This thesis describes the development of the idea of an 'obesity epidemic' that figures prominently in contemporary public health discourse. It uses conceptual approaches from Science and Technology Studies and the history of medicine to analyse changing ideas about obesity, particularly as formulated and mobilised by British researchers from the 1960s onwards, to show how excess body weight became understood as a significant public health problem in this period. The thesis begins by describing the post-war refocusing of medical attention in developed countries from infectious diseases, the rates of which are falling, to chronic disease such as heart disease, diabetes, cancer and stroke. Heart disease, in particular, became seen as an 'epidemic'. After World War II, increase research funding by the American government made possible the development of a new research method - the long-term prospective epidemiological study - and a new way of understanding chronic diseases as caused by risk factors such as high blood pressure, cigarette smoking and high blood cholesterol. Excess body weight was includes in this list of risk factors, and so became an object in increased medical attention. The thesis then outlines how a new public health coalition was formed around obesity in the 1970s by British biomedical researchers working on topics in the fields of nutrition, diabetes and coronary heart disease. It describes the development of what I call the 'individual paradigm' of obesity which characterises the condition as an individual problem that leads to heart disease and mechanical complaints and is treatable by weight loss diets. It then describes two key features of British obesity science in the 1980s and 1990s. The first of these is the adoption of the Body Mass Index and the standard cut-off points that are used to define overweight and obesity, which together facilitate the collection and dissemination of data on changes in average body weights, The second is the energy balance model of weight regulation, which served to unify the diverse disciplinary approaches to biomedical research incorporated into this new knowledge, but which could not account for the high rates of failure acknowledged as occurring with conventional treatments such as weight loss diets, anorectic drugs and bariatric surgery. The thesis describes how researchers in the field of obesity science than extended their institutional research to participate in the production of a series of reports for the World Health Organization, including one on the global epidemic of obesity published in 2000. This new platform, combined with data produced by prospective studies, enabled them to disseminate a new understanding of obesity and overweight - what I call the 'environmental paradigm' - which characterises it as a global health problem associated with an increased risk of many diseases and caused by structural factors such as inappropriate diet and sedentary lifestyles. Despite refocusing attention of structural determinants of ill health, however, public health experts were constrained by considerations of political practicality and commercial interest when calling for preventive measures in the areas of diet and physical activity. The thesis concludes by considering the different ways in which scholars have theorised the epidemiological transition from infectious to chronic disease. Drawing on approaches from the health inequalities literature, it argues that the conventional framings of chronic disease epidemiology have tended systematically to obscure structural links between obesity and other forms of diet-related ill health on the one hand, and relative poverty on the other.

Partnership has enjoyed fresh attention since the 1990s and consequently is a growing yet increasingly fragmented area of research. With the incoming Labour Government in 1997, policy has aimed to replace conflict with co-operation in employee relations. Partnership is an approach to managing the employment relationship based on the search for common ground between management, employees and their representatives and involves the development of long-term relationships built on high levels of trust and respect. Approaches to, and models of, partnership are still at a formative stage with no consensus on how partnership develops effectively. Despite the recognition that to understand partnership fully the study of the processes involved is necessary, little is known about these processes involved. Furthermore, the current body of literature on partnership in a UK context is limited in terms of its theoretical basis. The research set out to identify through which theoretical mechanisms partnership works. Informed by social exchange theory, the study examines the viability of partnership within the NHS and attempts to understand the conditions for its successful development. Two stages of empirical research using a mainly qualitative design were conducted. The first stage of fieldwork involved a preliminary investigation of the introduction of partnership in the National Health Service. The aim of this stage was to trace the introduction of partnership and to understand its antecedents and what had set out to achieve using data from eleven in depth interviews with key players at national, regional and local levels throughout the service. Stage two followed a case study approach and investigated the development of partnership in four NHS Acute Trusts. This stage involved a range of techniques (i.e. semi-structured interviews, focus groups, and documentation) examining the views of fifty five respondents from management and trade union representatives across the four Trusts and used data from 543 questionnaires to investigate employee's experiences of partnership. The study contributes to the partnership literature on the developmental processes of partnerships by utilising social exchange theory to better understand the viability of partnership. In particular, examining partnership from a social exchange perspective enabled a deeper understanding of the decision processes involved when deciding whether to co-operate. The study demonstrates that the theory (and its related concepts) can be helpful in examining the viability of partnership in understanding the mechanisms that lead to its successful development and the maintenance of the relationship over time. In assessing the viability of partnership, the thesis identifies the conditions under which partnership produces its effects and demonstrates how these differed in terms of changes in both the climate and the behaviour and attitudes of participants. In sum, the idea of social exchange would seem to provide an underpinning rationale for partnership. Some support for a new and expanding role for the trade union involving jOint work in developing policies was found. Trade unions appear to have a legitimate role in the relationship which is on the whole accepted by key management and trade union players. However, the union role has a low profile amongst managers and employees and trade unions lacked the organisation needed for partnership to be effective. Moreover, if trade unions are going to reap the potential rewards of partnership there should be a continuing effort to address the problems of capacity and capability (by increasing the numbers and capability of union representatives) in order to raise the profile and acceptance of the union among management and employees. In addition, there is a requirement for adequate training and support to ensure that these representatives have the attitude, skills and confidence to become effective representatives of the workforce.

