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BMC Health Services Research
Elusive implementation: an ethnographic study of intersectoral policymaking for health
Ditte Heering Holt1,
Morten Hulvej Rod2,
Susanne Boch Waldorff3 &
Tine Tjørnhøj-Thomsen1
BMC Health Services Research volume 18, Article number: 54 (2018) Cite this article
For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling.
On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts.
By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action.
We argue that the 'myth' of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.
The public health officers in 'Townville' sit around the table in their meeting room and discuss how to conduct the "kickoff meeting" launching the municipality's new health policy. The policy has just been adopted by the City Council. Now the administration must develop an intersectoral implementation strategy. The public health officers agree that it is very important that the policy aims are comprehensible and "by all means not fluffy" to non-health departments. They want to ensure support among all departments and not least to produce a high quality strategy. To achieve this purpose an external consultant, who helps plan the process, asks the public health officers to define what the policy aims mean. He asks about the aim "healthy measures". They struggle to come up with answers. There is silence. One suggests that it is "the structural". Another disagrees. She thinks it should not be limited to "regulation". They discuss whether "structural" is more than "regulation". They do not want regulation, as this is not considered politically feasible with the center-right majority in the City Council. The consultant suggests it is about "working systematically with the framework conditions". They all agree. They are happy with how he phrases it. One asks him to repeat it so they can write it down. Several of them make notes. There is a sense of relief among them. They move on to talk about the timeline of the process.
This excerpt highlights the key question of our paper: how can we understand the way good intentions to turn policy rhetoric into intersectoral action for health resulted in a process of producing abstract rhetoric and vague plans? The paper adopts an ethnographic perspective on the process of intersectoral policymaking for health in a Danish municipality. We investigate the apparent paradox that ideas about intersectoral policymaking have become popular among politicians and public health professionals, while simultaneously experienced as a great challenge to implement in practice [1,2,3].
For more than 30 years, policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health [4]. In 1986, the Ottawa Charter [5] emphasized the importance of healthy public policy. More recently, it has been followed by calls for health in all policies and joined-up government to act on the social determinants of health and hereby ensure better population health and health equity [3, 6, 7]. While many researchers, politicians and public health professionals agree on this intent, implementation of intersectoral policy remains a challenge [3, 8, 9].
Within public health, implementation is often conceptualized as the process of turning policy rhetoric into action [10, 11]. This is based on the assumption that policy will guide action by allocating resources and providing guidance on the division of responsibilities, as well as setting goals and targets to be met [9, 12, 13]. However, Ollila finds that "[i]deas [are] more easily transferred into rhetoric than practice, and implementation of intersectoral health policies remains challenging" [10]. While political science has long known that it is challenging to move from statements of intent to implementation [14,15,16], critics find that public health has remained naïve about the policy process and has paid little attention to how it affects implementation [17]. Generally, researchers call for a better understanding in public health of the processes and mechanisms involved with intersectoral policymaking [8, 12, 17,18,19,20].
The aim of this paper is to provide a better understanding of the process and social dynamics of intersectoral policy implementation. First we present our theoretical framework and then the methodological approach. In the Results we first give a detailed description of the implementation process to illustrate how an apparent failure to implement policy was effected by the reproduction of abstract rhetoric and vague plans. In the subsequent section we analyze the challenges and argue that idealization of universal intersectoralism, doubts about economic outcomes, and inconsistent demands about decision-making functioned to decouple the intersectoral strategy from directing action. In the Discussion we expand on the implementation challenges and discuss the implications of the study in relation to the existing research. We argue that decoupling rhetoric from action may not necessarily constitute a failure of implementation in the traditional sense, as the process serves to display good intentions, maintains high values that would otherwise be rejected, and keeps the process running.
Theoretical framework
The study is informed by organizational neo-institutionalism, and applies the concepts of rationalized myth and decoupling [21], as they hold explanatory power relating to the challenge of turning rhetoric into action.
Organizational neo-institutionalism is defined by a focus on how organizations take in institutionalized reform ideas as part of organizational rhetoric, because these ideas have become popular in the institutional environment, even 'taken-for-granted', as the legitimate and efficient way of organizing [21, 22]. These institutionalized reform ideas are conceptualized as rationalized myths. Rationalized myths excite and grab attention as powerful solutions to organizational challenges, due to their appearance as effective instruments, not their efficiency as instruments for change [21]. A rationalized myth, however, may disturb the organization's daily operations because it ensures legitimacy but not necessarily efficiency. Thus decoupling may be the organizational response to cope with rationalized myths as hypothesized by Meyer and Rowan [21]. The concept of decoupling suggests that reform ideas are adopted in rhetoric and policies as 'window-dressing' without affecting daily operations [23]. By decoupling formal rhetoric from organizational action, organizations are able to carry out their core tasks and cope with many, often opposing, demands from the institutional environment.
This study is part of an explorative study investigating intersectoral efforts for health in ten Danish municipalities [24]. In this paper we focus on a single municipality referred to as 'Townville'. The first author, DHH, followed the intersectoral process of implementing a municipal-wide health policy during a period of 1 year from August 2013 to August 2014. This was from when a new intersectoral health policy was about to be adopted and the following process of developing an intersectoral implementation strategy and establishing intersectoral governance mechanisms. Participant observation, together with semi-structured and informal interviews, were the main methods of data production to provide an in-depth ethnographic account of the process of local intersectoral policymaking for health [25,26,27].
Townville is an exemplary case in the sense that it represents general challenges and aspirations we found in the overall study. Moreover, Townville offered a unique opportunity to study intersectoral policymaking, because intersectoral collaboration was a key priority and great efforts were invested to achieve it. The case thus enables us to learn about critical aspects of intersectoral policymaking, which are most often not accessible for researchers to study directly. To gain access, DHH approached a public health officer who organized initial interviews. A meeting was set up with the Public Health Office (PHO) and the Children and Youth Secretariat to formalize an agreement outlining the aim and extent of the fieldwork. DHH was then invited when the strategy was on the agenda. The presence and aim of the research was briefly introduced at all intersectoral meetings, and oral permission was always asked to record discussions. The study was approved by the Danish Data Protection Agency.
Several health determinants are related to the local governmental level [28], and municipalities are often considered to possess features which place them in a key position to address population health due to their local governance models and responsibilities in a number of sectors [29, 30]. Denmark is a universalistic welfare state [31] with rather decentralized decision-making [32]. The main healthcare services such as hospitals and general practitioners are within the regional jurisdiction. A local government reform in 2007 made health promotion and prevention the responsibility of municipalities [33, 34]. This was to a great extent based on ideas about intersectoral action for health, as municipalities were expected to possess great opportunities to integrate health within local welfare services, such as schools, employment service, local planning, and social services among others [35]. Thus Danish municipalities provide a great opportunity to examine intersectoral policymaking and action at the local level.
Townville is a medium-sized municipality with an urban center, surrounding villages and agricultural hinterland with a population of around 70,000. Since the 2007-reform, Townville had initiated various health promotion and prevention interventions. Townville experienced rising costs related to non-communicable diseases and changing demographics of an aging population, as well as social inequalities in health. To address these concerns the new health policy was intended to establish broader, intersectoral commitment, and a more strategic approach to public health.
The intersectoral process was organized in intersectoral meeting groups; 1) a steering committee; 2) an intersectoral health committee referred to as Health Forum; and 3) three intersectoral working groups divided according to three main target groups: children and youth, at risk populations, and sick and debilitated. The process was planned by a project group in Townsville's PHO. The public health officers functioned as coordinators and facilitated all intersectoral meetings. Figure 1 provides an overview of the intersectoral organization as it was visualized by PHO.
