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As used in our website, the phrase “case materials” refers to case studies and simulations, as well as accompanying exhibits and teaching notes. While both case studies and simulations can be used as tools in the “case study teaching method,” they are different in form and manner of use. A case study is a narrative that recounts the factual history of an event or series of events. It is typically used as the basis for in-class analysis and discussion. A simulation is a set of facts, roles and rules that establishes the framework for an in-class participatory exercise.

Research has shown that existing law school teaching methods and curricula do not adequately teach students the full complement of “lawyering” skills they need to competently practice law. The traditional appellate case method assumes that a problem has reached a point where litigation is the only alternative, and presents students with a scenario in which all relevant issues have been identified, the questions of law narrowly focused, and the questions of fact resolved. Skills-oriented courses and clinical programs (such as law clinics and externships) have made significant contributions to law schools’9 ability to teach lawyering skills. Their reach, however, has been limited by a combination of factors, including their high cost and the relatively few law students who actually take advantage of these programs.

While we do not envision the case study method displacing the appellate case method or clinical programs, we do believe that the case method can be used in conjunction with existing teaching methods to add considerable educational value. Case studies and simulations immerse students in real-world problems and situations, requiring them to grapple with the vagaries and complexities of these problems in a relatively risk-free environment – the classroom.

Incorporation of case studies and simulations into environmental law school curriculums can bolster student skill acquisition in the critical areas listed below. Based on a 1990-1991 American Bar Association questionnaire, the MacCrate Task Force concluded that traditional law school curricula and teaching methods fall short in teaching these fundamental lawyering skills:

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The case study teaching method is adapted from the case method developed and used successfully for many years by the nation’s leading business schools. The method uses a narrative of actual events to teach and hone the skills students need to competently practice law. Students identify for themselves the relevant legal, social, business, and scientific issues presented, and identify appropriate responses regarding those issues. Suggested questions for class discussion are prepared in connection with each case study, itself the product of long, probing interviews of the people involved in the actual events. These narratives, or case studies, may be long or short, and portray emotion, character, setting and dialogue. Students present their thoughts on key issues during class discussion, usually from the viewpoint of the key protagonist in the case study.

Simulations are typically used to reinforce and synthesize concepts, skills and substantive law already covered in a course. The simulations are designed for limited instructor and maximum student involvement during the exercise itself. However, once the exercise has drawn to a close, ample time should be allotted for a debriefing session. During the debriefing, instructors and students can engage in a candid discussion of the relative effectiveness of different approaches used during the simulation, clear up any lingering questions about substantive issues, and probe ethical and/or policy issues raised by the simulation.

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• Published: 03 January 2023

An urban take on sustainable development policies and corresponding positioning strategies

• Stefan Wittwer   ORCID: orcid.org/0000-0002-6843-2526 1 ,
• Katrin Hofer   ORCID: orcid.org/0000-0002-2182-9059 1 &
• David Kaufmann 1  

npj Urban Sustainability volume  3 , Article number:  1 ( 2023 ) Cite this article

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• Politics and international relations
• Social policy
• Socioeconomic scenarios
• Sustainability

Cities have emerged as policy actors of global relevance in sustainable development, and their strengthened position challenges the primacy of national states in this area. To account for this shift and for potential emerging contestations between cities and national states, we propose a framework to understand national–urban relations in sustainable development policy-making. Based on a selection of twelve case study vignettes from European cities, we identify and discuss four ideal types of urban sustainable development policy, which are classified depending on their congruence with the national policy agenda and the scale of the issue at hand. Building on this typology, we reflect on positioning strategies that cities can develop to support, promote or defend these policies. We argue that accounting for these different positioning strategies is important for understanding how cities seek to put specifically urban takes of sustainable development on global agendas.

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Introduction.

Cities have become focal points for addressing sustainability issues and have emerged as important political protagonists in global sustainable development (SD) 1 , 2 . Numerous SD policy agendas at the urban level aim to balance and negotiate between environmental, social and economic goals 3 , 4 . A growing number of cities are taking steps to reduce their carbon footprint, welcome migrants, develop alternative economic development agendas and protect biodiversity within and beyond the city. Some city initiatives contain radical, progressive elements that prioritize the needs of the most disadvantaged 5 . These urban sustainable development (USD) policies frequently exceed national policies in terms of their depth, innovativeness and/or progressiveness. In doing so, they thereby challenge the primacy of national governments in SD.

This article examines an array of urban policy measures that fall within the realm of SD. It aims to better understand specific urban takes on SD and to examine how they are welcomed and/or contested in multi-level governance settings. We draw on the concept on multi-level governance (MLG) stemming from political science, to examine the manifold interactions between state and non-state actors across multiple policy-relevant scales without a structuring authority 6 . The concept of MLG challenges the state-centric and hierarchical distribution of power and responsibility; it encompasses state and non-state actors and assumes that these policy-making interactions contain degrees of negotiation but also policy disputes 7 , 8 . The MLG framework explicitly focuses on diverse strategies and forms of cooperation that actors at different policy-making levels adopt to advance their policy agendas.

While we acknowledge the work on multi-level processes in the sustainability transitions literature 9 , 10 , here we focus specifically on national–urban policy-making relationships for which the MLG framework is well suited. The framework allows us to consider in what cases USD policies align and advance national policy agendas and when the two are in conflict. Where policies are contested, cities may (explicitly or implicitly) deploy positioning strategies to contradict, stretch, or circumvent such higher-level agendas 11 , 12 , 13 .

Shifting the focus to urban policies and positioning strategies may thus advance the understanding of the role of cities in global SD agendas and highlight that urban policy-making for SD is not as de-politicized and uncontested between different levels of government as the literature sometimes suggests 5 , 14 . At the same time, we broaden the focus by not only looking at one relatively narrow policy area (such as migration governance) but discussing an array of social, environmental and economic policy measures that contribute to the wider goal of SD.

In this article, we introduce 12 illustrative case study vignettes from 11 European cities that have formulated and implemented SD policies (see Table 1 ). In each case, we focus on specific policy measures, not on whole policy programs or policy agendas. Our intent is not to map USD agendas or to present specific policies and positioning strategies that have been particularly successful. Rather, we seek to shed light on how specific urban policies are supported by corresponding positioning and cooperation strategies at different governance levels. By categorizing urban policy types and positioning strategies, we propose a way of reflecting on how cities seek to place specifically urban takes of SD on global agendas.

The 12 vignettes all present USD policy measures with varying thematic emphases, which are either discussed in the academic literature or showcased through international city networks. We have purposefully selected policy measures of high visibility. After an initial screening of the literature, we chose the cases and conducted semi-structured interviews with 16 experts involved in the implementation of these policy measures (see Supplementary Table 1 for a list of interview partners and Table A2 for the interview questionnaire). The interviews allowed us to better understand the nuances and dynamics of each case.

Urban policy types for sustainable development and corresponding positioning strategies

Based on the selected vignettes, we developed a framework that conceptualizes urban perspectives on MLG interactions in USD policy-making. The framework consists of two dimensions: (1) congruence between the national and urban policy levels, and (2) the scale of the policy issue. Accordingly, the first dimension identifies whether urban policies are aligned with the national agenda, or whether local authorities adopt policies that diverge from the national policy thrust. Building on reflections on MLG interactions, this factor is important as different levels of government may have different interpretations of policy problems, leading to the integration of contradictory goals in policy designs. Such differing interpretations across government tiers may thus produce ‘decoupled’ policies, in which government players follow divergent, or sometimes even conflicting, policy paths 15 . The second dimension indicates the scale of the policy, meaning whether the particular policy issue is to be addressed at a more global or national level or mainly on an urban scale. This factor is important as an indicator of whether cities approach these issues by ‘looking up’—i.e. with an ambition to scale up their activities—or by ‘looking around’, i.e. seeking guidance and exchange while retaining a primary focus on the implementation of the policy within their city or region 16 . Categorizing policies along these two dimensions yields a 2 × 2 table with four cells representing different Weberian ideal types of approaches to USD (Table 1 ).

For each policy type, we furthermore identified the primary cooperation and positioning strategies at different governance levels. Cities use various strategies to defend, legitimize or advance their policies in MLG settings 11 , 17 , 18 . These strategies can be either explicit or implicit 16 .

In analysing the vignettes, we found that cities build on different cooperation strategies linked to particular policy measures to position themselves within or against the national agenda. Depending on the policy type, these positioning strategies are deployed to (1) legitimate their actions, thus taking ownership of certain policy areas; (2) gain visibility; or (3) move beyond the local scale, thus seeking to contribute to the wider goal of global SD. These cooperation strategies may target multiple scales (a metropolitan area, cities in the same country, the national government, or international cities) that have been identified as relevant for MLG policy-making from an urban perspective 19 , 20 .

Table 2 summarizes our findings and links the urban policy types with corresponding ideal-typical positioning strategies: best practices, first practices, defiant practices and dodging practices. Our understanding of the latter two has been informed by Oomen et al. (2022), who examined strategies of divergence in migration governance (We borrowed the strategies presented by Oomen et al. (2022) for the cases that fall within our category of divergence (i.e. when national and urban policy are not congruent). We applied the strategies of defiance and dodging provided by Oomen et al. (2022), but not deviation and dilution as they do not align with explicit strategies in our cases.). Table 2 also displays our empirical findings with regard to possible cooperation strategies at the different governance levels, which cities employ to work towards policy implementation and to position themselves in the respective SD field. Although we acknowledge that in each type of positioning strategy, cities cooperate simultaneously with actors on multiple scales, the table displays the most important cooperation strategies in bold, to recognize the central role of this particular cooperation strategy for the advancement of the respective positioning strategy.

We will now turn to each of the four policy types and discuss them by reference to the illustrative case study vignettes. We focus on the cities’ positioning strategies and how these are linked to the specificities of the four ideal types of USD policies.

Policy alignment with global focus: best practices

This USD policy type emerged from analysing climate-positive policies in Stockholm and Sønderborg, along with the circular economy policies in Berlin and in the Capital Region of Denmark. Stockholm is developing a large-scale fossil-free urban district that features low resource consumption and sustainable construction, while Sønderborg is aiming for citywide CO2-neutral development. Berlin and the Capital Region of Denmark are metropolitan regions that actively promote a circular economy in the building industry and in waste management. Accordingly, both contract with builders that selectively dismantle buildings and reuse intact materials.

These policy examples are mainly located within the domain of environmental SD. Environmental protection is an important policy area at the national level with corresponding strong and well-funded national agendas and international networks 1 , 21 , 22 . As both the national and the urban levels support the same policy thrust, there is no apparent goal conflict between the two scales 2 , 21 , 23 . Measures that cities take in this field may even help the national government meet the targets articulated as part of national or international agendas. This is also expected as urban areas drive a large share of the national carbon footprint 24 . This policy type is labelled in Table 1 as ‘policy alignment with global focus’.

To promote their environmental agendas, the examined cities and metropolitan region actively seek cooperation partners at different scales. As their policy aims align with national and international goals, cities are also active at the national and international scale (Interviews 1 to 5; hereafter interviews will be identified as I). In Stockholm for example, the city official states that they “always try to get financial support from the national level, of course, and it also generates good PR” (own translation of I1). There are well-developed city networks that address environmental sustainability issues, and cities can explicitly position themselves as central actors for progressive measures against climate change 2 , 25 . For Stockholm, Sønderborg, and the Capital Region of Denmark, being part of networks like C40 or Cityloops/ICLEI not only grants them visibility but also helps them obtain funding for other climate change–related initiatives (I1, I2, I5). As for Cityloops, it was crucial to be able to rely on the network of ICLEI: “You need somebody who can help you identify partners if you do not already have a network on that” (I5). International and national networks also provide a platform for the exchange of knowledge and experiences (I2, I4, I5). Sønderborg, together with other Danish municipalities, developed a nationwide initiative to support locally adapted climate action plans. The Capital Region of Denmark, along with other cities in the Cityloops project, formulated a European Circular Cities Declaration, which seeks to support other cities in their transition towards a more circular economy. The local and metropolitan scale is also of importance for city actors, as they need local partners to implement projects.

In the examined cases, the cities and capital region present themselves as champions, or “municipal lighthouse” (I2), in the respective policy area. They seek to gain visibility by showcasing their progressive policy approaches as best practices. Doing so not only serves as a tactic to attract funding but also functions as an advocacy strategy to scale their approach up to the national level and to other cities (I1, I2, I3, I4, I5). The city official of Berlin, for example, explains that with the success of their measures, “people come from everywhere, take a look at it and bring it to the outside world. This leads to actors from outside also inquiring about what is being initiated in Berlin” (own translation of I4). We thus refer to the positioning strategy of the aligned policy type with global focus as ‘best practices’ (Table 2 ).

Policy alignment with urban focus: first practices

The second USD policy type has emerged from examining social innovation projects in Vienna and Newcastle upon Tyne, as well as ‘24 h’ policies in London. Vienna, as part of its ‘Smart City Framework Strategy,’ is not only centered on digitalization, but emphasizes ensuring a high quality of life for everyone and, as a city official explains, “addresses all aspects of city life. Not only mobility, buildings and energy, but also awareness raising, participatory processes, [or] creating new work opportunities” (I10). Digitalization is thus seen as a tool to support not only technical innovation, but more importantly also social innovation. Similarly, in Newcastle upon Tyne the University originally established a platform to experiment with projects and build on different forms of cooperation and enhanced digital developments. Originally a platform of engagement, the platform was then used to “feed new ideas into policy” (I11), for research and for innovation through projects. London, on the other hand, has created the policy focus, ‘24 h London,’ which recognizes and addresses contemporary changes in the city associated with the gradual growth of nocturnal activities.

Cities, as ‘burning glasses’ of our society 8 , experience the immediate consequences of spatial, socio-economic, environmental and political transformations and thus often have to find interdisciplinary approaches to address emerging challenges. Against this backdrop, cities around the world have increasingly introduced experimental projects and open-outcome processes to find alternative solutions and produce transformations towards SD 26 . One specific cultural and socio-economic change occurring in cities is that the classic dichotomy between day and night is becoming eroded 27 . As a result, 24 h policies have emerged as a means to develop the evening and nighttime economy of cities and to create safer city centres, since people who do not work from 9:00 a.m. to 5:00 p.m. often face more dangerous and stressful working conditions 27 , 28 . Whereas such initiatives do not directly conflict with the national policy thrust, they address issues that arise mainly at the urban level and are of less importance at the national scale. This policy type, shown at the top right of Table 1, is referred to as ‘policy alignment with urban focus’.

Promoting innovative, locally grounded policies for SD requires cities to establish partnerships with actors within the same city. In both Vienna and Newcastle, local networks and forms of cooperation at the urban level are central (I10, I11). These cooperative undertakings include partnerships across the public and private sectors, academia, and civil society for the immediate implementation of local projects (I9, I10, I11). Cooperation is thus project-specific and geared towards incorporating locally anchored stakeholders who are affected by specific policy issues. London, for example, has built its 24 h policy approach on inner-city partnerships and focuses on establishing good cooperation with all its boroughs (I14). For Newcastle, a member of the project teams explains that “a series of methods” have been developed as part of the platform, “to encourage that sort of cross-sector cooperation and partnerships” (I11). Beyond the city scale, all three examples are embedded in national and international city networks. This collaboration with other cities is geared largely towards the exchange of knowledge and experiences (I10, I11, I14).

Local, national, and international platforms allow cities to position themselves as pioneers (I10, I11, I14). This helps them gain visibility and recognition for their forward-thinking role and results in inquiries from other cities seeking to learn about their experiences in the respective policy fields. We thus conceptualize the aligned policy type with urban focus as ‘first practices’ (Table 2 ).

Policy divergence with global focus: defiant practices

The third USD policy type emerged from examining urban migration policies in Barcelona and Amsterdam. Barcelona formulated an inclusive and radical urban asylum approach (sometimes referred to as ‘Barcelona City of Refuge’) amidst the so-called European refugee crisis of 2015–2016. It called for the direct reception of refugees crossing the Mediterranean Sea and for shared responsibility and city-to-city refugee relocations between Southern and Northern European cities. This proactive approach openly challenged the national and European asylum policies 11 , 29 . In a similar vein, Amsterdam developed its ‘24 h Reception for Undocumented Migrants’ plan, which provides a very comprehensive support structure for irregular migrants in terms of access to housing, health care, legal counselling and police protection 30 .

Both cities’ actions provoked open conflict with the national government. Whereas the cities adopted immigration and asylum policies that supported people regardless of their residency status, their national governments wanted them to pursue integration only of people who possessed a formal residency status. A further decoupling from the national level can be seen in the interpretation of policy authority, as both cities challenged the national authorities. Amsterdam explicitly defied national migration policy by emphasizing the city’s responsibility to guarantee basic needs (including housing) for everyone who lives in the city 31 . An expert explains that the city “denounced the Spanish and EU migration policies to claim a bigger role for cities in the governance of migration” (I7). Such initiatives directly conflict with the national policy thrust while addressing an issue of global nature. Hence, this policy type, shown in the lower left quadrant of Table 1 , qualifies as ‘policy divergence with global focus’.

