La Mancomunitat fou el primer pas en la recuperació de l'autogovern de Catalunya, a l'època contemporània. Això es produeix en un període de profunda transformació de les societats industrials europees, i en rebé l'influéncia. Inspirat en les teories organicistes, la seva acció de govern s’estructura en tres àrees: cultural, econòmica i social. Les dues primeres ja han estat estudiades; la darrera constitueix l'àmbit de la nostra recerca. La Beneficència tradicional es transforma en la Seguretat Social, amb la participació dels poders públics. La Mancomunitat convertí els antics manicomis i incuses en moderns hospitals psiquiàtrics i tocoginecològics, amb funcions assistencials, docents i investigadores. Establí la regionalització dels serveis sanitaris i la comarcalització hospitalària. Relligà l'atenció social amb la sanitària. Definí els tres nivells de l'assistència: primari, secundari i terciari. En aquest àmbit, es palesa l'influencia francesa. La Sanitat Pública, inspirada en el model anglosaxó, passa de l'actitud defensiva a l'ofensiva, com a instrument de lluita contra els flagells predominants: pal.ludisme, tuberculosi, malalties de transmissió hídrica, goll endèmic, mortalitat infantil, etc. Es descobreix el valor econòmic de la salut. S'estableix la separació entre el finançament i la provisió de l'atenció sanitària. La Mancomunitat tingué un paper actiu en la formació sanitària de la població i dels professionals, així com en la recerca biològica. Cal assenyalar entre d’altres, l’educació sanitària, la promoció esportiva, la formació d'infermeres o el suport a la recerca en psicologia o fisiologia. També foren pioners en l'estudi de la salut laboral i de la higiene i la seguretat en el treball. En el camp social, s'inclinaren pel model germànic, de tipus mixt, és a dir, amb responsabilitat compartida entre les administracions públiques, les forces del treball i les organitzacions professionals. Aquest sistema es basava en la llibertat individual, l'autonomia professional i la solidaritat social, cosa que diferia del centralisme, el burocratisme i l’estatisme predominants a l’Espanya de llavors. En resum, la Mancomunitat representà un avenç qualitatiu i quantitatiu molt important en la incorporació de Catalunya al grup de pobles més civilitzats i la seva influència s'estén fins als nostres dies. / The “Mancomunitat” (1914-1924), was the first step in the recovery of the self-government in Catalonia at the Contemporary age. This happened in a period of deep changes in the European industrial societies, and it got their influx. Influenced by the organicist social theories, the Catalan government was structured in three major areas: cultural, economical and social. The last has be en the object of our study. The traditional charity was transformed in the modern Social Security with the participation of public administrations. The “Mancomunitat” transformed the old and insane asylum and foundling hospitals in modern and open centres, with teaching and research functions. Also has established a regional health division, connected the social and sanitary care, and established three levels of care (primary, secondary and tertiary). In these subjects, it is manifest the influence of French "public assistance”. The public health, inspired by the English model, moved from the cure to the prevention, in the field of malaria, tuberculosis, water-born diseases, infant mortality, etc., was discovered the economical value of health. Then, was established the separation between financing and provision of care. The “Mancomunitat” became very active in the field of health education, addressed to the citizens but also to the professionals, as well as in the biological research. In this area, were significant the efforts in physiology, psychology, etc., and some important contributions were made in the field of medicine and labour hygiene. The German model was chosen for the social security system. It has shared the accountability between the public administration, the labour and the professional organizations. It was based on the individual liberty, professional autonomy and social solidarity. Our study shows the positive social impact of regional self-government, because it was very near to the real needs of the people.

In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy. This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms. The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people�s lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity. In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.

This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing�s perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

Bibliography: leaves 463-496. / ix, 497 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / This thesis explores the dimensions of the actions of consumers, governments and service providers influential in contributing to the climate of reform in the health care area in Australia and the subsequent developments. There are clearly defined consumer models of complaints-handling for the health area, ascertainable from examination of the broader context of the development of the consumer movement and consumer organisations ; and specifically drawing on the common elements from the contribution of the consumer movement in health. A consumer model for complaints-handling at the local level is proposed. / Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1997?

Includes bibliographical references (leaves 310-325). / xvi, 325 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A study which investigates in a South Australian context: 1. What are the physical activity gaps between social groups and how do these gaps relate to health and the other benefits of physical activity? 2. What are the contraints on choices and what needs to be done to make the choices of people to increase moderate physical activity easier? 3. What is the role of the social environment in relation to moderate physical activity choices and what needs to be done to ensure supportive environments? The results show that physical activity frequently becomes the province of differents sectors of society at different times. Recent case studies demonstrate that policies about how governments organise their services lead to more fundamental changes than specific health policies. / Thesis (Ph.D.)--Adelaide University, Dept. of Public Health, 2001

Zugl.: Siegen, Univ., Diss.

Thesis (M. Med.)--University of New South Wales, 2005. / Also available online.

Thesis (Ph. D.)--Dept. of Community Medicine, University of Adelaide, 1992. / Typescript (Photocopy). Includes bibliographical references (leaves 307-320).

Thèse (Ph.D.)--Université Laval, 1999. / Comprend des réf. bibliogr.

Thesis (M.D.)--University of Adelaide, Dept. of Public Health, 1998. / Includes bibliographical references.