Organization of the intersectoral process adapted from a visualization produced by PHO
The fieldwork
DHH participated as participating observer [36] and followed the work of the steering committee, the Health Forum, the intersectoral working group representing Children and Youth Services – referred to as the working group – as well as PHO (see Table 1). It is noteworthy that politicians did not play a central part in the process and generally seemed to support the political proposals prepared by the administration on this issue. The fieldwork thus focused on the intersectoral collaboration of the administration in order to convey the greatest insight regarding the intersectoral process and included the few political meetings where the implementation strategy was on their agenda. Analyzing the role of the local politicians in more detail is beyond the scope of this paper, but see Holt [37] for further discussion on this matter.
Table 1 Overview of the meetings DHH participated in
Meetings are a common way to structure and restructure social life in contemporary organizations [38], and thus provide a unique opportunity to study organizational negotiations about what intersectoral policymaking for health is and should be, according to participants. Beyond the formal meetings, 'hanging out' prior to and after meetings and informal situations during breaks constituted part of the fieldwork. These situations provided opportunities for informal interviews and conversations that helped to establish trust, and contextualize and unfold observations from the meetings. The observations were initiated and followed up by semi-structured interviews with key participants representing top-level management, public health officers and involved civil servants mainly from Children and Youth Services. Eleven scheduled interviews in total (see Table 2 for an overview, and Additional file 1 for a template of the interview guide).
Table 2 Overview of scheduled semi-structured interviews
Analytical strategy and analysis
The empirical material consists of field notes, sound recordings of meetings and interview transcripts and summaries, as well as organizational documents like internal meeting reports and power-point slides, and formal documents like adopted strategies and policies. DHH has translated quotes and edited them for readability. Participants' intentions are described as they were depicted in meetings.
The study employed an abductive research strategy [39], which is characterized by producing theoretical hunches for unexpected research findings – such as our observation that the overall good intentions in Townville did not lead to the expected action. These hunches are then developed in an iterative process of working with the empirical data in 'dialogue' with the theoretical literature [39, 40]. We analyzed the intersectoral process by repeated readings of the empirical data to write up situations and practices related to intersectoral collaboration and the process of policy implementation. We used holistic data organization [41], where explanations are derived from analysis of the 'whole' process. This provides an understanding of the "intricately interwoven" parts of the data set relating to the complex intersectoral process [41]. To follow the principles of abductive analysis, the concepts of rationalized myth and decoupling, as well as health promotion literature on barriers and facilitators of intersectoral policymaking informed the analysis.
The Results consists of two main sections, each organized in three subsections. First, we give a detailed description of the ethnographic case. Next, we provide an analysis of the implementation challenges by applying the concepts of rationalized myth and decoupling.
The process of developing an intersectoral implementation strategy
In this section we give a detailed chronological description of the intersectoral process. This is structured to present 1) the participants' intentions, 2) the example of the "pitch" template, and 3) the outcome in terms of the approved strategy. We use the example of the pitch to illustrate how the process reproduced abstract rhetoric rather than plans for action.
High hopes and strong beliefs
"Everyone talks about breaking down the silos, but we try to achieve it".
Participants in Townville described that they were in a process of breaking down organizational silos. This was expressed in phrases like "breaking down the silos", "breaking the columns" or as "creating coherence and consistency". Intersectoriality was a main priority of the process and great efforts were put into achieving this: The policy had been developed in an intersectoral process and was accompanied by intersectoral governance mechanisms such as Health Forum and the working groups, intersectoral political consultations and a public conference, a public hearing, dedicated funding to support new initiatives, as well as commitment and leadership from top-level management, and a political mandate for intersectoral collaboration. Overall the process enjoyed great support among participants, who generally showed great enthusiasm. For instance, after the launch of Health Forum, several participants came over to congratulate the public health manager and told how excited they were. Only on one occasion did a local manager question whether it was necessary to introduce a new strategy. He did not receive much support from his colleagues though. Instead they argued for the necessity of an intersectoral strategy to ensure coordinated efforts:
"You can't save the world with an intervention in your department alone. It needs to be consistent with what is done in social services, in employment services etc. This is why we need to have a strategy."
The belief in intersectoralism was paralleled by a belief in control by strategic planning. At numerous occasions participants expressed how it was essential that the policy, and particularly the strategy, would set priorities and give direction for action: "It must be a tool to make priorities. It must give a direction". Generally, participants believed that introducing the intersectoral strategy developed through a thorough intersectoral process, would help control action across sectors, thereby creating coherence and consistency.
Structuring the strategy: The pitch template
"[The health policy] has been approved, but that in itself does not produce health. So now it must be brought to life […] We cannot bring the policy to life alone in our small office. It requires that everyone […] must be involved".
With these words the public health manager introduced the working groups to their task. The quote sums up their main intentions for the process: to move from policy to practice and to engage the entire municipality in the policy implementation. Implementation came across as a shared ambition that was highly desired, but constituted great challenges. For instance the working group initially described one of their aims as: "to do what we say we do" and "Townville employees must live up to our own policies". Another example was a discussion on local policies:
"The thing that's so damned about all the policies we have, because we have a billion policies and strategies. […] we can't say that it is not described. Everything is described. It is a matter of whether it is being done."
There was a general frustration among many participants who wanted a closer connection between policies and action.
To ensure this connection and achieve implementation, the project group introduced the "pitch template". The "pitch" was a table on one sheet of paper with fixed phrases to fill out in order to present interventions concisely. It was presented as an "innovation tool", as the template should help clarify and convey ideas without any "woolly talk", thus 'pitching' them to get clout:
"Academic and administrative language sneaks in too easily. All this must be stripped away. We must communicate clearly. If we can't communicate our ideas clearly we can't collaborate."
The pitch was conceptualized as a tool to establish collaboration and moving interventions from idea to action. On this background it was introduced to structure the strategy.
However, working with the pitch was difficult for participants, who struggled to concretize their ideas. For instance, during the workshop participants kept changing the overall theme of the pitch as they struggled to fill in the blanks in the template. E.g. relating to the aim mental health, they discussed whether preventing suicide or promoting general wellbeing was the objective. They were not sure what constituted the greatest problems or best line of action. Moreover, whenever participants were forced by the templates to make ideas explicit, these were the rare occasions when the atmosphere changed and became tense or tired.
Another challenge the pitch highlighted was the sheer number of objectives in the policy. The health policy outlined three overall aims: "healthy measures", "mental health", and "equality in health". Each aim included numerous explicit objectives, as well as statements of intent. The coordinators produced a table to create an overview, which amounted to 53 objectives. This included the objective to meet basic recommendations from the national prevention guidelines, which alone consisted of 176 recommendations. As such, the policy did not provide the direction they attributed to it and prioritization remained a key challenge. This was highlighted by the pitch template's tight structure. Participants struggled to suggest specific action while maintaining the purpose of the strategy as an overarching document:
"It's a challenge now that the implementation strategy is still at a very strategic, general level. If we use pitch it will be at least 30 pitches for each target group, so we need to lump it together in associated themes".
As a consequence, over a period of some weeks PHO decided to use the pitch template to describe more general areas of intervention, and thus moved away from the original intention to communicate plans for action.
The working group produced five pitches describing overall areas of intervention in Children and Youth Services: "health integrated as part of core operations" which focused on professional competences; "strengthening parenthood and mental health of young families"; "local health strategies in all daycare centers, schools and special services"; "promote health among the youth"; and "implement the national prevention guidelines". The pitches were distributed to the working group and members of Health Forum for final comments. Most feedback was positive but some did suggest a few changes, for instance:
A manager comments on "strengthening parenthood". The pitch suggests (among other things) to add an extra visit by community nurses to mothers within the first year of birth. The manager questions whether the costs of adding an extra visit would correspond with an equivalent outcome of better health. The coordinator replies that this proposal is based on the decision to meet national recommendations, which endorse five visits within the first year. Townville only offers 4. She adds that she will change the wording of the pitch and concludes: "I will try to rephrase this part of the pitch in relation to strengthening the parenting role, but without making a specific proposal".
The pitches were then adjusted to incorporate the last comments, thus rephrasing some details to make them less specific.
