<p>The global HIV/AIDS pandemic has emerged alongside a changing world order marked by the growing power and authority of business, new constraints on public authority and policy autonomy, and new global hierarchies, inequalities, and contradictory tendencies. These conditions have helped midwife new configurations of public and private power, authority, and relations and shaped normative and operating environments for global health governance. In these contexts, public-private partnerships emerged as an institutional experiment, ostensibly to address health governance gaps and failures, including access to HIV and AIDS medicines in the global South. This study investigates the growth and roles of private authority in health governance through the lens of four case studies of public-private partnerships intended to enhance access to HIV and AIDS medicines in the global South. The study reveals that public-private partnerships in health emerged from this history as institutional experiments, yet not convincingly as functionalist responses to governance gaps and failures. The history demonstrates that private business actors opted to engage in partnerships in the contexts of a convergence of social, political, and commercial pressures, and normative and structural transformations in the world order. The case study partnerships emerged as accommodation or <em>trasformismo </em>strategies which offered concessions in an attempt to neutralise and co-opt social contestation around treatment access, without succumbing to demands for deeper structural and legislative reforms. These strategies offer bilateral, narrow, and tactical contributions in a framework of poor design, governance, accountability, and equity considerations and obligations, and are ultimately unconvincing in their commitment or capacity to expand access to HIV and AIDS medicines. Ultimately, public-private partnerships in health present practical, strategic, and normative consequences that necessitate new approaches to reform and/or serious reconsideration of their role and prospects in global health governance.</p> / Doctor of Philosophy (PhD)

With the rising cost of health care, the debate about where each dollar is spent is putting increasing pressure on decision makers. Consequently, one of the biggest challenges of providing health care to rural populations, specifically, is determining which communities should receive funding to address access to services. Defining rurality in the context of health care is a challenge that governments and health care providers have struggled with for years. Each stakeholder in Canada’s health care system has developed different criteria for defining rurality to inform policy. Currently there is a gap in academic research exploring the benefits of applying Geographic Information Systems (GIS) in rural health care policy and program decision support. GIS can provide insight into rural health care accessibility by modeling and measuring the way patients seek medical treatment. This thesis seeks to explore usability mapping issues and identify how policy makers perceive rurality when presented with information displayed on a map. Usability in this study influenced the perceived usefulness of the mapping tool. Overall study participants felt that mapping tools should be used as a form of decision support in rural health policy issues. Mapping was seen as tool to obtain quicker consensus among decision makers, to provide more context to rural issues in the study scenario, and used as a platform which could potentially assist in the identification of new criteria used to define rural health policy. In terms of usability, system usability design principles play a key role in the success and adoption of mapping tools among rural health policy makers. The study found that Google Earth’s software design violated Nielsen’s usability design principles in the following categories: Help and Documentation, User Control and Freedom, and Navigation. Despite these usability issues, participants found the mapping tool to have three main advantages over the paper-based decision support, the tool allowed them to: 1) gain a more complete picture of the surrounding communities; 2) understand the proximity of health services; and 3) gain greater awareness of the geography of the area. / Graduate

EMS providers work in a high-stress environment and are routinely exposed to critical incidents. Many providers are left to deal with the chronic stress on their own, either because of lack of effective employer-based programs or a culture that discourages its use. The extent to which these factors -- as well as personal characteristics such as resilience, PTG, and coping skills -- influence PTSD and suicide ideation among EMS providers has not been well studied among EMS providers. An online survey was administered to a convenience sample of EMS providers. Of the 2,683 respondents, more than one quarter (27.7%) met the PTSD criteria of 50 or higher on the PCL-M. Close to half of the respondents (42.0%) reported having contemplated suicide in the last six months. Of those who had contemplated suicide in the last 30 days, nearly one third (27.1%) thought about suicide 10 or more days in the last 30 days. EMS culture and resilience were negatively associated with PTSD, while positive associations were found with some coping styles. PTSD scores and suicide ideation frequency were highest when post-incident services were not available in the workplace. No significant relationships were found between personal factors and suicide ideation.

