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Families who attract the attention of child protection services most often have ongoing lived experiences of poverty, gender-based domestic and family violence, problematic substance use and, sometimes, formally diagnosed mental health conditions. Without broader contextual knowledge and understanding, particularly regarding ongoing poverty, decision-making by child protection workers often leads to the removal of children, while the family’s material poverty and experiences of violence remain unaddressed. Case studies are a common tool to succinctly capture complex contexts. In this article, we make explicit, through case examples and analysis, how poverty is almost always the backdrop to the presence of worrying risk factors before and during child protection intervention. Further, we expose the existential poverty that parents live with after they lose their children into care and which invariably exacerbates material poverty. In the final section, we consider the multi-faceted organisational poverty that blights the work environment of child protection workers, and we suggest strategies for improved practice with families living in poverty.
We compared methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) captured by culture-based surveillance and MRSA septicemia hospitalizations captured by administrative coding using statewide hospital discharge data in Connecticut from 2010 to 2018. Observed discrepancies between identification methods suggest administrative coding is inappropriate for assessing trends in MRSA BSIs.
Honest and competent administration is essential to legitimate constitutional government. Administrators make rules with the force of law and apply the law to particular cases. The case-by-case implementation of established policies requires citizens to trust in the impartial application of the law. However, impartiality is not sufficient for administrative legitimacy. In addition, policymaking by the executive and the agencies needs to be consistent both with the competent use of expertise and with accountability to citizens and interest groups. Policymaking delegation is the inevitable result of the weakness of the legislative process as a site for detailed policy prescriptions. Gaps and ambiguities are inevitable. Furthermore, the electoral process is too aggregated and episodic to be the only legitimate route for citizen influence on policymaking. Referenda and surveys are not a responsible option for most policy choices; they risk measuring the views of uninformed individuals, often reacting to emotional appeals. Hence, other routes to public involvement beyond voting and surveys are a crucial aspect of legitimate, representative democracy. Administrative law scholarship needs to articulate practical ways to combine public input with the competent application of technical information to policy.
Partnered research may help bridge the gap between research and practice. Community-based participatory research (CBPR) supports collaboration between scientific researchers and community members that is designed to improve capacity, enhance trust, and address health disparities. Systems science aims to understand the complex ways human-ecological coupled systems interact and apply knowledge to management practices. Although CBPR and systems science display complementary principles, only a few articles describe synergies between these 2 approaches. In this article, we explore opportunities to utilize concepts from systems science to understand the development, evolution, and sustainability of 1 CBPR partnership: The Community Health Advocacy and Research Alliance (CHARA). Systems science tools may help CHARA and other CBPR partnerships sustain their core identities while co-evolving in conjunction with individual members, community priorities, and a changing healthcare landscape. Our goal is to highlight CHARA as a case for applying the complementary approaches of CBPR and systems science to (1) improve academic/community partnership functioning and sustainability, (2) ensure that research addresses the priorities and needs of end users, and (3) support more timely application of scientific discoveries into routine practice.
The “pathway to care” concept offers a helpful framework for preparing national dementia plans and strategies and provides a structure to explore the availability and accessibility of timely and effective care for people with dementia and support for their informal carers. Within the framework of the JPND-MEETINGDEM implementation project the pathways to regular day-care activities and the Meeting Centers Support Programme (MCSP), an innovative combined support form for people with dementia and carers, was explored.
An exploratory, descriptive, qualitative, cross-country design was applied to investigate the pathways to day care in several regions in four European countries (Italy, Poland, United Kingdom, and the Netherlands).
Before implementation of MCSP, of the four countries the United Kingdom had the most structured pathway to post-diagnostic support for people with dementia. MCSP introduction had a positive impact on the pathways to day-care activities in all countries. MCSP filled an important gap in post-diagnostic care, increasing the accessibility to support for both people with dementia and carers. Key elements such as program of activities, target group, and collaboration between healthcare and social services were recognized as success factors.
