Creating change in government to address the social determinants of health: how can efforts be improved?

Background - The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government. Methods - In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives. - We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. Results - We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design. Conclusion - Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next

Accountability and Responsibility in Agent Organizations

International audienceWe discuss the limits of current agent organizations, and the benefits of introducing an explicit account of responsibility and accountability. We, then, illustrate how through such notions it is possible to design both organization specifications and organization entities, that are guaranteed to properly distribute responsibilities , that is, not only to own but also to connect the needed, distributed control over the goal so as to enable its achievement

Accountability

The term “accountability” implies the duty to act in a responsible way and to be accountable to others for one’s actions, in order to maintain effective and logical links between planning, deciding, action, and verification. The term is complex and chameleonic (Sinclair 1995; Mulgan 2000), and it evokes at the same time: a principle, a duty, a behavior, a system, a process, and a series of operating tools. The term – particularly familiar in Western societies – comes, in a theoretical sense, from political science studies and should be considered a fundamental cornerstone of democratic systems (Shah 2010; Borowiak 2011). In any case, it represents the need to convey how financial and nonfinancial resources are used, the correctness of those who operate in a management capacity, the adequacy and conformity of actions taken compared to preexisting objectives, and the results reached over time. This is achieved by highlighting organization policies, laws, and political, social, cultural, and environmental requirements in which the entity – whether public or private – operates, in order to contextualize any evaluation of results and objectives, plans and behavior

Suspending Democracy? The Governance of the EU’s Political and Economic Crisis as a Process of Neoliberal Restructuring

The economic crisis of the European Union (EU) is threatening also the fragile foundations of European democracy. It is not, however, as it might seem, a transitional stage of ‘authoritarianism of emergency’ due to the severity of the crisis and the need to face it as quickly as possible. Conversely, as this chapter aims to demonstrate, the economic choices made in recent years, the policies imposed on States and European citizens, as well as the method chosen to implement these policies – in brief, what this essay defines as the ‘economic governance’ of the EU – can be read as a further step towards its neoliberalization. This new constitutionalism of the EU is based on a twofold development: on the one hand, the onward de-democratization of European politics, with the substitution of democracy with forms of neoliberal governance; on the other hand, the onward de-politicization of European economy, based on the empowerment of unelected bodies, such as the European Central Bank (ECB), and the marginalization of elected representatives. The chapter describes the neoliberal restructuring of the EU and national states both on the political and economic level, by analysing the EU’s responses to its democratic deficit and the role played by the ECB in the economic and financial crisis

Parliament centered or constituency centered? The professionalization of the parliamentary mandate

The question of the professionalization of the parliamentary mandate has long been debated in the literature. Rather than offering a theoretical approach, this chapter puts into perspective the process of professionalization of French and German MPs. It deals with the indicators of this process: developments in remuneration and equipment of the mandate; educational and professional background; self-perception as a professional. Moreover, the way the MPs pursue their careers, work in their district and manage an important workload are documented and analyzed. Altogether these different aspects illustrate the process of professionalization at work among the members of the German Bundestag and the French Assemblée nationale. At the same time, despite this common trend, it is also possible to distinguish between two patterns of professionalization, the German one being “parliament centered” whereas the French one is “constituency centered”