The issue of how to test and ultimately regulate tobacco products represents a critical challenge for the public health community. Although the current international testing regime for conventional cigarettes is widely acknowledged to be seriously flawed, there is a lack of data to guide potential alternatives, particularly in the area of human puffing behaviour. The current study sought to: 1) collect naturalistic measures of smoking behaviour, 2) examine the extent to which levels of tar, nicotine, and carbon monoxide from each of five testing protocols were associated with measures of nicotine uptake among smokers, and 3) examine the validity of self-report measures of smoking behaviour. These questions were examined through two different studies. First, a field study of smoking behaviour was conducted with 59 adult smokers, who used a portable device to measure smoking topography over the course of 3 one-week trials. Participants were asked to smoke their usual ?regular-yield? brand through the device for Trial 1 and again, 6 weeks later, at Trial 2. Half the subjects were then randomly assigned to smoke a ?low-yield? brand for Trial 3. The smoke intake and constituent yield of each brand was then tested under five testing protocols: ISO, Massachusetts, Canadian, a Compensatory protocol, and a Human Mimic regime. Participants also completed self-report measures of puffing behaviour at recruitment and immediately following each of the three one-week smoking trials. Several of these self-report measures were subsequently included in the Waves 2 and 3 of the International Tobacco Control Policy Evaluation (ITC) Survey?an international cohort survey of adult smokers from Canada, Australia, the US, and the UK. <br /><br /> The results of the field study indicate a high degree of stability in puffing behaviour within the same smoker over time, but considerable variability between smokers, including those smoking the same brand. Puffing behaviour was strongly associated with cotinine levels, particularly when included in an interaction term with cigarettes per day (<em>Part r</em> = . 50, <em>p</em><. 001). Smokers who were switched to a ?low-yield? cigarette increased their total smoke intake per cigarette by 40% (<em>p</em>=. 007), with no significant change in their in salivary cotinine levels. <br /><br /> The results indicate systematic differences between human puffing behaviour and the puffing regimes used by machine testing protocols. The puffing behaviour observed among participants during the one-week smoking trials was significantly more intense than the puffing parameters of the ISO and Compensatory testing regimes. When cigarette brands were machine tested using participants? actual puffing behaviour, the results suggest that participants ingested two to four times the level of tar, nicotine, and carbon monoxide indicated by the ISO regime, and twice the amounts generated by the Compensatory regime for ?regular-yield? brands. The Canadian and Massachusetts regimes produced yields much closer to the ?Human Mimic? yields, although nowhere near a maximum or intense standard, as they were designed to do. Only the nicotine yields from the Human Mimic regime were correlated with measures of nicotine uptake among smokers, and only moderately so (<em>Part r</em> = . 31, <em>p</em>=. 02). <br /><br /> Self-report measures of puffing behaviour collected during the field study were moderately correlated with physiological measures of puffing and exposure. Self-report measures of puff depth and puff number showed some promise as predictors of salivary cotinine, although the results are characterized by inconsistencies across models. The self-report measures included in the ITC survey were only weakly associated with age and cigarettes per day, with modest between-country differences. <br /><br /> Overall, this research highlights the importance of puffing behaviour as a determinant of smoke exposure, and provides strong evidence of compensatory smoking for ?low-yield? brands. The findings also highlight the variability in human smoking behaviour and the limitations associated with machine testing protocols. Perhaps most important, the findings underscore the immediate need to revise the ISO protocol, which systematically underestimates smoking behaviour among humans and exaggerates differences between cigarette brands.