This study shows that MCSP fills (part of) the gap between diagnosis and residential care and can therefore be seen as a pillar of post-diagnostic care and support. Further dissemination of Meeting Centers in Europe may have a multiple impact on the structure of dementia services in European countries and the pathways to day care for people with dementia and their carer(s).
ABSTRACT. In the 12th century, carvel construction dominated the Mediterranean, whereas in the Nordic seas, clinker construction was used according to Viking tradition. At the start of the 14th century, the northern cog appeared in the Mediterranean, but technical improvements in naval construction and navigation modes from the South were slow to gain acceptance in England. It was only in the 16th century that these discrepancies between Mediterranean and Nordic Seas disappeared.
RÉSUMÉ. Au XIIe siècle, le type de construction à franc-bord domine en Méditerranée, tandis que dans les mers nordiques, fidèles à la tradition viking, la construction à clin l'emporte. Au début du XIVe siècle apparaît la coque nordique en Méditerranée, mais les progrès techniques dans la construction navale et les modes de navigation, venus du sud, sont très lents en Angleterre. Ce n'est qu'au XVIe siècle que les divergences entre Méditerranée et mers nordiques disparaissent.
In the period immediately before the 12th century an observant traveller voyaging in both southern waters (the Mediterranean and the Black Sea) and northern waters (the eastern fringes of the Atlantic, the Channel, the North Sea and the Baltic) would have noticed that in both areas there were broadly speaking two types of vessels. In the south there were ships long in proportion to their beam, with a low freeboard and propelled principally by a large number of oars, generally known as ‘galleys’ or ‘long ships’, and other ships with a greater beam and deeper hulls, which relied more on sails than oars, often described as‘round ships’. In more northerly waters the same division between ‘long ships’ and ‘round ships’ seemed to exist but, if the traveller had looked more closely at vessels in both regions, he would have very soon been aware that ships in these two areas in fact differed markedly in design and construction (Figure 1).
SHIP TYPES IN SOUTHERN WATERS
In southern waters, shipbuilders drew on a long-established tradition which reached back to the days of the Greek and Romans.
Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs.
To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations.
Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers.
Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between −8% and +6%.
Recommended enhancements to care pathways only marginally increase individual-level costs.
The Millennium Development Goals (MDGs), established in 2000 under the auspices of the United Nations, aimed to reduce extreme poverty to half of its 1990 level, by 2015. This goal was achieved ahead of schedule, by 2010, but as impressive as this achievement is, the gains were not distributed equally across the world: 94% of the reduction in the number of people living in extreme poverty occurred in China. In Paul Collier's (2007) terminology, a “bottom billion” – 1.2 billion people – still live in extreme poverty (less than $1.25 per day) and 2.4 billion live in poverty (less than $2 per day).
Poverty, poor health, low life expectancy, and an unequal distribution of income and wealth remain endemic. Many poor countries have had very low or negative growth rates that challenge convergence models of development. Others have weak economic records in spite of a well-educated labor force. Even some countries that are well endowed with natural resources have poor growth records, low per capita income, and massive inequality. The MDGs set specific global development targets, but fulfilling those goals at the country level has proven much more challenging in some countries than in others.
The world's leaders continue to debate how to move forward. The MDGs, now called Sustainable Development Goals (SDGs), have been reformulated with the shortfalls of the first effort in mind. Recognizing the remaining problems of low growth and development, the World Bank in 2013 announced the establishment of a new mission: eliminating extreme poverty by 2030. Recent data suggest that this goal is overly ambitious for a variety of reasons, including the fact that a large number of people were just below the original cutoff. However, one part of the explanation is dysfunctional public and private institutions that both hold back growth and restrict the flow of benefits to those at the bottom of the income distribution. Neither public funds nor outside assistance are used as effectively as they could be. Low-income countries and those with weak growth records are often in difficulty because they are unable to use their human and material resources to further development and to aid the poorest. These countries need institutional reform, but such reform is difficult. Dams, highways, and port facilities are technically straightforward. Reforming government and nurturing a strong private sector are more subtle and difficult tasks that cannot be reduced to an engineering blueprint.