The draft of the strategy, including pitches from all three working groups, was then distributed among Health Forum and the Steering committee for approval. At this point, top-management in Children and Youth Services (where two of four top-managers were members of the steering committee) rejected the strategy. At a meeting between the top-management group of Children and Youth Services, the public health manager and working group coordinator, the pitches were rejected. DHH was not present at this meeting, but learned later that the pitches were still considered too explicit, despite the reworking. As a consequence it was finally decided to remove the pitch template completely from the implementation strategy. The strategy then consisted of general descriptions presenting the headlines and general aims of the 16 areas of intervention, but without explicating the action involved.
Approving the strategy
The strategy was then (verbally) presented to the City Council for discussion. Here some politicians reacted negatively to the long recitation of the now 16 suggested areas of intervention. The City Council did not express explicit opposition to the content, but advised that the number was cut down to create a better overview. PHO edited the strategy to make it more easily readable for the politicians. However, instead of removing suggestions they joined them together into six themes: "child obesity"; "child and adolescent mental health"; "intersectoral substance use prevention"; "better health for vulnerable populations"; "well-being among sick, debilitated and at risk populations"; and "increased intersectoral collaboration regarding old-age medical patients". The suggested areas of intervention were listed in boxes underneath the themes as "examples". As a result all suggested interventions were still potential future actions, although no action was prioritized and decided upon. Moreover, the suggestions remained highly abstract, only introduced by a heading. Therefore the final strategy did not provide the prioritization and direction for action, which was initially desired. The strategy was subsequently presented to the political committee with the mandate to approve health interventions, who adopted it without further changes.
In follow-up interviews, participants expressed general approval of the strategy and evaluated the process a success. For instance the director of Children and Youth Services concluded: "It's a good plan". He told that his employees had started referring to the health policy and talked a lot more about health than they used to. He believed this would contribute positively to the future implementation.
Producing generalities to maintain good intentions
This case raises the analytical question of why the very explicit and dedicated attempt to produce a clear strategy to direct action resulted in vague plans and abstract rhetoric, and how this can be considered satisfactory by participants. In this section we analyze our case as an example of decoupling. We show how intersectoralism was idealized, while tensions between inconsistent demands were not resolved, but were maintained in abstract rhetoric and vague plans. We argue that the strategy served as a document of good intentions, while seemingly being decoupled from having any significant impact upon the operations of the municipal organization. We argue that the very 'myth' of intersectoralism was instrumental in avoiding the specification of action that was intended to implement the policy.
The myth of intersectoralism
Intersectoralism was never defined, but referred interchangeably to various meanings. Despite this, the benefits of intersectoral efforts were never questioned by participants who praised it as a means to produce "coherence" and "consistency", and hereby "generate synergies", despite hardly any analysis or detailed plan of how this would be achieved. Intuitively they all agreed that avoiding "everyone running in opposite directions" was essential, reflecting the taken-for-granted appeal of the rationalized myth [21].
Intersectoralism was idealized and often considered more valuable than action within a single sector. For instance, the fact that the Children and Youth Policy already had health related objectives was seen as a barrier to overcome rather than an advantage. On several occasions the project group commented on this as a challenge: "it is particularly cumbersome with Children and Youth Services, because they have already started their own process. It would be easier if they were waiting around". In contrast, the ideal was the entire municipality functioning as one coordinated whole. E.g. it was often stressed that ensuring all citizens were met by the same approach was essential, and local pilot projects were not valued very highly if they were not systematically disseminated.
The steering committee briefly discussed whether the intersectoral process necessarily should include all departments, or whether some division e.g. between 'child' and 'adult' services could be made to ensure relevance while maintaining efficiency. However this was soon dismissed, as they believed Townville had a shared challenge that needed to be addressed intersectorally. A top-level manager said: "drugs and alcohol, the disadvantaged, they are cross-cutting problems, and transition from child to adult services […] I believe it is dangerous to separate it. I'm afraid we won't reach the synergy then". Attempts to designate certain areas for intersectoral collaboration were avoided in order to preserve the ideal of universal intersectoralism. Thus, the belief in a shared strategy to create coherence and consistency across all municipal departments functioned as a barrier to designate more specific action, as it entailed an unwillingness to move towards the local and unique. It appears that the greater the efforts to include and involve all departments, hence to do intersectoralism 'right', the more diluted (vague and abstract) the result, as the strategy only remained a shared document by maintaining the high level of abstraction. The idealization of universal intersectorialism thus legitimized and encouraged the reproduction of generalities. By keeping rhetoric and plans at an overall abstract level, Townville maintained the 'myth' of intersectoralism as a panacea; benefitting all aspects of the organization, being a universal solution everyone could support.
Economic expectations and doubts
Part of the myth of intersectoralism was expectations about economic benefits. The public health manager explained: "It's this idea that the gold is buried between the chairs" – chairs referring to different services and/or legislations. He referred to Townville's tight economy and planned budget cuts and explained that intersectoral collaboration was believed to initiate innovative solutions across departments. This was expected to result in improved efficiency and better effectiveness of municipal services. Generally, participants talked about "investing in health", assuming that better health would reduce the demand for expensive services, hereby improving Townville's economic situation. Effects were expected to be simultaneously health effects and economic effects, as expressed by the public health manager: "we need to do what works, so we get maximum value for money […] when we talk about evidence, we refer to best practice, best value for money, health economics and evaluations."
Despite the powerful myth, doubts about outcomes also defined the process. Uncertainty about economic outcomes was particularly mentioned as a concern. An example is a discussion in the project group about expected economic outcomes:
They discuss whether to suggest "reduced co-financing for hospitals" as an outcome. One says that maybe it is not within their control. They do not know whether the regional hospitals will just admit more patients: "co-financing is dangerous to add as effect". They decide that it is probably out of their control and agree it is better to change the wording to "increased economic flexibility". They are pleased with how this does not tie them to deliver specific savings on co-financing but includes the derived savings expected from better health promotion and prevention efforts.
The excerpt illustrates how doubts about outcomes functioned to produce abstract rhetoric. Especially economic concerns seemed to impose an uncertainty that encouraged decoupling by making plans and rhetoric less explicit. For instance, when asked about the decision to remove the pitches from the strategy, the managing director explained that they had to make the strategy less specific because: "the City Council won't approve an implementation strategy that cost 100 million [DKK]. And I believe it could easily cost that. Everyone knows they won't accept that." Despite small economic funding for new initiatives, it was a general assumption – sometimes expressed as an explicit requirement – that the policy was to be implemented within existing budgets. So regardless of expectations about economic benefits, the uncertainty about economic outcomes meant that Townville talked about investing in health, but adopted a strategy with no requirements for action, in order to satisfy budget demands.
Tensions regarding decision-making
Beyond economic expectations, the myth of intersectoralism was characterized by a strong intention to make the process inclusive and participatory. Organizing the process in multiple intersectoral groups was based on the assumption that an inclusive process would make it easier to implement the policy: partly because everyone had been involved in phrasing the challenges and suggesting solutions, which would thus produce a better strategy; partly because the inclusive process in itself would create ownership and commitment. As the public health manager noted: "we should be facilitators […] not public health experts […] we know we won't get anywhere if it is directed from the central […] so it is important to establish ownership and commitment […] It is so important to get it bottom-up". However, while aspiring for a role as facilitators, the project group was simultaneously concerned with ensuring the quality of the strategy. The public health officers saw their role as "adding professionalism" and "equip participants" to ensure that interventions were based on public health knowledge. They were determined not to let personal "unprofessional" conceptualizations of health among staff define local interventions. As a result the project group experienced a tension between the ideal of bottom-up involvement and their professional aspirations of ensuring public health knowledge as the basis of decision-making.
