Caroline Mullen

Choice vs. voice? PPI policies and the re-positioning of the state in England and Wales

Context and Thesis  Changing patient and public involvement (PPI) policies in England and Wales are analysed against the background of wider National Health Service (NHS) reforms and regulatory frameworks. We argue that the growing divergence of health policies is accompanied by a re‐positioning of the state vis‐à‐vis PPI, characterized by different mixes of centralized and decentralized regulatory instruments.

Moving around the City: Discourses on Walking and Cycling in English Urban Areas

There remains only limited understanding of perceptions of travel behaviour in relation to short journeys in urban areas and, in particular, the perceived role that walking and cycling for personal travel can realistically play in contemporary society. This paper reveals discourses surrounding the practice, performance, identity, conflicts, and visions relating to walking and cycling in English cities. These were derived from a large-scale study that utilised a comprehensive mixed-method approach using both quantitative and qualitative methods. Q methodology was used as an additional tool to investigate subjectivities on walking and cycling in the city in a structured, interpretable format and it is this approach that is the focus of this paper. The paper concludes with a discussion on the implications of these discourses for policy makers interested in encouraging a shift from car use to walking and cycling for short journeys in urban areas.

The Democratic Potential of Public Participation: Healthcare Governance in England

Public participation is commonly advocated as part of the solution to the problem of democratic deficit in the development and implementation of policy. This article considers the democratic function of different arrangements for public participation, with reference to alternative rationales for democratic engagement in the health services context. We review the limitations of aggregative and representative notions, before exploring the senses in which a deliberative approach based on justification to the public can increase confidence in the democratic legitimacy of decisions. This theoretical understanding is used to evaluate the democratic potential of the legal framework for Patient and Public Involvement (PPI) in healthcare governance in England.

The Governance of Genetic Information: Who Decides?

Introduction Heather Widdows and Caroline Mullen Section I. Problematising Governance of Genetic Information: 1. The medium and the message: tissue samples, genetic information and data protection legislation Neil C. Manson 2. Me, myself, I: against narcissism in the governance of genetic information Soren Holm 3. Decisions, consent and expectations of the individual Caroline Mullen Section II. Ethical Frameworks of Governance: 4. Constructing communal models of governance: collectives of individuals or distinct ethical loci? Heather Widdows 5. Rights, responsibility and stewardship: beyond consent Roger Brownsword 6. Who decides what? Relational ethics, genetics and well-being Sarah Wilson Section III. Redesigning Governance: 7. Involving publics in biobank governance: moving beyond existing approaches Kathryn G. Hunter and Graeme T. Laurie 8. Genetic information and public opinion Andrew Edgar 9. Harmonisation and standardisation in ethics and governance: Conceptual and practical challenges Ruth Chadwick and Heather Strange.

Representation or reason: consulting the public on the ethics of health policy.

Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate. The question then is whether there are forms of consultation which have the potential to realise more defensible decisions in either of these senses. Problems of adequately accounting for the views of those affected by policy decisions casts doubt on the plausibility of using consultation as a means of determining the opinions of the public. Consultation can have a role by bringing new ideas and challenges to debate, although it is uncertain whether this will increase the defensibility of any decision on ethics.

The car as a safety-net: narrative accounts of the role of energy intensive transport in conditions of housing and employment uncertainty

Less car travel increases prospects of limiting transport energy. Policy attempts to reduce car use by encouraging people to choose other modes face criticism that travel needs are not simply about choice but are structurally influenced, especially by urban form. Mullen and Marsden extend understanding of travel need by showing how uncertainty in housing and employment further constrains people’s control over travel, resulting in needs for complicated journeys often at short notice. Some respond to uncertainty by running a car even where this presents financial problems. Those without a vehicle face lost opportunities and hardship. In the face of increasing employment and housing precarity, policy needs to rethink focus on choice and instead find ways of meeting complex travel needs without extensive resort to cars.

Book review: The Car Dependent Society: A European Perspective

Hans Jeekel, The Car Dependent Society: A European Perspective, Ashgate: Farnham and Burlington, VT, 2013; 292 pp.: 978 1 4094 3827 4, £68.00/US

Chapter 7 The Role of Walking and Cycling in Reducing the Impacts of Climate Change

124.95 (hbk)

Policies for promoting walking and cycling in England : a view from the street

Purpose – To examine the potential for switching short trips in urban areas from cars to walking and cycling, and the possible contribution, this could make to a reduction in transport-related greenhouse gas emissions. Methods – Case studies in four urban areas combining a questionnaire survey, interviews with households and during journeys and in-depth ethnographies of everyday travel. Findings – The barriers to an increase in walking and cycling in British urban areas are emphasised. It demonstrates that motivations for walking and cycling are mostly personal (health and local environment) and that the complexities and contingencies of everyday travel for many households, combined with inadequate infrastructure, safety concerns and the fact that walking and cycling are seen by many as abnormal modes of travel, mean that increasing rates of walking and cycling will be hard. Given that the contribution of trips less than 2 miles to transport-related greenhouse gas emissions is relatively small, it is argued that any gains from increased walking and cycling would mostly accrue to personal health and the local environment rather than to the UKs carbon reduction target. Social implications – Positive attitudes towards walking and cycling are motivated mainly by personal concerns rather than global environmental issues. Originality – Use of detailed ethnographic material in policy-related transport research.