There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. The study included data on the uptake of Aboriginal health assessments from July 2008 to December 2012. The study population was 83190 in 2008/9, 856986 in 2009/10, 88256 in 2010/11 and 90903 in 2011/12. Logistic regression was used to examine the relationships between organisations within forums and the regional uptake of Aboriginal health assessments. The independent variables included before and after the AHNPA, state, remoteness, level of representation from Aboriginal organisations and links between Aboriginal and mainstream organisations. The introduction of the AHNPA was associated with a shift in power from central government to regional forums. This shift has enabled Aboriginal people a much greater voice in governance. The results of the analyses show that improvements in the uptake of health assessments were associated with stronger links between Aboriginal organisations and between mainstream organisations working with Aboriginal organisations. Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity.

This paper explores the role of consensus statements in a risk society. It uses Beck's theory of risk to show that scientists have employed consensus statements in order to re-establish faith in science. Through analysing the goals of participants in consensus fora and comparing them to the fora processes, this paper considers how consensus statements and guidelines in public health can be viewed as remedies for the decline in expert trust experienced in the current risk society. To collect data, 25 interviews were undertaken with consensus panel participants from the USA, UK and Australia. Interviewees were from peak national agencies/commissioning agencies and were categorised as policymaker, practitioner and consumer stakeholders. Participants made recommendations for improving consensus processes in order to mitigate perceptions of risk. These were: (1) clearly stated goals; (2) robust, evidence-based and transparent processes of methodological development and participation/deliberation/decision-making; (3) diverse stakeholder representation, including increased consumer participation; (4) transparency about conflicts of interest; and, (5) robust, carefully worded recommendations. Poor-quality consensus statements can further entrench scepticism about the scientific enterprise. While consensus statements can be seen as a tool for moderating perceptions of risk, policymakers and scientists must ensure the integrity, strength and transparency of their research methods. This has the potential to facilitate policy, improve scientific accountability to the public and legitimise processes. While fostering greater trust is not a primary objective for scientists, an increase in legitimacy of process can be an important unintended consequence of improved quality consensus statements and an important antidote to the risk society. ARTICLE HISTORY

BackgroundDecision-makers tend to make connections with researchers far too late in the game of public policy, expecting to find a retail store in which researchers are busy filling shop-front shelves with a comprehensive set of all possible relevant studies that a decision-maker might some day drop by to purchase. This linear type of relation between research and policy needs to be replaced by a more interactive model that facilitates both researchers obtaining a better understanding of policy processes and policymakers being more aware and involved in the conceptualisation and conduct of research. This paper explores the role of governance in facilitating the research–policy nexus, testing a typology of research utilisation based on Murray’s (Soc Policy Society 10(4):459–70, 2011) analysis that considers various degrees of researcher–policymaker deliberation in decision-making processes. The projects were all part of various evaluation efforts carried out by the researchers to explore the use of governance in health promotion activities.MethodsThree case studies were chosen to provide some specific examples that illustrate each level of Murray’s typology. The examples involve intersectoral health promotion collaborations that combine evidence-based research in health policy initiatives with various levels of researcher involvement. For all three projects, interview data was collated in the same way, coded thematically and analysed to consider the relationship between researchers and policymakers.ResultsComparing the three models and their applicability to health promotion interventions, it could be observed that all programmes demonstrated successful examples of research translation. Strong governance imperatives structuring relationships led to more successful outcomes, whereby research was successfully translated into a public policy initiative that also led to improved health outcomes. The key idea across all of these models was that strong governance arrangements mitigated some of the barriers evidenced by the varying degrees of deliberation and researcher involvement in processes.ConclusionsThe paper demonstrates that successful research utilisation is related to strong governance agendas and that early and ongoing involvement of relevant decision-makers and researchers in the governance processes, that is both the conceptualisation and conduct of a study, tend to be the best predictors of success.

BackgroundEligibility to access the Victorian voluntary assisted dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity and clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions.AimsThis review of prognostic tools explores their accuracy to determine 6‐month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD).MethodsA systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl.ResultsLimitations of prognostication identified include the following: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include the following: (i) the area under the curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context.ConclusionsPrognostication is a significant aspect of VAD, and the utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD.

Depressive symptoms, including those as part of a major depressive disorder, are common at the end of life. A number of psychiatrists consider that a diagnosis of major depression precludes the capacity to make a decision to request voluntary assisted dying (VAD), although this is not a unanimous view. This paper uses a case of a patient in which two different psychiatric opinions were formed regarding her capacity to make the decision to request VAD. The difference of view can be related to whether major depression was diagnosed and the association made between depression and the capacity to request VAD. The view that an absence of major depression is required in order to establish the capacity to request VAD is potentially at odds with the legal definition and not necessarily in keeping with the patient's experience at the end of life.