Another tension regarding decision-making was between demands for political leadership and management flexibility. The working group requested direction from their politicians: "the problem is deciding what is good, what is good enough […] we need the politicians to make these decisions". The ambition to make a powerful strategy involved the demand for strong political leadership making priorities. However, this was countered by a simultaneous demand that politicians should not interfere in details of management: "Townville is decentralized, so politicians shouldn't be involved in the details. Politicians decide on the overall objectives but leave space for management." This concern was voiced by both top-management and participants in the working group. They did not want politicians to interfere in the details of operations. Hence, the process entailed conflicting demands regarding political leadership making both prioritizations and space for managerial control.
The process was therefore characterized by tensions regarding who should decide on priorities, and on what grounds. However these tensions were rarely articulated explicitly. Rather, the different demands remained abstract expressions of good intentions, and participants generally agreed to the various demands despite underlying inconsistencies. On few occasions, when inconsistencies between such demands were voiced explicitly e.g. relating to budget- or political requirements, abstract rhetoric was actively produced to avoid resistance, as the excerpts in the introduction and on the pitch "strengthening parenthood" illustrate. Abstract rhetoric accordingly functioned to maintain inconsistencies, making the strategy a document of good intentions. This way, the myth of intersectoralism remained intact, while the strategy was decoupled from having substantial impact on other parts of the municipal organization.
In this section we sum up our findings and discuss implications in relation to implementation of intersectoral policymaking.
We find that the myth of intersectoralism posed a barrier to the ambition of moving from overall statements of intent to more specific plans for action. The process produced activity, but activity that seemed somewhat parallel to and decoupled from daily operations. So despite elaborate governance mechanisms – which are often recommended as the means to foster intersectoral collaboration [9, 42, 43] – the process did not entail the expected move from rhetoric to action.
From existing literature on joined-up government and partnerships we know that boundary spanning skills are required in order to successfully manage intersectoral collaboration [44,45,46,47]. These skills include managerial creativity and flexibility in order to exploit collaborative opportunities, which Bardach refers to as craftsmanship [45]. Managing intersectoral collaboration requires a specific set of 'soft power' skills such as problem-solving skills, coordination skills (getting people to the table), brokering skills (seeing what needs to happen), flexibility, deep knowledge of the system, and a willingness to undertake the emotional labor associated with relational working ([46], p. 8). Both Carey and Crammond [46] and Hunter and Perkins [47] find that strong leadership at multiple levels are particularly important together with establishing trust and good working relationships between partners. Additionally, Hunter and Perkins [47] identify a number of barriers to efficient partnership working, among others: different agency priorities, lack of a shared goal that can create ownership, reluctance to share power, and missing links between levels. Applied to our case, we find that while the positive characteristics of trust, good working relationship and strong leadership were all present in Townville, so too were barriers such as different departmental and sectoral priorities and lack of a shared goal at the operational level. As such, the challenge of implementing the policy may be no surprise. The contribution of our analysis is to highlight how the myth of intersectoralism was instrumental in escaping the development of shared priorities and a common goal: The idealization of universal intersectoralism, together with uncertainty about economic outcomes and inconsistent demands regarding decision-making, meant that Townville maintained and produced abstract rhetoric and plans, and thus decoupled the implementation strategy from directing organizational action as no clear priorities were made. By not specifying plans for actions, Townville to a great extent maintained the myth of intersectoralism.
However the concept of decoupling suggests a rather strategic decision to talk and act to satisfy different demands. In our case, we find that maintaining and reproducing abstract rhetoric and plans was not only a matter of actively decoupling talk from action. Whereas economic concerns seemed to actively encourage decoupling, other tensions were not explicitly articulated to the same extent. For the most part, everyone seemed happy to maintain and reproduce the generalities. Thereby they maintained the tensions between inconsistent demands, thus making the strategy a document displaying and maintaining good intentions.
These findings may be explained by the Swedish organization theorist Nils Brunsson [48, 49] who convincingly argues that popular organizational models can be adopted "with much talk of beautiful principles and little discussion about practice" [49]. Brunsson finds that agreement is better achieved by keeping talk abstract and simple, as it is easier to agree on abstract terminology than more complex, precise and explicit plans [48]. However, the consequence being that the talk is unable to provide a good basis for joint action [48, 49]. Moreover, by producing abstract rhetoric and vague plans Townville ensured compatibility between the strategy and potential future actions. This may even be considered a way to avoid complete decoupling, because it allowed Townville the necessary flexibility to continue implementation. Paradoxically, the strong intentions to implement the policy might thus be the very reason that the strategy ended up being so washed out. As Townville strongly wished to turn the policy into action, they needed to leave enough flexibility for the strategy to accommodate inconsistent demands and function side by side with budget cuts, multiple national reforms and various traditions and organizational cultures in different sectors.
Our case therefore questions the notion of implementation as a matter of moving from policy rhetoric to action. Pinto et al. [50] along with Freiler et al. [12] define implementation of health in all policies (HiAP) as "actions to carry out governmental decisions as specified through legislation, formal strategy or mandate". Thus, when formal talk – such as policies and strategies – cannot be made into action there is a problem of implementation. According to Brunsson [48], when talk cannot be realized in action this may be because the ideas are not suitable for translation because they are not clear-cut and precise enough, e.g. when strategies result in a compromise based on contradictory demands and expressed in vague terms [48].
A more general question our study thus touches upon is the ability of policies and strategic planning to control action, which is often assumed in public health [12, 42]. Greer and Lillvis [9] for instance emphasize plans and targets as a means to ensure implementation. Our findings question this governing optimism. Winter [16] argues that vagueness and ambiguity of policy goals are well-known in implementation research, and policy goals are not always expected or even intended to be achieved. But this does not necessarily constitute a problem. Brunsson [48] compellingly shows how inconsistent demands are a basic condition in political organizations. Elected politicians and complex government organizations purposely represent multiple conflicting interests, values and ideas. The inherent tensions between inconsistent demands should therefore not be considered an error of silo-based government, but rather an integral part of sectoral realities. Sectors purposefully represent institutionalized mobilizations of bias, and as such different interests and values [51]. By having loose couplings, i.e. solving some demands with talk, some with decision-making, and some with action, organizations are able to meet contradictory demands simultaneously [48]. Brunsson contemplates this so-called "hypocrisy" as a solution rather than a problem because no matter how positive the demands are, it is not easy – if possible at all – for an organization or a government to satisfy them all. Hence, success in one direction will often undermine success in another. Accordingly, loose couplings (and decoupling) are not necessarily dysfunctional. Rather, loose couplings between talk and actions make it possible for organizations to show support for high values by talk and decision-making, even if they are not able to act in accordance with it themselves. This way many more can support high values than would be the case if only the few who act in accordance with them were allowed to do so [48]. By adopting the strategy, Townville maintained the mandate for intersectoral action to improve health, thus maintaining and displaying good intentions that may be difficult to meet in circumstances of budget cuts and inconsistent demands. Moreover, despite not directing action, the strategy did ensure that local action was still possible, and intersectoral efforts still a formal priority in Townville, in contrast to a scenario where a political decision had been made to dismiss the strategy due to inconsistency with other demands.
While the literature on intersectoral policymaking and joined-up approaches for health is growing [3, 9, 12, 20, 50, 52], the assumption that decoupling between rhetoric and action is a failure of implementation is generally not questioned. However, with Brunsson we highlight the potential contribution of decoupling as a means to ensure flexibility that may allow for continued implementation in light of inconsistent demands, and not least the display of good intentions and thereby continued support for these values. Though a limitation of the neo-institutionalist approach is that it does not provide a prescriptive theory that can help direct practice. Rather, maintaining good intentions by decoupling requires a continued belief in the rational organization where policies or 'talk' control action.
Another contribution of our study is methodological. Shankardass et al. [20] argue convincingly to promote the methodology of the realist explanatory case study to further insights on the implementation of HiAP. In their approach, interviews are conducted 2-10 years after initiation [50]. However, we have shown how ethnography contributes with important insights about the intersectoral process, which follow-up interviews did not disclose. We argue that only relying on interview data thus limits the insights on intersectoral dynamics and thereby our understanding of the implementation of intersectoral policymaking.