This thesis explores the statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. The research has been conducted in the broad Interpretist tradition, seeking to understand rather than merely explain human behaviour. A model depicting the health information and knowledge environment has been developed to show the how the infonnation behaviour of the various populations in the research are interpreted and where they are placed. The provision, access and use of health information by consumers is the focus of the inner core of the model and is the first theme of the thesis. Several discrete groups of the information poor are investigated to explore their information needs and behaviour. The middle layer of the model depicts the second theme of this thesis focusing on the attitudes of academics, health and social care professionals in their use and access of health information and IT in everyday practice. The information behaviour of the health information and library professional is the focus of the third theme of the thesis and is represented by the outer layer of the model. This theme explores the detail and the contribution of the role to the clinical team, the use of Evidence Based Medicine and Clinical Governance. Conclusions support the opening statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. Recommendations are made to promote better and more frequent use of health information and health information professionals in the everyday practice of health and social care; to improve the access and provision of health information for consumers.

Contemporary English health policy is saturated with claims about what the world is like and how it might be otherwise. These claims span the wide range of subject matters covered by health policy, from hospital waiting times to our preparedness for major disease outbreaks; from structures for the planning and purchasing of healthcare to requirements around the sharing of patient records. Despite this, empirical studies of health policymakers working at the national level in the UK suggest that research evidence plays only a very limited role in policy development (Lavis et al. 2005; Dash 2003; Dash et al. 2003; Innvær et al. 2002; Petticrew et al. 2008). This apparent contradiction was the starting-­‐point for this project. If civil servants are not drawing on research knowledge in their work, how is it that they are able to devise policy about such complex and technical policy issues? Policy-­‐making requires knowing the world in some way in order to act upon it. My research asks, what kinds of knowledge are civil servants in England’s Department of Health using in their work, and what forms does this use take? This thesis is situated in an emerging field of interpretive policy analysis which treats policymaking as realised in the daily work practices of communities of individuals (Wagenaar & Cook 2003; Wagenaar 2004; Colebatch 2006; Colebatch et al. 2010; Freeman et al. 2011). I have adopted an ethnographic approach, conducting 60 hours of original data collection in the form of interviews and meeting observations among mostly mid-­‐ranking civil servants working on various high-­‐profile health policies in 2010-­‐11. By analysing my fieldwork experiences and the resulting data, and by relating these to insights from theoretical resources in sociology, psychology and philosophy, I offer an account of the different forms of knowing and knowledge entailed in the practice of policy-­‐making. I identify three forms of knowledge and knowing that were integral to the work of the civil servants I studied: the ‘practices of knowing’ by which they came to understand the objects of their policies and think through the possibilities for their reform; the ‘pragmatic use of knowledge claims’ in which facts, figures and stories were invoked to generate support for policies and to defend decisions taken; and the ‘know-­‐how of policymaking’, which was the most important form of knowledge for the civil servants’ professional identities. In the conclusion, I reflect on the aspects of knowledge and knowing which are shared by the civil servants’ practices and my own work in producing this thesis.