To navigate the contested migration policy context, Barcelona and Amsterdam have organized themselves in city networks to build up pressure from below. Barcelona is active in creating alliances and engages in strong networks with other Spanish cities, as well as with cities throughout Europe (I6, I7). Parallel to other efforts within Spain, Barcelona’s mayor, Ada Colau, has openly called on European countries to accept more asylum seekers 29 . Barcelona has also entered into direct discussions with EU representatives, which have enabled the city to leapfrog the Spanish national government (I6, I7). A city official explains the intentions: “We are very active in city-networks because we often feel that the Spanish state is not helping much (…). If we do not have the support of the national government, let’s go abroad, let’s go to other cities, let’s go the EU” (I6). Furthermore, the interview partner stresses the importance of accompanying and supporting such an urban migration policy with a political positioning strategy: “It is was not only a practical operation, but also political operation to gain more autonomy” (I6).

Meanwhile, Amsterdam has invested in joining forces with Dutch cities to create a broad urban alliance to directly negotiate migration policy issues with the Dutch state (I8). Dutch cities’ unified position on migration policy allowed them to enter into negotiations with the national government in 2017 (I8). The resulting ‘24 h Reception for Undocumented Migrants’ policy represents a compromise between Amsterdam and the Dutch government: “The compromise was more about the process of dealing with undocumented migrants than the actual policy, in which we actually disagree [with the national government]” (I8). However, Amsterdam is determined to make use of its implementation discretion to secure the basic needs of people without a regular residency status (I8).

Both Barcelona and Amsterdam seek to stretch, counter or circumvent their policy-making limitations in migration policy. Given this conflictual policy-making setting, cities have networked with other cities throughout Europe to create a critical mass and to articulate a specifically urban perspective on migration policy. Oomen et al. (2022) describe these strategies as defiant, in that local governments are directly, sometimes vocally, opposing policies at the national level. Accordingly, we refer to this positioning strategy as ‘defiant practices’ (Table 2 ).

Policy divergence with urban focus: dodging practices

The fourth USD policy type emerged from our examination of Preston, London, and Milan. In Preston, we focus on their measures linked to Community Wealth Building, which are directed towards embedding and democratizing economic processes at the local level. Through these measures, the city aims to strengthen locally anchored institutions (e.g. universities and hospitals), as well as to leverage staff and public procurement processes to support the local population and small businesses 32 . Moreover, Community Wealth Building promotes so-called public-common partnerships in which political authorities work with civil society organizations to provide public services. In London and Milan, we highlight measures that help to provide more public spaces. In London, such approaches are linked to the regulation of privately owned public spaces so as to prevent the privatization thereof, while in Milan, measures are geared towards reclaiming streets for slow traffic and public recreation.

These examples illustrate locally embedded measures on specifically urban issues. They are typically developed in cities because the impact of austerity policies and the commercialization of public spaces manifest themselves there 12 , 33 . An expert explains that “Cities certainly create the conditions for people to come together to contest some of those conditions of capital accumulation, the concentration of those issues (…). This creates the conditions for this kind of politics.” (I13). These interventionist approaches conflict with liberal, free-market policies at the national level. However, as these challenges are prevalent only at the urban scale, the cities’ approaches contest national policy only indirectly. Especially the examples of Community Wealth Building “are beneath the radar of national politics”, as an expert puts it (I13). Accordingly, the cities try to circumvent national-level policy paradigms rather than directly challenging them; the focus is primarily on improving local conditions. Hence, in contrast to the former policy type (policy divergence with global focus), there is no conflict in policy authority because of the specific urban relevance of the policy area. We therefore label this policy type, located in the bottom right quadrant of Table 1 , as ‘policy divergence with urban focus’.

The local focus of these policies makes cooperation with other stakeholders at the metropolitan scale essential (I12, I13, I15, I16). A city official explains that the expansion of bike lanes beyond city boundaries “gives an alternative to many people not just within the city but also outside the city to better connect with the inner core” (I16). The main goal of these cities is to build strong local partnerships so that the cities have the resources and flexibility to independently solve emerging problems. Cooperation with actors outside metropolitan borders is of secondary importance. Nevertheless, the cities in these examples do engage in national and international networks with other cities. Here, the goals are exchange of knowledge and engagement in international debates on these issues (I12, I13, I15, I16). Whereas cooperation with higher-tier governments seems generally less important, the example of Milan shows that cooperation with the national level can still prove useful. Despite an apparent policy incongruence, the Italian government supported Milan’s initiative by financing public provision of bicycles and making regulatory changes to enable bike boxes and protected bike lanes (I16).

As noted above, the cities in these examples are reacting to inherently urban problems. Accordingly, they invest mainly in creating local partnerships and in horizontal networks with other cities to exchange knowledge and experiences. Cooperation with the national level may help to remove possible legal obstacles that could derive from decoupled policy agendas. Here again we find inspiration from Oomen et al. (2022), who describe these strategies as dodging, since the local governments do not necessarily proclaim their opposition to the national government but rather circumvent the national policy thrust and, in doing so, expand their local authority. Consequently, we label this positioning strategy as ‘dodging practices’ (Table 2 ).

Our analysis highlights that the different policy types require different positioning strategies. Policy types represent the contextual setting, which influences the positioning strategy cities choose, the actors they cooperate with, and the scales on which they cooperate. Through this analysis, we detected interesting patterns. In the context of national and urban policy divergence, cities tend to jump scales instead of building (linear) connections across them. Cities with SD policies that diverge from national agendas seek cooperation with other (international) cities to deliberately leapfrog the national level. However, when cities promote policies that are aligned with the national policy framework, a bridging of scales along the formal vertical lines of authority seems to be the most pragmatic and opportunistic approach, and it is also in the interest of the national government. These findings corroborate existing MLG literature showing that cities make use of versatile strategies to target different actors in the context of specific policies 11 , 20 .

Although a specific policy type certainly informs a city’s positioning and cooperation strategy at different governance scales, we recognize that this typology glosses over real-life complexities and that the categories are not as clear-cut in reality as we have presented them. Indeed, the differences between them can be marginal at times. Furthermore, the positioning strategies described in this paper are linked to specific policy measures and do not necessarily represent the overall positioning of the city. Cities formulate diverse measures and agendas depending on the policy issue at stake. We therefore do not intend to portray this connection between the policy type and the corresponding strategies as a purely deterministic relationship. Nevertheless, examining these ideal-typical positioning strategies is important for understanding how cities aim to put specifically urban takes of SD on global agendas.

In conclusion, this article has examined and compared different SD policy measures in 11 European cities. While appreciating the value of the multi-level framework in the sustainability transition literature 10 , we argue that a MLG perspective can enrich the theorization of relations, contestations and strategies between levels of government. We therefore contribute to the recent literature on (contested) relations between local governments and higher governmental authorities 11 , 13 , 16 by specifically focusing on SD policy-making and introducing a framework to understand national–urban relations and multi-level policy-oriented strategies.

The framework suggests four ideal types of USD policy (Table 1 ) and maps out their corresponding cooperation and positioning strategies (Table 2 ). The different strategies reveal how cities can take ownership of certain policy issues and how they can strengthen collaborations across scales or, if necessary, defend their position in potential MLG contestations. We have shown that cities frequently formulate their own SD policies, which often reflect a specifically urban take on SD. To support their policy takes, cities build collaborative partnerships at the local, regional, national and international levels. Cities are thus not mere implementers of national or global SD agendas but active policy-makers and policy influencers.

Not all the policy types and strategies in our analysis receive the same level of attention in academic literature and policy debates. Existing discussions of SD policies tend to focus on certain policy domains such as climate change or social innovation. In these domains, we usually observe alignment with the national level’s perception of how SD should be implemented in cities. Divergent urban policy examples, such as urban migration policies or measures for Community Wealth Building, receive less attention in SD debates. However, these types of urban policy are important for challenging the common perception that USD is geared primarily towards environmental measures 14 , 34 and in showing that cities can bring forth more radical and inclusive visions of SD 5 . These types of social or economic urban policies are defended in MLG contestations through broad coalitions of urban actors 11 , 29 . We therefore believe it is important for further research to highlight these more diverse—and sometimes contested—approaches that cities are taking to address global SD issues.

We suggest that future studies should test and consolidate our findings. For example, this analysis focuses mainly on the relationship between the local and national governments. This delimitation does not do justice to the complexity of the actors’ networks and ignores the important role of local communities, social movements, and epistemic communities involved in addressing SD agendas. Similarly, we have not delved into the comparative differences which exist among path-dependent legal systems and governance structures. Moreover, all the selected vignettes are European case studies of high visibility. Contrasting these findings with observations of smaller, lesser-known cities, especially ones outside Europe, could be an interesting future contribution.

Although the frameworks presented in this article provide an incomplete glimpse of the diversity of USD policies and strategies, we nevertheless think that our analysis yields interesting results. We have demonstrated that there exist specifically urban take to SD, and that these approaches sometimes oppose or contradict national (or even international) SD policy agendas, especially when they challenge national-level policy-making competencies or focus on serving those who are most disadvantaged.

Case selection

We selected our 12 case studies based on the rationale that they should present USD policy measures with different thematic focuses—that is, social, environmental and economic policy measures. Of the 12 case studies, four focus on the environmental dimension of sustainability (Stockholm. Sonderborg, Capital Region of Denmark and Berlin), four on the social dimension (Barcelona, Amsterdam, London and Milan), and four on the economic dimension (Newcastle, Vienna, London and Preston). We selected the cases because they are covered in the academic literature (in urban studies and related fields, such as planning, public policy or sustainability studies) and/or are highlighted as examples on the websites or in the reports of international city networks. We thus purposefully selected USD policy measures of high visibility. With regard to finding the international city networks relevant for our research, we consulted overview articles such as Acuto and Leffel 35 and conducted additional web searches.

Interviews (data collection, interview questionnaire, coding)

The data for the analysis of the 12 cases came from a literature review and 16 semi-structured interviews. As suggested by Berry 36 and Rathbun 37 , we first reviewed all publicly available academic and grey literature on these cases before conducting the interviews. This ‘frontloading’ of desk research helped to pose more targeted and informed interview questions. We conducted at least one interview per case because we wanted to ensure the triangulation of non-reactive data (i.e., written documents) with reactive data (i.e., interviews) 38 , 39 . We conducted semi-structured interviews with 16 experts involved in the implementation of these policy measures (see Supplementary Table 1 for the list of interview partners). Semi-structured interviews were considered the most suitable method because they allowed us to better understand nuances within cases and obtain information about policy processes 37 . In the interviews, we could ask specifically about the processes behind USD policy measures and positioning strategies (how?) and the reasons for adopting them (why?). Without conducting these interviews, we would have been forced to rely on written statements about the USD policy measures, and the positioning strategies would have remained largely a black box.

All three authors conducted the interviews, using the same interview questionnaire that featured the categories of policy design, implementation, cooperation and positioning strategy (see Supplementary Table 2 for the interview questionnaire). The interviews lasted between 30 and 90 min. We conducted them by videoconference (and once by phone) and recorded them if we had the interviewee’s approval. Immediately after the interviews, we wrote down interview protocols.

We then thematically coded the interview protocols as well as the gathered literatures (see Supplementary Table 3 for a summary of the interviews) 40 , 41 . We then categorized and conceptualized the cases, and we discussed the results of the different case among all three authors. We explicitly looked for patterns in our coding and interpretation of the data 40 , 41 . In the discussion, we recognized the pattern that the USD policy measures differ regarding national-urban goal congruence and the global/urban scale of the measures. We grouped the USD policy measures accordingly, resulting in the four groups displayed in Table 1 . In a next step, we examined whether we can detect specific forms of cooperation and positioning strategies inside the four groups of USD policy measures 40 . While we found specific forms of positioning strategies for each group, the distinction of cooperation strategies were less clear-cut and these positioning strategies are not mutually exclusive. We, however, highlight the cooperation strategies that were necessary for the respective positioning strategy. We display these findings in Table 2 .

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

The sample questionnaire for the interviews, a summary of the interviews, and the list of interviewees can be found in the Supplementary Information. The report written for the City of Zurich (in German) is available at the research collection of ETH Zurich, https://www.research-collection.ethz.ch/handle/20.500.11850/495756 .

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Acknowledgements

We thank our interview partners for their valuable time and insights, Mala Walz for her excellent research assistance in the beginning of the project, and Raffaele Bazurli for his comments on an earlier draft of this paper. We want to note that the City of Zurich funded a report that is the empirical basis of this article.

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All authors S.W., K.H. and D.K. contributed equally to project planning and approved the manuscript prior to submission. S.W., K.H. and D.K. conducted and analyzed interviews, D.K. arranged the funding and S.W. drafted the first version of the manuscript.

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Wittwer, S., Hofer, K. & Kaufmann, D. An urban take on sustainable development policies and corresponding positioning strategies. npj Urban Sustain 3 , 1 (2023). https://doi.org/10.1038/s42949-022-00080-y

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Article Contents

1. introduction, 2. boundary organizations and boundary spanning processes, 3. methodology, 4. findings, 5. discussion, 6. conclusion, acknowledgements.

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Environmental science and policy: A meta-synthesis of case studies on boundary organizations and spanning processes

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Danielle K Jensen-Ryan, Laura A German, Environmental science and policy: A meta-synthesis of case studies on boundary organizations and spanning processes, Science and Public Policy , Volume 46, Issue 1, February 2019, Pages 13–27, https://doi.org/10.1093/scipol/scy032

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We conducted a meta-synthesis of published qualitative articles to better understand how features and strategies of boundary organizations and spanning processes influence whether environmental science was utilized in politically oriented outcomes. Meta-synthesis is a peer-reviewed research technique which is becoming more prolific as disciplines compare qualitative research studies and generalize qualitative knowledge. In this work, thirty-nine published case studies were analysed through a systematic grounded theory approach and thirty-nine structured interviews were performed with authors to validate the results. Overall, forty-seven boundary spanning variables were evaluated using disaggregated statistics to determine correlation with policy outcomes. Our results develop the possibility that successful boundary spanning linkages may be less about utilizing formal boundary organizations and more about fostering the process through which science and policy are intermingled.

Humanity faces increasingly intractable environmental problems characterized by high uncertainty, complexity, and swift change ( Crona and Parker 2012 ). How science is developed and applied to policy-making is one major factor influencing ‘humanity’s environmental future’ ( Caldwell 1990 ). Yet, science is currently underutilized in environmental policy despite the growing call for effective scientific engagement in public policy ( National Science Foundation 2002 ). Current obstacles to effective scientific engagement in environmental policy include the inability to frame information in terms that resonate with policy and decision-makers ( Jacobs and Pulwarty 2003 ); insufficient efforts to ‘translate’ scientific information in environmental policy ( Ascher et al. 2010 ); poor access to research findings ( Driscoll et al. 2011 ); and the tendency for social and political framings to shape both the formulation of scientific explanations of environmental problems, and the solutions proposed to reduce them (i.e. science and policy are always mutually constituted) ( Forsyth 2003 ; Hess 1997 ). Further difficulties include the recognition that more science does not mean better policy ( Sutherland et al. 2013 ); knowledge hierarchies that distance scientists from real-world application ( Gieryn 1995 , 1999 ); the tendency to frame questions and methods in the absence of early policy engagement; and a paucity of published literatures relevant to policy needs ( Janse 2008 ). Additionally, a growing body of anti-science literature, or ‘a twisting of the findings of empirical science’ ( Ehrlich and Ehrlich 1996 ), bolsters predetermined worldviews which can support political agendas and undermine scientific credibility. How to effectively research and address these obstacles will be a top priority in the twenty-first century.

Scholarship on boundary spanning from the natural sciences to the humanities is dominated by boundary organization theory ( Guston 2001 ; O’Mahony and Bechky 2008 ). Boundary organizations are institutions that straddle politics and science ( Guston 1999 ) and are identified based on the formality of the institution and their focus on the science–policy interface ( Crona and Parker 2012 ). Classic examples of boundary organizations include the EPA, the Sea Grant Program, and the Intergovernmental Panel on Climate Change (IPCC) as outlined in Guston et al. (2000 ). Comparative analyses of boundary organizations and boundary spanning have included analysis of ozone depletion politics, knowledge systems supporting El Nino forecasts, acid rain and climate change, and policy debates around environmental education in public schools and the role of social science in the National Science Foundation ( Betsill and Pielke 1998 ; Buizer et al. 2010 ; Clark et al. 2011 ; Gieryn 1995 , 1999 ; Lemos and Morehouse 2005 ; Zehr 2005 ).

Yet, additional comparative research is needed which systematically analyses key processes of boundary spanning and associated scientific integration into policy outcomes ( Crona and Parker 2012 ; Hoppe et al. 2013 ; McNie 2007 ), especially with regard to environmental topics. This article provides a systematic comparison of environmental boundary spanning published case studies through a meta-synthesis to evaluate the strength of the relationship between variables (i.e. strategies and tactics) employed by boundary organizations and through boundary spanning processes and subsequent scientific integration in policy-oriented outcomes. The intent of this work is to understand the efforts of boundary organizations and/or boundary spanning processes which try to intermingle science and policy. Our work is not focused on the demarcation of science and policy, but rather, on the act itself of intermingling through boundary organizations and/or boundary spanning processes. Each of the case studies chosen specifically focus on boundary organizations and/or boundary spanning processes which seek to interconnect science and policy. Following a literature review describing the theoretical framings of our research, we present the methodology of meta-synthesis. The results of the meta-synthesis follow the methodology with the boundary organization and boundary spanning literature framing our discussion. Finally, we provide concluding thoughts and future recommendations.

Boundary organizations and boundary spanning processes (processes designed to enhance the integration of science and policy) link scientific and political worlds ( Lemos and Morehouse 2005 ). The boundary spanning literature discusses boundary organization theory and various characteristics of and actions taken by boundary organizations and boundary spanning processes.

