As the public sector and specifically the health sector, undergo reform throughout the Western world in order to find systems that work better and cost less, the phenomenon of accountability is of increasing concern to policy-makers. Although the public administration concept of accountability is ancient, and has been debated and described in the languages of many diverse disciplines, little academic work is available on its meaning or application to the Canadian Health System. Without a clearer understanding of the concept, the basis for improving accountability in the Canadian Health System will remain unknown. This dissertation seeks to clarify the concept of health system accountability and elucidate the issues related to improving accountability in the system. This is accomplished through a concept analysis methodology using two qualitative data collection strategies: a structured review of Canadian literature on accountability from the domains of health policy/administration, professional and popular literature sources; and an interview process whereby 24 health system leaders from five Canadian provinces were interviewed. The findings reveal that the concept of accountability, in its current explicit, performance-based form, is relatively new to Canadian health system policy discussions, its use only beginning in the 1980’s. Prior to this, accountability was implicit in the delegation of health matters to self-regulating professions. The concept evolved from public administration theory and continues to evolve as a health concept. An attempt is made to disentangle the concept of health system accountability from its many related concepts and references. The defining attributes of accountability are: a performance assessment according to standards/goals; an obligation to render an account; and an answerability to the community served. Antecedents or pre-requisites to accountability include a renewed culture, strategic direction, citizen engagement, information management, performance measurement and reporting. Consequences of accountability are: a sustainable health system, increased public confidence, improved health outcomes and quality services, added bureaucracy and uncertainty. Although there is a majority view on the defining attributes, there are several conceptions of accountability: as a theoretical or ethical construct; as gesture; as a formal system or set of practices; as an on-going political process; and as desired outcomes or results. Likewise several normative modes or models exist: the historical professional model, the emerging managerial model and the potential citizen participation model. These are all encompassed within the broader political framework. Also, accountability is a multi-level construct: personal, organizational and political. There are several policy issues related to accountability and democratic governments in today’s modem societies. Within the health sector, the key issues identified, by health system leader research participants, as problematic to improving accountability included: a lack of direction and role definition, cultural issues, a lack of citizen engagement, and a lack of appropriate measurement and information with which to evaluate organization and system performance. Although the purpose of this dissertation is not to answer or provide prescriptions to policy issues, several health policy questions are generated. I trust that the conceptual analysis presented here will assist to clarify our language and understanding of accountability as it continues to evolve in health care, provide a helpful reference point from which to discuss health system policy issues, and prompt further research in an area that has largely been ignored by Canadian academics. We need to get clear about our language, (so that), our intelligence is not bewitched by our language. (Hodgkinson, 1996, p.144) / Graduate

Introduction: Understanding the life-course determinants of resilience to brain ageing could significantly reduce the burden of cognitive impairment and dementia on individuals, heath care providers, and societies. The focus of this work is the concept of cognitive reserve (CR), which implies that some individuals are able to remain cognitively healthy despite the accumulation of age-related neuropathology. Methods: The determinants of brain structure and function were statistically modelled using three ongoing ageing cohort studies [Aberdeen Birth Cohort of 1936 (ABC1936), Aberdeen Children of the 1950s (ACONF), The Three-City French Cohort (3C)]. First, I performed a systematic literature review to identify life-course determinants of CR. Then, I examined whether other potentially modifiable life-course factors such as birth weight, mid-life occupational profile, and late-life social relationships and technology use provided individuals with greater CR. I modelled data in STATA and SPSS/AMOS. Results: I found that the effects of low birth weight and pre-term delivery on cognitive functions persists into mid-life (ACONF). I showed that childhood intelligence at age 11 has almost twice the protective effect on cognitive ageing than mid-life occupation (ABC1936). The quantity and quality of social relationships (3C), and the aspects of technology use in latelife (ABC1936) did not provide greater CR. Conclusion: Early-life factors contribute to later-life brain health. A major implication of this work is that studies and/or programs should consider a life-course perspective (with a focus on early-life) to accurately assess and to improve the brain health of older adults.

