Recent calls for a critical geographical approach to public health have facilitated an engagement with a new range of research topics and methodologies, of which obesity is a particularly prescient example. This thesis aims to first, examine and compare obesity's historical emergence in the UK and US through three conceptual spheres: governmentality the political economy of food and cultural anthropologies of consumption. Second, this work questions what obesity, as both a biomedical epidemic and one of meanings, reveals about the tensions inherent within neo-liberal governance in the two countries through examples of obesity prevention measures in London and Austin, Texas. This work charts and critically interrogates the emergence of a global epidemic of obesity in the last two decades with reference to the 'obesity studies' literature. This discussion then backgrounds an analysis of relevant policy documents and newspaper coverage showing how the biomedical epidemic has been rhetorically employed to create an "epidemic of signification", legitimating public health intervention. The UK Labour government has recently promised to "support informed choice", while in the US, the doctrine of "personal responsibility" with regards to health has been at the fore of obesity prevention policy. These epistemological differences are explored through findings from semi-structured stakeholder interviews, health survey data, censuses and market research. In the light of such discussions, the three conceptual spheres are revisited to compare and contrast the case study findings and investigate the tensions at work within UK and US neo-liberal governance. The thesis concludes that obesity is not a universal or generalisable global epidemic, but exhibits distinct and localised risk factors, health outcomes and costs that are inextricable from the wider systems of governance that both frame and manage the condition.

No description available.

The thesis aims to analyse how Social Services are organised and financed in Chile, with a special focus on the regional impact of social policies. In the first place, the study concentrates on describing the procedures and strategies that each social ministry or sector, (Health, Education, Housing, Social Security) has for financing its programmes. This makes possible for the first time in the Chilean case an intersectoral view of the organization of social services. In order to address this issue it was necessary to investigate the formal sectoral organization and its functions. Special emphasis is given to the analysis of the ministerial budgeting and planning procedures discussing its links and problems. The study also gauges the discretionary powers that the regional social services have; this was approached through the analysis of different models of decentralization and government functions. To obtain information in this area, interviews were undertaken with social sector planning and budgeting specialists. Since 1975, the Government has advocated a new "regionalization" policy, aimed at decentralising the power of national Government, eliminating regional inequalities, and reducing poverty. In the second place, therefore, the study analyses the patterns of the regional allocation of social expenditures testing its relation to regional well-being, urbanization and needs. To address this issue it was necessary to define some standard criteria to allocate the actual social expenditure figures. However, to obtain the social expenditure figures it was necessary to study the inter- and intra-ministerial transfers and price indexes. Estimates of regional social expenditures per capita are produced for the first time for Chile; they cast light on the present pattern of regional allocation of social expenditures. These figures are then compared with regional social indicators of need in order to determine the relationship between these variables. The results are presented and conclusions drawn.

The thesis investigates the occupational experience of child care social work and the way this is made a shared and meaningful activity for members of a welfare setting. It is demonstrated that social work is an inherently 'invisible' trade that cannot be 'seen' without sharing in the practitioners' own routines for understanding their complex occupational world. Social work is invisible in three ways. First, social workers who visit people in the privacy of their own homes do so unobserved by colleagues. Secondly, social work is also invisible to the extent that the outcomes of practice are uncertain and ambiguous. Lastly, social work is invisible in so far as practitioners do not typically collect, order and analyse, the events that make up their routine activities. Like all of us they engage in relationships, meanings and acts that are taken for granted and make for a predictable social world. These features of the occupational experience have profound consequences on the way work is socially organised, particularly in relation to the assessment of work as satisfactory or otherwise. The thesis examines the way in which members of a social work setting routinely organise their day to day work and make this a shared and thereby visible orderly event. In doing so the enquiry looks to organisational, collegial and consumer elements of the occupational world. it is shown that workers practice from and sustain an insulated organisational locale where there is minimal scrutiny of daily routines. They look to their immediate colleague group for a sense of esteem and occupational worth deemed absent in the work environment. Within this colleague network practices are made visible through shared assumptions about satisfactory social work. Similarly, those who receive the service are managed in the context of practitioners' definitions about appropriate relationships between themselves and the clientele. The research consists of a discovery and analysis of the way that members perceive and manage organisational, collegial and consumer relationships. In doing so the thesis reveals the typical practitioner ways of making unobserved and uncertain practice a visible predictable and satisfactory day to day activity.

Over the past few years the term empowerment has entered the common vocabulary of welfare service provision, especially since the introduction of community care legislation. The aim of this research has been to explore what empowerment means and what happens at practice level for a particular group of people in a specific welfare setting - people using learning disability services. By focusing attention on a group of hitherto relatively powerless welfare service users, this research has sought to identify some of the specific issues and problems involved in translating the rhetoric of empowerment into practice. A qualitative, ethnographic approach was adopted, using participant observation as the primary research method.This thesis has been organised into eight chapters: Chapter One provides an introduction to this research. Chapter Two is a review of the literature relating to empowerment, particularly in the context of welfare service delivery and community care.Chapter Three provides a broad overview of relevant local and national policies, and the specific political,organisational and managerial structure of the learning disability services looked at during fieldwork. Chapter Four gives details of the research methodology and methods used. Chapters Five to Seven embody the principal fieldwork findings that emerged,organised into three broad 'case study' areas. These focus attention on advocacy, in-service training and people's everyday experiences of using services and living in the community. Finally, Chapter Eight summarises and discusses the main findings, including some practical suggestions for moving forward towards making empowerment a reality.A number of issues emerged during fieldwork that highlighted the problems in practice associated with different empowering strategies. As far as advocacy is concerned, there appeared to be little 'bottom-up' control within collective self-advocacy groups who remained reliant upon service provider support. There were also relatively few people involved, either individuallyor collectively. in speaking up for themselves. In service training initiatives were revealed as potentially empowering, especially those involving people using services. However, values based training, specifically intended as empowering, appeared to be less effective. especially for those staff who held entrenched ideas and attitudes. Finally, the everyday experiences of people using services highlighted the problems involved in protecting and empowering 'vulnerable' people; the inextricable links between 'service user' and 'citizen' empowerment; and the variety of mediating factors affecting empowerment practice including the nature of bureaucratic services. wider structural inequalities and interpersonal relationships.Overall, this research highlights the greater ease of talking about empowerment compared to actually putting it into practice. Also, the importance of paying more attention to listening to the views of people using services regarding empowerment.