The theory of boundary organizations analyses boundary organizations, boundary spanners, and boundary spanning processes in terms of their relations with the domains of science and politics ( Guston 1999 ). Boundary organization theory developed in a variety of contexts, including the environmental arenas related to climate ( Miller 2001 ), health ( Guston 1999 ), agriculture ( Carr and Wilkinson 2005 ; Cash 2001 ), and water ( White et al. 2008 , 2010 ), among others. Boundary organizations are typically defined as formal organizations which create a more ‘neutral’ space for knowledge co-production, dissemination, and brokering activities ( Guston 2001 ). These organizations frequently (a) provide accountability and responsibility to stakeholders to establish checks and balances between entities at the boundary so trust can develop ( Guston 2000 , 2001 ); (b) involve the participation of principals (i.e. policymakers), agents (i.e. scientists), and professional mediators, to facilitate effective communication with the added help of professional facilitation ( Braun and Guston 2003 ); and (c) consult with stakeholders directly affected by policy choices to help grasp ‘local realities’ during scientific research and public participation efforts ( Bremer and Glavovic 2013 : 109).

Boundary organizations also utilize boundary spanners (individuals, rather than organizations, which span science–policy efforts) to strengthen the integration of politics and science ( Weertz and Sandmann 2010 ). Scholars argue that boundary spanners are particularly important to maintaining relationships, building trust, communicating information needs and concerns, and bridging gaps between various stakeholder groups ( McNie et al. 2008 ). Boundary organizations further develop and utilize boundary objects ( Star and Griesemer 1989 ) or ‘hybrid, flexible, portable tools’ ( White et al. 2010 : 222), which sit among various social worlds (i.e. science, non-science, and public). Boundary objects such as repositories and maps ( Star and Griesemer 1989 ), databases ( Quay 2004 ), computer programs, and modelling (see White et al. 2008 , 2010 ) are argued to enhance the boundary spanning as they fuel collaboration and cooperation between various entities at the boundaries ( White et al. 2010 ).

However, recent literature critiques boundary organization theory (and boundary spanning writ large) as it is problematic to assume a clear distinction among science, politics, and boundary spanning processes. Instead, boundary organizations and spanners occupy a hybrid space in which science and politics co-mingle and constituents embody elements of both ( Miller 2001 ). As Crona and Parker (2012) highlight, the boundary spanning process is a continuous process of negotiating among tensions derived from inconsistent demands placed on boundary organizations and spanners by different stakeholders. Decision-making processes and outcomes are still subjected to local politics and underlying priorities despite the best intention of boundary organizations and partnerships ( Cash 2001 ). Thus, organizations bridging science and policy are inextricably interlinked and ‘co-produced’ ( Jasanoff 2004 ) with politics rather than separate from it (i.e. boundary organizations do not exist in political vacuums).

To make sense of this wide-ranging literature, we distill evidence and debates surrounding the role of specific characteristics of boundary organizations and spanning processes, and specific strategies or actions employed at the boundary, that are deemed to be influential in shaping the success of scientific integration in political arenas.

2.1 What characteristics of boundary organizations and spanning processes are deemed most influential in shaping policy outcomes?

Various boundary spanning processes affect the uptake of environmental science in policy efforts. First, the kinds of academic disciplines and modes of engagement are discussed as significantly influencing the science–policy interface ( Guston 2001 ; McNie 2007 ). Boundary organizations and boundary spanning processes which are interdisciplinary or cross-disciplinary in nature are said to enhance scientific relevance for policymaking ( Thrift et al. 2009 ). Transdisciplinarity is also identified as an important feature in enhancing science–policy integration by engaging academic-oriented disciplines and various individuals, groups, institutions, and stakeholders who may be impacted by policy decisions or able to contribute valuable insight to addressing problems not captured through disciplinary measures alone ( Clapp and Mortenson 2011 ). Boundary organizations and spanning activities can involve various entities such as scientists, policymakers, universities, industry, consultants, think-tanks, state agencies, private companies, community organizations, representatives of indigenous groups, non-governmental organizations, funding agencies, among others to help influence legislative actions and implementation.

The formality (i.e. pre-established organizations with prescribed practices) of boundary organizations and boundary spanning processes is also discussed as impacting successful science–policy integration measures ( Hastings 2011 ). There is considerable disagreement on whether formality is beneficial or harmful to achieving policy influence. Some argue that the formality of boundary organizations or boundary spanning processes better aids institutional and policy process engagement as pre-established networks and institutional capacity are already in place to aid science–policy interaction ( Bremer and Glavovic 2013 ). Others contend that boundary organizations and boundary spanning processes which are flexible and dynamic are significant to successful environmental science–policy linkages as it allows for multifaceted stakeholder participation as well as ideas about research to remain in flux. Thus, innovative solutions to specific problems can be addressed through best available options, instead of through a fixed team of specialists or traditional metrics applied to addressing policy issues across the board ( Hastings 2011 ). Similarly, some maintain that ad hoc and self-organized processes are more effective, as they are organically arranged ( Hahn et al. 2006 ; Kallis et al. 2009 ) around particular environmental issues and thus are able to assemble appropriate stakeholders (both scientific and non-scientific) to accurately influence environmental policy measures ( Bremer and Glavovic 2013 ).

Scholars seem to also disagree on whether boundary organizations and spanning processes which are operationalized through official (government) or unofficial (non-profit, non-governmental) pathways are most effective. Zehr (2005) and Tuinstra et al. (2006) argue that government-centred processes are more effective, as government involvement lends them added credibility among decision-makers. Boundary organizations or spanning processes which are driven by specific legislation, and therefore tied to specific policy aims, are also said to be more effective as policymakers have already approved the initiative in support of the interests of various stakeholders, [e.g. Resource Management Act of New Zealand highlighted by Bremer and Glavovic (2013) or the Enhanced Forest Management Pilot Projects of Innes (2003) ]. Shaw et al. (2013) and Tomich et al. (2007) , on the other hand, view science–policy efforts which are not-for-profit as most effective as actions and research on behalf of environmental issues are seen as free from economic influence.

Sources of funding are also relevant to the discussion of the effectiveness of boundary organizations and/or boundary spanning processes ( Kirchoff et al. 2013 ). Some argue for boundary organizations and boundary spanning which are funded by the government as this can increase perceived credibility and accountability by stakeholders ( Franks 2010 ). Other argues that processes funded by a foundation are important as it demonstrates both private and public interest for an initiative ( Clapp and Mortenson 2011 ). Still others suggest that processes funded by the public are most effective for demonstrating the overarching need detailed by members of society ( Kueffer et al. 2014 ), or that processes funded by industry help by supporting more intensive and project-driven efforts (e.g. Clapp and Mortenson 2011 ).

Finally, issues of scale are also discussed in the literature as relevant to the discussion of the effectiveness of boundary organizations and/or boundary spanning processes. The importance of scale highlighted in science–policy literatures emphasizes how science–policy integration occurs best when operationalized through a multi-dimensional, adaptable approach which recognizes local to global scales while being open and transparent to facility dialogue and collaboration between a wide-range of different actors ( Watson 2012 ). For example, if environmental policy efforts target local riparian protections, scholars argue research should reflect this policy objective through focusing science on local riparian issues. Science–policy engagement exists at a multitude of scales in the literature ranging from local, state, regional, national, and international boundary organizations and spanning processes. Arguments for a more regional boundary spanning approach are stated in the literature as these efforts can pin-point specific environmental strategies finely tuned for an area ( Bremer and Glavovic 2013 ).

2.2 Which strategies at the boundary are deemed most influential in shaping policy outcomes?

Boundary organizations and spanning processes engage in various actions to attempt to influence legislative, policy change, and/or support implementation. But which of these strategies are most influential in shaping policy? Boundary organizations and boundary spanning processes that facilitate dialogue and communication, as well as coordinate entities at the boundary (science, policy, citizens, etc.), are said to influence policy as enhanced communication between entities increases the chance of finding common ground and areas for science–policy incorporation ( Breuer et al. 2010 ). The brokering of information and the effective exchange of research directly help environmental science become more accessible to policymakers, and thus, more easily translated into policy ( Cash 2001 ).

Knowledge co-production further supports policy influence by allowing for the mutual investment of all entities acting at the boundary ( Dilling and Lemos 2011 ). Co-production operates from the foundation that all knowledge is ‘co-produced’ in science and society as ‘each [science and society] underwrites the other’s existence’ ( Jasanoff 2004 : 17). A co-productionist model is undertaken by boundary organizations and through boundary spanning processes, whereby the research agenda is shaped in an ongoing, iterative fashion between knowledge producers and users ( Dilling and Lemos 2011 ).

Another set of actions employed by boundary organizations and/or through spanning processes focuses on relational dimensions. Boundary organizations and spanning processes that help develop and maintain strong social relationships enhance social bonding and personal networking that provides improved conditions for knowledge creation and dissemination ( Holmes and Savgård 2009 ). Developing enhanced social relationships are said to occur through building social capital with the target audience through current institutional networks so as to tap into existing social capital as well as the expertise available through organizations, institutes, universities, scientists, policymakers, etc. ( McNie 2007 ). Others maintain social capital is best forged through participating in informal forms of engagement ( Bremer and Glavovic 2013 ) with social events outside of the workplace (retreats, fieldwork activities, luncheons, etc.) to help break down work-related barriers which may impede successful science–policy integration. Finally, some authors explore the importance of managing power differentials (e.g. conflicting demands, positions, and resources) in order to create a more ‘neutral’ space for collecting information and ideas from all stakeholders ( Kirchoff et al. 2013 ).

Many of the strategies at the boundary focus on creating salient , credible , and legitimate knowledge for all stakeholders ( Cash et al. 2003 ) as it is argued to create an inclusive, objective scientific investigation, while also reflecting the needs of stakeholders affected by decisions. Saliency, credibility, and legitimacy associated with science–policy integration are created through several mediums in the literature:

First, developing standards, recommendations, or plans through boundary organizations and/or boundary spanning processes are argued to enhance the effectiveness of boundary organizations and spanning processes as they provide a strong salient starting point for future policy development as plans can easily translate into policy and/or provide evidentiary support for why or why not certain legislation should pass depending on results of a plan ( Lopez-Rodriguez 2015 ). Boundary organizations and/or spanning processes that develop standards and recommendations further aid decision-making processes, as clearly articulated options to address issues can be easily translated into legislation ( Kamelarczyk and Gamborg 2014 ). During the processing of developing standards, recommendations, or plans effective working groups on various topics are also created through boundary organizations and/or boundary processes which ultimately help to influence policy decisions ( Tuinstra et al. 2006 ).

Second, how knowledge is distributed by boundary organizations and/or processes is also identified as important to develop legitimacy . Some argue for disseminating research results directly to policymakers, regulators, and regulating organizations as this builds trust between various entities at the boundary and increases input from decision-makers which enhance saliency, and thus, applicability of science to policy decisions ( Cutts et al. 2011 ; Hastings 2011 ). Others argue instead for distributing information to the media to help relay environmental science to the public and influence policy indirectly as this builds public knowledge and awareness of an issue regardless of its political sensitivity which can either force the hand of the government to act or create conditions conducive to science–policy interaction to put legislation into place to fix an issue ( Quay 2004 ; Schwach et al. 2007 ). Still others focus instead on how knowledge is packaged, and emphasize the need to produce several types of documents for distribution to stakeholders as this increases effective translation of scientific materials ( Eden 2011 ; Hahn et al. 2006 ; Bremer and Glavovic 2013 ).

Some argue for the need to go beyond one-way communication and one-off encounters to foster ongoing engagement with governmental bodies—which is deemed necessary for adequately tailoring the message to policymakers (e.g. governmental organizations, cooperative extension services, and local, state, and federal agencies, among others), to provide consistency in research requests, and to effectively build lasting relationships to enhance the ability for science to inform policy ( Brunel et al. 2013 ; Buizer et al. 2010 ). Still others argue for approaches that blur the boundaries between research and dissemination, such as promoting conditions conducive for learning through experiential, social, and institutional learning which allows for enhanced collaboration to occur and helps break down situational barriers while fostering a more collective and informed stakeholder group ( Klerkx and Leeuwis 2009 ).

Third, shaping the research trajectory and executing scientific research are effective by enabling boundary organizations to bolster credibility by helping manage scientific uncertainty ( Holmes and Savgård 2009 ; Hoppe 2010 ) when participating in research design and dissemination. Efforts to tailor research approaches are also hailed in the literature as important for the uptake of science in policy as it allows for detailed and tailored attempts to successfully influence legislative actions and implementation measures ( Kallis et al. 2009 ). Those emphasizing the nature of the research process have also argued for scientific research conducted at specific places on specific issues and problems—coined site-specific research ( Innes 2003 ), place-based research ( Shaw et al. 2013 ), and ‘problem-oriented’ research ( Schut et al. 2013 : 95)—as this approach provides precise data, thus strengthening its credibility for use by decision-makers. Other research strategies include: (a) long-term or sustained research as decision-makers are more apt to incorporate scientific data due to the capacity to provide enhanced monitoring and follow-up during implementation ( Bremer and Glavovic 2013 ); (b) systematic evaluations throughout research design as it provides enhanced capabilities for adaptation of research and is thus perceived as more precise to address science–policy issues ( Schwach et al. 2007 ); and (c) familiarity with the details of government structures, politics, and cultural practices ( Rice et al. 2009 ) so research can be strategically designed and dispersed into the political arena.

Qualitative meta-synthesis 1 ( Jensen and Allen 1996 ; Sandelowski et al. 1997 ; Thorne et al. 2004 ) is a synthesis in which the findings from qualitative studies are formally combined through grounded theory analysis. Meta-synthesis is a peer-reviewed research technique which is becoming more prolific as disciplines compare qualitative research studies and generalize qualitative knowledge ( Sandelowski et al. 1997 ). Biomedical, health, and nursing research (e.g. Knowles et al. 2014 ; McCarthy-Jones et al. 2012 ; Ooi et al. 2016 ), in particular, utilizes meta-syntheses to extract key medical practices discussed in qualitative studies to further medical application and theory ( Timulak and Creaner 2013 ). Meta-syntheses are also conducted in the fields of education (e.g. Sipe and Curlette 1997 ), social science (e.g. Hicks and Wood 2016 ), computer science (e.g. Douglas 2008 ), social work (e.g. Aguirre and Bolton 2013 ), psychology (e.g. Fehr et al. 2010 ), linguistics (e.g. Yoder and van Hover 2016 ), among others. Qualitative meta-synthesis was utilized in this study to provide a systematic means of deriving new science–policy knowledge from findings available in existing research studies.

3.1 Meta-synthesis phase completion

This meta-synthesis was operationalized through the six key phases. The traditional meta-synthesis approach, conducted by Sandelowski et al. (1997) and Timulak and Creaner (2013) , was utilized for our study in addition to structured first-hand interviews with authors of the published case studies. A description of each meta-synthesis phase follows:

3.1.1 Phase I: Identification of research question

The following research question guided this meta-synthesis:

What features and strategies of boundary organizations and spanning processes result in effective policy influence and other intermediate outcomes?

3.1.2 Phase II: Creation of an inclusion and exclusion protocol

Meta-synthesis inclusion criteria (adapted from Timulak and Creaner 2013 ).

3.1.3 Phase III: Coding of published case studies

The systematic coding procedure ( see Charmaz 2006 ; Glaser and Strauss 1965 ) taken in this meta-synthesis was shaped by analysing features and strategies of boundary organizations and spanning processes present in each article, and relating these to outcomes. We built our code lists by adding/collapsing code categories as needed to reflect the data and facilitate coding. We re-coded data as needed. Features were characterized based on the structural component of the boundary organization or boundary spanning process. Strategies were defined as courses of action of boundary organizations and/or through boundary spanning processes. Other variables that did not fit into either of these categories were also identified, and subsequently categorized as factors endogenous to the scientific process. Finally, outcomes were determined based on a review of the science–policy literature as well as studies in political science and law and policy science. We drew on the Institutional Analysis and Development (IAD) framework, a systematic approach towards policy analysis which evaluates complex social situations by distilling them into manageable sets of practical activities ( Polski and Ostrom 1999 : 25). Drawing on the IAD framework (Imperial 1999; Ostrom 2011; Rudd 2004), policy outcomes were determined by evidence of science influencing: (1) legislative, executive, and/or judicial proceedings (2) and evidence of implementation. Rather than only determining whether environmental science in each case study impacted legislative, executive, or judicial proceedings and its implementation, intermediate outcomes such as increased awareness and other legal and governmental actions were also included. Overall, eight science–policy outcomes were identified.

3.1.4 Phase IV: Construction of the formal conceptual framework

Formal meta-synthesis conceptual framework: features.

Meta-synthesis conceptual framework: strategies.

Meta-synthesis conceptual framework: other.

Meta-synthesis conceptual framework: outcomes.

3.1.5 Phase V: Interviews

Since it could not be assumed that every author who published their case study had objectively evaluated each of the variables analysed, let alone using the same criteria, phone and Skype interviews were conducted with each case study author in late 2016 and early 2017. During these interviews, we asked the primary author of each environmental boundary spanning case study to identify which variables ( Tables 2–5 ) were present in their case study. A ‘yes’ or ‘no’ was gathered from the authors as well as any additional information authors’ felt needed conveyed to accurately reply to the science–policy variables and outcomes. Overall, thirty-nine interviews were completed.