A limitation of our study is that the process is not followed over a longer period of many years. Thus, we are not able to provide insights on subsequent implementation or sustainability of intersectoral efforts. Moreover, we only give detailed insight into the process in one government organization. A question for further research would be to investigate this in different contexts. Nonetheless, we have shown how the process was attributed great significance in follow-up interviews and how participants considered it a success, despite not meeting the initial intentions and not producing the expected action.
Implications for intersectoral policymaking for health
In the Danish context, we find that Townville represents an exemplary case. Correspondingly, the inconsistent demands are somewhat similar to the contradicting logics found in Holt et al. [53]. Whereas the Danish context is unique, we find that the 'myth' of intersectoralism may represent more general implications for intersectoral policymaking. For instance, despite great uncertainties regarding the effects of intersectoral policymaking and reservations associated with (measuring) the outcomes [54,55,56], HiAP is expected to create better health and health equity, generate synergies between sectors, and deal with rising costs of the demographic development [42, 57, 58]. Moreover, health is presented as both a matter of wellbeing and happiness as well as good business: an important enabler and prerequisite for attaining both social and economic goals [42]. We find that these high values represent similar myth-like qualities, as a 'taken-for-granted' solution to improve health. This is in line with Carey and Crammond [46] who critique the normative bias depicting joined-up approaches, such as HiAP, as wholly positive, while being out of sync with the state of evidence. Similarly, Exworthy and Hunter [3] argue that joined-up innovations may not be the panacea often believed. Degeling [51] finds that the call for intersectoral action in public health is naïve, and goes as far as to describe intersectoral collaboration as a "contradiction in terms". Thus we caution that intersectoral policymaking intuitively be considered a powerful solution for promoting health. Instead, further attention should be paid to how cases of successful implementation have dealt with the inherent inconsistent demands. This would make an interesting topic for further research.
The paper contributes to the current literature on Health in All Policies and the broader field of policy implementation by showing how the myth of intersectoralism posed a barrier to turn the intersectoral health policy into action. Particularly three elements functioned to avoid the necessary specification that would direct action: 1) idealization of universal intersectoralism, 2) doubts about economic outcomes, and 3) tensions between inconsistent demands. By producing abstract rhetoric rather than directly addressing these challenges, the myth of intersectoral policymaking resulted in diffuse responsibility and no priorities, all the while the intuitive appeal of the myth was maintained. However, we argue that this decoupling between rhetoric and action may not simply be a failure of implementation, but also a means to sustain good intentions and hereby allow for continued action. The study thus contributes to current debates about the process and social dynamics of intersectoral policymaking for health, and particularly expands the discussion regarding policy implementation by showing how abstract ideas may result in elusive implementation.
HiAP:
PHO:
The Public Health Office
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We are thankful to the participants in Townville for honestly and enthusiastically sharing their experiences and allowing us to get an insight view of the policy process.
The study was funded by Trygfonden (the Tryg Foundation) and The Danish Cancer Society. The funding sources had no involvement in the study design, data collection, analysis and interpretation of data or the decision to submit it for publication.
The dataset, consisting of detailed field notes and interview transcripts, generated and analyzed during the current study are not publicly available in order to ensure the confidentiality and anonymity of the municipality and the individual participants.
University of Southern Denmark, National Institute of Public Health, Studiestræde 6, Copenhagen, 1455, Denmark
Ditte Heering Holt
& Tine Tjørnhøj-Thomsen
Metropolitan University College, National Research Centre for Disadvantaged Children and Young People, Kronprinsesse Sofies Vej 35, 2000, Frederiksberg, Denmark
Morten Hulvej Rod
Copenhagen Business School, Department of Organization, Kilen, Kilevej 14a, 2000, Frederiksberg, Denmark
Susanne Boch Waldorff
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DHH is the principal investigator responsible for the project, including data collection, data analysis and writing the manuscript. TT has made a substantial contribution to the conception and design of the study. TT, MHR and SBW have been involved in the analysis and interpretation of data, as well as critically revising the manuscript. All authors have read and agreed on the final version of this manuscript.
Correspondence to Ditte Heering Holt.
According to the National Committee on Health Research Ethics in Denmark formal ethics approval is not required because no human biological material was sampled. The study was carried out in accordance with current Danish rules of ethics and legislature and has been approved by the Danish Data Protection Agency, 23rd May 2013, record number 2013-41-1960.
A written agreement outlining the aim and extent of the research was signed by the involved parties. Oral permission was always obtained to record meetings and interviews during the fieldwork.
The authors declare they have no competing interests.
Additional file 1:
"General template: Interview guide for initial interviews". The supplementary material presents the general template of the interview guide which directed the majority of the interviews. (DOCX 18 kb)
Holt, D.H., Rod, M.H., Waldorff, S.B. et al. Elusive implementation: an ethnographic study of intersectoral policymaking for health. BMC Health Serv Res 18, 54 (2018). https://doi.org/10.1186/s12913-018-2864-9
Intersectoral policymaking
Intersectoral collaboration
Policy process
Municipal health promotion
Health policy, reform, governance and law


AI startup SenseTime raises $600m - My Startup World - Everything About the World of Startups!
The Company set a record by raising US$410 million in its series B round of funding last July, it once again sets a new record for venture capital funding in the AI sector. The capital injection will provide important impetus to the buildout of SenseTime's AI platform, advancing the company's technological innovation and opening up new business opportunities.


It's always nice to live or work in a room with a view. That's why corner offices and beachfront properties are always in high demand and come at a premium. This means that the vast majority of the population cannot afford to own a home facing the sea or a Lake. The good news is that anyone can own property which not only overlooks the a lake or ocean, but actually floats on it, offering a near-360 degree view of the open waters. These properties are normally referred to as houseboats. As the name suggests, these are homes which float like boats. They have become incredibly popular in crowded cities which do not have any vacant land to develop. Seattle houseboats are incredibly popular and they offer great value for money. Finding a floating home which can meet all your needs is not easy. It takes special skills and knowledge as well as a lot of resources to find the right home. Fortunately, Special Agents Realty has a lot of experience in this market.
Special Agents Realty has a large database of Seattle houseboats. Depending on your unique requirements, you can search their database of houseboats in the city of Seattle. Once you find what you're looking for, you can schedule an appointment to discuss the property further or ask to view the property. The beauty of buying a floating home is that location is not an important factor to consider. After all, you can always float the houseboat to a more suitable location and secure it on that spot. These homes can be used as full-time residential property or as vacation homes for weekend, holiday and seasonal getaways.
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External Debt in Greece increased to 403410.77 EUR Million in the fourth quarter of 2018 from 397351.76 EUR Million in the third quarter of 2018. External Debt in Greece averaged 353999.77 EUR Million from 2003 until 2018, reaching an all time high of 453124.10 EUR Million in the fourth quarter of 2012 and a record low of 142217 EUR Million in the first quarter of 2003.
External Debt in Greece is expected to be 405000.00 EUR Million by the end of this quarter, according to Trading Economics global macro models and analysts expectations. Looking forward, we estimate External Debt in Greece to stand at 426000.00 in 12 months time. In the long-term, the Greece Total Gross External Debt is projected to trend around 445000.00 EUR Million in 2020, according to our econometric models.
In Greece, external debt is a part of the total debt that is owed to creditors outside the country. This page provides the latest reported value for - Greece External Debt - plus previous releases, historical high and low, short-term forecast and long-term prediction, economic calendar, survey consensus and news. Greece Total Gross External Debt - actual data, historical chart and calendar of releases - was last updated on April of 2019.