The overall scope of this thesis is to document the relevance of health capital investments for development, as well as highlighting barriers for the accumulation of health capital in the context of policies and programmes aimed to this. In order to promote development, Mexico decided to focus its social policy on generating incentives for human capital investments. For this approach to work, returns to human capital, part of which is health, have to be positive and sufficiently high. Using data from a national representative survey, I found that returns to health in Mexico are positive and in order of magnitude similar to those reported for other countries, and that social mobility is present, although still there is an important intergenerational transmission of educational attainments. One key assumption for interventions and policies aiming promote development through increasing the accumulation of human capital, and in particular health capital is that increasing access and utilization of health services will translate into health capital. The capacity of health services to generate health is related to its quality. Structural quality is a necessary but not sufficient factor for quality. I present results for primary health services in Mexico, showing that magnitude of heterogeneity on structural quality is large, and that is negatively correlated with locality marginalization. One key element for development is the accumulation of appropriate levels of human capital. Insufficient attention has been paid to factors that may counterbalance investments in human capital. Risk behaviours such as smoking and unprotected sex may reduce both creation of human capital and accumulated stock. Analyzing data from the Mexican CeT programme Oportunidades, I found that this programme may decrease participation in risk behaviours, although among its target population (poor households) they are still highly prevalent. The analysis reported in this thesis makes the case for increasing investments in health capital among the means through which to increase the accumulation of human capital, but at the same time devoting resources to increase the chances of these investments in translating effectively to human capital. That is, increasing quality of health services and promoting healthy behaviours.

No description available.

Care for people with dementia impacts on citizenship, in particular, judgements about capacity affect legislative rights. As a matter of social justice, people considered 'vulnerable', need more rather than less protection by and from the State. Health and social care practitioners attempting to work in ways which support citizenship, find themselves negotiating conflicting ideological positions. This thesis examined social work and community psychiatric nurse practice to analyse how people with dementia were dis/empowered in the care process. Practice values were analysed using the feminist'ethic of care' perspective. Conventional approaches to dementia were critically examined. Dementia is considered a contested concept, therefore a feminist, social constructivist approach was taken. The methods of observations of practice and in-depth interviews were used to establish what informs citizenship based care for people with dementia. The data were analysed using theories related to values, empowerment, and current policy. It was found that though citizenship was substantially upheld for people with dementia, 10% of people with dementia in this research were detained against their will, the most restrictive of care outcomes. Practitioners' values guided this practice, rather than available policy or legislation. Policy and practice guidance for citizenship-based care is provided.

Based on the experiences of Chinese in London, this research has sought to respond to debates about the construction of ethnic identity. It explores how a diverse sample of Chinese people living in London define their identity and the extent to which they construct a shared notion of ‘Chineseness’. In-depth interviews and a focus group were carried out to explore meaning and sensemaking of Chinese identity. Unlike most research on the Chinese in Britain which has studied subgroups of the Chinese, this project involved a diverse range of Chinese people with different backgrounds and experiences. A striking feature of the findings is that the Chinese individuals managed to simultaneously hold on to a sense of an ‘imagined community’ while at the same time accommodating multiple attachments to cultures and places. The experience of being Chinese in London is a complex interplay between the seemingly bright boundary of ‘community’ and the blurry boundaries of multiple identities. It is a dynamic negotiation of these identities in different ways in different contexts. It also involves multiple attachments to different scales of home, not just to the Chinese nation but also places across countries at national and local levels. Chinese identity is a performance of negotiating identities in relation not just to the non-Chinese, but also to other Chinese people. In this ‘dance’ of Chineseness, my own position as a recent migrant from China who speaks both Mandarin and Cantonese was crucial. I encountered shifting identifications by the participants in the course of the interviews, a process which may differ for researchers from other backgrounds. My supervisors, who are non-Chinese, also added important dimensions to the development of the study.

The thesis assesses the degree to which the Malaysian government exerts influence over the activities of private providers in health. The government's stated objective in its mid-term Review of the Sixth Malaysia Plan (1991-1995) and Seventh Malaysia Plan (1996-2000) is to gradually reduce its role in the provision of health services and increase its regulatory and enforcement functions. The thesis examines the functioning of the regulatory system. It investigates the role of local government in licensing new hospitals and the Malaysian Medical Council and Malaysian Medical Association in regulating doctors. The study focuses on the issues of management and analysis of information, and the principal-agent relationship. The study demonstrates that many of the Government's objectives for regulating the private health sector are not realized due to lack of legal frame work as well fragmentation and lack of coordination among the relevant agencies. This is compounded by insufficient funding for a personnel policy that would increase its capacity. The study also demonstrates that the regulatory bodies of the medical profession do not reflect the interest of the users adequately. Their composition mostly represents medical practitioners and medical organisations. Their regulatory processes do not provide clear channels through which users can voice complaints. There are few sanctions for behaviour that harms patients.