When coding differed between case study authors and our coding results, follow-up questions were asked during the interviews for clarification. Differences in reporting detail existed due to the emergence of outcomes following the publication of case studies and the time-lapse between the case studies (which started as early as 1999) and due to the inability of the case study authors to acknowledge and mention certain variables and outcomes due to the limitations of publishing in journals. Ultimately, these interviews checked the accuracy of coding and ensured each of the codes was answered objectively by the primary expert of the environmental boundary spanning case study. This eliminated third party bias and ensured the validity of our results.

3.1.6 Phase VI: Results

Results: two-way explanatory variables and science–policy outcomes.

3.2 Limitations of the methodology

It is important to note the main restrictions to this research approach before discussing the results. The sample size is limited ( n  = 39). Even though peer-reviewed meta-syntheses generally analyse ten to fifty case studies ( Timulak and Creaner 2013 ), this sample size may not reflect the diversity of published case studies on environmental science–policy issues worldwide. In addition there are difficulties in tracing the political impacts of scientific research. Difficulties may exist due to (1) the complications of tracking the impact of a particular research project alongside the many other strands of evidence that typically inform a policy decision ( Holmes and Savgård 2009 ); (2) the time lags of research uptake ( Holmes and Savgård 2009 ); (3) an absence of identifying conceptual impacts, not just instrumental ( Holmes and Savgård 2009 ); and (4) a lack of precision in research program objectives ( Holmes and Savgård 2009 ). Thus, while research is often initiated to support policymaking, many research outcomes may not reach the policy arena and may arrive in fundamentally different ways than intended ( Schut et al. 2013 )—and therefore tend to be underreported. However, due to the variety of boundary spanning case studies analysed and the years in which these took place, the interviews with the authors of the case studies strengthened our results as they were able to report, first-hand, whether policy and other outcomes had materialized over time.

Findings are reported according to each of the outcomes in the conceptual framework. The statistical results are first presented in summary form, followed by a discussion of findings for each of the dependent variables.

4.1 Statistical results

Table 6 depicts the results of the statistical analysis for the two-way tests of the relationship between each of the boundary features and strategies and the corresponding environmental policy outcomes (Chi-square, Fisher’s exact, and gamma tests). Only those statistical tests reported as significant are provided, despite the 376 tests performed. Positive gamma statistics are indicative of a greater likelihood of the associated outcome when the predictor is present; negative gamma statistics are indicative of a lower likelihood of the associated outcome when the predictor is present.

4.1.1 Outcome 1: Awareness of policymakers

F10 (Industry): When the boundary organization and/or boundary spanning process was funded through an industry involved with the science–policy issue in the case study, there was less evidence that the boundary spanning effort had increased awareness of the scientific issue among policymakers.

S13 (Adapted Research, Scope): When the boundary organization and/or boundary spanning process adapted the scope of scientific research to better inform the specific environmental policy decision, there was evidence for increased awareness of the scientific issue among policy-makers.

S15 (Engaged in Adaptive Management): When the boundary organization and/or boundary spanning process engaged in adaptive management techniques (continuous monitoring, evaluation, and adjustment of science and subsequent policy recommendations) to enhance research uptake, there was evidence for increased awareness of the scientific issue among policy-makers.

S17 (Scientific Knowledge Dissemination): When the boundary organization and/or boundary spanning process delivered scientific information (i.e. presentations and reports) to policymakers during decision-making process, there was evidence for increased awareness of the scientific issue among policymakers.

4.1.2 Outcome 2: Awareness of public

F4 (Local Scale): When the boundary organization and/or boundary spanning process occurred at the local (district or lower) level, there was evidence for increased awareness of the scientific issue among the general public.

S9 (Mass Media Invovlement): When the boundary organization and/or boundary spanning process actively involved mass media to build support for policy decisions among the public, there was evidence for increased awareness of the scientific issue among the general public.

S21 (Dissemination of Research/Data to Public): When research/data were delivered to the general public directly by either scientists, members of boundary organization, or policymakers, there was evidence for increased awareness of the scientific issue among the general public.

4.1.3 Outcome 3: Creation of governmental committee

F7 (National Scale): When the boundary organization and/or boundary spanning process occurred at the national level, there was evidence of government committees being created to handle the science–policy issue in case studies.

S1 (Utilized Boundary Organization): When a boundary organization was utilized at the science–policy interface, there was evidence of government committees being created to handle the science–policy issue in case studies.

S9 (Mass Media Involvement): When the boundary organization and/or boundary spanning process actively involved mass media to build support for policy decision among the public, there was evidence of government committees being created to handle the science–policy issue in case studies.

S14 (Gathered Local Perspectives): When the boundary organization and/or boundary spanning process gathered local perspectives (i.e. community and indigenous) to aid scientists and policymakers involved in decision-making processes, there was evidence of government committees being created to handle the science–policy issue in case studies.

S18 (Managed Scientific Uncertainty): When the boundary organization and/or boundary spanning process worked alongside scientists and policymakers to manage the scientific uncertainty associated with the environmental science utilized for case study, there was evidence of government committees being created to handle the science–policy issue in case studies.

S20 (Joint Visits to Research Sites): When the boundary organization and/or boundary spanning process structured and facilitated visits for policymakers to research site to enhance their understanding of the research/evidence, there was evidence of government committees being created to handle the science–policy issue in case studies.

S22 (Utilized Conflict Resolution): When the boundary organization and/or boundary spanning process provided traditional conflict resolution techniques (i.e. forcing, collaborating, compromising, and smoothing) during interactions between scientists and policymakers, there was evidence of government committees being created to handle the science–policy issue in case studies.

4.1.4 Outcomes 4 and 5: Evidence of judicial impact

Zero variables were found to be correlated with evidence of environmental science utilization during court proceedings or influencing court decisions.

4.1.5 Outcome 6: Evidence of executive order impact

One variable correlated with environmental science impacting executive orders due to the involvement of a boundary organization and/or boundary spanning process: boundary spanning occurring at the state level.

4.1.6 Outcome 7: Evidence of legislative impact

F7 (National Scale): When the boundary organization and/or boundary spanning process occurred at the national level, there was evidence of the environmental science brought to the table during the boundary spanning process shaping environmental legislation.

F8 (International Scale): When the boundary organization and/or boundary spanning process occurred at the international level, there was evidence of the environmental science brought to the table during the boundary spanning process shaping environmental legislation.

S25 (Enhanced Transparency of BO/BSP Process): When the boundary organization and/or boundary spanning process worked to enhance transparency of the boundary spanning process, there was evidence of the environmental science brought to the table during the boundary spanning process shaping environmental legislation.

Oth8 (Utilized Quantitative and Qualitative Evidence): When the science–policy interface in case studies drew on both quantitative and qualitative evidence, there was evidence that this undermined the tendency for the environmental science brought to the table during the boundary spanning process to shape environmental legislation.

4.1.7 Outcome 8: Evidence of implementation

F7 (National Scale): When the boundary organization and/or boundary spanning process occurred at the national level, there was greater evidence that these processes shaped the implementation of legislation.

Oth8 (Utilized Quantitative and Qualitative Evidence): When the science–policy interface in case studies drew on both quantitative and qualitative evidence, there was a lower percentage of cases with evidence of implementation.

Features associated with scale (F4, F5, F7, F8) and industry funding (F10) correlated with several outcomes (O1, O2, O3, O6, O7, and O8). One strategy (S9, Mass Media Involvement) correlated with two outcomes (O2 and O3) while 10 strategies (S1, S13, S14, S15, S17, S18, S20, S21, S22, and S25) correlated with one outcome. Finally, one other variable (Oth8) correlated with two outcomes (O7 and O8). Below, we explore the possible interpretations for our findings by drawing on the wider literature.

5.1 Features

Only features associated with scale (F4, F5, F7, and F8) and industry funding (F10) correlated with science–policy outcomes for this sample.

5.1.1 Scale

Predictors associated with scale correlated with several science–policy outcomes including increasing public awareness of scientific issues (O2), the creation of governmental committees (O3), impacting executive orders (O5), and legislative changes and implementation (O7 and O8). Attention to scale when integrating science and policy is well established across boundary spanning and science–policy literatures ( see Cash and Moser 2000 ; Sarkki et al. 2013 ). The suite of opportunities present at different scales and the factors that matter the most at those scales produce favourable policy changes with scholars noting how scientists are better able to influence the uptake of science into policy, when scientists adapt their research to the scales that match policy interests ( Sarkki et al. 2013 ).

When boundary organizations and/or spanning processes were executed at the more local-level it correlated with increasing the public’s awareness of the environmental science–policy issue at hand (O2). In line with our results, Bremer (2009) and Bremer and Glavovic (2013) as well as Reid et al. (2006) found that boundary spanning processes which exist at the local scale led to greater awareness by the general public due to the enhanced ability to mobilize local stakeholders’ participation in the science–policy interface and thus, increase their knowledge concerning the scientific issues at hand.

Hoppe et al.’s (2013) work provides an explanation for why boundary organizations and spanning processes occurring at state and national levels correlated with several science–policy outcomes in our study as relationships of trust influence science–policy cooperation as well as providing precise expertise as to how environmental science can influence policy in the political sphere in which it exists. As Hoppe et al. (2013) argued, ‘successful boundary arrangements are those that have adjusted to their diverse national contexts of policy issue politics and political-cultural spheres’ (p. 17). Hoppe et al. (2013) found in their work on the science–policy interface and climate change that boundary spanning is a social relationship between a provider and user of expertise with boundary organizations and spanning processes at the national-level displaying strong instrumental roles in support of their national governments. Overall, this ‘nationalized’ expertise provided enhanced trust and political control, or a closer link between science and national politics.

When boundary organizations and/or spanning processes were executed at the international level, it correlated with evidence that environmental science impacted legislation (O7). The science–policy literature recognizes how research at global scales lends itself to larger policy endeavours. For example, science–policy boundary spanning through the IPCC impacts national legislation and international agreements ( Bremer and Glavovic 2013 ); the Southern African Millennium Ecosystem Assessment ( Fabricus et al. 2006 ), the Intergovernmental Platform on Biodiversity and Ecosystem Services ( Perrings et al. 2011 ), and the United Nations Environment Programme, are further international-scale efforts which resulted in shaping national and international environmental policies. Additional research concerning issues of scale should focus on how boundary organizations and/or spanning process mobilize stakeholder participation and how models of participation could influence science–policy efforts across varying scales.

5.1.2 Industry funding

When the boundary organization and/or boundary spanning process was funded through industry, there was less evidence of increased awareness of the scientific issue among policymakers. Possible explanations for this negative correlation could be limitations placed (e.g. through possible defunding) on boundary organizations and/or spanning processes funded through industry to relay scientific results to policymakers. This would not be out-of-the-ordinary as evidence exists of industry suppressing scientific evidence (e.g. climate change, see Dunlap and McCright 2010 ), particularly studies associated with environmental science ( Kuehn 2004 ; Martin 1981 ). Furthermore, scholarship demonstrates that when scientific research is funded through industry efforts, faculty behaviour in the aftermath of their involvement in industry/commercially funded projects changes as scientists engaged in entrepreneurial activities are more likely to deny requests from fellow academics for research results ( Louis et al. 2001 ) and faculty members with industry support are more secretive regarding their research findings ( Blumenthal et al. 1996 ). Thus, industry funding could suppress scientific dissemination by boundary organizations and/or through spanning processes as well as restrict research sharing vis-à-vis scientists at the boundary, impacting the ability to inform policymakers involved at the science–policy interface. More research should be conducted regarding the impacts of industry funding as well as a broader study of how various funding mediums shape science–policy outcomes as there remains considerable disagreement over the appropriate funding for shaping science–policy outcomes with scholars advocating for government ( Franks 2010 ; Kirchoff et al. 2013 ), foundation (e.g. Clapp and Mortenson 2011 ; Hastings 2011 ), public (e.g. Klerkx and Leeuwis 2009 ; Kueffer et al. 2014 ), and industry funding ( Clapp and Mortenson 2011 ) and subsequent science–policy influence.

5.2 Strategies

One strategy (S9, Mass Media Involvement) correlated with two outcomes (O2 and O3) while 10 strategies (S1, S13, S14, S15, S17, S18, S20, S21, S22, and S25) correlated with one of the eight outcomes.

5.2.1 Media

Our results indicate the direct involvement by boundary organizations and/or through a boundary spanning processes with the media (S9) correlated with increasing awareness of the scientific issue to the general public (O2). Our results reflect other studies which conclude the use of mass media as an influential tool for widening public awareness of environmental issues ( Schoenfeld et al. 1979 ; Slovic 2000 ). It also points to research on the science–policy–media interface which details how social relationships are built over time between scientists, policy actors, and the public through media distribution ( Boycoff and Boycoff 2007 ). Thus, media involvement enhanced relationship building at the boundary which correlated with increasing public awareness and the creation of a governmental committee as media coverage itself served to intersect public, science, and government entities.

5.2.2 Boundary organizations

Our results indicate utilizing a boundary organization (S1) correlated with the creation of a separate governmental committee to continue handling science–policy issues associated with the case studies (O3). This result is not surprising as the literature argues boundary organizations provide a more ‘neutral’ space for knowledge co-production, dissemination, and brokering activities ( Crona and Parker 2012 ; Guston 2001 ). The stability associated with providing accountability and responsibility to a variety of stakeholders ( Bremer and Glavovic 2013 ; Crona and Parker 2012 ; Guston 2001 ; Vogel et al. 2007 ), and professional mediation and facilitation ( Braun and Guston 2003 ) further create ideal conditions in which a government entity can successfully forge meaningful long-term reciprocal relationships (both scientific and personal) with those occupying a stable science–policy space through a boundary organization.

In contrast to this interpretation, the positive correlation between utilizing a boundary organization and the creation of a separate governmental committee to continue handling science–policy issues may also indicate that boundary organizations (nor perhaps scientists) are not trusted by policymakers, and thus a committee is created to provide oversight to the boundary process and to handle ongoing scientific issues ( see Roux et al. 2006 ). In addition, governmental committees may be constituted to better align the scientific aspect of the policy process with special interests by ‘stacking’ committees. As Sarewitz and Pielke (2007) argued, scientific research trajectories are often influenced by political pressure and powerful political entities who have a stake in the outcome of research results. Thus, continued influenced between boundary organizations and/or processes and governmental committees regarding scientific issues could impact research trajectory, results, and the uptake of information in policy. Further exploration into how government entities/committees influence boundary organizations and/or spanning process should occur especially with regard to deeply political issues associated with the environment.

5.2.3 Scientific and boundary spanning process

Our results indicate when boundary organizations and/or boundary spanning processes adapt their scope or research (S13), engage in adaptive management techniques (S15), manage scientific uncertainty (S18), provide conflict resolution (S22), and enhance the transparency of the spanning process itself, several outcomes resulted (O1, O2, O3, and O7). Adapting the scope of research to the issue at hand is well documented in the literature to ensure relevance to policymakers while linking the results to specific measurable policy goals and strategies ( Bremer and Glavovic 2013 ; Hoppe et al. 2013 ). In addition, engaging in adaptive management behaviour and is further discussed as an effective means to increase the uptake of science in policy as it ensures the applicability of knowledge in changing economic, political, and climatic contexts ( Eden 2011 ). For example, Innes’ (2003) work in sustainable forest management in British Columbia found adaptive management successful in intermingling science and policy through ‘learning by doing’ or the adoption of a controlled approach to management experiments, complete with replication. Managing scientific uncertainty and the spanning process itself is further documented as effective as policymakers expect interaction and information to be as objective and certain as possible ( Brugnach et al. 2007 ). Finally, providing conflict resolution during spanning processes correlated with outcomes. The CALFED Bay-Delta Program highlights not only the importance of a transparent boundary spanning process, but also the execution of conflict resolution to keep stakeholders on task ( Karl et al. 2007 ). Overall, our work demonstrates the importance of boundary organizations and/or spanning processes in designing scientific work and spanning processes with decisionmaker needs at the forefront. Additional research should focus on identifying additional research and management adaptation mechanisms and how these can be incorporated into existing and future science–policy efforts.

5.2.4 Collaboration and knowledge dissemination

Our results indicate when boundary organizations and/or boundary spanning processes engage with local knowledge and perspectives (S14), disseminate scientific knowledge to policymakers (S17) and the public (S21), and provide trips for policymakers to research sites (S20), several outcomes resulted (O1, O2, and O3). The case studies analysed gathered local perspectives in a variety of ways: Tomich et al.’s (2007) work focused on ‘participatory research with rural communities’ through ‘documenting local ecological knowledge’ (p. 278). Other forms included ‘special consultative processes’ ( Bremer and Glavovic 2013 : 109) involving a ‘systematic engagement with local knowledge’ ( Bracken and Oughton 2013 : 16). Consultation with First Nations also occurred and included ‘effective grassroots communications strategies with Aboriginal people and communities’ ( Innes 2003 ; Thrift et al. 2009 : 990). Overall, the aim with this type of consultation was to grasp ‘local realities’ as Vogel et al. (2007 : 358) noted, to ensure local needs were met in subsequent policy decisions. Newman et al. (2004) suggest that the field of social and public policy are opening to new forms of interaction between state and citizens, including the development of collaborative governance. With collaborative governance a shift from ‘governing to governance, from hierarchies to networks, from representative to deliberative democracy, and from direct control by the state to strategies designed to engage civil society’ occurs ( Newman et al. 2004 : 217).