<p>After the 2012 London Summit on Family Planning, there have been major strides in advancing the family planning agenda for low and middle-income countries worldwide. Much of the existing infrastructure and funding for family planning access is in the form of supplying free contraceptives to countries. While the average yearly value of donations since 2000 was over 170 million dollars for contraceptives procured for developing countries, an ongoing debate in the empirical literature is whether increases in contraceptive access and supply drive declines in fertility (UNFPA 2014). </p><p>This dissertation explores the fertility and behavioral effects of an increase in contraceptive supply donated to Zambia. Zambia, a high-fertility developing country, receives over 80 percent of its contraceptives from multilateral donors and aid agencies. Most contraceptives are donated and provided to women for free at government clinics (DELIVER 2015). I chose Zambia as a case study to measure the relationship between contraceptive supply and fertility because of two donor-driven events that led to an increase in both the quantity and frequency of contraceptives starting in 2008 (UNFPA 2014). Donations increased because donors and the Zambian government started a systematic method of forecasting contraceptive need on December 2007, and the Mexico City Policy was lifted in January 2009. </p><p>In Chapter 1, I investigate whether a large change in quantity and frequency of donated contraceptives affected fertility, using available data on contraceptive donations to Zambia, and birth records from the 2007 and 2013 Demographic and Health Surveys. I use a difference-in-difference framework to estimate the fertility effects of a supply chain improvement program that started in 2011, and was designed to ensure more regularity of contraceptive supply. The increase in total contraceptive supply after the Mexico City Policy was rescinded is associated with a 12 percent reduction in fertility relative to the before period, after controlling for demographic characteristics and time controls. There is evidence that a supply chain improvement program led to significant fertility declines for regions that received the program after the Mexico City Policy was rescinded. </p><p>In Chapter 2, I explore the effects of the large increase in donated contraceptives on modern contraceptive uptake. According to the 2007 and 2013 Demographic and Health Surveys, there was a dramatic increase in current use of injectables, implants, and IUDs. Simultaneously, declines occurred in usage of condoms, lactational amenorrhea method (LAM), and traditional methods. In this chapter, I estimate the effect of the increase in donations on uptake, composition of contraceptive usage, and usage of methods based on distance to contraceptive access points. The results show the post-2007 period is associated with an increase in usage of injectables and the pill among women living further away from access points. </p><p>In Chapter 3, I explore attitudes towards the contraceptive supply system, and identify areas for improvement, based on qualitative interviews with 14 experts and 61 Zambian users and non-users of contraceptives. The interviews uncover systemic barriers that prevent women from consistently accessing methods, and individual barriers that exacerbate the deficiencies in supply chain procedures. I find that 39 out of 61 women interviewed, both users and non-users, had personal experiences with stock out. The qualitative results suggest that the increase in contraceptives brought to the country after 2007 may have not contributed to as large of a decline in fertility because of bottlenecks in the supply chain, and problems in maintaining stock levels at clinics. I end the chapter with a series of four recommendations for improvements in the supply chain going forward, in light of recent commitments by the Zambian government during the 2012 London Summit on Family Planning.</p> / Dissertation

The study of policy transfer has seen remarkable developments and received considerable attention in developed countries, but it has so far been ignored in the context of Libya. Thus, this research will fill a gap in the literature and further understanding of the topic of policy transfer, not only in relation to Libya but developing countries in general. This thesis aims at providing a comprehensive and systematic picture of the public health care system in Libya and, at the same time, to learn lessons from the UAE which can be transferred to the Libyan context in order to achieve a more effective health service. At the theoretical level, this research depended on the assumption that lessons can be drawn from the UAE to help build the public health system in Libya. This was achieved through the application of the framework of policy transfer. In order to build a more complete picture in relation to the success or failure of the transfer, the path dependency approach was used to explain the importance of old trajectories or how past legacy can lead to “lock-in" or decrease the ability of the lesson-drawing. Empirically it examined the public health sector in Libya as its main case study, comparing it with the UAE. Qualitative data collection methods were used, including personal interviews and official documents. With this in mind, the research aims to understand the public health care systems in the two countries and, through comparative analysis, make suggestions as to what lessons can be learned. The findings reveal that many lessons can learned from the practices of the UAE public health policy. Such experiences would help to remove the problems in public health services in Libya as well as to facilitate improvement of policies and plans. However, there are two factors, namely the legacy of the past regime and state capacity, which may hinder the success of the transfer. Furthermore, political will held by policy makers, including a desire for modernization of the public sector, could facilitate the transfer of the suggested lessons.

