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Australian local government plays a pivotal role not only as a major element in the democratic structure of the country but also as a significant economic entity in its own right. This chapter provides a synoptic description of Australian local government and its main problems.It considers the policy environment surrounding Australian local government, and the policy-making and policy capacity in Australian local government. It proposes a stylised model of policy-making in Australian local government using structural reform through forced municipal mergers as a salient example. The chapter ends with concluding remarks about the general and academic preoccupation with ensuring the ongoing financial sustainability of local government, and makes suggestions for empirical research.

Finally, we look at some of the tools available to address the issue of climate change in the present World Power System. We must find the way to reengineer multinational enterprises in a way that they address climate change issues in their day-to-day operations. A flawed agency theory has led to improper firm governance, the maximization of shareholder short-term interests leading to a massive production of negative externalities. We need to move to true cost accounting by integrating into the accounts of reporting entities the replacement cost of the CO2 used in their value chains. Using the notion of replacement cost prevents any attempt at pricing environmental services. Pricing would be subjective and/or artificial. The move allows to go beyond the financial sustainability of firms, which is a prerequisite but is insufficient. Firms also need to show that they are compatible with the preservation of natural resources. It is the only way to ensure the sustainability of our kind of society, with strong rights of autonomy, including property rights.

This chapter first evaluates five aspects of financial sustainability: trends in health-care expenditures and their distribution by sector; sources of financing; compliance (evasion and payment delays); subsidies to supply versus demand; and the financial-actuarial balance. It then deals with efficacy or the potential impact of the reforms on health standards.

Implementation of concerted and standardised global health programmes depends on the actions of national governments. Except under extreme circumstances, national sovereignty is to be respected. Where and how do global and national actors involved with immunisation meet each other? What influences national responses to global programmes and recommendations? Analysing the relations between international organisations and national authorities more generally, research in international relations suggests, first, that a distinction has to be made between rich and poor countries, and second that nation states are under increasing pressure to meet global expectations. New vaccine introduction has become a principal concern of global organisations active in public health, notably GAVI. In this chapter it is used as a ‘probe’ with which global–national relations in the immunisation field more generally can be illuminated. Prior to GAVI local evidence, fit with national priorities and the adequacy of the delivery system played an important role in deciding on the introduction of new vaccines. This has changed, and poor countries, eligible for GAVI support, may now introduce new vaccines faster than richer countries. Highly dependent on external resources for health, Malawi is an example of such a ‘model country’. In India, by contrast, public health activists have contested the grounds on which decisions to introduce new vaccines have been taken. Critique, which has involved legal actions, has emphasised that decisions were taken despite the lack of national data proving health need. Pressures to conform, however, reflect more than dependence on external resources alone.

This chapter studies the many barriers and obstacles that groups have to deal with, as well as the support they receive. It explores the limits of what groups can or want to do, and the potential to facilitate the work of the groups. The financial sustainability of the groups is also examined. The chapter furthermore discusses the range of external supports the groups receive, the kind of help they get and where it comes from, and what forms of support the groups value.

This chapter acknowledges that mass higher education is a work in progress. It holds that higher education faces a general crisis that goes beyond the perennial challenges of financial sustainability, adjusting to new learning paradigms and new patterns of knowledge production, evolving new models of organisation and so on, and even beyond more immediate and urgent challenges such as the COVID-19 pandemic and global warming. The chapter lays down the three possible responses to this general crisis, one of which is taking a radical leap forward. It underscores that the historic link between higher education and elites must be finally broken, and that tertiary education should be available to all. Higher education must be re-centred as a progressive project.

This chapter examines the evolution of water supply as a private business from its origins in sixteenth-century London until its transfer to a public monopoly at the start of the twentieth century. Over time, services were consolidated into eight local monopolies to avoid damaging competition and then transformed through technological progress and regulation to provide treated, high-pressure, universal services affordable to all. Financial sustainability was achieved through continuous expansion and a pricing policy that kept basic household connection charges constant in nominal terms for two and a half centuries. Over the long run, users paid for services, with wealthier households providing a cross-subsidy to poorer ones over time. The policy implication is that grants, soft loans, or patient equity may be necessary to launch private water services, but that quality and price regulation are needed to drive quality improvements, achieve universal coverage, and cap excess profits.

At the core of this chapter is a series of projects in a rural community in South Africa that succeeded in developing a well-functioning community network (CN). The chapter highlights several key conditions to achieving sustainability: the community taking part in all design decisions; the efforts to build local capabilities for running and maintaining the CN; and the steps towards ensuring its financial sustainability, based on legal provisions and a well-considered business model. Research revealing the complex ecology of repair shops in developing countries strengthens some of these insights, in particular the need to practise the ‘creative repurposing’ of materials and design for the easy maintainability and repair of technical devices.

This chapter examines the Japanese social security system, which is mostly a Pay-As-You-Go (PAYGO) system. The rapid aging in Japan is expected to cause great stress on the PAYGO pension system. Never-ending reforms of social security are inevitable in Japan, where only fine-tuning of programs even in the face of changing circumstances is acceptable in the political arena. It is observed that the basic design of the pension program has to be incentive-compatible. Contributions must be much more directly linked with old-age pension benefits, while an element of social adequacy should be incorporated in a separate tier of pension benefits financed by sources other than contributions. Financial sustainability of social security pensions is unattained even if its income statement enjoys a surplus. The balance sheet approach is an indispensable tool to help us to understand the long-run financial sustainability of social security pensions and to evaluate varying financial impacts of different reform alternatives.

This chapter contains an analysis of the development of the NHS under the Coalition Government. While some argue that under the Coalition Government the UK approaches the end of the NHS, the analysis shows that the reforms initiated by the Coalition Government have diverging directions and diverging ideological foundations. Whereas in the first part of the Coalition Government’s rule merely competition, privatization and marketization dominated the debate, the second part stills carries the heritages of the neo-liberal paradigm but also introduces other measures to improve the performance of the NHS and guarantee its financial sustainability: prevention, integration and localisation. But the question is if these initiatives are strong enough to guarantee a bright future for the NHS.

The recent economic downturn has accelerated the trend toward reforms in many European countries aimed at rationalizing the levels of public investment in higher education. However, reforms have focused not only on cost-containment and budgetary cuts, but also on changes in the administrative governance of universities and accountability systems. Many European universities have embarked upon deep restructuring, with the adoption of new governance systems favoring financial accountability, cost-efficiency, and performance orientation rather than input-driven funding strategies. Underpinning these reforms, collectively termed as the “modernization agenda,” has been the assumption that public funding of higher education in Europe is not increasing enough in real terms, and, as a result, both universities and the higher-education sector need structural changes in order to respond effectively to financial and economic crises.

This chapter offers an in-depth look at health politics and the tax-financed, universal health system in Spain. It traces the development of the Spanish healthcare system, focusing in particular on its double transition in the 1980s and 1990s from a centralized social insurance system, mostly funded through workers’ and employers’ contributions, to a decentralized universal model financed by general taxation. The new national health system aimed at covering all residents and transferred healthcare competences to the regions, i.e. the seventeen Autonomous Communities, a process completed in 2001. Key issues include rationalization, harmonization, and territorial equity-building of the decentralized healthcare system; efficiency improvement through the introduction of private management elements; and cost containment to bolster the system’s financial sustainability in the context of growing demand and scarce resources. As the chapter argues, these challenges along with the remarkable changes in the political party system have increased the political salience of healthcare in public debate in the 2010s, but the prospects for developing consensual healthcare policies have worsened, such that structural problems are likely to persist.