Unsurprisingly, when scientific knowledge was disseminated to policymakers (S17), this correlated with increasing awareness of the scientific issue for policymakers (O1). This finding demonstrates the awareness of better science communication over the last 40 years (Mea et al. 2016) and how scientists are facilitating a discussion of their work through various mediums (e.g. boundary organizations and/or spanning processes) to build bridges between themselves, their work, and the policymakers who need scientific information to make informed decisions (Fishcoff 2013; Treise and Weigold 2002 ). Also, when scientific knowledge was disseminated to the public (S21), this correlated with increasing awareness of the scientific issue for the public (O2). Scientists have long argued the public must be able to understand the basics of science to make informed decisions ( Brownell et al. 2013 ). Increasingly, the communication of science to the general public is recognized as a responsibility of scientists and those working at the science–policy boundary ( Greenwood 2001 ; Leshner 2003 ). Finally, while the dissemination of knowledge is important, it is also significant for interaction at the boundary to occur between stakeholders. Actively building and maintaining relationships with those at the boundary and policymakers through field days will increase the likelihood that research outcomes will inform policy decisions ( Gibbons et al. 1994 ).

5.3.1 Utilizing quantitative and qualitative evidence

Interestingly, when the boundary organization and/or spanning process in case studies drew on both quantitative and qualitative evidence, there was a lower percentage of cases with evidence that the environmental science utilized during the boundary spanning process had shaped environmental legislation or implementation. There were also no positive correlations with the use of either qualitative or qualitative evidence. These results counter much of the literature and longstanding science–policy experiences which argue that both quantitative and qualitative modes of evidence and analysis are critical to inform decision-making processes ( Curry et al. 2009 ; Jick 1979 ), to reject ‘epistemological hierarchy’ ( O’Neill et al. 2010 ), and provide fruitful social and political responses ( O’Neill et al. 2010 ). To address this issue, additional research should explore whether and how the use of mixed-evidence qualitative and quantitative currently influences political decision-making.

5.4 Statistical insignificance of variables emphasized in the literature

Some of the key features, roles and strategies hailed in the literature as substantial to the uptake of science in policy were not correlated with science–policy outcomes in our sample. The co-production of knowledge ( Jasanoff 2004 ) and creation and use of boundary objects ( Star and Griesemer 1989 ), for example, are discussed as significant activities undertaken by boundary organizations and spanning processes ( Clark et al. 2011 ; Dilling and Lemos 2011 ; Driscoll et al. 2011 ; Jasanoff 2004 ; Lemos et al. 2012; Rice et al. 2009 Lemos et al. 2012). A lack of correlation among co-production of knowledge and the creation and use of boundary objects with science–policy outcomes was particularly surprising, given their prevalence in the literature and their almost taken-for-granted status as key strategies of boundary organizations and spanning processes.

Prior research has also consistently identified the need for institutionalized formal boundary organizations ( Cash 2001 ; Guston 2001 ; White et al. 2010 ). Yet, the utilization of a boundary organization did not correlate with several science–policy outcomes in this study including the uptake of science in legislation and subsequent implementation. This is surprising, given the reliance (both academically and practically) in science–policy contexts. However, as Hoppe et al. (2013) noted, formal boundary organizations can become vulnerable to losses in credibility and trust as organizations become entangled in politics surrounding scientific issues which can negatively impact policy results. In addition, Blades et al. (2016) found that formal boundary organizations require high levels of investment and resources from all participants which can negatively impact science–policy integration efforts; a need for more short-term partnerships between scientists and policymakers is needed, they argued.

This study provided a systematic analysis of published environmental boundary organization and boundary spanning case studies ranging from 1999 to 2016, to better understand which boundary spanning processes (including those utilized by boundary organizations) result in science–policy outcomes; key information currently lacking in boundary spanning scholarship ( see Crona and Parker 2012 ; Hoppe et al. 2013 ; McNie 2007 ; Vogel et al. 2007 ). While providing detailed processes and variables associated with boundary organizations and boundary spanning, this extended cross-case comparison also provides the necessary conditions to further develop the theory of science–policy linkages, and boundary organization theory specifically.

Overall, thirty-nine published environmental science–policy case studies were analysed through the peer-reviewed method of meta-synthesis, a systematic grounded theory approach of analysis ( Sandelowski et al. 1997 ; Timulak and Creaner 2013 ). We updated the method of meta-synthesis to also include structured interviews which occurred with the thirty-nine authors of the published science–policy case studies to validate our grounded theory efforts and to check the accuracy of the results of this meta-synthesis. Overall, forty-seven explanatory science–policy variables were coded and evaluated using the Chi-square test (and Fisher’s exact test when necessary).

When evaluating the strength of relationships between boundary organization and spanning processes and science–policy outcomes, the most frequently correlated feature was the national-level scale of the boundary organizations and/or boundary spanning process. This variable correlated with the creation of governmental committees for continued guidance over science–policy issues (O3), and evidence of legislative changes and implementation (O7 and O8). Additional research on boundary spanning should occur which explores national science–policy endeavours and the mechanisms through which boundary spanning effectively links with government initiatives at the national level.

The most frequently correlated strategy variable was the use of mass media (S9) by the boundary organization and/or boundary spanning process. This science–policy variable correlated with the increasing awareness of the public (O2) and the creation of governmental committees for continued guidance over science–policy issues (O3). Even with media involvement positively correlating with two science–policy outcomes, the literature points to how environmental issues frequently attract widespread attention and yet, tend to decline from public view which ultimately lends them to remain largely unresolved ( Downs 1972 ). This explains why media coverage may have increased public and some governmental response, but did not correlate with impacting legislation or implementation. The lack of media influence on legislation and/or implementation is disheartening especially as Kitzinger and Reilly (1997) found that high levels of media coverage do not last long and that a lack of policy events (i.e. legislation) leads to a lack of media interest. Peters (2012) provided a 30-year assessment of research centred on science and the media which found scientists consider visibility in the media as important; however, their communication practices are outdated (with science purposefully distancing itself from the media for issues ranging from credibility to the belief that scientific results will be mis-interpreted)—even within the younger generation of scientists. As the contentiousness between science and politics grows in the twenty-first century, it behooves scientists to study and transform the media–science interface to ultimately improve the likelihood of increasing awareness for the general public.

Overall, similar to Blade et al. (2016), our results question whether boundary organizations are the most effective means to span science–policy boundaries and effectiveness of formal features of boundary organizations and spanning processes. Instead, effective boundary efforts may be less about the formal organization or structure itself, but about the process itself. A shift in focus from development of formal/institutional boundary organizations may be fruitful to overcome current science–policy interface obstacles. As the literature indicates, boundary arrangements include a wide variety of hybrid organizational forms that straddle and mediate the boundary between science and policy, of which formal boundary organizations are one type ( Hoppe et al. 2013 ). The focus of boundary spanning as seemingly separate from a formal institution or organization may enhance its perception (and reality) of being distant from political interference, thus bolstering its potential credibility to influence science–policy efforts. By concentrating on the process itself, the alignment of different types of knowledges from different actors (e.g. citizens, professionals, bureaucrats, and experts) may be better exercised to ultimately coordinate the effective production, dissemination, and acceptability of knowledges for political decisions ( Hoppe et al. 2013 ).

Our work provides a starting point for understanding the crucial role played by specific boundary organization and spanning variables and how these connect to outcomes, but additional work is required to understand the nuances and dynamics involved within each of these processes. Academic and applied researchers should focus on exactly how variables result in science–policy outcomes, while investigating other explanatory variables (alone and in combination) which may also significantly influence the uptake of environmental science in policy efforts. Finally, this work highlights the need for an updated approach towards meta-synthesis to include more qualitative approaches towards understanding the nuances involved in producing the science–policy outcomes.

Also referred to as qualitative meta-data-analysis ( Paterson et al. 2001 ), meta-ethnography ( Noblit and Hare 1988 ), meta-study ( Paterson et al. 2001 ), thematic synthesis ( Thomas and Harden 2008 ), formal grounded theory ( Kearney 1998 ), and meta-interpretation ( Weed 2008 ).

Defined for the purposes of this research as “a particular instance of something used or analyzed in order to illustrate a thesis or principle” (Oxford Dictionary 2015).

Online Appendix A. Environmental Science and Policy: Meta-synthesis Search Strategy.

Online Appendix B. Environmental Science and Policy: Articles Reviewed by Meta-synthesis Inclusion Criteria.

Online Appendix C. Environmental Science and Policy: Search and Appraisal Process Flowchart.

Online Appendix D. Environmental Science and Policy: Published Case Studies Included in Meta-Synthesis.

Online Appendix G: Environmental Science and Policy: Preliminary Meta-Synthesis Conceptual Framework.

The Fisher’s exact test was appropriate to use when the expected number of observations in a cell was <5.

We appreciate the scholarly input received from Dr Ladislav Timulak, Dr Jenn Rice, Dr Rob McDowell, Dr Don Nelson, Dr Robert Hoppe, Dr David White, Dr Lisa Dilling, Dr Elizabeth McNie, Kathy Jacobs, and Jacob Weger as well as from the University of Georgia’s Statistics Consulting Center (in particular, Kim, Fei, and Yuan). We also want to thank the authors’ of the qualitiative published case studies who graciously accepted our request to be interviewed including Dr Norman Breuer, Dr James Buizer, Dr Roger Wilkinson, Dr David Cash, Dr William Clark, Dr Beatrice Crona, Dr Bethany Cutts, Dr Charles Driscoll, Dr Susanna Eden, Dr David Guston, Dr Thomas Hahn, Dr Laurens Klerkx, Dr Christoph Kueffer, Dr Simo Sarkii, Dr Jenny Shaw, Dr Lada Timotijevic, Dr Scott Bremer, Dr Alex Clapp, Dr Amy Donovan, Dr John Innes, Dr Kewin Kamelarczyk, Dr Myanna Lahsen, Dr María López Rodríguez, Dr Larissa Naylor, Dr Ray Quay, Dr Jenn Rice, Dr Marc Schut, Dr Vera Schwach, Dr Charles Thrift, Dr Willemijn Tuinstra, Dr Esther Turnhout, Dr Oksana Udovyk, and Dr Stephen Zehr.

This work was supported by the Science of Science and Innovation Policy Program of the National Science Foundation (DDRIG No. 1535885) as well as the University of Georgia’s Graduate School Dean’s Award, Summer Graduate Research Fellowship, the Innovative and Interdisciplinary Research Grant, and the J.W. Fanning Policy and Graduate Board’s Fellowships.

Conflict of interest statement . None declared.

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Environmental sustainability: a case of policy implementation failure.

1. Introduction

3.1. general trends, 3.2. the causes of policy failure.

• Incomplete specification of aims or objectives;
• Inappropriate agency for implementation;
• Conflicting objectives within or between policies;
• Incentive failures;
• Conflicting directives from agencies or senior official;
• Limited competence of agency or those tasked with implementation;
• Inadequate administrative resources to support policy implementation; and,
• A failure to communicate with the affected community.

4. Discussion

4.1. interrelated structural causes, 4.2. implementation traps, 4.3. knowledge/scope issues, 4.4. comparison of policy failure in different contexts, 5. conclusions, 6. further research, acknowledgments, author contributions, conflicts of interest.

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© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/ ).

Share and Cite

Howes, M.; Wortley, L.; Potts, R.; Dedekorkut-Howes, A.; Serrao-Neumann, S.; Davidson, J.; Smith, T.; Nunn, P. Environmental Sustainability: A Case of Policy Implementation Failure? Sustainability 2017 , 9 , 165. https://doi.org/10.3390/su9020165

Howes M, Wortley L, Potts R, Dedekorkut-Howes A, Serrao-Neumann S, Davidson J, Smith T, Nunn P. Environmental Sustainability: A Case of Policy Implementation Failure? Sustainability . 2017; 9(2):165. https://doi.org/10.3390/su9020165

Howes, Michael, Liana Wortley, Ruth Potts, Aysin Dedekorkut-Howes, Silvia Serrao-Neumann, Julie Davidson, Timothy Smith, and Patrick Nunn. 2017. "Environmental Sustainability: A Case of Policy Implementation Failure?" Sustainability 9, no. 2: 165. https://doi.org/10.3390/su9020165

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Climate Change, Public Health, and Policy: A California Case Study

CONTRIBUTORS

Anthropogenic activity will bring immediate changes and disruptions to the global climate with accompanying health implications. Although policymakers and public health advocates are beginning to acknowledge the health implications of climate change, current policy approaches are lagging behind.

We proposed that 4 key policy principles are critical to successful policymaking in this arena: mainstreaming, linking mitigation and adaptation policy, applying population perspectives, and coordination. We explored California’s progress in addressing the public health challenges of climate change in the San Joaquin Valley as an example.

We discussed issues of mental health and climate change, and used the San Joaquin Valley of California as an example to explore policy approaches to health issues and climate change. The California experience is instructive for other jurisdictions.

Climate change is currently affecting the health of populations and is projected to do so far into the future. 1 With the current chaotic policy environment in the United States, gains made in policy addressing climate change may be reversed or halted at the federal level. Without continued progress on these issues, it will likely become more difficult in the future to address the potential serious health implications of climate change. In this environment, it may be critical for states to lead when the federal government lags behind. The policy literature recommends several principles 1 that public health policymakers can use to address this important issue. We believe that 4 of these are the most important: mainstreaming, a linked approach, a population perspective, and coordination ( Table 1 ). 3–6 Our choice of these 4 principles is further supported by the work of Gould and Rudolph, whose analysis of individual-level and structural barriers to greater public health engagement in climate change and public health indicated that these principles were supported by perceptions in the field. 7 Our goal was to explore the health impacts of climate change and examine how California has implemented public health policy, based on these 4 principles. We performed a policy scan to identify associations between health and climate change, relied on published research, and used publically accessible state data for our analysis. We discuss public health policy and climate change in California, using mental health as an example. Our goal is to highlight larger policy issues and interrelationships among climate change, public policy, and the public, and how these 4 principles might be instructive to law and policy for other jurisdictions.

TABLE 1—

Key Principles That Public Health Policymakers Can Use to Address Health Implications of Climate Change

Note. GHG = greenhouse gas; PM2.5 = particulate matter ≤ 2.5 μm in diameter; SJV = San Joaquin Valley, California.

CLIMATE CHANGE AND THE SAN JOAQUIN VALLEY

To review policy “on the ground,” we narrowed our analysis to the San Joaquin Valley in central California. We chose to examine the San Joaquin region because of its significant climate disruptions and its concentration of vulnerable populations. We sought to study the resulting public health implications and to understand how California policy addressed health issues and climate change at the local level. The San Joaquin Valley is often called “the nation’s salad bowl” because of its fertile soil and the variety of produce grown in the region. It is a significant part of California’s agricultural industry, which generated $47 billion in 2015. The San Joaquin Valley has 8 counties—Kings, Fresno, Kern, Merced, and Stanislaus counties, and parts of Madera, San Luis Obispo, and Tulare counties—and had a population of 3.9 million according to the 2010 census. The socioeconomic conditions in the San Joaquin Valley are strikingly different compared with the rest of California and the rest of the nation; Hispanics made up 48.5% of the population, one fifth of the households in the region had incomes below the poverty level, approximately 30% of the population did not have a high school diploma, and most of the communities were linguistically isolated because 84% of the population had limited English proficiency. 8

California became dramatically hotter in the last several years, with temperatures in 2014 more than 3°F higher compared with the historical data from 1949 to 2005. In the San Joaquin Valley, a persistent decline in both precipitation and run-off led to drought conditions, with 2012 to 2014 being the hottest and driest years recorded. 9,10 Although previous studies dismissed any link between anthropogenic climate change and the California drought, 11 recent studies concluded that anthropogenic activity accounted for up to 30% of the drought conditions from 2012 to 2014. 12 These conditions led farmers in California to dig 1800 feet down to tap into ground water. Increased pumping of groundwater led to land subsidence, with parts of the San Joaquin Valley sinking by as much as 28 feet. Land subsidence is known to stress water systems, which leads to permanent failures in wells. 13 In March 2017, Tulare County’s Office of Emergency Services reported 1612 cumulative domestic well failures in Tulare County alone. 14 The air quality in San Joaquin Valley is one of the nation’s worst and has repeatedly failed to meet federal standards for fine atmospheric particulate matter 2.5 micrometers in diameter or smaller (PM2.5) pollution. The PM2.5 pollution arises from farming practices (e.g., tilling, burning crop harvesting, and so on), dairy operations, animal feed, and off-road vehicles. Climate change may further affect exposures to PM2.5 by affecting weather patterns and anthropogenic emissions. 15

We found that the health-related effects of climate change were particularly striking in the San Joaquin Valley. Compared with the state average of 11 per 100 000 of the population, the rates of heat-related emergency room visits from 2005 to 2010 were considerably higher in the San Joaquin Valley, ranging from 17 to 28 per 100 000 of the population. Because the main occupation in the region is agriculture, the rise in heat-related hospitalizations could be the result of the physical strain combined with continuous exposure to the heat outdoors, which could lead to fatigue and respiratory illnesses. A strong correlation was observed between exposure to particulate matter (PM2.5) and negative health outcomes, such as cardiovascular illnesses and exacerbation of asthma symptoms. A combination of heat waves, dust storms, and changing weather patterns also led to a 6-fold increase in Valley Fever (a disease caused by a fungus that is found in the soil) in California between 2000 and 2011, with more than 75% of the cases reported in the San Joaquin Valley. 16

In addition to physical health implications, climate change can have grave consequences for the mental health of affected populations. In the United States, the mental health consequences among populations affected by extreme weather events, especially Hurricanes Katrina, Sandy, and Ike were well documented. 1 Most individuals affected by acute weather events experience trauma, shock, stress, grief, and distress symptoms, which ameliorate once safer conditions are restored. However, for many individuals, the experience leads to major clinical and anxiety disorders, substance abuse disorders, posttraumatic stress disorders, and suicidal ideation. 1 Persistent drought has financial implications for individuals who rely on rainfall for their economic survival, which places an increased burden on their mental health. 1 Individuals who live in drought-affected areas experience psychological distress and ongoing worry about future drought conditions that might affect their livelihood. Long-term stress further affects their physical health, strains social relationships, and creates a cycle of despair. Psychological distress contributed to suicides among farm workers in countries (e.g., Australia and India) that experienced prolonged drought. 17,18 Drought was also a major contributor to the increase in suicides among male farm workers in the Midwestern United States in the 1980s. 19 Similarly, exposure to extreme heat was correlated with an increase in hospital and emergency room admissions, aggressive behaviors among those with mental illnesses, and death among those who experienced psychosis and dementia. 20,21 Another profound impact of climate change is solastalgia, which is a sense of desolation and loss of identity that an individual experiences as their familiar home environment changes, becomes uninhabitable, or hampers their livelihood. 22 Loss of identity because of climate change is often associated with occupations such as farming and fishing, which are place-based. 23 Finally, the impacts of climate change are unequal. Many populations such as indigenous communities, low-income groups, women, children, older adults, individuals with disabilities, and those living in high-risk areas are more vulnerable to the mental health impacts of climate change. 24 Although the health burdens caused by climate change are significant, persistent, and intractable, the impacts of mental health consequences are particularly concerning and are the focus of our discussion.

