locals are the interpreters, are part of a management plan to protect a private forest park forest from logging.     

Ancestral Puebloan mtDNA in context of the greater southwest

Ancient DNA (aDNA) was extracted from the human remains of seventy-three individuals from the Tommy and Mine Canyon sites (dated to PI-II and PIII, respectively), located on the B-Square Ranch in the Middle San Juan region of New Mexico. The mitochondrial DNA (mtDNA) haplogroups of 48 (65.7%) of these samples were identified, and their frequency distributions were compared with those of other prehistoric and modern populations from the Greater Southwest and Mexico. The haplogroup frequency distributions for the two sites were statistically significantly different from each other, with the Mine Canyon site exhibiting an unusually high frequency of haplogroup A for a Southwestern population, indicating the possible influence of migration or other evolutionary forces. However, both sites exhibited a relatively high frequency of haplogroup B, typical of Southwestern populations, suggesting continuity in the Southwest, as has been hypothesized by others (8, 9, 29, 45 and 57). The first hypervariable region of twenty-three individuals (31.5%) was also sequenced to confirm haplogroup assignments and compared with other sequences from the region. This comparison further strengthens the argument for population continuity in the Southwest without a detectable influence from Mesoamerica.