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BIRD Foundation Announces $4.2 Million Investments in Cooperative Clean Energy Projects
Business News/Analysis, Federal Agency/Executive Branch, Funding/Financing/Investing, Israel, Process, R & D Focus
(PRNewsWire) Awards Were Approved for Joint Development Projects Between the United States and Israel in the Areas Of Biofuels, Wind Energy, Solar Energy and Energy Efficiency
The BIRD Foundation will invest $4.2M in five clean energy cooperative projects, between U.S. and Israeli companies, under its "BIRD Energy" program. "BIRD Energy" was established following an agreement between the U.S. Department of Energy/EERE and the Israeli Ministry of National Infrastructure (MNI) to promote U.S.-Israel cooperation in clean/renewable energy technologies.
The U.S. – Israel Energy Cooperation Program was authorized in the Energy Independence and Security Act of 2007, and was approved by the Israeli Government in 2008. This program was launched last year through the Binational Science Foundation (BSF), which administers cooperation in the Academic area and the Binational Industrial Research and Development Foundation (BIRD), which administers cooperation in the industrial area.
Projects that can be submitted to BIRD Energy are those between U.S. and Israeli companies, or collaborations between a company and a research institution aiming to develop and commercialize renewable energy and energy efficiency technologies.
Dr. Eitan Yudilevich, Executive Director of the BIRD Foundation, said "The importance of renewable energy is far more significant given the oil spill in the Gulf Coast. In his speech to the nation, President Obama stressed the need for energy policy that will develop alternative energy sources and will minimize the dependence on oil. At the same time, the Government of Israel is developing a program to further develop oil substitutes. The U.S.-Israel Binational Foundations will be a main mechanism to promote collaborations between the two countries."
The five projects selected for award help address critical shared bilateral energy-related goals, and will leverage private sector cost-share for a total project value of $12.8 million:
– HCL CleanTech Ltd., Tel Aviv, Israel and Virent Energy Systems, Madison, Wisconsin: will develop and test a process to produce biogasoline from cellulosic non-food sources.
– IQwind Ltd., Bazra, Israel and Ricardo, Inc., Detroit, Michigan will design, test, and commercialize a variable ratio wind turbine gearbox.
– OMAT Ltd., Jerusalem, Israel and General Dynamics Ordnance and Tactical Systems, Inc., Scranton, Pennsylvania will develop and implement a system to monitor, control, and economize energy consumption in metal machining industries.
– Panoramic Power, Ltd., Kidron, Israel, and Mazzetti Nash Lipsey Burch (MNLB), San Francisco, CA will develop and pilot self-powered, wireless current sensor that will facilitate load management strategies in commercial buildings.
– Ram Power, Ltd., Herzliya Pituach, Israel and Turbine Air System (TAS), Houston, TX will develop, engineer, and commercialize an integrated cycle power block that will improve the efficiency of solar thermal power plants and reduce the need for water cooling. READ MORE

redpajama_set_name: RedPajamaCommonCrawl


text:
New star finds feet in outback
Extra firefighters delployed to Valley
by Nathanael Cooper
THE Sunshine Coast's newest TV star has never had an acting lesson, never set foot on stage and has never appeared in front of the camera.
But he is set to win the hearts of the nation as the rookie jackeroo in Channel 10's new ob-doc Keeping Up With The Joneses.
Maroochydore's Jeff O'Connor left his beachside lifestyle behind and headed north to Coolibah Station, 1000km outside of Darwin, for a new life in the outback.
His journey features heavily in the series which starts tomorrow night, and let it be told that it is a fascinating one.
"It was definitely an eye opener," Jeff said of his trip to Coolibah.
"You don't think people still live like that, but you get out there and it's very real."
From the relative suburbia of Maroochydore, Jeff headed to a life where vigilance for crocodiles and snakes is a constant reality, and in the vastness of the outback travel by helicopter is as common as by car.
"I'd never been anywhere like it," Jeff said.
"I came in on a road train and there wasn't much to see – trees, dirt, road and not many buildings. I think we went past one pub."
Despite having to trade in his board shorts for jeans and his Billabong cap for an Akubra, the young helicopter pilot found himself feeling right at home in his new digs in no time.
"I missed the ocean, just being able to have it there and see it, but it's always good to have a bit of a change," Jeff said.
"It was cool going pigging with the dogs and doing things like that.
"It really makes you understand where everything comes from. If you don't go cut up a beast you don't get to eat, or if one of the boys doesn't go fishing you only eat beef for a month."
Jeff's plan at Coolibah was to get more experience at the helm of a helicopter after earning his licence here on the Coast, and when he finally got up in the air he found himself doing plenty of activities that most of us can't even imagine.
From mustering cattle from the air instead of on horseback to shifting croc traps and other adventures straight from the Dangerous Book For Boys, it was five months the budding heartthrob won't soon forget.
Not that it will be easy to forget with his time at Coolibah documented for the world to see in Keeping Up With The Joneses.
But don't ask him if he is a TV star in the making.
"I haven't even thought about that really," he answered shyly.
"I haven't even told too many of my mates much about it… not until I see it, then I'll have a chat."
You can find out for yourself when Keeping Up With The Joneses premieres tomorrow night on Channel 10 at 8pm.


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Top 10 Movies That Rebuke Racism
In light of the recent increase of racial tension in our country, Movieguide®'s editorial staff, which has reviewed thousands of movies over the years has put together a list of 10 wonderful movies that rebuke racism and remind us that all people are created equal under God. Instead of spurring increased anger, hate and division, these movies stress empathy and compassion for others.
Some of the movies are not family-friendly, and feature difficult subject matter, and have coarse language, so please read the reviews before viewing.
-1 Discretion advised for older children.
PRIDE is an inspiring story about a black teacher and swim coach who turns around an inner city recreation center in Philadelphia by getting local black teenagers interested in swimming. PRIDE is an entertaining, compelling, uplifting sports drama with a very strong moral worldview and positive Christian content, but it does contain foul language.
Full Review ⇾
-2 Discretion advised for adults.
In GRAN TORINO, Clint Eastwood stars in and directs a story about an elderly, grizzled, mean, widowed Korean War veteran who has to figure out a way to stop a small violent gang of Asian immigrants from destroying the lives of his new Asian neighbors. GRAN TORINO has a powerfully redemptive worldview with strong, positive Christian content, but those elements are mitigated by an awful lot of strong foul language and some multicultural religious ceremonies.
SCHINDLER'S LIST tells the story of a German businessman, Oskar Schindler, who risked his life and fortune to save Jews during World War II. Aside from the nudity, sex and violence, Spielberg has captured on film the utter horror of the holocaust with its dehumanization of the Jews; but he has also shown what one individual can accomplish with determination.
With a really good 1860's look, GLORY is a biblical moral lesson about overcoming racism through reconciliation, not rebellion or revenge, set in the context of history that we all need to see. GLORY is a great film for mature, discerning Christians.
42 tells what happens when the Brooklyn Dodgers baseball team signed the first black player in the Major Leagues, Jackie Robinson, in 1947. 42 is an inspirational, superb movie showing how the Christian faith of both Dodgers General Manager Branch Rickey and Jackie Robinson helped end racism in professional baseball. However, there is a fair amount of foul language and some racial epithets, so caution is advised, especially for children.
ONCE UPON A TIME…WHEN WE WERE COLORED
+2 Moderately questionable elements.
ONCE UPON A TIME...WHEN WE WERE COLORED, based upon the critically acclaimed book chronicles the early life of its author Clifton Taulbert. Clifton is encouraged by the Christian faith, love and kinship of his tightly knit "colored" community to overcome the racial intolerance prevalent in the deep South of the 1950s and 60's. The movie contains only moderately questionable elements while promoting Christianity, family loyalty, personal responsibility, and a biblical worldview.
THE LILIES OF THE FIELD
+4 Biblical worldview, with no questionable elements whatsoever.