We used published data to examine the mental health burden in the San Joaquin region and reviewed climate change policies for their inclusion of mental health. We also examined the current mental health burden in the region. According to the California Health Care Foundation, more than 16% of adults have a mental health need, and 5% have a serious mental illness in California. 25 San Joaquin Valley had some of the highest rates of mental illness in California, with 8% of adults with serious mental illness and 5.3% of children with serious emotional disturbances. The burden of mental illness and the unmet need became even more significant, when we examined the mental health workforce in the Valley. The numbers of all licensed mental health professionals in the San Joaquin Valley were well below the state average. 25 A community health needs assessment conducted by Kaiser found that in select San Joaquin Valley counties (i.e., Fresno, Kings, Madera, and Tulare), access to health care services was the main concern among residents. Other prominent issues included lack of transportation, difficulty in scheduling appointments and navigating the system, language barriers, and paying for copayments and medications. More than 80% of the population in these counties lived in a health professional shortage area for primary care. 26 The high rates of mental illness, low access to providers, and the likely impacts of drought and climate change on mental health made this a serious climate-related health issue. We consider California’s approach to addressing this issue in this article.

CALIFORNIA’S APPROACH TO CLIMATE CHANGE

There are 2 goals in addressing climate change: mitigation and adaptation. Mitigation seeks to reduce greenhouse gases (GHGs). Policy approaches here include cap-and-trade systems, carbon sequestration, changes to energy generation systems, and transportation policy. Adaptation seeks to respond to the inevitable changes resulting from climate disruption. Many of these policies provide opportunities or “co-benefits” to improve the health of communities.

Mitigation Policy

California has taken aggressive steps to reduce GHGs and has been singled out as a leader in climate change policy. The Global Warming Solutions Act of 2006 is the center of California’s mitigation policy. It originally required California to reach 1990 levels of GHG emissions by 2020 and was recently updated to require a reduction in GHGs to 40% below 1990 levels by 2030. 27 This policy also requires the state to evaluate mitigation efforts in terms of public health. Currently, California uses a cap-and-trade system to reduce GHGs and to achieve its reduction goals. This system generates funds that the state uses on projects that reduce GHG emissions. In 2012, the legislature passed SB 535, which requires that, in addition to reducing GHG emissions, 25% of the monies from the GHG fund must be spent to benefit disadvantaged communities (DACs). Specifically, 10% of these funds must be spent on projects located within DACs. 27

The California Environmental Protection Agency (CalEPA) created a tool, CalEnviroScreen, to identify these DACs for purposes of GHG mitigation by measuring pollution burden and population characteristics by census tracts. 28 We used CalEnviroScreen 2.0 to study the San Joaquin Valley and found that 38.4% of census tracts in the San Joaquin Valley had a CalEnviroScreen score in the highest 15% (i.e., 85%–100%). With such a high percentage of DACs, the San Joaquin Valley communities experienced a unique combination of environmental pressures and inequities.

Adaptation Policy

California’s first step toward preparing for the impacts of climate change—its adaptation policy—was the result of a 2008 Executive Order that required state agencies to develop a strategy to identify and prepare for climate impacts. 29 Since then, California has continued to update its Climate Adaptation Strategy. 30 Although these policies are not as well developed as California policies that target mitigation, the Climate Adaptation Strategy has now moved to include more structural elements in adaptation goals, and the state’s adaptation policy has continued to expand, to rely on regular assessment of the issue through the California Climate Change Assessments. 31 In terms of public health explicitly, county public health departments have been working with the California Department of Public Health to identify public health risks in their communities, by building awareness and documenting climate change efforts in communities. 32

EVALUATING CALIFORNIA’S HEALTH POLICY

We propose 4 key principles to evaluate health policies focusing on climate change: mainstreaming, linked approach, population perspective, and coordination. The California example shows us how these principles have been incorporated, where they have fallen short, and the ensuing implications.

Mainstreaming

Mainstreaming is “a process whereby adaptation measures are integrated ‘into some aspect of related government policy such as water management, disaster preparedness and emergency planning or land-use planning.’ Mainstreaming is not, therefore, a specific policy proposal, like a carbon tax, but rather a policy for policy proposals.” 5 (p25) With mainstreaming, the effects of climate change are integrated into public health policy and planning. California has taken steps to integrate climate change adaptation and resiliency into its requirements for the general planning process of communities. 33 The Governor’s office has also required the integration of climate adaptation planning into state policy, which also mandates the California Natural Resources Agency to develop a state adaptation plan. That adaptation plan, Safeguarding California, focuses on community resilience and response capacity to health threats, indicator development, and improved coordination. 34 The recommendations provided in these adaptation plans are in broad strokes and lack the granular detail available in other climate change policies, and may not be sufficient to address more serious health problems in California.

We noted that a mix of public sources fund mental health services in California when we reviewed California policy with regard to our issue of mental health in the San Joaquin Valley. California counties, through their public health systems, have significant responsibilities related to the provision of mental health services. Services are paid for through a combination of federal, state, and local funds that combine revenue from Medi-Cal, sales taxes, vehicle fees, property taxes, and other miscellaneous funding. 35 Low-income uninsured adults who have no other source of care receive care from a medical indigent program run by counties known as County Medical Services Program (CMSP). Although some counties have expanded their CMSP offerings, many others have considerably cut back on coverage and services provided because of financial constraints. County funding decisions for mental health are currently independent of statewide policy priorities. 35 We believe that if climate change adaptation planning were part of policymaking in this area, additional mental health resources might be made available to residents of the San Joaquin Valley counties, thus providing cobenefits. States and counties could include the effects of climate change when planning and then provide additional resources for areas particularly affected by climate disruptions. Counties participating in the CMSP have already embarked on several innovative approaches to manage care for the neediest patients (e.g., contracting with local health plans, changing program benefits, providing more preventative care rather than episodic care, using technology for application screening, and so on). Even if the structure of mental health funding makes this mainstreaming difficult initially, simply moving the issue into the mainstream of mental health policy would help to identify structural policy barriers that were previously unknown. The narrow focus of public health funding and the mandate of programs could contribute to the difficulty of mainstreaming climate change in policy discussions. Addressing the larger political, policy, and legal constraints to public health would be key here. 7

Linked Approach

A linked approach that views adaptation and mitigation as parts of the same climate policy is required, as one can influence the other, and each can have serious implications for health. 4,5 For example, mitigation policy might promote smart growth solutions that emphasize public transit and dense urban development as a tool to reduce GHG emissions. An unintended consequence of this policy might be the development of urban heat islands that are detrimental to human health. 5 In this example, a linked approach would include the possible exacerbation of heat islands in the adaptation planning process itself.

Mitigation and adaptation policies need better linkage in California. California took strides in explicitly and expressly linking mitigation policies to environmental justice policy goals when it enacted the California Global Warming Solutions Act of 2006: Greenhouse Gas Reduction Fund (SB 535), which required investments on GHG mitigation specifically in communities that experienced poor outcomes related to environment. California spent approximately $320 million for GHG mitigation projects in the San Joaquin counties (excluding the funding for the California high-speed rail project), with only $58 million of the total amount targeting or benefiting DACs. By comparison, the state spent approximately $2.2 billion dollars across California. 36 Although these SB 535 investments targeted DACs in California, they did not necessarily target investments that would reduce the health burden related to climate change in this area. For example, a number of projects in the San Joaquin counties related to affordable housing, vehicle replacement, irrigation improvements, and carbon sequestration received SB 535 investment funding under the California system of GHG mitigation. Although these projects succeeded in bringing resources to DACs, these mitigation strategies might have exacerbated or failed to address climate-related health issues in the short term. For example, SB 535 investments included additional affordable housing in Fresno, 37 although the San Joaquin counties had some of the highest PM2.5 concentrations in California. As stated earlier, exposure to PM2.5 is associated with poor health outcomes. The legislature acknowledged this issue in a series of reforms passed in August 2016 that sought to improve oversight of the Air Resource Board and improve data on individual pollution sites. 38 Even with this attempt at reform, there is no expressed link between mitigation cobenefits strategy for SB 535 and adaptation policy in California. This tenuous link could have serious health consequences in the short- and long-term, as we found in the San Joaquin region, where none of the currently funded projects addressed mental health issues. Although more work is needed here, SB 535 and the California approach demonstrated that it is possible to link mitigation policy to other policies, including adaptation. We also noted that an emphasis on the health co-benefits of climate change policy might facilitate improved linkages and engagement with the public health sector. 7 Linking adaptation and mitigation, along with coordination, might be the 2 most difficult challenges facing any community or state that seeks to address the health effects of climate change.

Population Perspective

The California approach using CalEnviroScreen is an example of how societies might apply the population perspective to public health and health policy around climate change. By relying on a strong evidence base and indicators supported by research, CalEnviroScreen provides a fair tool for making comparative evaluations at the census level. It provides a useful way to compare and contrast populations in California and can allow policymakers to visualize health inequities, structural and social determinants of health, and other population-level health issues. Health policy planners could explore use of CalEnviroScreen data for mainstreaming issues related to climate change in California into public health and health policy planning, and direct funding to areas where the public health impact of climate change would be substantial. For example, policymakers in California could overlay the prevalence of mental illnesses, the current distribution of mental health resources, and the CalEnviroScreen Scores in the San Joaquin Valley to address the impact of climate change in this area and develop policies and investments to target affected communities. SB 535–related investments demonstrated how funding could be linked to clear policy goals. Inclusion of additional measures of health indicators in the CalEnviroScreen tool might help to identify vulnerable populations that might be particularly sensitive to the disruptions associated with climate change. However, CalEnviroScreen scores are calculated using parameters that rely heavily on pollution measures, and therefore, might not capture other climate change vulnerabilities. CalEPA continues to modify the tool and has recently included new indicators (e.g., cardiovascular disease and rent-adjusted income) to the CalEnviroScreen tool. This approach, although not perfect, is particularly effective and may help to facilitate the political process in addressing climate change. In addition to CalEnviroScreen, the CalEPA has other tools that focus on environmental justice 39 ; other states and jurisdictions have developed similar tools. 40 The use of the population perspective would facilitate the analysis of health policy problems. Inclusion of scores from tools such as CalEnviroScreen would provide a transparent and open system to guide policy decisions in this arena.

Coordination

Finally, any approach should focus on coordination. The Lancet Commission made this point most clearly:

[governments should] adopt mechanisms to facilitate collaboration between Ministries of Health and other government departments, empowering health professionals and ensuring that health and climate considerations are thoroughly integrated in government-wide strategies. A siloed approach to protecting human health from climate change will not work. 41 (p1862)

Legal scholars suggested multiple approaches to achieving this coordination and noted the difficulties in designing a legal regimen that could manage the complex issues associated with this topic. 6 California addressed this coordination issue in several ways. Three are worth noting: participation in subnational agreements; the Integrated Climate Adaptation and Resiliency Program (ICARP) at the Office of Planning and Research to coordinate among levels of government; and the Climate Action Team to coordinate within the state government. California worked with other jurisdictions on a subnational level to coordinate efforts around climate change. These included the Western Climate Initiative, which is made of up of several Western states and Canadian provinces and agreements with subnational counterparts in China. 42 ICARP was created in 2015 to provide a framework for coordinating among state, regional, and local governments. The framework also created a Technical Advisory Council to assist planning efforts. At the state government level, California relies on a Climate Action Team composed of state agency secretaries and the heads of various boards and departments. This team is led by the Secretary of CalEPA. Each of these approaches are important steps in coordinating responses to climate change and might be the most important and challenging aspect of public health policy and its approach to climate change.

The actual approaches to coordination are less important than understanding the role of politics and political will in responding to initiatives linked to climate change. A key factor contributing to the creation of these systems has been strong grassroots and community support, coupled with strong leadership in state government. Public health advocates and practitioners must be more tightly integrated into these coordination initiatives. They must lead the efforts to coordinate health responses within our complex and uncoordinated health care systems. Without a formal mechanism to coordinate the various funding sources and state policy objectives, we see a mismatch between health burden and health resources. Although policies in California emphasize the importance of coordination and are taking great strides, this issue has not moved into the policy fore in the way SB 535 moved environmental justice concerns into the realm of mitigation policy. This coordination of policy efforts may be the most difficult legal and policy challenge facing the public health sector as it seeks to address the health impacts of climate change.

CONCLUSIONS

The California approach demonstrated how to link resources to outcomes in a way that emphasized accountability and to connect mitigation and adaptation concerns. However, the experiences of the San Joaquin Valley region suggested a need for greater coordination of resources. Importantly, we believe California might have benefited from linking adaptation and mitigation policy from the beginning. Legal theorists also suggested that an approach that addresses both mitigation and adaptation as part of one regulatory policy might be useful. 5 California’s experience suggests that, to be effective, coordination must be incentivized, there must be political will, and the issues might need to be mandated. Finally, we believe that there are opportunities to link climate change and public health policy. For jurisdictions that rely on tools such as CalEnviroScreen to link climate change and health, policymakers must understand fully the inclusion and exclusion of population and environmental indicators and their implications for health equity. Focusing on the health implications of climate change and the health cobenefits of mitigation strategies might benefit the health of populations, as well as address the ongoing and future impacts of climate change. California’s successes, challenges, and willingness to update policy in this area are all instructive for communities working to prepare for the health effects of climate change and to mitigate its causes.

HUMAN PARTICIPANT PROTECTION

No protocol approval was necessary for this study because no human participants were involved.

See also Perker-Flynn, p. S58 .

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Environmental policies, politics, and community risk perception: case study of community contamination in Casper, Wyoming

Affiliation.

• 1 Department of Community Health and Sustainability, 3 Solomont Way, Lowell, MA 01854, USA. [email protected]
• PMID: 18184626
• DOI: 10.2190/NS.17.4.i

Objectives: We identify and explain factors that affected a community's perception of risk due to extensive industrial contamination and people's distrust of government agencies regarding the environmental investigations.

Methods: Intrinsic bounded case study methodology was used to conduct research about extensive environmental contaminations due to activities of an oil refinery in North Casper, Wyoming, and the citizens' response. Data were collected from multiple sources that included public testimonies, observations, public hearings and meetings minutes, newspaper articles, archived records obtained from federal and state environmental and health agencies, as well as industry records obtained through Freedom of Information Act (FOIA) requests.

Findings: The overarching theme that emerged was lack of trust due to several critical events and factors such as no response or delay in response time to community concerns, lack of transparency, perceived cover up, vague and fragmented communication by government and state officials, perception of pro-industry stance, and perceived unfair treatment.

Discussion and conclusion: People's perception of environmental risks and their willingness to accept official explanations and outcomes of environmental investigations are strongly affected by their direct experiences with government agencies and the evidence of influence the powerful industries exert over relevant investigations. The government cannot successfully address public and community concerns about environmental health impacts of contaminations and in turn the public perception of risk unless it adopts and implements policies, procedures, and protocols that are clear, timely, transparent, and free from industry influence.

