A mix of economic interests, humanitarianism, and political concerns over future regional security and stability drove twentieth century attempts to counter indigenous morbidity and depopulation in the Pacific. However, chronic under-resourcing impeded colonial health developments. An opportunity for change came in 1913, when the International Health Board of the Rockefeller Foundation negotiated with the British Colonial Office for joint programmes to control hookworm disease in Britain's tropical dependencies. After surveying the health situation and potential for work in the Pacific region in 1916, a short-lived campaign followed in Fiji (1917-1918). The American philanthropy then focused on Australia, where co-operative hookworm programmes advanced the objectives of the Foundation and increased Federal involvement in public health while and also served the interests of "White Australia". Under Dr. Sylvester Lambert, work in the Island Pacific resumed in 1920, to promote the health and economic viability ofindigenous labour in the Australian territories of Papua and New Guinea. Plantation interests supported survey and treatment work in the British Solomon Island Protectorate, and in 1922 the Fiji campaign re-opened. Lambert expanded the International Health Board's involvement from initial hookworm survey and treatment programmes in the British and New Zealand dependencies in the South Pacific, into other aspects of public health and medical services: water supplies and latrines; a bacteriological laboratory in Suva; hospital expansion; and medical education. Integrating local initiatives, Lambert advocated a Unified Pacific Medical Service, in which key elements were centralisation., rationalisation and affordability. The most radical aspect of his plan was the development of a Central Medical School for the Pacific territories, to provide targeted professional training for indigenous medical practitioners who had a crucial (although still subservient) role in economic service delivery and the diffusion of biomedical understanding among local communities. Also controversial - and Jess successful - were attempts to improve the career opportunities and standard of European Medical Officers, by creating a single medical service for the British Pacific dependencies. Attempts to achieve these goals influenced the shape and outcome of health and medical services which developed in the different island communities by 1939, when Lambert's retirement signalled an end to active Rockefeller Foundation involvement. This thesis examrnes the ways in which colonial administrations, medical staff, the Rockefeller Foundation, labour and mission interests, and Pacific Islanders interacted in the introduction of the dramatically new medical concepts and practices of western science (and specifically tropical medicine) and their effect on indigenous populations.

No / This paper aims to estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/ health board and corresponding National Health Service (NHS) costs in the UK. This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients’ characteristics, wound-related health outcomes and health-care resource use were quanti ed for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices. An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any speci c diagnosis. The prevalence of acute, chronic and unspeci ed wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities. Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates. Declaration of interest: The study’s sponsors had no involvement in the study design, the collection, analysis and interpretation of the data, the writing of this manuscript and the decision to submit this article for publication. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research (NIHR), the Department of Health, or any of the other sponsors. / NIHR Wound Prevention and Treatment Healthcare Technology Co-operative (National Institute for Health Research WoundTec HTC), Bradford Institute For Health Research, Bradford, West Yorkshire, UK, following an open tendering process. Additional funding was provided by: 3M Health Care Limited, Loughborough, Leicestershire, UK; Activa Healthcare Limited, Burton On Trent, Staffordshire, UK; Brightwake Limited, Kirkby In Ashfield, Nottinghamshire, UK; KCI Medical Limited, Crawley, West Sussex, UK; Longhand Data, Welburn, North Yorkshire, UK; Medira Limited, Cambridge, Cambridgeshire, UK; Mölnlycke Health Care Limited, Dunstable, Bedfordshire, UK; Park House Healthcare Limited, Elland, West Yorkshire, UK; Perfectus Biomed Limited, Daresbury, Warrington, UK; Pulsecare Medical LLC, North Andover, Massachusets, US; Smith & Nephew Medical Limited, Hull, East Riding Of Yorkshire, UK; Sozo Woundcare Limited, Harrogate, North Yorkshire, UK; Systagenix Wound Management Limited, Gatwick Airport, West Sussex, UK; Trio Healthcare, Great Missenden, Buckinghamshire, UK; Urgo Limited, Loughborough, Leicestershire, UK; Willingsford Limited, Southampton, Hampshire, UK.

This dissertation compares and connects the parallel histories of two indigenous community-controlled health services, the Seattle Indian Health Board (SIHB) and The Aboriginal Medical Service (AMS) of Sydney. These were among the first clinics of their kind to be established and run by and for urban indigenous communities in the U.S. and Australia. Formed in the 1970s within months of each other, I bring their seemingly disconnected histories together to illuminate a larger transnational history about the political ramifications of twentieth-century postwar urbanization (and the associated growth of an indigenous diaspora) on native people’s concepts and practices of political sovereignty. By considering how these clinics provided a key forum for new urban pan-indigenous forms of political and cultural identity—and claims to indigenous rights—to be expressed and recognized, my work makes two significant contributions. First, it reveals the importance of health as an arena of indigenous political action in the twentieth century. Second, it underscores that indigenous sovereignty, as a political project, must be understood as both adaptive and responsive to change. Drawing on archival research and oral histories conducted over two years across Australia and the United States—including interviews with activists and health workers who were on the front lines of indigenous politics in the 1950s-1970s—I explain why in their pursuit of self-determination, urban pan-indigenous communities steadily turned away from a purely western conception of sovereignty as jurisdiction over land. The health struggles of urban indigenous peoples since the Second World War are a pointed demonstration of how the loss of even limited territorial sovereignty (that is, relocation from reserves and reservations) led to damaging structural invisibility, discrimination, and neglect within the social welfare system. Thus, this dissertation shows how and why the communities in Seattle and Sydney were driven to pursue other forms of practiced, or what I call “deterritorialized”, sovereignty centering on their rights to self-governance through the creation and transformation of various social organizations (in this case health clinics) in line with distinctive cultural perspectives. This is the first book-length study to take healthcare reform seriously as an arena in which indigenous political actors worked to redefine the reach and the meaning of indigenous sovereignty for communities without recourse to land or nationhood in the assertion of their sovereign rights. Moreover, by bringing a comparative view to this historical inquiry, my work reminds us that trans-Pacific networks of ideas and people formed a shared context for these peoples and histories. I argue that indigenous health activists in the U.S. and Australia became active at precisely the same moment, because each saw their struggle for recognition and self-determination as part of a global challenge to racism during the Civil Rights era. Moreover, these indigenous community-controlled clinics should be recognized as part of broader changes taking place in grassroots health advocacy at the time, as reflected in the contemporaneous community and women’s health movements, and the movement to form People’s Free Clinics by the Black Panthers. In its consideration of the unique problems of recognition faced by urban pan-indigenous communities, “Sovereign Bodies” also contributes towards an understanding of processes of ‘place-making’ in a period of great mobility following the Second World War. This dissertation argues that the indigenous urban health clinics very quickly came to represent the social production of a new kind of political space: not a tribal homeland or even a mosaic of different homelands, but a generic native space in the city that gave physical form to new ideas of a non-territorial, or ‘deterritorialized’ sovereignty. Moreover, it shows that at work in the efforts of Seattle and Sydney’s urban indigenous health activists, was the idea of a ‘portable’ or ‘mobile’ indigenous status. This was intended, among other things, to allow indigenous people to live in cities—or wherever they choose for that matter—without having to give up their identity, cultural practices, or their legal status as indigenous people and ensuing ability to make special claims on the government. At stake in their health activism, this dissertation argues, was a form of place-making that aimed to make indigenous people at home everywhere within the national spaces of the U.S. and Australia.