Tackling concentrated worklessness: integrating governance and policy across and within spatial scales

Spatial concentrations of worklessness remained a key characteristic of labour markets in advanced industrial economies, even during the period of decline in aggregate levels of unemployment and economic inactivity evident from the late 1990s to the economic downturn in 2008. The failure of certain localities to benefit from wider improvements in regional and national labour markets points to a lack of effectiveness in adopted policy approaches, not least in relation to the governance arrangements and policy delivery mechanisms that seek to integrate residents of deprived areas into wider local labour markets. Through analysis of practice in the British context, we explore the difficulties of integrating economic and social policy agendas within and across spatial scales to tackle problems of concentrated worklessness. We present analysis of a number of selected case studies aimed at reducing localised worklessness and identify the possibilities and constraints for effective action given existing governance arrangements and policy priorities to promote economic competitiveness and inclusion

Are drug treatment services only for 'thieving junkie scumbags'? Drug users and the management of stigmatised identities.

This article uses qualitative interviews with 53 problematic drug users who had dropped out of treatment in England, UK to explore how they describe the stigmatisation of drug users and drug services. It discusses the construction of the category of the junkie through its association with un-controlled heroin use and criminality. It shows how some drug users carefully manage information about their discreditable identities by excluding themselves from this category, while acknowledging its validity for other drug users. The junkie identity was generally seen as shameful and therefore to be avoided, although it holds attractions for some drug users. For many of the interviewees, entry to treatment risked exposing their own activities as shaming, as they saw treatment as being a place that was populated by junkies and where it becomes more difficult to manage discreditable information. The treatment regime, e.g. the routine of supervised consumption of methadone,was itself seen by some as stigmatising and was also seen as hindering progress to the desired ‘normal’ life of conventional employment. Participation in the community of users of both drugs and drug services was perceived as potentially damaging to the prospects of recovery. This emphasises the importance of social capital, including links to people and opportunities outside the drug market. It also highlights the danger that using the criminal justice system to concentrate prolific offenders in treatment may have the perverse effects of excluding other people who have drug problems and of prolonging the performance of the junkie identity within treatment services. It is concluded that treatment agencies should address these issues, including through the provision of more drug services in mainstream settings, in order to ensure that drug services are not seen to be suitable only for one particularly stigmatised category of drug user

Reproducing vulnerabilities in agri-food systems: tracing the links between governance, financialisation and vulnerability in Europe post 2007-2008

Interconnected sets of vulnerabilities have emerged in the European food system since 2007–2008, raising concerns about food security in a region with arguably some of the most advanced and prosperous economies and environmental governance frameworks. Historically, this is suggesting the current “double jeopardy” problem in food system vulnerability—with systemic declines both in sustainability (the ability of the food system to ecologically renew itself) and food security (the ability of a population to access sufficient nutritional foods and feed itself). By focusing on both drivers and impacts of food system vulnerabilities in the European Union and United Kingdom, this paper explores a grounded and relational approach to financialization—recognized as a key expression of recent growing vulnerabilities. Through the prism of the current socio‐economic pressures facing food producers, and the emergence of potentially “stranded assets” in the agri‐food system more generally, the analysis seeks to show how the combined relationships between neo‐liberalized governance and the market volatilities encouraged by new rounds of financialization are creating “nested” vulnerabilities. As we conclude, a critical, grounded, and systemic understanding of food system vulnerabilities thus becomes a key feature and precursor for potentially developing more resilient agri‐food systems—both regionally and globally

Screening and brief interventions for hazardous alcohol use in accident and emergency departments: a randomised controlled trial protocol

Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption on the physical, psychological and social health of the population. There also exists a substantial evidence base for the efficacy of brief interventions aimed at reducing alcohol consumption across a range of healthcare settings. Primary research conducted in emergency departments has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness. Within this body of evidence there is marked variation in the intensity of brief intervention delivered, from very minimal interventions to more intensive behavioural or lifestyle counselling approaches. Further the majority of primary research has been conducted in single centre and there is little evidence of the wider issues of generalisability and implementation of brief interventions across emergency departments. Methods/design The study design is a prospective pragmatic factorial cluster randomised controlled trial. Individual Emergency Departments (ED) (n = 9) are randomised with equal probability to a combination of screening tool (M-SASQ vs FAST vs SIPS-PAT) and an intervention (Minimal intervention vs Brief advice vs Brief lifestyle counselling). The primary hypothesis is that brief lifestyle counselling delivered by an Alcohol Health Worker (AHW) is more effective than Brief Advice or a minimal intervention delivered by ED staff. Secondary hypotheses address whether short screening instruments are more acceptable and as efficient as longer screening instruments and the cost-effectiveness of screening and brief interventions in ED. Individual participants will be followed up at 6 and 12 months after consent. The primary outcome measure is performance using a gold-standard screening test (AUDIT). Secondary outcomes include; quantity and frequency of alcohol consumed, alcohol-related problems, motivation to change, health related quality of life and service utilisation. Discussion This paper presents a protocol for a large multi-centre pragmatic factorial cluster randomised trial to evaluate the effectiveness and cost-effectiveness of screening and brief interventions for hazardous alcohol users attending emergency departments

Drug policy constellations: A Habermasian approach for understanding English drug policy

Background: It is increasingly accepted that a view of policy as a rational process of fitting evidence-based means to rationally justified ends is inadequate for understanding the actual processes of drug policy making. We aim to provide a better description and explanation of recent English drug policy decisions. Method: We develop the policy constellation concept from the work of Habermas, in dialogue with data from two contemporary debates in English policy; on decriminalisation of drug possession and on recovery in drug treatment. We collect data on these debates through long-term participant observation, stakeholder interviews (n=15) and documentary analysis. Results: We show the importance of social asymmetries in power in enabling structurally advantaged groups to achieve the institutionalisation of their moral preferences as well as the reproduction of their social and economic power through the deployment of policies that reflect their material interests and normative beliefs. The most influential actors in English drug policy come together in a ‘medico-penal constellation’, in which the aims and practices of public health and social control overlap. Formal decriminalisation of possession has not occurred, despite the efforts of members of a challenging constellation which supports it. Recovery was put forward as the aim of drug treatment by members of a more powerfully connected constellation. It has been absorbed into the practice of ‘recovery-oriented’ drug treatment in a way that maintains the power of public health professionals to determine the form of treatment. Conclusion: Actors who share interests and norms come together in policy constellations. Strategic action within and between constellations creates policies that may not take the form that was intended by any individual actor. These policies do not result from purely rational deliberation, but are produced through ‘systematically distorted communication’. They enable the most structurally favoured actors to institutionalise their own normative preferences and structural positions

Assessing UK Drug Policy from a Crime Control Perspective.

Over the entire last quarter of the 20th century the British drug problem worsened, despite the implementation of a variety of approaches and commitment of substantial criminal justice and other resources. The link between chronic use of expensive drugs and property crime makes this experience important for understanding trends in crime and justice in Britain. The worsening of the problem can be seen in the growing number of new heroin users each year over almost the entire period 1975–2000, on top of which was layered, starting in the late 1990s, the first major outbreak of chronic cocaine use. This was not the common pattern in Western Europe over that time and by 2000 the UK had Western Europe’s most serious drug problem. The response initially took the form of increasing enforcement against drug markets; in just the decade 1994–2005 the number of prison cell years handed out in annual sentences has tripled. Even with this expansion we estimate that the annual probability of incarceration for a class A drug dealer is only approximately 6 per cent. Since 2000 there has also been a massive increase in treatment resources linked to the criminal justice system. The number of treatment assessments in recent years has been as large as 58 per cent of the number of persons estimated to be problematic users of Class A drugs. The government believes that drug policy has contributed to the decline in crime in the UK since 2000. Using what is known about treatment outcomes, we argue that despite impressive evidence of effect on individual level offending, the effect of treatment expansion in reducing overall crime rates is likely to have been limited