Le paludisme demeure un des principaux fardeaux de l'humanité en dépit d'une évolution générale favorable du nombre de cas de paludisme. Les travaux contenus dans cette thèse concernent le déploiement d'une combinaison antipaludique à base de dérivés de l'artémisinine en zone rurale à transmission modérée. Le choix du traitement à adopter doit reposer sur l'évidence, dont la forme la plus aboutie demeure la revue systématique et méta-analyse. Cependant, la présentation des résultats peut être améliorée dans le but de faciliter la prise de décision. En outre pour compléter cette preuve expérimentale, il est nécessaire d’étudier l’utilisation des médicaments en pratique courante, dans une approche de médecine factuelle et d’en effectuer le suivi sur plusieurs années concernant l'efficacité, tolérance, sensibilité in vitro, qualité de la prise en charge, épidémiologie du paludisme.Un programme pilote de prise en charge du paludisme intégré dans le système de santé publique a été mis en place au dispensaire de Mlomp, Sénégal à partir de l’année 2000 : un traitement avec la combinaison artésunate + amodiaquine après confirmation parasitologique (en lieu et place d'un traitement présomptif par mono-thérapie). Ces travaux d'accompagnement de la mise à l'échelle des nouvelles directives de prise en charge du paludisme ont permis d'apporter des éléments pour améliorer la qualité des soins ainsi que permettre une meilleure compréhension des obstacles à la mise en place de la nouvelle stratégie et ses effets sur la santé de la population. / Malaria remains a major health burden for mankind despite trends towards a decrease in the number of cases in most endemic areas. The research summarized in this thesis concerns the deployment of an artemisinin-containing antimalarial drug combination (ACT) in a rural district of moderately intense transmission. The choice of an adapted treatment must be evidence based. Systematic reviews and meta-analysis are considered the most robust form of evidence. However, visual displays should be improved in order to improve decision making.Furthermore, to complement evidence from clinical trials, drugs should be studied when used in real-life conditions and followed-up over time for their efficacy, safety, parasite susceptibility, quality of case management, malaria epidemiology.A pilot programme to change case management modalities was started in 2000 in Mlomp, Senegal. The programme was embedded in the public health system and aimed at replacing the previous policy (single-agent treatment on clinical grounds) with the new policy (ACT for parasitologically confirmed malaria). The work conducted to support the scaling-up of the new policy allows improving case management and provides elements towards a better understanding of obstacles to the deployment of the new strategy and its effects on the health of populations.

Through a multiple case study approach, this dissertation outlined patterns of activism, examined the factors that assist in decision-making strategies used for the political mobilization of black women, and assessed the role and influence their organizations have in the health policy arena. Building on the belief that the intersectionality of race, gender, and class guides the activism of black women, the study acknowledges the importance of analyzing the political conditions of black women that are different from black men and white women. Furthermore, the research offered an argument for the need of a theoretical framework that provides a multidimensional analysis of black women’s political representation. For that reason, the theory developed in this study was a Black Women’s Activism Theoretical Framework. Expanding on black feminist thought, the framework reveals ways in which black female activists have mobilized for self-representation and building of their own collective self, vision, and voice. A mixed research method and holistic case studies of five national black women- led organizations in the areas of breast cancer, cardiovascular disease, and HIV/AIDS were applied. The qualitative data were quantified, coded, and placed on outcome, legislative, and perception success scales to gauge the level of successfulness achieved by the organizations from 2001 to 2015. The data were analyzed with a Black Women’s Activism model. With this analytical tool, the role and level of successfulness of black women-led organizations in the health policy arena were examined within the context of socioeconomic factors and historical barriers due to the intersectionality of their race, gender, and class, thus validating that the shared experiences of black women characterize their organizational behavior. Moreover, this study challenges the traditional definitions of activism, opting instead to place black women as political actors independent of the dominate group. The findings reveal that there are multiple pathways leading to the attainment of the ability to influence health policy and that black women-led organizations have played a pivotal role in doing so. Dispelling the myth that the political activism of black women should be through the lens of victimhood, the utilization of a Black Women’s Activism model has the potential to assist researchers in increasing their accuracy when assessing the extent in which black women-led organizations have been able to exercise a critical voice within the prevailing political culture.

