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This thesis examines the origins of estrogen related HEM as a science-policy concept that emerged during a period of socio-political ambiguity in the 199Os. The thesis tracks a complex pattern of reciprocal influence between science and policy (mainly European) in the regulation of synthetic chemicals, low dose exposure, and HEM - with reference to BPA. Specifically, the thesis demonstrates that precautionary appraisal procedures changed the involvement and weighting of basic science in decision-making processes. From this position it suggests that the precautionary principle (PP) made regulatory knowledge processes for chemicals more reflexive to experimental hypotheses relating human health to environmental estrogens. It is argued that by harnessing basic science in this way to address user-oriented issues, the PP evolved a highly reflexive science-policy model with analytic and deliberative procedures to drive, produce, distribute and evaluate scientific knowledge. However, the dynamics provoked by these procedures (arOlmd EM theory) caused the system to oscillate between different states of nomological possibility and epistemic risk which, for chemicals like BPA, broke down to perpetuate an indefinite cycle of research. It appears that this cycle becomes harder to break when technical and social uncertainties act together to motivate further research so that the system becomes almost selfregulating, building a 'body of knowledge' around a perceived problem (male reproductive disorders). In conclusion the thesis argues that the societal response to chemical concerns stimulated a different form of scientific and social scrutiny, reflexive to the motivations and perspectives of precautionary policy, scientific conjecture, and public perception. This changed the nature of technical evidence counting as policy relevant knowledge, which has made it difficult to bring closure to the hazard assessments associated with BP A, and indicates the potential for future difficulties in regulatory science.

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The increased incidence of lifestyle related diseases, such as obesity and diabetes, across the western world is now an established fact, and presents many challenges to researchers trying to understand the determinants of poor health. Measurement of health needs and health outcomes is a fundamental component of evidence-based policy, strategy and delivery of health care services and interventions at scales from the local to the national. A central contention of this thesis is that health outcome indicators should be cognisant of factors such as personal behaviour, lifestyles, community influences, living and working conditions, accessibility to services and educational attainment which all impact upon the health of the individual and the wider community. It is therefore sensible to explore these differences by understanding both the social space comprising of different population sub-groups and the geographical within which they live. Good quality data underlie the functioning of evidence-based decisions. Data provide the building blocks for understanding the nature and composition of neighbourhoods, together with the expected health outcomes of their residents. But within the health arena there are many complicated data issues. Existing operational health data sets are often incomplete or not up-to-date and accessibility is often limited by data protection and medical confidentiality policies. They are derived from disparate sources: GP registers, Hospital Episode statistics (people who are admitted to hospital), Child Registry and Accident and Emergency records, all adhering to different data collection and storage standards and systems that vary between organisations. Cross-referencing between these datasets is technically difficult because of these issues. Frequent quality issues of operational health data limit the extent of analysis that can be carried out with confidence. Furthermore, health survey data are released at coarse geographical scales where the ecological fallacy limits the potential for exploring local variability. Given these limiting factors, the theme of this research is to extend the health inequalities research and its associated data framework to explore variability in the spatial and social domain. This enables the identification of social facts relating to health harming lifestyle choices and behaviour that contribute to 'diseases of comfort'. This is carried out by developing and exploring the usefulness of geodemographics for analysing health inequalities, thereby adding the social and spatial context to our undertanding of causes of health inequalities. This thesis presents a more straightforward yet effective alternative to exploring the measurement of health impacting behaviours and predicting health outcomes using operational health data, national health surveys and a geodemographic classification. Geodemographic analysis of health outcomes can capture different lifestyle behaviours, and has already proven useful not only in improving customer segmentation in the commercial sector, but also to better target public services (Harris et al., 2005). By applying geodemographic classifications to national health surveys and NHS operational datasets at postcode level, interesting conclusions can be drawn in terms of different health harming lifestyle behaviours at very fine scales. Furthermore it is common practice that academic research projects occur in isolation, and exploitation of research findings and best practices in local government sectors is often beset by many obstacles. Consequently, within local government the adoption of new innovative technique and tools may often be slow. An inner London Primary Care Trust (PCT) is used as a test bed for disseminating and evaluating the geodemographic framework and indicators. The concluding sections of the thesis discuss the practicalities of embedding geodemographics in particular and geography in general into a professional environment where these technologies are new and innovative.

This thesis investigates three different aspects of glaucoma awareness using both quantitative and qualitative methods. Patient Awareness: This qualitative study looked at patients perceptions of glaucoma. Participants (N=28) reported low levels of awareness of glaucoma prior to their diagnosis and assumed that symptoms were the ‘normal’ deterioration of eyesight. As symptoms have a gradual onset, participants had learnt to cope with diminishing sight ability. Findings suggested health promotion a priority to increase public awareness of the existence and symptoms of glaucoma among those at high risk. Current public awareness: This study looked to document public awareness and knowledge of glaucoma. The study used health knowledge questionnaires in three different populations: 1. nationally representative sample of 1009 people 2. telephone Interviews – 500 Isle of Wight, 226 Ealing 3. face-to-face interviews – 300 Ealing Between 71-93% of those interviewed by telephone had heard of glaucoma. However, only 23% of those interviewed face-to-face in Ealing reported having heard of glaucoma. We found a relatively high level of awareness and knowledge of glaucoma in the general UK population but identified at least one pocket of poor knowledge in a specific subpopulation. Can we change awareness? This study investigated whether a public health campaign could increase awareness and change help-seeking behaviour with respect to ocular health with residents in Southall, Ealing aged 60+. The health knowledge questionnaire from the previous study was used to assess the campaign. The health campaign comprised of four components. 1. Television 2. Local Press 3. Local Radio 4. Places of worship The results showed a significant increase in the number of people who had heard of Glaucoma rising from 22% to 53%. Before the intervention most people had heard about glaucoma from their GP, friend or relative. After intervention the majority (69%) had heard of glaucoma from the radio. This study showed a significant increase in awareness from using different kinds of media and showed radio to be the most effective in the target community. Although the campaign raised awareness it did not show a change in help seeking behaviour.

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