This wonderful family movie teaches the Gospel in a winsome, entertaining way that's unsurpassed by most other movies. In the story, a group of German nuns transplanted to Southwest America convince a young black man to help them build a local church. In the meantime, the young man teaches the nuns the joys of Pentecostal Protestant worship focused on Jesus and His Gospel. Both Jesus and the local church are lifted up.
AMAZING GRACE is the story of William Wilberforce who, after a young life of debauchery, came to Christ at the age of 25 and believed he was called by God to stop the slave trade and reform morals in England in the 18th Century. The acting, directing and production values in AMAZING GRACE are superb. It also has deep, soul-stirring Christian references to the sinfulness of people, the salvation of Jesus Christ, and the divinity of Jesus Christ, with frequent renditions of the great hymn "Amazing Grace."
+3 Some minor questionable elements.
Based on a true story, REMEMBER THE TITANS depicts the forced integration of an all black high school with an all white school and its impact on football in 1971 Alexandria, Virginia. Faced with the need to unify their team, two coaches, one of them played by Denzel Washington, must help the team to learn that the real victory lies in changed hearts. Humorous as well as dramatic, TITANS is a moral, uplifting, well-acted tale.
DRIVING MISS DAISY is a great character study with strong Christian values about a wealthy Jewish matron who's befriended by her black chauffeur, a committed Christian full of wisdom. Beautifully acted by Jessica Tandy and Morgan Freeman and containing only two exclamatory curses, DRIVING MISS DAISY will not only fill you with joy and love, but also encourage you to follow Jesus Christ more closely.
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East of 8th Music Blog
independent thoughts on indie rock, alternative, and indie pop music
REVIEW: THE WEEKS – SECRET SHOW
April 17, 2017 eastof8th Live Show Reviews, Nashville, Photos Leave a comment
Nestled in a repurposed warehouse district, Nelson's Green Brier Distillery is a bit of a Nashville hidden gem. Within the classic-meets-modern bourbon maker is a wonderful concert space, the Oak Room, the exposed brick and concrete of which was the perfect match for a secret show for bluesy rockers, The Weeks.
Just last week, the band released their new album Easy and found themselves on a stopover in their adopted home of Nashville. In support of their new album, the group rewarded fans and listeners of local indie station Lightning 100 with an intimate look at their new work. With an audience of fans, the band needed little introduction, instead jumping right into "Ike"–one of several uptempo songs from their new album.
There was something special about the raw setup for the concert–there wasn't even a clear dividing line for where the "stage" ended and the crowd began. Frontman Cyle Barnes noted that this was a stripped down Weeks show which was true–the array of instruments was scaled back and there was no crowdsurfing by either the fans (or band members, which happens from time to time at their shows). The band was relaxed and clearly in the moment, enjoying the chance to play for their loyal fans. Midway through the set, they played another song from Easy, "Gold Don't Rust," a pure rock anthem dedicated to the band's love of being a band. With frequent smiles between the band members and many supportive hoots from the crowd, it was hard to tell whether the band or the fans were having more fun.
"We're trying to make sure you get the best possible songs," Barnes said of the set list. While it was clear the band was trying to feature their new album, they still managed to work in fan-favorite "Ain't My Stop," off of their prior album Dear Bo Jackson. Indeed, it felt like the band had put together a showcase of their distinctive southern rock groove, and then, ever the unpredictable, they closed the show with "Don't Be Sad," the touching end to Easy. The Weeks formed a bond with the crowd and left it wanting more.
There's always a special vibe around a secret show and this one didn't disappoint. With the venue's warehouse echo, the fun vibe, and The Weeks's signature blues thump ringing out, Tuesday's show was all the more garage, underground, and dare I say–rock n' roll.
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[This review and these fantastic photos were handcrafted with tender, loving care by the one and only George Maifair; you can catch up with him on Twitter–@georgemaifair.]
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Health Champion Henry Waxman Retiring
WASHINGTON—The National Health Law Program's (NHeLP) Executive Director Emily Spitzer released the following statement in response to Rep. Henry Waxman's announcement that he will retire at the end of the 113th Congress:
"Congressman Waxman is the quintessential public advocate, working decades to truly improve the lives of all Americans. His list of achievements is long and impressive and will continue to benefit all Americans for decades after he retires. Mr. Waxman ushered through pivotal pieces of health care legislation, most notably the Affordable Care Act. Without his input and stewardship, millions of Americans might still be uninsured.
He showed unwavering support for Medicaid and protecting and advancing health care for our nation's most vulnerable through major expansions of the program and vigorously defended it from attacks. He made family planning a reality for low-income women by advocating for federal funding in Medicaid and has swiftly opposed barriers to reproductive care for women.
In addition, he's responsible for the Ryan White Care Act, which allocates billions of dollars in federal money to provide medical care and services to Americans living with HIV/AIDS.
I thank Mr. Waxman for his exceptional service and dedication. We worked hand-in-hand with him many times during his almost 40 years in the House, most notably on defending and expanding Medicaid and the ACA. He has been a true ally not only to NHeLP, but to all health advocates. As a tremendous force in making America a better and healthier place, he will be very much missed."
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Big Money is Moving …and you'll be shocked where it's going!
Proof that all that glitters ain't gold.
Elvis impersonators, flashy lights, pretty girls with costumes made up of more feathers than fabric… it's got it all.
And every casino in Vegas is crammed to the rafters with suckers looking for an entertaining way to throw all their hard-earned money away.
You roll past the poker, the black-jack, the roulette wheel. But hang on, who's that over there? It is! It's Warren Buffet!
What's he doing in Vegas? You don't become the world's third richest man by backing a rigged game – unless you know the game is rigged in your favour.
And who's that sitting next to him? It's old boy Larry Fink, the chief of Blackrock – the largest money-management firm in the world. And to his left is John Angelo, from Angelo, Gordon and Co.
Together, these guys control more wealth than many nation states. So what are they doing in Vegas? What game are these guys backing?
Property?!? What, are they crazy? Everybody knows the US property market is a disaster zone. Sure, there have been some solid signs lately, but property prices nationally are still 30 percent lower than they were at the peak almost 6 years ago, way back in mid 2006.
And a lot of Americans still find themselves deep underwater.
But as you're scratching your head, you remember the golden rule of investing.
And that's exactly what these guys are doing. If you follow the big money in America right now, it will show you that the serious investors believe that the property market has bottomed, and we're launching into an upswing dynamic.
And if you follow the scale of funds being directed into property, it tells you that these guys believe that a lot of property markets over-corrected in a big way in the downturn. That is, prices fell too far and a lot of high-performing properties are massively undervalued.
Las Vegas is a case in point.
In the run up to the housing peak, Las Vegas and Nevada led the country is housing construction, and it was one of the hottest housing markets in the country.
Between 2006 and early 2012, house prices in the city of lights fell a staggering 62 percent. It was the biggest fall in any US metropolitan centre, and the real estate market was smashed to pieces.
But while it was clear that prices were over-valued before the crash, prices seem undervalued now. A lot of people got very badly burnt in the crash, and as the saying goes, once burnt, twice shy. This is keeping a lid on demand for what are now, very cheaply priced homes.
And this gap in demand is being filled by Buffett and the boys. They know that the market has overcorrected on the down-side – and there are some awesome bargains to be found.
And so large investment funds have been snapping up land and properties in Las Vegas and other cheap markets across the country. They've also been very active in the foreclosed property market, where they've been snaffling up some incredible bargains.
They're not bound by sentimentality and fear, and just see an investment for what it is – the promise of a particular return at a particular price.
And though the eyes of a cold-blooded accountant, investing in US property makes a lot of sense right now.
This is all a classic play for Warren Buffett. He's not a short-term, get in and out quickly kind of investor. He's made his fortune by backing major macro trends, and keeping an eye on the big picture. He's a master at positioning.
And he's also done it by keeping a level head, and knowing when the market has lost touch with reality. He gets out when things are too hot and people are too excited, and he gets in when people become too pessimistic and the market is undervalued.
He zigs when they zag.