Public Law 131-336, Americans With Disabilities Act (ADA), is comprehensive legislation created with the intention of integrating the disable into the work place and every segment of society. Forty-three million Americans are disabled. Of these, twenty-three million seek employment, but because of discrimination are unable to find work. The law provides requirements for access to public accommodations. All disabled Americans deserve the opportunity to enjoy the same public services as the non-disabled. Businesses are now required to provide reasonable accommodations to a disabled employee if these accommodations will allow the employee to perform the essential functions of the job. Businesses are also required to make necessary renovations to their facilities to allow the disabled to move freely about and enjoy the services and amenities of the facility. This researcher attempts to compile the costs of complying with the ADA in one hospital. The analysis is limited to one facility. However, the findings may be beneficial to other facilities because severe civil penalties can be levied on facilities which do not comply. The study involved surveying a healthcare facility using points from Title I of the ADA determined by the researcher to be necessary for compliance. Title III compliance was accomplished using a facility survey from developed by the American Hospital Association. The researcher complied total expenditures by The Medical Center at Bowling Green, Bowling Green, Kentucky, to comply with Titles I and III of the ADA as well as projected costs associated with recommendations to resolve deficiencies. The findings support the hypothesis that practical approaches and inexpensive solutions are readily available so facilitates can fully comply with the intent of the law and avoid undue hardship.

This Thesis argues that the state by contracting out prison food services to private companies and then failing to enforce basic standards has abdicated their responsibility to ensure and protect the physical and mental health of prisoners. Michigan as a case studies reveals the negligence of government to hold Aramark responsible to basic standards of feeding. As a result, leading to a wide-spread case of food-borne illness. The governments unwillingness to protect the basic human rights of prisoners under the control of privately operated prison food services has negatively impacted the health and well-being of prisoners.

Fifteen million children have been orphaned by AIDS. A growing body of evidence documents impacts of parental deaths on orphans, but little is known about impacts faced by AIDS-orphan carers. This study set out to: (a) investigate physical and mental health outcomes of adults caring for children in Umlazi, a high HIV prevalence township in South Africa; (b) assess whether AIDS-orphan carers face worse outcomes compared to other carers; and, (c) identify risk and protective factors for health. Using a cross-sectional survey, data was gathered from a representative community sample from August 2008 to March 2009 resulting in the largest known study conducted on AIDS-orphan carers to date (n=1599). The majority of carers looked after non-orphaned children (66.85%) followed by AIDS-orphan (22.45%) and other-orphan children (10.69%). Orphan carers had significantly worse general health and functioning, depression, and post-traumatic stress than non-orphan carers but patterns were less clear when orphan carers were disaggregated into AIDS-orphan and other-orphan carers for comparison. This suggests that health interventions might target orphan carers, rather than singling out AIDS-orphan carers. Differences in age, gender, education, economic assets, and source of household income fully accounted for the association between being an orphan carer and poor health. Social policy grants reduced negative health disparities between orphan carers and non-orphan carers. Social support, education, economic assets, food, access to water, and housing were iii also identified as risk and protective co-factors that might reduce orphan carer disparities in health. By highlighting health as a serious issue for orphan carers and identifying risk and protective factors for health, this study offers policy and program insights into how to mitigate negative impacts faced by carers in high HIV prevalence communities facing escalating numbers of orphans.

Internet technologies are increasingly advocated as a means for transforming health care and improving people’s health. In the field of e-health questions on the health implications of internet use are typically approached through attempts at measuring the effect of internet use on health outcomes. In this, information is usually conceptualised as a form of knowledge/power and online information practices are enrolled in discourses on patient empowerment. Taking the different meanings ascribed to information in these approaches as my point of departure, in this thesis I rethink the implications of internet use on health through an empirical exploration of alternative conceptualisations of the relationship between information and health in the context of contemporary HIV treatment and care. I do this through two analytical moves. First, drawing on the concept of performativity, a concern with what effect internet use has on health is turned into one of how internet use enacts health. Second, rather than treating information as knowledge/power, through an analysis of how a specific group of women ‘living with HIV’ in the UK use the internet, I reconfigure the connections between internet use and health through a conceptualisation of information as care. Drawing on a range of empirical materials – including forty-seven in-depth interviews with patients and internet content providers, non-participant observations, document and website analysis – three areas of health-related internet use are analysed in detail: the seeking out of health-related and specifically biomedical information; the seeking out and sharing of experiential knowledge and narratives about living with HIV; meeting prospective partners and dating. However, rather than studying these areas of internet use in order to interrogate what they can tell us about the internet, I analyse them as part of the ethical regime of ‘living with HIV’, in which the virus, previously thought of as ‘terminal’, becomes, through info and bio technologies, normalised as ‘chronic’. From this perspective, enacting health not only entails working on and with one’s body, but also always invokes its distribution across bodies, to other areas and relations, including internet technologies and the networks of relations established via these technologies.