This study has examined concepts of empowerment as they relate to young people's health. Beginning with an analysis of recent theories of power, the thesis offers a critical exploration of the conceptualisation of empowerment and identifies how current uses of the term appear to have moved away from many of their original theoretical underpinnings. Identifying these theoretical tensions provided the impetus for an empirical enquiry which sought to critically question the relationship between empowerment and young people's health. The goal of the investigation was to reveal the possibilities for, and limitations of, empowerment among young people. Informed by an interpretivist epistemology and drawing upon ethnographic methods, data were collected from young people aged 15-16 years through focus group discussions, individual interviews and observational data in a school and surrounding community settings. Themes drawn from the research were analysed for their implications for 'emic' conceptualisations of health and empowerment. Key findings pointed to young people's preference for more positive understandings of young people and their health. Participants described how dominant perceptions of young people as 'immature' and 'risky' negatively impacted on their health; shaping subsequent possibilities for, and limitations of, their empowerment. Based on study findings and informed by Steven Lukes' (2005) tripartite perspective on power, the thesis offers a new conceptual framework for understanding the concept of empowerment and its relationship to young people's health.

Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children's to adult services. However, there is little evidence on transition services for young adults with life-limiting conditions, with few models of good practice in the literature. The aim of the study was too identify the organisational factors, and interactions between factors, involved in promoting or hindering a successful transition for young adults with life-limiting conditions. A realist evaluation approach using a mixed methods design was adopted with four phases of data collection. The first phase involved the distribution of a questionnaire survey to health, social, education and voluntary organisations known to be providing services to young adults making the transition to adult services in Northern Ireland and one Health Services Executive area in the Republic of Ireland. The second phase involved interviews with young adults and the third phase involved focus groups with parents/carers. The final phase involved interviews with service providers from statutory and non-statutory organisations. There were 104 individual responses from 29 organisations in the survey questionnaire; eight young adults participated in interviews, two focus groups with parents/carers were facilitated and 17 service providers participated in interviews throughout Ireland. Eight interventions were identified associated with a successful transition from children's to adult services. Enabling contextual factors included the availability of adequate resources and knowledgeable staff in adult services and young adults who are interested and capable of engaging in transition related activities. Causal mechanisms triggered by interventions included a reaction in the young adult which demonstrated an interest in taking responsibility for their medical management, an enhanced sense of involvement in their transition process and a response of ownership in directing their own journey into adult services.

This Portfolio includes two papers This study presents a systematic literature review of predictors of resilience in children and adolescents with chronic illness. Systematic searches were completed using 3 databases. The searches revealed 139 articles for consideration, of which 19 met criteria for inclusion. Factors associated with resilience were highlighted in relation to social, familial and individual factors. These findings were discussed in relation to their grounding in the literature, the limitations of the study and implications for future research: In this study, we explored the experiences of pregnancy for women with phenylketonuria (PKU) in Northern Ireland. A rationale is presented in relation to relevant gaps in the literature. The methodology used was qualitative in nature. Data was collected using semi-structured interviews and analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were presented and discussed. Conclusions were made in relation to clinical implications and the potential contribution to the research domain.

Access to health care for children is important. It is dependent on access to health professionals and also parental attitudes towards illness. Children have the right to receive medicines that are scientifically evaluated for both efficacy and safety. Counterfeit and substandard medicines unfortunately result in the death of many children worldwide. There have been particular problems with diethylene glycol which has been used as a solvent in counterfeit medicines. It has also been found in contaminated substandard medicines. It has been responsible for the death of many children in different countries throughout the world. I performed a literature review of all cases of diethylene glycol poisoning that have been published. I have described the clinical signs and symptoms and hope that these findings increase the awareness of diethylene glycol poisoning in children. It is well known that there are clear inequalities in health and access to health care in the UK. This inequity has been particularly noticed amongst certain minority groups. Children of “at risk” groups, such as Asylum Seekers and Refugees, and Gypsies and Travellers, were recognised as having possible barriers in accessing health care and medicines. I conducted a study to explore children’s access to medicines in the East Midlands area in the UK. Alongside determining accessibility to health care the study also wished to explore parental attitudes towards receiving treatment for pain, asthma and epilepsy Both quantitative and qualitative research methodology was used in this study. The research data was gathered with the aid of semi-structured interviews with parents from the “at risk” groups and control parents. Fifty parents from each group were selected and interviewed regarding their children‟s health and their access to health care and medicines. The semi-structured interviews allowed participating parents to state their opinions about any barriers they had encountered to their children receiving medicines. Parents from both “at risk” groups and children from the Traveller group had more health problems than the controls. The attitude of some Gypsy and Traveller parents (11%) not to immunise their children was a significant problem. One in six Refugee parents reported difficulties while obtaining medicines. The two main barriers were language/communication problems and financial difficulties. Both Refugee and Traveller children received fewer OTC medicines than the children of the control group. It was not clear from the interviews whether this was due to financial difficulties or reluctance to use medicines without a doctor having seen the child first. Parents from both “at risk” groups were less likely to give analgesics for treating earache than those in the control group. Parents of Refugee children were more reluctant to tell others about their child’s epilepsy. Access to health care is an essential human right. Children are dependent upon both their parents and the health system for ensuring access to health care. This study has identified problems both within the system and also in relation to parental beliefs that may affect the access to health care and treatment for children. It is important that both of these potential barriers are addressed in order to improve the health of children of “at risk” groups. It is hopeful that the findings in this study will help to identify ways of improving access to health care and medicines for these groups.

