No / Globally supermarkets have been seen as a remedy to the problems of poor diets in deprived neighbourhoods where access to healthy foodstuffs has been limited. This study seeks to quantify the consequences of one such United Kingdom intervention, in Seacroft, Leeds. Where previous work often focused on fruit and vegetables, this paper presents evidence on all food and drink consumed before, and after, the new opening. It is shown that utilising large format retailers can also bring significant negative consequences for already unhealthy diets, exactly the opposite of what policy makers set out to achieve. Suggestion is therefore made that policymakers consider using price, or education, interventions rather than promoting large shops, which, while stocking cheap healthy food also offer shoppers the unhealthy produce they like at low prices.

Ce travail de recherche propose d’étudier les inégalités de santé et de recours aux soins entre la population native et la population immigrée. Une attention particulière est portée au rôle du capital social, qui suppose une influence des réseaux sociaux ou des interactions sociales sur l'état de santé et le recours aux soins. Nous adoptons une approche micro-économétrique et construisons notre réflexion autour de trois thèmes : (i) la mise en évidence des inégalités de santé et de recours aux soins liées à l’immigration, (ii) la compréhension des mécanismes qui génèrent ces inégalités, et enfin (iii) l’évaluation de l’impact causal du capital social sur l’état de santé et le recours aux soins des immigrés. En termes de politiques publiques, l’analyse des mécanismes générant les inégalités incite à penser que plusieurs leviers d’action sont envisageables. Compte tenu du rôle protecteur du capital social sur la santé, le développement d’actions de proximité spécifiques apparaît nécessaire pour accroître l’insertion sociale et le soutien social des personnes immigrées. L’importance de la couverture complémentaire santé dans la détermination des inégalités témoigne ensuite, de la nécessité de simplifier l’accès aux droits à l’Aide Médicale d’État et à la Couverture Maladie Universelle afin de favoriser la prévention et l’accès aux soins des personnes immigrées / The objective of this research is the study of health and health care use inequalities between immigrant and native populations. A special attention is focused on the role played by social capital, which supposes an influence of social networks or social interactions on health and health care utilisation. In using a micro-econometric framework, our analysis is based on three topics: (i) the emphasis of health or health care use inequalities related to immigration, (ii) the understanding of the contributory factors that generate inequalities, and (iii) the evaluation of the causal impact of social capital on immigrant health and health care use. From a public policy perspective, the analysis of the determinants of health inequalities shows that several types of action could be envisaged. Given the protective role played by social capital on health status, the development of specific neighbourhood actions would seem relevant in improving immigrants’ social inclusion and social support. The prominent role of complementary health care coverage also gives evidence of the need to simplify access to Sate Medical Assistance and mean-tested health insurance so as to favour health prevention and access to health care for immigrants

This thesis examines intergenerational change in prevalence of and attitudes to physical activity by comparing first and second-generation South Asians in Britain. British South Asians have poorer health outcomes including a higher prevalence of cardiovascular disease (CVD) and diabetes than White British people. Physical inactivity is one of the risk factors for CVD and diabetes. Physical activity levels are lower among British South Asians than the White British population, for reasons that include cultural factors related to being South Asian, the low socioeconomic status of some South Asian groups, and living in deprived neighbourhoods. However, existing literature on physical activity levels does not clearly distinguish between first and second-generations. Understanding generational differences in the influences on physical activity among South Asians is important for developing appropriate interventions. First, I review the existing quantitative and qualitative literature on physical activity in second-generation South Asians. There is some evidence that second-generation South Asians are more physically active than the first-generation. Despite this, second-generation South Asians remain less active than White British people. Neither the quantitative nor the qualitative literature has adequately explored the reasons for these findings. I then use data from the Health Survey for England to explore the ways that adult Indians, Pakistanis and Bangladeshis are physically active. When analysed by age and sex, all South Asians and the White British group were physically active in different ways to each other. However, there was little difference between younger Indians and younger White British people in the contribution of walking to total activity. Finally, I present a qualitative analysis of how ethnicity influences physical activity in second-generation South Asians. I interviewed 28 Indian women living in Manchester, England. I found that a British schooling and messages from the media had strongly influenced second-generation Indian women's attitudes to physical activity. Consequently, their motivations and barriers to physical activity were generally very similar to those reported for White British women. Second-generation Indian women had mostly adopted Western gender roles, with Indian gender expectations having a limited impact on their physical activity. In contrast, the traditional roles of Indian women constrained the leisure-time physical activity of the first-generation Indian women. There was no generational difference in how the local neighbourhood influenced physical activity. This thesis demonstrates clear differences in physical activity prevalence and attitudes between first and second-generation South Asian women in the UK. Interventions aimed at improving local environments for physical activity are likely to help all people living in deprived areas, regardless of ethnic background. Changing generic Western social norms around femininity and being physically active may be more important than tailored interventions for second-generation Indian women.