Background: With almost 80,000 Europeans estimated to die annually from the consequences of exposure to second-hand smoke (SHS) and over a quarter of all Europeans being exposed to the toxins of cigarette smoke at work on a daily basis, SHS is a major European public health problem. Smoke-free policies, i.e. policies which ban smoking in public places and workplaces, are an effective way to reduce exposure. Policy options to reduce public exposure to SHS were negotiated by European Union (EU) decision makers between 2006 and 2009, resulting in the European Council Recommendation on smoke-free environments. A variety of stakeholders communicated their interests prior to the adoption of the policy. This thesis aims to analyse the engagement and collaboration of organisational stakeholders in the development of the Council Recommendation on smoke-free environments. Methods: The case study employs a mixed method approach to analyse data from policy documents, consultation submissions and qualitative interviews. Data from 176 consultation submissions serve as a basis to analyse the structure of the policy network using quantitative network analysis. In addition, data from these submissions, selected documents of relevance to the policy process and 35 in-depth interviews with European decision makers and stakeholders are thematically analysed to explore the content of the network and the engagement of and interaction between political actors. Results: The analysis identified a sharply polarised network which was largely divided into two adversarial advocacy coalitions. The two coalitions took clearly opposing positions on the policy initiative, with one coalition supporting and the other opposing comprehensive European smoke-free policy. The Supporters’ Alliance, although consisting of diverse stakeholders, including public health advocacy organisations, professional organisations, scientific institutions and pharmaceutical companies, was largely united by its members’ desire to protect Europeans from the harms caused by SHS and campaign for comprehensive European tobacco control policy. Seemingly coordinated and guided by an informal group of key individuals, alliance members made strategic decisions to collaborate and build a strong, cohesive force against the tobacco industry. The Opponents’ Alliance consisted almost exclusively of tobacco manufacturers’ organisations which employed a strategy of damage limitation and other tactics, including challenging the scientific evidence, critiquing the policy process and advancing discussions on harm reduction, to counter the development of effective tobacco control measures. The data show that the extent of tobacco company engagement was narrowed by the limited importance that industry representatives attached to opposing non-binding EU policy and by the companies’ struggle to overcome low credibility and isolation. Discussion: This study is the first that applies social network analysis to the investigation of EU public health policy and systematically analyses and graphically depicts a policy network in European tobacco control. The analysis corroborates literature which highlights the polarised nature of tobacco control policy and draws attention to the complex processes of information exchange, consensus-seeking and decision making which are integral to the development of European public health policy. The study identifies the European Union’s limited competence as a key factor shaping stakeholder engagement at the European level and presents the Council Recommendation on smoke-free environments as an example of the European Commission’s successful management of the policy process. An increased understanding of the policy network and the factors influencing the successful development of comprehensive European smoke-free policy can help to guide policymaking and public health advocacy in current European tobacco control debates and other areas of public health.

Este é um estudo das relações intergovernamentais entre as três esferas de governo que ocorrem na implantação e implementação da política de saúde no estado do Acre, com o foco na função de coordenação da esfera estadual do SUS na condução dessa política. A investigação buscou identificar como ocorre essa coordenação que envolve transferências de recursos financeiros entre as esferas de governo que são negociados no âmbito do sistema de saúde. A investigação foi centrada na Secretaria Estadual de Saúde e na Secretaria Municipal de Saúde de Rio Branco. Os demais 21 municípios do estado foram estudados nas suas relações com a esfera estadual no seu papel de gestora do sistema de saúde. Foi adotada a estratégia do estudo de caso para caracterizar, descrever e analisar o Sistema Único de Saúde do Acre no período do início da década de 1990 até o final de 2008. Para contextualizar as especificidades do Acre foram estudados os serviços de saúde antecedentes ao SUS. Realizou-se investigação documental, observação sistemática e entrevistas com os principais atores envolvidos com essa política. A implantação do SUS no Acre foi um processo lento com divergências entre as esferas de governo quanto à descentralização dos serviços. Essas divergências eram maiores e retardavam mais o processo nos municípios onde os gestores locais tinham identificações partidárias diferentes do gestor estadual. O processo de implantação da política de saúde no Acre aconteceu em cenários de escassez de recursos financeiros sendo que em alguns momentos os poucos recursos e falhas administrativas causaram graves crises nos serviços. Em 1999, a receita fiscal do Estado do Acre foi de 81,83 milhões de Reais e os gastos com a saúde foram de 97,37 milhões de Reais. Em 2008, a receita fiscal foi de 555,33 milhões de Reais e os gastos com a saúde foram de 373,48 milhões de Reais. Embora pareça um significativo aumento da receita, nesse período houve a descentralização de serviços de saúde para os municípios e os mesmos passaram a receber recursos financeiros da União para sustentarem seus serviços. Tanto na esfera estadual como nos