The thesis addresses the diversity of concerns to be represented in the calculative practices of clinical efficiency decisions. The empirical site taken is the National Institute for Health and Clinical Excellence (NICE) and its Health Technology Assessment (HTA) process. The HTA process represents many diagnostic areas within one centralised, calculable process. The qualities of calculative practice, which mediate such complexity within one central framework, are explored. The theoretical lens used to examine the perceptions of calculative practices, from diverse human contributors in HTA, is Actor Network Theory (ANT). In particular, Callon's (1986b) Sociology of Translation is used along with key insights from Latour (1987, 2005). This is underpinned with an interpretative approach to defining calculative practices. The empirical examination involved observations of HTA meetings and interviews with key actors who were involved in contributing to HTA decision making. The degree of enrolment which human actors had with the NICE HTA black box, was shown to vary with several networking elements. These included diagnostic area, tenure of HTA experience, repertoire of health economics, personality/motivation and inter-contributor dynamics. Findings are presented within these particular issues and are analysed through the four stages of Callon’s (1986b) model: problematisation, interessement, enrolment and mobilisation. Theoretical and empirical contributions are centred on the examination of NICE, using ANT. Accounting's use of ANT is advanced. The thesis contributes to accounting's work within a healthcare context and advances the need to examine calculative practice with a broad and reflexive interpretation as to what constitutes form.

The initial part of this thesis is an exploration of the effectiveness of health education campaigns that utilise the mass media. Research evidence is drawn from the traditions of media effects, audience reception and health campaign development which has qualified the author's understanding of what mass media could achieve in the health domain. In Britain, the frustrations resulting from the limited success of mass media campaigns in health education have in recent years led some health educators away from conventional approaches to using the mass media to promote their health messages and towards more imaginative strategies. This thesis utilises one innovative project as a case study which has drawn on the knowledge from earlier failures and successes with mass media, and sought to incorporate best practice in an integrated media based health communication strategy. The development of a health alliance between four district health authorities in the West Midlands, and a BBC Local Radio station is the basis for the case study on which this research is based. This alliance led to the development of a media-based health communication strategy that incorporates models of media advocacy, education entertainment and social action broadcasting. This thesis is based on the implementation of the case study. Focusing on the implementation of the strategy enabled an exploration of the relationship interface of the three partners, drama production, programme production and health professionals; with each group exhibiting differing norms and values in terms of their perception of health and mode of operation. The empirical part of the thesis consists of an ethnographic account and analysis of the relationship interfaces with the three parties involved in the implementation of the health communication strategy, health, drama and programme production staff. The thesis concludes with a discussion of the research findings in the context of their relevance, for health promotion specialists, broadcasters and communication researchers, in seeking to affect the portrayal of health.

Section one is a systematic literature review that has carefully explored the inferred relationship between adult attachment style and empathy, with consideration to the theoretical underpinnings to such a relationship. The papers reviewed were quality appraised and methodological weaknesses were acknowledged throughout. The review suggests that there may be a positive relationship between attachment security and empathic traits. This is followed with a discussion highlighting some of the associated clinical implications, particularly with respect to professions who have a caring or supportive role towards people in need. Section two addresses some of the issues raised in section one, by going on to explore the influences of attachment style and empathy in a scarcely researched area: probation. The study makes use of an online survey with a total of 145 probation officers participating. Social distance is considered in relation to offence type, officer characteristics and potential study confounders. The clinical implications are discussed and recommendations made for future research. Finally, section three critically appraises the above empirical research. This includes further thoughts regarding the ramifications of the findings, considered in the context of probation services at the time, including political and societal influences. Personal reflections are made with regard to conducting this research taking the above into consideration, and ideas for alternative ways to conduct similarly beneficial research are presented.

This thesis examines the emergence, evolution and professionalisation of the environmental health practitioner (EHP) from the sanitary reform era to the award of a Royal Charter in 1994. The approach was chronological and historiographic, with analysis using sociological theories of professionalisation. The EHP evolved from the ancient offices of 'inspector of nuisances' and 'leavelooker', but the true genesis came in the 1840s when 'nuisances' became associated with disease and it was necessary to appoint full-time inspectors with a dedicated public health role. The thesis provides inter alia the first published evidence of the appointment by a UK local authority health committee of an EHP, in Liverpool in 1844; pre-dating Liverpool's celebrated appointment of the UK's first Medical Officer of Health. The thesis elucidates the role of the Health of Towns Association and the significance of the Liverpool precedent. It fills the gap in knowledge surrounding the constitution of the first examination board and explains the sequence of changes of the inspectors' official designation. Professionalisation was characterised by a struggle against medical dominance and the related power asymmetry at critical junctures, in particular during the initial establishment of the examination board. Social class was the principal structure that influenced the early evolution of the EHP. The main facilitator was an increasingly powerful occupational association. Full professionalisation was not attained until the qualification incorporated the full body of professional knowledge, from 1966, and complete professional autonomy was achieved in 1974 when the MOH function was removed from local government. The thesis reveals two historically unique forms of 'state-mediated medical subordination': in the linking of state closure with the sustained exclusion of the inspectors from the examination board, and in subordination through title change. It also proffers the concept of 'institutional medical dominance' to explain an extreme form of embedded medical domination.

No description available.

No description available.

No description available.

No description available.

No description available.

Unobserved heterogeneity is one of the main concerns for applied economists, this is particularly so when modelling health and health related behaviours. This thesis illustrates four studies on modelling unobserved heterogeneity using some recent developments in latent class analysis. Chapter 2 examines two sources of individual unobserved heterogeneity when subjective indicators are used to measure health status: variations in unobservable true health and differences in self-reporting behaviour for a given level of “true health”. These two sources are separately identified using both objective (biomarkers) and subjective health indicators. Chapter 3 examines the so called positive correlation test. This test rejects the null of absence of private information in a given insurance market when individuals with greater coverage experience more of the insured risk. This test is shown to lead to puzzling results where there exists multiple sources of private information (multidimensional heterogeneity). An alternative strategy proposed uses a finite number of heterogeneous types and extends the standard adverse and favourable selection definitions into local and global ones. We implement a finite mixture model to identify the unobserved types and test the multidimensionality of private information. We apply these approaches to the US long-term care and Medigap insurance markets.