Previous research on female street sex workers (FSSWs) has primarily concentrated on the stigmatisation of women's involvement in the sex industry particularly with reference to the spread of HIV/AIDS. The response of the criminal justice system to the regulation of the illegal aspects of women's engagement in street sex work has also been criticised. However, the impact of street sex work on the health and wellbeing of these women requires further research. The aim of this study was to explore the perceptions and needs of female street sex workers in relation to their own health and wellbeing. The study used a qualitative mixed methods approach that included analysis of three sets of data: visual data, secondary data and primary data. There were 10 FSSWs recruited for the primary data sample. The epistemological position underpinning this study is social constructivism and a feminist paradigm has informed the conduct of the research process and data analysis. The theoretical application of Bourdieu's framework of habitus, capital and field has provided the lens through which to explore the socially constructed experiences of FSSWs health and wellbeing. Findings from this study revealed that FSSWs experienced poor physical, mental and social health and wellbeing. They faced limited life choices and often felt discriminated against by the agencies and institutions that should have offered support. The women spoke of their personal histories especially traumatic life events in childhood consisting of sexual abuse, neglect, loss, rejection as well as intimate partner violence in adult life. The loss of their children to social services, housing difficulties and addiction to alcohol and crack cocaine were also significant in contributing to social exclusion and their multiple positions of vulnerability. This study contributes to the body of work on women's health and wellbeing. In particular, it adds to our understanding of the lived experiences of women involved in street sex work. A key public health priority should be the development of policies and systems to provide quality services to support the health, safety and wellbeing of FSSWs.

The collapse of the communist regimes in Central and Eastern Europe in 1989-1990 heralded the beginning of an economic transition from central planning to market economies. The subsequent period was marked by malfunctioning of these countries’ social sectors, including their health care systems, raising serious issues of equity. This thesis examines the impact of the transition period and the introduction of social insurance on equity in health care provision in Bulgaria. Equity in health care is investigated with respect to function - i.e. financing (according to ability to pay) and delivery (according to need) - and outcomes - i.e. health status, income inequality and poverty. Differences in health, health care financing and delivery are explored by income, education, ethnic, employment, marital status, age and sex groups. Furthermore, the thesis outlines the impact of health care provision, in particular social insurance, on poverty and health inequalities. The thesis employs empirical analysis based on household data. Its methodology includes concentration and decomposition analysis, and provides new ways of modelling health care financing and delivery, as well as the link between health and health care delivery. The thesis concludes that social insurance does not provide a uniform means of improving equity and that the root cause of the problem lies in the large proportion of out-of-pocket payments and the rather limited size of the health insurance sector. Inequity in health care provision leads to poverty and untreated illness. The data suggests that there are differences between socio-economic groups as regards their likelihood to seek treatment for their ill health, which result in differences in their health status. The social factors that have impacted the most on health are low education and low income.

Using data for every elective procedure in 2007 in the English National Health Service, we found evidence of socioeconomic inequality in the probability of having a procedure cancelled after admission while controlling for a range of patient and provider characteristics. Whether this disparity is inequitable is inconclusive.; Using data for every elective procedure in 2007 in the English National Health Service, we found evidence of socioeconomic inequality in the probability of having a procedure cancelled after admission while controlling for a range of patient and provider characteristics. Whether this disparity is inequitable is inconclusive. Copyright A[c] 2012 John Wiley & Sons, Ltd.; � Using data for every elective procedure in 2007 in the English National Health Service, we found evidence of socioeconomic inequality in the probability of having a procedure cancelled after admission while controlling for a range of patient and provider characteristics. Whether this disparity is inequitable is inconclusive.

Increasing time trends in the recorded incidence of childhood cancer have been reported in many different settings. The extent to which these trends reflect real changes in incidence, rather than improvements in methods for diagnosis and registration, is controversial. Using data from the National Registry of Childhood Tumours (NRCT), this thesis investigates time trends in cancer diagnosed under age 15 in residents of Britain during 1966-2005 (54650 cases), and considers potential sources of artefact in detail. Several different methods are used to estimate completeness of NRCT registration. The history of methods for diagnosis and registration of childhood cancers in Britain is described, and predictions are made for effects on recorded incidence. For each of the 12 main diagnostic groups, Poisson regression is used to fit continuous time trends and ‘step’ models to the annual age-sex-standardised rates by year of birth and year of diagnosis. Age-specific rates by period, and quinquennial standardised rates for diagnostic subgroups, are shown graphically. For three broad groups (leukaemia, CNS tumours and other cancer), geographical variation is compared by period of diagnosis. The results of these analyses are discussed in relation to the predicted artefacts. The evidence for a positive association between affluence and recorded incidence of childhood leukaemia is briefly reviewed. A special form of diagnostic artefact, the ‘fatal infection’ hypothesis, is proposed as an explanation of both this association and the leukaemia time trend. This hypothesis is examined in a novel test based on clinical data. The recorded incidence of childhood cancer in Britain increased in each of 12 diagnostic groups during 1966-2005 (from 0.5% per year for bone cancer to 2.5% for hepatic cancer, with 0.7% for leukaemia). Evidence presented here suggests that these increases are probably artefacts of diagnosis and registration. The potential implications for epidemiological studies of childhood cancer should be considered.