municípios, a sustentação da política de saúde depende dos recursos da União. As relações da esfera estadual do SUS com os municípios passaram por sucessivos conflitos para a descentralização de serviços e no período recente persiste um tratamento desigual da esfera estadual em relação aos municípios / This is a study of intergovernmental relations between the three spheres of government that occur in the deployment and implementation of health policy in the state of Acre, with the focus on the coordinating role of the state sphere of SUS in the conduct of that policy. The investigation sought to identify how this coordination occurs which involves transfers of funds between the spheres of government that are traded within the health system. The investigation was centered on the State Health Department and the Municipal Health Secretariat of Rio Branco. The remaining 21 counties in the state were studied in their relations with the state level in his role as manager of the health system. We adopted the strategy of case study to characterize, describe and analyze the National Health System of Acre during the beginning of the 1990s until the end of 2008. To contextualize the particularities of Acre were studied health services background to SUS. We carried out documentary research, systematic observation and interviews with key actors involved with this policy. The implementation of the NHS in Acre was a slow process with divergent levels of government regarding the decentralization of services. These differences were larger and more retarded the process in the municipalities where local managers had different party identifications of the state administrator. The implementation process of health policy happened in Acre on scenarios of scarcity of financial resources and in some instances the few resources and administrative failures caused serious crises in services. In 1999, tax revenue of Acre was 81.83 million Reais and health spending were 97.37 million Reais. In 2008, tax revenue was 555.33 million Reais and health care expenditures were 373.48 million Reais. Although it seems a significant increase in revenues during this period was the decentralization of health services to municipalities and they began to receive Union funds to sustain their services. Both at the state level as in the municipalities, the support of health policy depends on the resources of the Union\'s relations with the state level SUS municipalities have gone through successive conflicts for the decentralization of services and in the recent period there remains an unequal treatment of state level in relation to municipalities

Por mais de trinta anos, a República de Angola esteve envolvida em uma guerra civil que gerou um impacto negativo no desenvolvimento nacional, na saúde e nutrição da população, especialmente de crianças e mulheres. Especificamente com relação à saúde da mulher, devido à guerra civil e à agitação política nos últimos anos, a literatura dispõe de dados pouco precisos sobre a situação da saúde da mulher angolana; porém as fontes disponíveis demonstram que as taxas de mortalidade materna e de fecundidade são elevadas. Considerando o contexto sócio- político-econômico atual e a prática assistencial em saúde disponibilizada às mulheres angolanas, torna-se evidente a necessidade de se analisar historicamente as políticas públicas relacionadas a esta área de atuação, no sentido de fornecer subsídios para que profissionais de saúde compreendam a importância das diretrizes políticas que devem ser seguidas na assistência à mulher angolana. Objetivos: o objetivo geral deste estudo é descrever o panorama histórico das políticas públicas voltadas à saúde da mulher em Angola, considerando o contexto político e econômico desde 1975 até a atualidade. Os objetivos específicos são contextualizar historicamente o período de análise; identificar os documentos relacionados às políticas de saúde da mulher em Angola; analisar os documentos identificados utilizando os preceitos da análise documental. Método: Trata-se de pesquisa de perspectiva histórica, utilizando a análise documental e análise categorial de dados históricos oficiais provenientes do Ministério da Saúde (MINSA), Direção Nacional de Saúde Pública (DNSP) e de site oficial da Organização Mundial da Saúde (OMS) no período de 1975 a 2012. Os documentos foram identificados, selecionados e obtidos durante o período de setembro a novembro de 2012, nos sites oficiais da OMS, UNICEF, e do Ministério da Saúde de Angola (MINSA) e alguns documentos foram solicitados diretamente à DNSP e MINSA, com o apoio do Instituto Superior de Enfermagem da Universidade Agostinho Neto. O corpus documental foi constituído de manuais, relatórios, boletim, leis e planos referentes à temática do estudo. Resultados: de acordo com a contextualização do período, a guerra prolongada impediu o desenvolvimento de um sistema de saúde adequado e, após a guerra, os investimentos voltados ao setor da saúde ainda não conseguiram estruturar uma rede de assistência que possa atender a toda a população. Com relação às políticas de saúde da mulher, destaca-se que estas se misturam com as políticas de saúde para a população, com investimentos suecos e de organismos internacionais que visavam a melhoria das condições de saúde da mulher e também da população em geral. As políticas e os acordos elaborados foram fortemente influenciados pela conjuntura mundial no período, apesar do aspecto cultural de desvalorização da mulher, tão presente no país. Houve uma grande dificuldade para a completa implementação das ações previstas, por inúmeros fatores, que vão desde as dificuldades geográficas e econômicas, até a adequada gestão política e financeira dos recursos. Considerações: evidencia-se que as necessidades de saúde das mulheres em Angola ainda não são completamente atendidas. Apesar dos esforços realizados durante o período, o desafio de Angola continua sendo a melhoria da prestação de cuidados de saúde, que engloba a saúde da mulher, e o aumento do acesso a serviços de qualidade a toda a população. A articulação