And this is just what he's doing in property. He's buying up bargains because people just don't trust property right now – for no good reason. Just fear.
That's why Buffet has been aggressively bidding for billions of dollars of distressed loans and underwater properties. He's also buying up mortgage brokers and their loan portfolios, real-estate vendors, and even brick-making companies.
He's going all out to take on a massive exposure to the US property market.
And will he be right?
Well, no one knows the future. But I can tell you one thing: no one has made much money betting against Warren Buffett in the past 50 years!
And while it does seem clear that some markets in the US are massively undervalued, there are also some tried and tested recovery dynamics on his side.
In a cyclical market like housing, it all comes down to supply and demand.
On the supply side, the crash knocked out a lot of supply. A lot of real-estate vendors and homebuilders went underwater. This is holding back the markets ability to respond to increasing demand, which therefore gets translated into increasing prices.
Sure, there was probably an over-supply of houses during the peak. But that was six years ago. The market is a lot tighter than what it was.
The other key factor is demand. The US economy is holding up and confidence is returning. During the GFC, a lot of young people returned to the nest, creating 'doubled-up' households.
In 1985, only11 percent of 25-34 year olds lived with their parents. In 2010, that percentage had almost doubled to 21.6 percent.
I remember being 25 and I remember being 30. I guarantee you this is about economic necessity, not choice.
So as America's economic fortunes continue to improve, and as young people feel more and more financially secure, they'll be super-keen to head out on their own. They'll be eager to form a household of their own.
Between 2008 and 2011, America added an average 650,000 households a year. In the year to September 2012, that had spiked to 1.2 million households.
This translates into a huge pick up in demand. And with supply still constrained, that will quickly translate into an increase in prices.
These are the fundamentals that are pulling the big money to the table.
…and with that momentum, remember you can't pick bottom. Well at least I can't.
But, I'm not silly enough not to recognise momentum and we now have it in the USA market.
I know what I will be doing.


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A view of the UNHCR tent at the border crossing in Tumbes, Peru, where Venezuelans can receive assistance in applying for refugee status.
VenInformado: technology to support Venezuelan migrants & refugees
Yesibeth Centeno
Adaptado de este blog en español: VenInformado: una plataforma digital para migrantes y refugiados venezolanos en Perú
Migrating is a complex and challenging process for anyone who decides to undertake the journey. Many are forced to migrate because they can no longer find a viable alternative in their homeland.
Such is the case in Venezuela, where the political and economic crisis has subjected many to violence, persecution and limited access to health care and food, forcing more than 5.3 million people to flee to surrounding countries in search of decent living conditions. In Peru, there are more than 1 million Venezuelan refugees and migrants, each with unique needs relating to legal status, health, education, shelter and employment.
Developing a digital platform to inform and guide
Lutheran World Relief developed the digital platform VenInformado to help connect the Venezuelan refugee and migrant population with critical, accurate information and personalized virtual legal, psychosocial and livelihoods assistance. VenInformado launched in October 2018 with the support of our local partner Encuentros Servicio Jesuita al Migrante.
The free digital platform was created to inform and guide migrants and refugees on migration issues, reducing the gap in access to information and promoting sustainable solutions for local integration. Lutheran World Relief soon learned that to provide greater support and promote integration into society, the platform also needed to prioritize mental health. In October 2020, VenInformado launched a new feature that focused on psychosocial and emotional health by collaborating with the Center for Psychosocial Care (CAPS), a local nonprofit that advocates for mental health care for people affected by political and social violence.
A VenInformado staff member shares information about the program
Encouraging conversations around emotional well-being
Together, Lutheran World Relief and CAPS created the channel #SaludableMente (#HealthyMind), a space that addresses various issues around change, grief, depression, violence, xenophobia and other important content to empower and encourage conversations around emotional well-being with migrants and refugees.
The platform's mental health efforts are supported with thematic articles, weekly publications and live webinars. Most recently, we created VenInformado Contigo, a new podcast that allows us to connect with the platform's followers in an innovative way.
Currently, the podcast is showcasing a miniseries called El Poder de la Escucha (The Power of Listening). We tell the story of Yani, a Venezuelan teenager in Peru who, because of the overwhelming process of leaving her home country and starting a new life, is struggling with her mental health. Yani's family worries about her well-being and contacts a psychotherapist at CAPS who is now accompanying her to confront and overcome these challenges.
Migrants and refugees can identify with stories from people like Yani and use the podcast as a tool to find support during their process of social integration.
Estefany Gabriela Martinez, 24, arrived in Peru as a Venezuelan refugee and was unsure about her residency status. She found her answers through VenInformado, a digital platform offering practical information and real-time advice.
One-stop shop for useful, verified information on immigration
VenInformado is a digital platform that evolves and transforms. It is providing free guidance to more than 4,000 monthly users and reaches 700K unique accounts through posts across its social networks. On the multichannel space users can reach personalized guidance from specialists and access content that is shared across social media posts, in-depth blog articles, live webinars with professionals, and now audio content through podcasts. It serves as a one-stop shop for Venezuelans to find useful, verified information on immigration, laws, and life in Peru.
Lutheran World Relief and our local partners are committed to supporting Venezuelan migrants and refugees and the communities that host them. Access the VenInformado platform at the links below.
Website: www.veninformado.pe
Facebook: VenInformado
Instagram: VenInformadope
YouTube: VenInformado
Spotify: VenInformado Contigo
Yesibeth Centeno, Sep 16, 2021


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Proud Dachsie helps owners through crisis by going to pick up their take-away
© Jagger Long - Facebook
A Dachshund was spotted walking along a Toronto street the other day carrying a bag of fast food in its mouth. Meet Oliver: the saviour of one family isolated by C-19.
By Nick Whittle
Small and sausage-like he may be, but Dachshund Oliver is being hailed something of a champion by his owner Jessica Adario. The Canadian took a stroll with her dog to a nearby fast food restaurant and allowed him to carry it back all by himself, albeit under her watchful eye.
A McDonalds delivery from my new neighbour & Uber Eats boy named Oliver on King Street West downtown Toronto. Jessica Reanne you have one harding working doggie there! IMPORTANT: For licensing and usage, contact: licensing@viralhog.com Join Facebook group Karma Tickets - Worldwide Sports & Concerts
Posted by Jagger Long on Sunday, March 29, 2020
Doggy duties
It is not the first story of canine conscientiousness amid lockdowns and self-isolation. Last month we wrote about a dog that was sent to a shop to buy his master some Cheetos.
We also reported on quarantined Colorado woman Renee Hellman, who receives her groceries from her neighbour's Golden Retriever, Sunny.
Teach your dog commands. Learn about competitive obedience.
The Independent recently wrote about an owner who, along with her Bulldog Rocky, visits self-isolating residents in Middlesbrough, UK.
Jenny Bromfield visits those who are in need of company and distraction due to self-isolation.
Writes The Independent, Rocky gives out plenty of hugs and attention to those most in need.
37-year-old Ms Bromfield said, "Helping other people makes me feel like a valuable member of the community.
"I'm so proud of how social he is and I feel so much better in myself, knowing that I can help people get through their isolation periods a little easier.
If you know of someone in need of assistance, offer your services to them. Some people may not wish to depend on others, but there will be those who are in desperate need not just of provisions, but also of company.
Remember: Stay at home wherever possible, and take heed of the government's advice.
Nick Whittle
Nick John Whittle is an author and artist based in Birmingham, UK. He studied education at Gloucester University. Nick's family has owned various breeds of dog since he was a child such as poodles and boxers. Although he has no pets at the moment, on occasion he dog-sits a happy, yet infirm, 17-year-old Yorkshire terrier. Nick is particularly interested in the history of canine domestication.


Frank Baldwin is a General Dentist (General Dentistry dentist) practicing in Washington, District of Columbia. This dentist is listed on Dentist Network with a medical license speciality in General Dentistry.
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