This dissertation is an empirical work dealing with child health issues in developing . countries and specifically in Pakistan where the emphasis is put on the analysis of the relationship between socioeconomic determinants and health impacts. The first chapter includes a general discussion of child health and its importance for economic development in Pakistan and other developing countries. Undoubtedly, the health of children and young people are among the most important health issues. In this regard, the under-five mortality rate is widely used as credible measure of child health in this study. Children tend to be most vulnerable in their first year of life when their health is influenced not only by their own physical condition but also by the social and environmental conditions of the household (Elder & Shanahan, 2006; Lerner et al., 2011). This strong relationship between child mortality and socioeconomic conditions has ensured its continued and widespread use in monitoring social inequalities in health. This is combined· with the fact that preventing early deaths is an effective approach to increasing life expectancy and the monitoring of child mortality rates remains a key component of effective public health action. This dissertation has three objectives. The first objective is to examine the socioeconomic determinants of child health as well as the environmental degradation and child malnutrition variables on child health across the panel countries. The second objective is to develop regression based decomposition analysis to measure the child health inequalities among different socioeconomic groups in Pakistan. The third objective of the study is to investigate the impact of women empowerment and relative bargaining power on child health in Pakistan. In order to reach the first objective, this study used panel data methods to estimate the determinants of child mortality employing World Bank data for 96 low and middle income countries. This study empirically examined the socioeconomic and environmental determinants of child mortality outcomes by applying various panel data estimation methods i.e, Pooled, Fixed Effect, R~dom Effect, 2SLS, 2SLS FE and system GMM. Moreover, the analysis also examined if fertility is causal to child mortality and the effect of fertility on child mortality using 2SLS. The analysis revealed that the System GMM estimate is the best model which suggests a positive and significant coefficient of lagged child mortality, implying that child mortality is persistent over time. The results provide strong evidence that women's education, women's labour participation, immunization coverage and real GDP per capita are important detelminants of child mortality for developing countries. Other important findings are that immunization coverage and environmental degradation have significant effects on child mor,tality. Overall the results suggest that more attention should be given to the economic costs of poor health associated with environmental damage such as air pollution. Immunization coverage and improved sanitation seyms to be much more effective in reducing child mortality in developing countries. Therefore, it is argued that investments in these specific activities will yield significant social benefits within the sample of countries examined. . The second objective is achieved through the application of a decomposition approach to explain socioeconomic inequalities in child health in Pakistan. Inequalities in child health are measured using the concentration index, which is then decomposed into its contributions to socioeconomic inequality in the observed determinants of child health. Data for the analysis came from the 1998/99, 2001102, 2005/06 and 2007/08 Pakistan Social and Living Standard Measurement Survey (PSLM). The analysis reveals that child under five mOliality inequalities are concentrated among socio-economic groups that are poor in Pakistan in all four years of the survey. Furthermore, the results from decomposition analysis shows that household income, urban residency, mother's education, no breastfeeding and having no sanitation facility each made a sizeable contribution to child health inequality. This study recommends that scaling up social and economic policies that are in alignment with child health policies could bridge the current avoidable and unjust gap between the child health of advantaged and disadvantaged groups in Pakistan. .'~ The third objective of this study is to evaluate the hypothesis that women empowerment and relative bargaining power is related to lower child mortality. This hypothesis is again tested using PSLM data from Pakistan. The study attempts to focus light on the status of women and the effect on early childhood mortality controlling for the effect of other associated determinants. To allow for unobservable heterogeneity across birth cohorts and geographical districts, this study constructs a pseudo panel for a sample of children under the age of five from three repeated cross sections observed in 2001/02, 2005/06, and 2007/08. It is evident by the results that women empowerment and women bargaining power seemed to have the strongest effect on child m011ality in Pakistan. This study concludes that empowerment of women bestows further benefit to society indicating that there is the need for increasing the incentives for good care of children. The health status of children clearly increases with lower mortality, and this probability is higher when women are more empowered to make decisions within the household, suggesting the need for interventions that increase women's financial and physical autonomy.