inter-setorial também é necessária, pois pode potencializar as ações para a melhoria das condições de vida geral da população / For over thirty years the Republic of Angola was involved in a civil war that led to a negative impact on national development, in health and nutrition of the population, especially children and women. Specifically with regard to women\'s health, due to civil war and political unrest in recent years, the literature has little accurate data on the health situation of Angolan women; however the available sources demonstrate that rates of maternal mortality and fertility are high. Considering the current socio-economic-political context and assistance practice in health care available to Angolan women, it becomes evident the need to analyze historically public policies related to this area, in order to provide subsidies for health professionals understand the importance of the political guidelines that must be followed in assistance to Angolan woman. Objectives: The essential aim of this study is to describe the historical background of public policies for women\'s health in Angola, considering the political and economic context from 1975 to the present. The specific objectives are to contextualize historically the period of analysis, to identify the documents related to women\'s health policies in Angola; review the documents identified using the precepts of documentary analysis. Method: It\'s a survey of historical perspective, using documentary analysis and categorical analysis of official historical data from the Ministry of Health (MINSA), the National Public Health (DNSP) and the official website of the World Health Organization (WHO ) in the period between 1975-2012. The documents were identified, selected and collected during the period of September to November of 2012, at the official websites of WHO, UNICEF, and the Ministry of Health of Angola (MINSA) and some documents were requested directly to the DNSP and MoH, with support from the Higher Institute of Nursing, University Agostinho Neto. The documentary corpus consisted of manuals, reports, newsletter, laws and plans relating to the theme of the study. Results: According to the contextualization of the period, the prolonged war prevented the development of a proper health system and, after it, the investments directed to the health sector have failed to structure a support network that can meet the entire population\'s needs. Regarding to women\'s health policy, it is emphasized that these are mixed with health policies for the population, with Swedish and international organizations investments which aimed the improvement of the conditions of the women\'s health and also of the general population. The policies and agreements drafted were heavily influenced by the global conditions in the period, despite the cultural aspect of depreciation of women, strongly present in the country. There was a great difficulty for the complete implementation of the actions planned, for numerous factors, ranging from geographic and economic difficulties, to proper political and financial management of resources. Considerations: it is evident that the health needs of women in Angola haven\'t been completely met. Despite the efforts made during the period, the challenge of Angola remains being the improvement of health care provision, which includes women\'s health, and the enlargement of the access of quality services for the entire population. The intersectoral coordination is also necessary because it may increase the actions to improve the general living conditions of the population

A comparative history of the development of palliative care services and policies in England and the Netherlands during the post-war period is presented in this thesis. These countries were chosen as England is the country where the modern hospice movement started, whereas a different set of services developed in the Netherlands. Examples of questions addressed are why the service developments in these two countries differed substantially and how specialist services for the dying related to the health care system. Given the choice to study England and the Netherlands, attention had to be paid to the impact of the acceptance or rejection of euthanasia on the development of palliative care as well. Chapter 1 provides an overview of the thesis and its aims. It also includes a literature review and elaborates on the comparative research approach chosen. Chapter 2 discusses the development of palliative care services and policies in England. The main topics addressed are the establishment, expansion, and diversification of palliative care services by the voluntary sector and the governmental policies that led to an increasingly close connection between these voluntary organisations and the National Health Service. Chapter 3 is an intermezzo that discusses the main characteristics and developments of the health care system in the Netherlands. Chapter 4 considers the role of nursing homes in the development of palliative care in the Netherlands. It is concluded that these institutions cannot be considered the equivalent of the English hospices. Moreover, two projects to improve care for the dying and their attempts to obtain public funding are discussed. Chapter 5 focuses on various models for specialised services for the dying that were developed in the Netherlands during the 1980s and early 1990s. Major differences with the English hospice based model of palliative care existed as volunteers had a central role in providing palliative care in the Netherlands. Moreover, the Dutch government aimed to develop palliative care as a generalism rather than the specialism that it became in England. Chapter 6 covers the period from the mid 1990s to the present. The policy programme that the Dutch government initiated because of the imminent legalisation of euthanasia, and its impact on palliative care are the main topics. Conclusions, illustrations of the policy relevance of these histories, and suggestions for further research are presented in the final chapter.