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Ecological source identification and ecological security pattern construction from the perspective of ecosystem service supply and demand: A case study of Baiyangdian Basin in China

• Published: 19 August 2024

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• Xing Gao 1 , 2 , 3 , 4 ,
• Zhongyuan Guo   ORCID: orcid.org/0009-0001-9651-2021 1 ,
• Mengmeng Zhang 1 ,
• Xinyu Liang 1 ,
• Meiran Zhao   ORCID: orcid.org/0009-0001-7050-0233 1 &
• Ling Qin   ORCID: orcid.org/0009-0005-6386-0512 5  

Achieving a balance between the supply and demand of ecosystem services is crucial for ensuring ecological security and promoting the healthy development of regional ecosystems. This study focuses on 35 county-level administrative regions within China's Baiyangdian Basin. The supply and demand of four ecosystem services, namely water supply, carbon sequestration, food production, and entertainment services, were quantitatively evaluated. Ecological Sources are identified from the perspective of supply and demand, with the basic Resistance Surface corrected using VIIRS/DNB nightlight data and Circuit Theory applied to identify Ecological Corridors and Key Points. A regional Ecological Security Pattern was established. The results reveal the presence of 163 Ecological Sources in this area, which cover a total area of approximately 6,479.24 km 2 . These sources were predominantly found in the Taihang Mountains in the northwest, as well as in the central and eastern river basins of the area. A total of 76 main and 112 potential Ecological Corridors were extracted, totaling 3,241.63 km. Additionally, 124 Ecological Key Points were extracted, including 74 key Pinch Points, 30 general Pinch Points, and 20 Obstacle Points. These ecological elements are interconnected to form a basic structure of the Ecological Security Pattern. The study identifies a spatial pattern of "Three zones—One belt—Multiple corridor and point" and provides targeted policy suggestions based on these findings. The research contributes valuable insights for ecosystem management and the development of land space ecological restoration policies in both the Xiong'an New Area and the Baiyangdian Basin.

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Data Availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Sincere gratitude to the editor and the three anonymous reviewers for their constructive comment. Responsibility for the content of the manuscript remains solely with the author.

This project is supported by National: Natural Science Foundation of China: Realization Mechanisms, Influencing Factors and Optimization of Urban Ecosystem Service Delivery: A Case Study of Beijing and its Surrounding Areas (42371279); The National Natural Science Foundation of China: Research on Safety Resilience Evaluation of Critical Infrastructure Systems in Urban Cities and Optimization of Operation (72374063); Hebei Province Graduate Student Innovation Ability Training Funding Project: Study on the Multi-scale Spatial Convergence of Urban Land Green Use Efficiency in China(CXZZSS2024091).

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Xing Gao, Zhongyuan Guo, Mengmeng Zhang, Xinyu Liang & Meiran Zhao

Center for Urban Sustainability and Innovation Development, Hebei University of Economics and Business, Shijiazhuang, 050061, China

Hebei Collaborative Innovation Center for Urban-Rural Integrated Development, Hebei University of Economics and Business, Shijiazhuang, 050061, China

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X.G., L.Q. contributed to the conception of the study; M.Z., M.R.Z. performed the experiment and data processing; Z.G., X.L. contributed significantly to analysis and manuscript preparation; M.Z., Z.G. performed the data analyses and wrote the manuscript. X.G. and Z.G. have contributed equally to this work.

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Gao, X., Guo, Z., Zhang, M. et al. Ecological source identification and ecological security pattern construction from the perspective of ecosystem service supply and demand: A case study of Baiyangdian Basin in China. Environ Dev Sustain (2024). https://doi.org/10.1007/s10668-024-05302-0

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Facilitators and barriers to implementing successful exclusion among children with shiga toxin-producing Escherichia coli : a qualitative analysis of public health case management records

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Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health concern as they can cause serious illness and outbreaks. In England, STEC incidence is highest among children and guidance recommends that children under six diagnosed with STEC are excluded from childcare until two consecutive stool cultures are negative. We aimed to describe the barriers and facilitators to implementing exclusion and the impact of exclusion policies on young children and their families.

Individual level data was obtained from a wider study focusing on shedding duration among STEC cases aged < 6 years between March 2018 – March 2022. Data was extracted from England’s public health case management system. The case management system includes notes on telephone conversations, email correspondence and meeting minutes relating to the case. Collected data consisted of free text in three forms: (1) quotes from parents, either direct or indirect, (2) direct quotes from the case record by health protection practitioners or environmental health officers, and (3) summaries by the data collector after reviewing the entire case record. We analysed free text comments linked to 136 cases using thematic analysis with a framework approach.

The median age of included cases was 3 years (IQR 1.5-5), with males accounting for 49%. Nine key themes were identified. Five themes focused on barriers to managing exclusion, including (i) financial losses, (ii) challenges with communication, engagement and collaboration, (iii) issues with sampling, processing, and results, (iv) adverse impact on children and their families and (v) conflicting exclusion advice. Four themes related to facilitators to exclusion, including (i) good communication with parents and childcare settings, (ii) support with childcare, (iii) improvements to sampling, testing, and reporting of results, and (iv) provision of supervised control measures.

Conclusions

Qualitative analysis of public health case records can provide evidence-based insights around complex health protection issues to inform public health guidelines. Our analysis highlights the importance of considering wider social and economic consequences of exclusion when developing policies and practices for the management of STEC in children.

Peer Review reports

Shiga toxin-producing Escherichia coli (STEC) belong to a pathogenic group of E. coli . STEC infections pose a significant public health threat due to the potential severity of disease. Symptoms can range from mild diarrhoea to haemolytic uraemic syndrome (HUS), which is the most common cause of acute renal failure in children, and can be fatal [ 1 ]. STEC is diagnosed by laboratory testing of the stools of an infected person. STEC are zoonotic and spread from animals to humans via direct contact or consumption of food or water contaminated with animal faeces or can spread from person-to-person by the faecal-oral route. The infectious dose is low, facilitating transmission and increasing the potential to cause large outbreaks [ 2 ].

Outbreaks of STEC infection occur in childcare settings and this may be due to a combination of factors including prolonged shedding, poor/under-developed personal hygiene measures and immature immune systems in this age group [ 3 ]. To limit transmission, public health authorities often require children to stay away from childcare settings until laboratory tests confirm they are microbiologically clear of STEC bacteria [ 2 , 4 , 5 ]. In England, children under the age of six are excluded from childcare settings, until they have two consecutive culture-negative stool samples [ 2 ]. Prolonged carriage in children can result in lengthy exclusion [ 6 , 7 ]. Current exclusion policies can result in disruption to families in terms of potential loss of earnings, the child’s education, emotional and mental stress and disengagement with the health system [ 8 ].

In England, it is a legal requirement that all cases of STEC are reported to the national public health institute, the UK Health Security Agency (UKHSA) [ 9 ]. Regional health protection teams (HPTs) within UKHSA record each case on a national public health case management system and public health follow up is often managed jointly by HPTs and Environmental Health Officers (EHOs) in local authorities [ 2 ].

A previous study in England identified challenges in implementing exclusion in 30% of children with STEC [ 6 ]. The study identified parental anxiety and/or communication issues as the most frequently reported challenges encountered, followed by concerns over social isolation, disruption to family life, sampling issues, financial hardship and childcare. However, this study did not contribute any further insights beyond stating the encountered difficulties. Given the accumulative evidence of socioeconomic inequalities in gastrointestinal infections [ 10 , 11 ], it is becoming increasingly important to explore the hardships experienced by families and consider how these factors may play a role in adherence to exclusion policies. There is scarce research on parental experiences of prolonged exclusion due to STEC and understanding their perspective is important to facilitate better engagement with public health authorities.

To our knowledge, this is the first study to qualitatively assess the barriers and facilitators to STEC exclusion by analysing public health case record data. By doing so, this paper aims to fill the existing research gap and enhance our understanding of factors influencing successful exclusion. These insights will inform recommendations to guide effective case management, promote carers’ engagement with public health policies and facilitate compliance.

Data source

Data was obtained as part of a suite of studies undertaken among STEC cases aged < 6 years attending childcare settings with an onset date or sample date from 31st March 2018 and 30th March 2022 [ 12 ].

Data was collected from the national case management system used by HPTs to manage cases of infectious disease including STEC. The case management system includes notes on telephone conversations, email correspondence and meeting minutes relating to the case. Public Health England was the predecessor of UKHSA and as the study data collection period encompasses the times when both PHE and UKHSA served as the national public health institute, both organisation names are referenced.

The present study focuses on data regarding challenges with managing exclusion and measures to help manage exclusion.

Data collection

This qualitative document review involved data extraction performed by trained health protection practitioners ( n  = 3) or members of the national gastrointestinal team ( n  = 2). Following review of the case record, relevant data was extracted into an electronic data collection tool produced in Snap Survey (Snap 11 Professional), a web-based survey tool. Case records that included free text information on barriers to, or facilitators of, exclusion in the data collection tool, were included in this study. Collected data consisted of free text in three forms:

Direct or indirect quotes from parents (Parents reported). Indirect quotes from parents are defined as direct quotes from the case record which have been written by the health protection practitioner that directly spoke to the parents of the case e.g., “Called mother, she said she is frustrated” whereas a direct quote from parents would be a quote from an email from the parent in the case record.

Direct quotes from the case record (HPT/Environmental Health Officer (EHO) reported).

Summary created by the data collector following review of the entire case record (Reviewer noted). This format may have been recorded by the data extractors in cases where extensive notes were present in the case records.

The data source is the operational record of the public health agency, which may reflect the perspective of the practitioner creating the record but also include some direct quotes from parents.

We used thematic analysis with a framework approach to analyse the data [ 13 ]. Data from the survey was imported into Microsoft Excel and was anonymised prior to analysis. Familiarisation with the data was achieved by reading the free text several times by two authors. Initial coding was performed on approximately 20% of the data by two authors independently. The coding framework was developed based on both a priori themes arising from previous research (e.g., parental anxiety, communication issues, disruption to family, social isolation, financial issues, childcare issues and sampling issues), and new themes identified from the initial coding of the data [ 6 ]. Consensus on a coding framework was reached through discussion with the study team. This framework was then applied to the remaining free text comments by one author and used to capture key themes of interest. The coding framework was applied inductively, to allow new codes and themes to be added as analysis progressed. The themes were added and modified until data saturation was achieved.

Characteristics

Between 31st March 2018 and 30th March 2022, 367 cases of STEC aged < 6 years old with a known serotype had evidence of attending a childcare setting [ 12 ], of which 37% ( n  = 136) included free text information on barriers to, or facilitators of, exclusion in the data collection tool and were included in the study. The median age of included cases was 3 years (IQR 1.5-5), and males accounted for 49%; these were representative of the wider study population. Of the cases with ethnicity information ( n  = 104), 81 (77%) were White, 11 (11%) were Mixed or Other, 8 (8%) Asian and 4 (4%) Black. Clinical presentation of this subset of cases was comparable to the wider study population with diarrhoea or bloody diarrhoea reported in 95% and 43% of cases, respectively, and 8% of cases with HUS. There were 14 (10%) asymptomatic cases.

Overall themes

We identified nine key themes. Five themes focused on barriers to managing exclusion, including (i) financial losses, (ii) challenges with communication, engagement and collaboration, (iii) sampling, processing, and results, (iv) adverse impact on children and their families and (v) conflicting exclusion advice. The other four themes related to facilitators to exclusion, including (i) good communication with parents and childcare settings, (ii) support with childcare, (iii) improvements to sampling, testing, and reporting of results, and (iv) provision of supervised control measures. An overview of all themes identified, along with additional free text comments that informed the framework and classification of the themes is provided in Supplementary Table S1 (Table S1 ).

Key barriers in managing exclusion

Financial losses.

The financial losses incurred by the family due to exclusion were one of the major challenges encountered. Several cases had working parents, who had to take extended unpaid leave during the prolonged exclusion period, while still paying for the nursery fees.

The parents have been paying full nursery fees for 5 weeks now and having to take unpaid leave because the child is still not able to go back to nursery because of lack of results. This is costing them around £1500 a week [mum got very upset at this point]. (Reviewer noted). I cannot financially have any more time off work[, ] nor can I afford to keep paying for nursery fees he isn’t utilising. (Parents reported)

Parents also felt pressure from their employer to return to work.

The mother is very anxious to get back to work as she is not getting paid. Mum is unable to go to work whilst child is at home awaiting clearance. She is ringing EHO multiple times a day in tears as she has received a warning from work. (Reviewer noted)

Additionally, parents who were self-employed could not work properly and had to bear financial losses.

Exclusion of child prevents his mother from working. She is self-employed so losing out financially. (Reviewer noted)

Several queried if financial compensation was available to support families with nursery fees and living expenses due to lost income.

Mother asking if there is any financial support as she is still needing to pay nursery fees. (Reviewer noted)

Adverse impact on children and their families

Parents were particularly concerned about the loss of education, and the physical, mental and social impact the duration of exclusion would have on their child.

Case has been out of nursery for over a month ……. Mother also concerned of the impact this is having on the case with him being out of nursery for so long and not being able to have contact/socialise with other children[, ] this is beginning to impact him. (Reviewer noted) A very frustrated, nearly 3[-]year[-]old who is at home and not in her usual routine of attending her education. This is going to really unsettle [child] emotionally when she does have to return and then settle back into her routine. (Parents reported)

Families also reported to have experienced stress, disruption and health issues due to exclusion of their children.

The stress of the situation was causing stress on mother’s marriage and causing her physical and mental health problems. (Reviewer noted) Mother is asking for any advice as the case is asymptomatic but still testing positive, and it is becoming disruptive to the lives of child and mother. (Reviewer noted)

Furthermore, parents of children with special educational needs and disabilities (SEND) emphasised exclusion intensified an already complex situation, burdening the entire family.

Case is autistic and she is on reduced school hours due to high anxiety, it has been difficult settling her into school so the more time off the harder it will be for her to go back. Case has complex behavioural issues and staying at home is putting a lot of strain on the family. (Reviewer reported)

Additionally, some cases had limited family support, with no other alternatives for childcare which further caused difficulties in managing the exclusion.

Mum is very understanding of the situation around why we need to get clearance but is struggling with childcare provision as she normally works: she said it is very tight for her at the moment and that she has used up all her leave, and does not have family around. Difficulty finding alternat[ive]. (Reviewer noted)

Challenges with communication, engagement and collaboration

Analysis highlighted that there was lack of parental engagement with the authorities. For example, some parents did not submit samples, or respond to calls.

Case’s family were extremely hard to communicate with so there were periods of non-response to messages, calls etc. and no clearance samples being submitted. (Reviewer noted)

In some instances, parents were “disgruntled” with the clearance process. Some parents questioned the exclusion guidance, particularly concerning the reasons for exclusion when a child was asymptomatic and the requirement for two negative samples.

Mum felt that HPT didn’t understand the situation that she was in having a healthy child at home, trying to work fulltime and paying nursery fees. Nursery had all the PPE [personal protective equipment] in place and child was having a solid stool, she had never been symptomatic, she didn’t understand why she could not take [child] into nursery. (Reviewer noted) Mother struggling with childcare during prolonged exclusion and questioned why the child could not return as they were symptom free. (Reviewer noted)

At other times, the parents were frustrated with the process of exclusion and case management and ignored the exclusion advice from EHO.

Mum expressed that she was very frustrated by how this situation has been handled by GP/EH[O] as she felt she had been given conflicting advice and the way she had been notified of her child’s diagnosis at the beginning was very unprofessional. (Reviewer noted) EHO informed parents that child needs to be excluded but, despite this they sent the child into nursery anyway. (Reviewer noted)

Analysis also highlighted the challenges HPTs faced while engaging with parents who were seeking their own information from other sources.

Father had been googling and was arguing that exclusion not necessary. (Reviewer noted)

In other cases, the parents preferred to engage with their GPs or testing at private labs.

Family did not want to use PHE clearance process and used GP surgery for clearance sample as more convenient for them. (Reviewer noted) Parents preferred to submit samples to GP surgery and not via our [postal sampling] system (HPT reported).

In a specific case, the family had travelled abroad in the middle of the case’s clearance process and submitted a sample there, which was negative for E.coli . The reviewer also noted this resulted in the family being quite resistant and distrustful towards the UK process.

Some parents were not aware of exclusion or misunderstood the advice given to them, which resulted in children returning to childcare settings before the exclusion period was over.

Mother assumed the results from the second clearance sample was negative and so sent child back to school before being informed of the result.” (Reviewer noted) Parents misunderstood exclusion advice and child went back to school without any negative clearance samples. (Reviewer noted)

In certain cases, language barriers were the key factor in the misunderstanding of advice provided by public health teams.

Some language barriers resulting in confusion with sample/form labelling.” (Reviewer noted) Language barrier, family did not understand clearance, child went back once symptom free for 48 h. (Reviewer noted)

Issues with sampling, processing and results

Several issues causing delays in the sampling process were reported by parents and HPTs.

Samples submitted to GP surgery but not logged so potentially lost. (HPT reported). This [Case being out of nursery for over a month] has also not been helped by the hospital losing 2 of his stool samples and the most recent sample being “delayed” due to not being tested correctly. (Parents reported).

Further, the length of time for processing the samples, and notification of the results was seen to be prolonged, which disappointed many parents.

Called an unhappy Mum to say [reference laboratory] reporting sample for [date 1] and [date 2] are still showing as Pending. Will check again tomorrow and report asap. She complained this is “ridiculously slow”. (HPT/EHO reported) Mother very frustrated at length of time it takes to get results of clearance samples. Mum says they are submitting 4–5 samples per week but haven’t had any results now for 11–12 days. (Parents reported)

Moreover, in some cases incorrect and contradictory clearance results were provided, which further caused frustration among parents.

[Date 1] – Mum received a text this morning saying case was positive and another one this evening saying she was negative. Has also received another text which says still positive but has no name and may be about case’s sister. Mum is not happy about the confusing text messages she has receive[d]. (Reviewer noted)

Conflicting exclusion advice

In some cases, conflicting exclusion advice was provided by the different authorities, including clinicians, hospitals, GPs and EHOs.