Corrupt incentives exist because state officials have the power to allocate scarce benefits and impose onerous costs. Because scarcity lies at the heart of corrupt deals, basic insights derived from microeconomics can help structure efforts to reduce corruption. Some benefits and costs are not limited in amount, but public officials decide who gets the benefits or must bear the costs. For those allocations as well, economic analysis can provide insights. This chapter and Chapter 5 focus on incentive-based reforms that reduce the benefits or increase the costs of malfeasance. Chapter 6 discusses the criminal law as a deterrent. Here, we consider the following reform options.
• program elimination or legalization of payments,
• reform of public programs,
• reform of procurement systems, and
• privatization as an anticorruption tool.
Anticorruption measures must first locate where corruption takes place and identify the underlying incentives to pay and to accept payoffs. Reform efforts will be inefficient and wasteful unless the costs of corruption outweigh the costs of reform. We build on the previous chapters to outline the basic incentives for corruption and to set the stage for an assessment of alternative reform strategies.
The following incentives encourage corruption on the part of public servants: power over the distribution of a public benefit or the imposition of a cost, discretionary rather than rule-based decision making, low wages, lack of professionalism, lack of monitoring, low or ineffective punishment, lack of accountability, poor transparency, and the proportion of one's peers who are (perceived to be) corrupt. On the demand side, the high costs of government policies – both regulations and taxation; complex or confusing rules; the desire to limit competition; and acquiring valuable government contracts are all incentives to engage in corruption. In addition, those who commit crimes may also seek to make payoffs to avoid arrest and prosecution. In short, individuals will seek to minimize the costs imposed on them by government, while firms try to maximize profits. It is difficult to estimate the relative importance of each of these factors, but as Klitgaard (1988: 75) writes, corruption is more likely when a public official has monopoly power over a service combined with discretion to exercise that power and a lack of accountability. Although an oversimplification, Klitgaard's formulation highlights situations in which corruption is likely to occur when several risk factors occur together.
International corruption is facilitated by the practices of multinational firms. However, even if such firms all pledged to refuse to make payoffs, the big business of international organized crime would remain a corrupting influence. Furthermore, money laundering not only facilitates such crime, but also smooths the way for corrupt officials to transfer their funds abroad. Policies that make it difficult for illicit funds to cross national borders and to enter the legitimate financial system are thus a key subsidiary aspect of global efforts against corruption. Explicit international efforts to constrain corruption are not sufficient. Hence, in this chapter we consider efforts to change the behavior of business firms by invoking principles of business ethics and ask how the global fight against organized crime and money laundering can indirectly limit the benefits of international corruption. Both of these initiatives have broader goals than the control of corruption per se, but they are tightly linked to the incentives for and the gains from grand corruption. Even when the United States or the European Union cannot press charges for bribery, they may prosecute foreign firms or individuals for money-laundering offenses. Many organized crime groups are international in nature, and their corrupting activities are far-reaching. To successfully disband such groups and prosecute individual members requires international cooperation.
We begin with the obligations of multinational businesses, especially large firms whose size and market power exceed that of many nation-states. Then we discuss the importance of international cooperation, outside of existing anticorruption treaties, in dealing with organized crime and money laundering.
Corruption in International Business: The Obligations of Multinational Firms
Corruption involves a buyer and a seller. It cannot properly be described as “imported” by evil multinational firms into innocent developing countries. Nevertheless, multinational firms are central actors in many large-scale corrupt deals. Anticorruption reformers have tried to enlist these firms in anticorruption efforts and to convince them to alter their own behavior. These efforts can complement other efforts to fuel growth, reduce poverty, and enhance government legitimacy, and most saliently, they can improve the overall international business climate.
