Why is health improvement policy so difficult to secure?

Many governments seek to improve population health, and some seek to reduce health inequalities. Yet, there remains a large gap between their policy statements and actual outcomes. Perennial questions in public health research include: why is this gap so large, why does it endure, and what can be done to close it? This essay uses political science and policy studies insights to address these questions, focusing on the distinctive issues that relate to (1) broad aims like 'prevention', (2) specific strategies for health improvement, or (3) new events. On the one hand, the idea of 'prevention' has widespread appeal, when governments think they can save money or reduce inequalities by preventing problems happening or worsening. While health protection seeks to inoculate populations against communicable diseases, health improvement strategies, including 'Health in All Policies' (HiAP), primarily address non-communicable diseases (NCDs). Further, the coronavirus disease 2019 (COVID-19) pandemic highlights the unequal spread of ill health, showing that preventive health ideas should be at the core of policy. On the other hand, there is a large gap between rhetorical and substantive commitment to prevention, a continuous HiAP implementation gap, and a tendency for COVID-19 health protection to overshadow health improvement. Explaining each problem clearly helps to identify the factors that generally undermine prevention policies and those specific to more detailed strategies like HiAP or events like COVID-19. We do not prioritise leadership or 'political will' as the policymaking problem. Instead, we identify the systemic factors that apply to even the most sincere, competent, and energetic policymakers. Health improvement policy is typically undermined by a lack of: clarity about what prevention means in practice; congruity between the prevention agenda (emphasising the need for major change to policy and policymaking) and routine government business; and, capacity to overcome obstacles to policy change.

The Challenges of Putting Systems Thinking into Practice Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health".

In theory, 'systems thinking' offers a remarkably attractive solution to the persistent challenges of preventive public health. Haynes and colleagues' recent analysis of the Prevention Centre in Australia offers reason for optimism that it might be possible to translate this promise into action on the ground. In this commentary, we critically assess the claims from this promising case study and their broader applicability to the cause of preventive health. We argue that, in many other contexts, persistent obstacles remain, such as a lack of buy-in from senior policy actors, and a lack of tangible or concrete action following through on an abstract commitment to systems thinking.

Red Imported Fire Ant (Solenopsis invicta) Chemosensory Proteins Are Expressed in Tissue, Developmental, and Caste-Specific Patterns.

The red imported fire ant, Solenopsis invicta, is a eusocial invasive insect that has spread worldwide. Chemosensory proteins (CSPs) are ligand-binding proteins that participate in a diverse range of physiological processes that include olfaction and chemical transport. Here, we performed a systematic survey of the expression of the 21 gene S. invicta CSP family that includes at least two groups of apparent S. invicta-specific gene expansions. These data revealed caste, tissue, and developmental stage-specific differential expression of the SiCSPs. In general, moderate to high SiCSP expression was seen in worker antennae and abdomen tissues with lower expression in head/thorax regions. Male and female alates showed high antennal expression of fewer SiCSPs, with the female alate thorax showing comparatively high SiCSP expression. SiCSP expression was lower in male alates tissues compared to workers and female alates, albeit with some highly expressed SiCSPs. SiCSP expression was low during development including in eggs, larvae (early and late instars), and pupae. Global analyses revealed examples of conserved, divergent, and convergent SiCSP expression patterns linked to phylogenetic relationships. The developmental and caste-specific variation seen in SiCSP expression patterns suggests specific functional diversification of CSPs that may translate into differential chemical recognition and communication among individuals and/or reflect other cellular roles of CSPs. Our results support a model for CSPs acting as general ligand carriers involved in a wide range of physiological processes beyond olfaction. As compared to the expression patterns of the S. invicta odorant binding proteins (OBPs), an inverse correlation between SiOBP and SiCSP expression was seen, suggesting potential complementary and/or compensatory functions between these two classes of ligand carriers.

The Influence of Process Parameters and Build Orientation on the Creep Behaviour of a Laser Powder Bed Fused Ni-based Superalloy for Aerospace Applications.

Additive Layer Manufacturing (ALM) is an innovative net shape manufacturing technology that offers the ability to produce highly intricate components not possible through traditional wrought and cast procedures. Consequently, the aerospace industry is becoming ever more attentive in exploiting such technology for the fabrication of nickel-based superalloys in an attempt to drive further advancements within the holistic gas turbine. Given this, the requirement for the mechanical characterisation of such material is rising in parallel, with limitations in the availability of material processed restricting conventional mechanical testing; particularly with the abundance of process parameters to evaluate. As such, the Small Punch Creep (SPC) test method has been deemed an effective tool to rank the elevated temperature performance of alloys processed through ALM, credited to the small volumes of material utilised in each test and the ability to sample material from discrete locations. In this research, the SPC test will be used to assess the influence of a number of key process variables on the mechanical performance of Laser Powder Bed Fused (LPBF) Ni-based superalloy CM247LC. This will also include an investigation into the influence of build orientation and post-build treatment on creep performance, whilst considering the structural integrity of the different experimental builds.

The politics of institutionalizing preventive health.

Prevention is an attractive idea to policymakers in theory, particularly in health where the burden of spending and care is increasingly taken up by complex and chronic conditions associated with lifestyle choices. However, prevention in general, and preventive health in particular, has proven hard to implement in practice. In this paper, we look to one tangible legacy of the recent rise of the prevention agenda: agencies with responsibility for preventive health policy. We ask how this form of institutionalizing preventive health happens in practice, and what consequences it has for the advancement of the prevention agenda. We draw on qualitative data to compare the trajectories of newly formed agencies in Australia, New Zealand and England. We find that building and maintaining legitimacy for such agencies may come at the expense of quick progress or radical action in service of the prevention agenda.