She [Mother] was incorrectly advised by the GP to delay exclusion sampling for a week. HPT later corrected this advice” (Reviewer noted) Mother states EHO discussed child returned after 1 negative sample so was very angry to learn from HPT it was in fact 2. (Reviewer noted)

Some other cases indicated multiple agencies gave conflicting advice, which confused the parents.

Conflicting information from GP/hospital clinicians & HPT on diagnosis, sample results and exclusion requirements received by parents. Were initially told by hospital that case did not have E. coli and was clear to return to nursery - at this stage diagnostic sample results were still positive. (Reviewer noted)

On one occasion, the GPs were unsure of exclusion advice, and required HPT support.

[GP] spoke to the mother of the patient she is concerned with advice PHE have given - she has been told to keep child off nursery even though she is asymptomatic. Mother cannot work if child is not able to attend nursery. So would like clear guidance issued by PHE. GP would like PHE to call (Reviewer noted)

On some occasions, the conflicting advice given by the GPs/EHO/hospitals resulted in cases returning to their settings before achieving clearance.

Mum of case claimed to have received a call to say that samples were negative, and case could return to nursery. (Reviewer noted) Family advised by A&E that [case] could return to setting prior to exclusion advice being provided from HPT/EH[O]. (Reviewer noted)

Facilitators to manage exclusion

Good communication with parents and childcare settings.

When consistent and comprehensive communication between UKHSA and parents was maintained, this helped parents to manage difficulties that arose when their children were excluded from school or nursery:

Frequent and regular communication to parents assisted with keeping them on board. In addition, a proper explanation of the rationale including legal remit & evidence base behind the request did actually help to calm the parents (Reviewer noted)

There were instances that indicated that the parents wanted to be regularly updated.

Mum is very keen to be kept in the loop about results/to have as much communication as possible. (Reviewer noted)

The HPT were able to provide detailed information to parents on the risk of STEC infection to others, the necessity of exclusion, sampling processes and possible timescales, the legal basis for exclusion, and hygiene precaution arrangements.

HPT communicated regularly with family to explain a complex and frustrating process. (Reviewer noted)

Parents were frequently kept informed about each step of the process through phone and email to avoid confusion that came with the involvement of multiple agencies in the exclusion process:

Due to complexities with the clearance arrangements & involvement of various stakeholders, parents were starting to get confused as dealing with so many different people. HPT outlined clearly in an email a response to parents’ concerns and questions to provide some clarity including a plan for return to school (Reviewer noted) [Date] – I have this afternoon spoken to the mother of [child] and explained the process, the result and the results to come; and promised to let her know the outcome tomorrow afternoon. I have asked her to keep going with the samples till we say stop. [Date] – Called [child] Mum and gave her the good news that [child] can at last return to nursery almost 3 months after [child] original onset. Very happy Mum! (HPT/EHO reported)

EHOs developed good working relationships with parents. It helped the parents to overcome issues encountered during the exclusion process and ensure compliance with exclusion requirements.

EHO formed good working relationship with parents which helped to smooth out the issues. (Reviewer noted) EHOs developed good relationship with mother especially which helped to ensure compliance with exclusion requirements. (Reviewer noted)

Schools were also regularly contacted to give updates and multi-agency meetings were held when needed.

Joint meeting with parents and HPT and UKHSA national team and school visit to school with HPT, CICN [Community Infection Control Nurse], EHO, headteacher. (Reviewer noted)

Support with childcare

The analysis also highlighted that support with childcare was an important facilitator in parents’ ability to adhere with exclusion advice. In some cases, the HPT and EHO communicated with parents’ employers, explaining the need for the parents to have time off work due to exclusion of the child from childcare settings.

HPT wrote to employer requesting they allow family to have paid carer’s leave. (Reviewer noted) Email sent to headteacher of parent (mum) by EHO explaining the need for parent to have time off work as child cannot be sent to childcare setting until two clearance samples are received. (Reviewer noted)

In other settings, it was not needed as childcare was provided by grandparents or family friends. On certain occasions, childcare providers were requested by the HPT team to waive fees. HPTs also advised the parents to reach out to local authorities and Citizens Advice for financial support.

HPT advised mother to seek advice from the LA [local authority] regarding an emergency payment if available to support compliance. Otherwise, to contact Citizens Advice for further benefits information (Reviewer noted)

Improvements to sampling, testing, and reporting of results

HPTs and EHOs facilitated timely submission and testing of samples, as well as prompt reporting and communication of sample results to the relevant authorities, which helped to manage the exclusion. Measures taken included HPTs opting for couriers to transport samples instead of GP sampling and EHOs personally assisting with sampling at home.

HPT tried to speed up testing process by communicating directly with the lab and arranging with EHO and lab for results to be reported over the weekend. (Reviewer noted) EHO visited case’s home to take samples themselves to ensure no further confusion. (Reviewer noted)

HPT were honest about the mistakes at the laboratory and investigated the issues with the laboratory directly to obtain clarification and latest clearance results:

Email sent to parent by consultant: …. I apologise for the inconvenience you have faced in this process …. I am sorry that the clearance sampling was difficult for [Name]. The process is managed by multiple organisations and appreciate that it could be improved. I have spoken with colleagues and will be reviewing to try and make sure the delays are less likely to be repeated in future. (HPT/EHO reported)

They continued to regularly check for the results and liaised with the GP to ensure parents receive the results from EHO or HPT as soon as possible:

I will continue to chase results and before too long we will see the infection clear – they always do! (HPT/EHO reported)

Provision of supervised control measures

In some cases, a risk assessment was conducted by HPTs, EHOs, infection control nurses, childcare setting and parents, and children were allowed to return to the setting before achieving clearance, with extra hygiene and handwashing controls in place.

EHO observed hand washing – was assessed as thorough and competent. EHO also visited the school and confirmed with the inclusion teacher that case would be supervised with hand washing after using the toilet and before meals until she had two negative stool samples. (Reviewer noted)

This qualitative analysis of public health case records enhances our understanding of barriers and facilitators in managing exclusion for children with STEC. The study’s findings emphasise the complexity of exclusion, which presents challenges for a range of stakeholders, including children, parents, various public health authorities, parents’ employers and childcare organisations. There are considerable social, emotional and economic burdens placed on families that need to be considered when implementing exclusion policies.

A comprehensive understanding of barriers to exclusion in the context of STEC is vital. There may be similarities in the barriers identified for compliance with, for example, COVID-19 self-isolation [ 14 , 15 , 16 ] but the potentially lengthy exclusion period for STEC may amplify these barriers. Our findings highlight the financial and social consequences of exclusion policies on families. Working parents caring for excluded children experience both loss of income from being out of work for a prolonged period and ongoing childcare expenses. Previous research around COVID-19 often identified lack of financial support for people self-isolating as a key factor in not engaging with public health interventions [ 15 , 16 , 17 , 18 ]. With higher rates of GI infections in children from more disadvantaged groups [ 10 ], the financial costs of exclusion policies can have more severe economic consequences for these groups and widen already existing inequalities. The emotional strain of exclusion policies on both the carer and children is evident from our analysis. Parents’ concerns for their children were predominately around disruption to usual routine and reduced social and physical contact with others. These effects have been shown to have a negative impact on the psychological and physical wellbeing of children in terms of anxiety, sleep and appetite, particularly in young children with SEND [ 19 ]. The emotional and physical toll on parents identified may be attributed to balancing attempting to comply with the guidelines while doing what is felt best for their child [ 20 ]. For working parents, we also identified the pressure from their employers to return to work as a contributing factor to distress experienced in the exclusion process.

Our study also identified that challenges in cooperation with public health authorities in the clearance process were key barriers. This was often attributed to a lack of understanding of the ongoing risk of transmission in this vulnerable population after symptom resolution, the purpose of clearance samples and how these aspects fit with the overall exclusion guidance. Our analyses indicated that some parents believed measures were unnecessary for asymptomatic children, a rationale that was often cited as a key belief during the COVID-19 pandemic [ 21 , 22 , 23 ]. Previous research indicates that if carers perceive a threat as minimal, there is a risk that their child will return to the community while infectious [ 20 ]. A lack of clarity on the rationale of preventative health measures contributed to the confusion around advice on COVID-19 provided and ultimately poorer adherence [ 24 ]. Moreover, it became evident that there were difficulties encountered in sample processing, and while our study did not uncover specific reasons for these challenges, anecdotal evidence points toward incomplete sample forms or mislabelling of samples playing a role, indicating a possible need for improved clarity in the sample submission process for parents.

Our findings also suggest that disengagement with HPTs could be due to parents’ preference of completing the clearance process through their GP which may reflect the higher level of trust patients place in familiar medical professionals.

With families already having to navigate dealing with multiple authorities (HPTs, EHOs, GPs and hospitals), contradictory messages from these parties added further to frustration and sometimes resulted in children returning early to childcare setting. Lack of awareness of guidelines among clinicians outside of public health agencies may account for some of the variability in advice. Studies have shown receiving inconsistent information can lead to increased confusion, stress and loss of confidence in authorities [ 20 , 25 , 26 ].

Financial concerns and concerns about the impact on the child’s education and well-being already pose challenges to compliance with exclusion. However, the addition of having a child who is asymptomatic or experiencing delays in receiving clearance results can make an already challenging situation far more difficult and amplify existing challenges. These issues then become more embedded barriers to engaging with HPTs. Recent implementation of new rapid testing methods and more efficient logistics for processing clearance samples in laboratories local to the case should improve the timeliness of reporting results back to the parents.

Facilitators

Our analysis not only highlighted the importance of regular, honest and detailed communication between public health teams and parents as a key facilitator in effectively implementing exclusion but also communication between public health teams and all relevant stakeholders, including parents’ employers, childcare settings, GPs and laboratories. This supports previous research which has shown open communication outlining reasons for recommended actions increases perceived credibility of authorities and enhances compliance [ 27 , 28 ].

Additionally, we also show that having one team take charge of liaising with all partners proves beneficial in expediting the clearance process, as well as potentially alleviating parents’ wide-ranging concerns. Facilitators identified in relation to testing were use of couriers and assistance with sampling at home in certain cases; this may not always be practical or cost-effective but is in line with prior research indicating speed and convenience of testing [ 18 , 29 ] influence testing uptake. HPTs conducting regular risk assessments with partners resulting in implementation of precautions in settings enabled early return. Deploying this approach is dependent on the risk assessment and may only be appropriate for those children deemed as being a lower risk to return. Regular joint reviews of risk may demonstrate public health agencies’ proactive efforts to minimise the exclusion period for children, leading to improved relationships with families, ultimately enabling better adherence to exclusion policies. However, not all children can have early return; therefore, regular review may falsely raise parental expectation and cause more disappointment and thus may not be applicable for all cases.

Recommendations

The insights generated from our study highlight the importance of considering the wider social and economic effects of exclusion policies. Financial assistance programmes for lower income households are required to reduce widening already existing inequalities of GI infections.

Our study also identified examples of good practice. We suggest developing a toolkit for public health teams (HPTs in England) to support incorporation of this good practice into routine public health practice. The toolkit could be co-produced with families, childcare settings and local public health teams and be tailored for local use. It should include both existing and additional material such as frequently asked or inclusion questions (FAQs) and infographics for families and childcare settings, template letters for settings, employers and GPs, as well as a risk assessment checklist including questions on mental health and financial impact on children and families.

Aspects to be covered include:

Engage in detailed communication with parents, specifically emphasising the risk of STEC infection to others, the role of clearance in reducing asymptomatic transmission and the potentially lengthy clearance process.

Have access to translators who have previous experience of working in health protection.

Be aware of avenues of financial support locally, so practitioners have the ability to signpost families when needed.

Explain the situation to parents’ employers, which may add legitimacy to parents’ request for time off work or flexible working arrangements and alleviate tension between parties.

Liaise with childcare settings to promote the provision of support for affected children that may help with the detrimental social, mental and educational impact of exclusion.

Incorporate a holistic approach to regular risk assessments for children with prolonged shedding in close collaboration with parents, EHOs, public health microbiologists and childcare settings.

Raise awareness of STEC exclusion advice and the clearance sampling and reporting process among clinicians, to reduce the mixed messages parents receive.

Strengths & limitations

This study represents the first effort to understand implementing STEC exclusion policy through qualitative analysis of public health case records. Unlike other qualitative studies that recruit participants after the event, public health case records offer information in real-time allowing us to analyse conversations that families were having at the point of child’s diagnosis and exclusion. This may provide a better reflection of experiences in terms of minimal recall bias. Furthermore, in the absence of participant recruitment, this method mitigates potential selection bias originating from families with specific experiences seeking participation in the study. However, this approach relies on secondary data, which was not originally collected for the specific purpose of this review and data may be incomplete and lacking standardisation. A key limitation of the study was that the free text responses that were completed after reviewing the case records did not always provide a comprehensive picture. For instance, the distinction between lack of engagement from the beginning and deliberate disengagement with the clearance process among carers could not be accurately discerned. Additionally, while having 20% of the quotes reviewed by a second researcher is pragmatic, reviewing all data by more than one author would have increased reliability. Another limitation to consider is that our study focused on cases where exclusion issues were reported. This subset represents only a portion of all cases, and it is possible that the remaining cases did not experience any problems with exclusion, which could indicate the effectiveness of the current system. While ethnography or interviews may offer deeper insights, these methods are more resource-intensive and expensive, with reported challenges in recruitment [ 30 ]. Using the public health case management system as a data source generates valuable insights into the complexities of managing exclusions, with the potential for greater generalisability at less cost, and can also generate hypotheses for subsequent in-depth qualitative studies.

Qualitative analysis of public health case records is a pragmatic method to gather insights on the impact of exclusion policies on children and families. Effective implementation of childcare exclusion policies relies on developing public health practices that address the barriers and facilitators highlighted in this study. This approach can interrupt disease transmission while minimising social and economic consequences. We hope our findings inform more sensitive exclusion policies that ensure the public health benefit of exclusion is balanced against potential harm from exclusion.

Data availability

Data are incorporated into the article and material contained within. Individual level data cannot be shared due to ethical/privacy reasons. The datasets generated and/or analysed during the current study are not publicly available as the dataset is a part of clinical management database of the UK Health Security Agency, which is not publicly shared but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge the following people: Vrinda Lobo (Gastrointestinal and Food Safety (One Health) Division), Michael Harte (Gastrointestinal and Food Safety (One Health) Division) and the HPTs and EHOs involved in the management of these cases. Additional thanks to Mari Morgan, Field Epidemiology Training Programme supervisor for reviewing the manuscript.

This study is funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, a partnership between the UK Health Security Agency, the University of Liverpool and the University of Warwick. The views expressed are those of the author(s) and not necessarily those of the NIHR, the UK Health Security Agency or the Department of Health and Social Care. CR is supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections at the University of Liverpool in partnership with UKHSA in collaboration with the Liverpool School of Tropical Medicine and The University of Oxford, the NIHR HPRU in Gastrointestinal Infections at the University of Liverpool in partnership with UKHSA, in collaboration with the University of Warwick and the NIHR HPRU in Behavioural Science and Evaluation at the University of Bristol, in partnership with UKHSA. CR is based at UKHSA.

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Amoolya Vusirikala and Yanshi contributed equally to this article and share first authorship.

Authors and Affiliations

UK Health Security Agency, London, England, UK

Amoolya Vusirikala,  Yanshi, Charlotte Robin, Sam Rowell, Girija Dabke, Georgina Fox, Jade Bell, Rohini Manuel, Claire Jenkins, Nicola K Love & Sooria Balasegaram

UK Field Epidemiology Training Programme, UK Health Security Agency, London, England, UK

Amoolya Vusirikala & Sooria Balasegaram

NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, England, UK

Yanshi, Rohini Manuel, Claire Jenkins, Nicola K Love, Noel McCarthy, Dana Sumilo & Sooria Balasegaram

School of Medicine, Trinity College Dublin, Dublin, Ireland

Noel McCarthy

Warwick Medical School, School of Medicine, Warwick, England, UK

Noel McCarthy & Dana Sumilo

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Contributions

AV and YY were the principal investigators and led the writing of this report. SB, CR and SR made significant contributions to conception of the study design. AV, YY, SB, CR, SR, GD, GF, JB, RM, CJ, NL, NM and DS contributed to the interpretation of results and critical review.

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Correspondence to Amoolya Vusirikala .

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UKHSA has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002 to collect confidential patient information ( http://www.legislation.gov.uk/uksi/2002/1438/regulation/3/made ) under Sect. 3(i) (a) to (c), 3(i)(d) (i) and (ii) and 3(3) as part of its responsibility to diagnose, recognise trends, control, prevent, monitor and manage communicable diseases and other risks to public health in the population. As this work is covered by Regulation 3 it fell outside the remit for ethical review by the UKHSA Research Ethics and Governance Group. The informed consent has been waived by the UKHSA Research Ethics and Governance Group. All data were collected within statutory approvals granted to UK Health Security Agency for infectious disease surveillance and control. Information was held securely and in accordance with the Data Protection Act 2018 and Caldicott guidelines.

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Vusirikala, A., Yanshi, Robin, C. et al. Facilitators and barriers to implementing successful exclusion among children with shiga toxin-producing Escherichia coli : a qualitative analysis of public health case management records. BMC Public Health 24 , 2272 (2024). https://doi.org/10.1186/s12889-024-19580-w

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Received : 30 October 2023

Accepted : 24 July 2024

Published : 21 August 2024

DOI : https://doi.org/10.1186/s12889-024-19580-w

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