We begin by discussing the corporation as an actor with moral responsibilities and argue that multinational firms should consider their obligations as international actors that exceed in size and influence some of the nations with which they deal.
Public accountability is necessary for the control of corruption. Both autocracies and democracies can be deeply corrupt, and each can be held accountable in different ways. Elections can constrain politicians, but, as we have seen, they are an imperfect tool. Public accountability is possible even in countries without elections or with a dominant party that always wins the vote. These constraints may be more difficult for autocrats to accept than for elected officials, but even democratic officials resist reforms that expose them to public scrutiny and criticism. Corruption can be limited by internal government structures and organizations that constrain malfeasance and by outside pressure from the public.
Limits on the power of individual politicians and political institutions, accompanied by independent monitoring and enforcement organizations, can be potent anticorruption strategies that also constrain other forms of self-dealing. In a democracy, a key institution is the separation of powers between the legislative and executive branches that permits each source of power to check the other (Section I). Even if elections are unimportant, an independent judicial and prosecutorial system and a federal structure can limit the power of political leaders. But the decentralization of political power is not necessarily effective. Under some conditions, a system with multiple veto points is particularly subject to improper influence, and a federal system may simply give state and local political leaders the leeway to enrich themselves at public expense (Section II). Independent sources of prosecutorial and judicial power are less problematic although, of course, these institutions must also be largely free of corruption and patronage. Some degree of independence is necessary but not sufficient, and too much independence can breed impunity (Section III).
Another group of reforms increases the openness and accountability of government to outside scrutiny (Section IV). Under this scenario, government collects and provides information; both the media and citizens’ groups operate freely, and groups and individuals have effective avenues for challenging official actions. Although such policies are likely to be more acceptable to democratically elected leaders, these reforms can also have an effect in undemocratic systems whose leaders nevertheless need public support to retain and exercise power.
Legislatures frequently delegate implementation to the executive and often voluntarily limit their own control over executive policy making and implementation. The statutes leave the development of precise standards to government agencies, but may include detailed procedural requirements (Moe 1990; Rose-Ackerman 1992: 33–96).
A strong and competent public sector is the necessary backbone of anticorruption policies that target the provision of government services. Cross-country research supports the view that a well-functioning bureaucracy contributes to economic growth (Mauro 1995; Evans and Rauch 1999: 750–3; Rauch and Evans 2000). Furthermore, other public-sector goals, such as redistribution to the poor, equitable and impartial service delivery, public security, and effective procompetitive regulation, will not be effective unless the state is capable of administering complex public programs.
A personnel system based on patronage and political loyalty undermines the efficient delivery of services and leads to the unfair administration of tax and regulatory laws. If corruption and self-dealing are embedded in a government that is otherwise democratizing and promoting market competition, this can delegitimize political and economic reform. An apolitical civil service can smooth changes in political leadership by maintaining continuity in service delivery (Adamolekun 1993: 41–3). The goal is not to isolate public administration completely from politics – an impossible task in any event – but to find ways to mediate the relationship. The Weberian ideal is a professional civil service that is politically neutral, has security of tenure, is paid a decent salary, is recruited and promoted on merit, and does not have property or business interests that conflict with the fair performance of its duties (ibid.). Some reformers question aspects of this traditional model, but even they support the principle that civil servants should not be hired and fired for political reasons (Reid and Scott 1994; Scott 1996).
There are several interlocking ways in which the public administration can perform poorly, over and above the corrupt incentives created by particular rent-generating programs, discussed in previous chapters. The main sources of failure are the lack of professionalism in the civil service; vague, complex, and confusing legal rules; poor management of government finances; and the risk of corrupt hierarchies. Corruption and self-dealing are symptoms of these underlying roots of failure.
A first key to the functioning of the modern bureaucratic state is the separation of roles. Modern government officials do not own their offices and must distinguish between actions appropriate to their roles as public agents and their roles as family members, friends, and members of larger ethnic, religious, or other groups.