This thesis is intended as a broad examination of the distribution of health resources in South Africa. Issues both macro and micro in nature have been covered to provide a perspective that would be Jacking in a narrower study. Although the title refers to a redistribution of resources, the intention of this thesis is to stress the importance of providing appropriate health measures rather than merely apportioning existing facilities evenly. This realization is insufficient, however, if it is not accompanied by the introduction and utilization of analytical approaches for identifying resource selection priorities. The influences on health status are many. In defining appropriate measures to improve health status it is important to be aware of the limitations of medical-care. Chapter three involves a cross-sectional regression analysis of various countries in order to examine the influences certain variables have on health status. This study suggests the need for an integrated approach to improving the health of a population. Merely focusing on medical care will only have a limited affect. However, this does not mean that medical-care is not important. It must just be provided in an appropriate manner. The rest of the thesis evaluates health-care resource distribution in South Africa. The existing distribution of health-care resources in South Africa is ill-suited to the existing health status of the population. There is a bias toward urban based curative facilities. Furthermore, the location of facilities has been based on racial criteria, whereby some areas have sufficient resources for their needs while others do not. Two methods of identifying how these issues should be dealt with are produced in this thesis. The first deals with a method for adjusting the broad distribution of funds toward those areas where need is greatest. The suggestion put forward by this thesis is that a formula be developed that would be able both to define need on a geographical basis, and to allocate resources based on that need. The formula would be used to allocate government health expenditure. This section is based on a formula that was developed in the United Kingdom. The second deals with a method for defining appropriate medical interventions on the micro level. It is called cost-effectiveness analysis (CEA). CEA is used for micro-economic decision-making where a choice has to be made between at least two alternatives for attaining a particular objective. Furthermore, CEA evaluates projects or programmes that are on-going in nature. It should be noted that CEA can also evaluate non-medical interventions to solve a particular health problem. In order to indicate the type of information that a CEA can provide, an investigation into cervical cancer procedures used on black females was produced. The entire black female population of South Africa was examined. A computer simulation of incidence and mortality rates of the disease was used to evaluate various scenarios. The results indicate that significant gains can be made by introducing cervical cancer screening on a large scale in South Africa. A major priority of this thesis was to stress the importance of using economic criteria to assist in making decisions concerning health-care resource allocations. Very little work of this nature is produced in South Africa. Hopefully this will not always be the case.

An attempt has been made to examine the relationship between social structure and medical factors in a framework which links cosmopolitanism to health orientation and behavior. Specifically, this study has attempted to investigate the variations in health knowledge, beliefs, attitudes and behavior among individuals whose social structure varies in terms of cosmopolitanism.

Thesis (Ph.D.) -- University of Adelaide, Dept. of History, 2001. / Includes bibliographical references (leaves 280-305).

香港醫療衛生發展的論述，通常至1941年便停止，然後由1945年重新探討，跳過了二次大戰期間的日治時代。雖然有大量關於英軍回憶、遊擊隊、一些口述歷史等的研究書籍，但這時期仍未得到充分的關注，尤其在社會發展方面。本文以《香港日報》為主要材料，嘗試析述被忽略的日治醫療衛生史。 / 有關戰前香港醫療衛生的史觀，主要有「殖民醫學」與「殖民現代性」兩套理論。前者認為殖民力量將西醫強加於本地社會；後者則強調殖民統治帶來的正面作用，和殖民地有其獨特形式的現代性。直至日治前夕，香港的中西醫仍較為對等，中醫在民間有極大支持；西醫在政府政策上享有優勢。然而戰後出現的卻是另一景象，無論民間或政府皆接受西醫為主流醫學，中醫則潛藏於民間繼續傳承。這不代表中醫已被淘汰，只是西醫的發展已蓋過中醫，其中原因須追溯日治期間。日治政府承接英國殖民政府推行西醫，社會上有大量西醫常識流通，藥物使用習慣講求科學，日治時期的這些因素都為西醫在戰後普及做準備。 / 本文為過往研究所忽略作補充，藉此重新思考「日治歷史」的意義。誠然這段歷史是傷痛的，但也不可主觀地跳過而不作討論，日治時期是連接香港二戰前後的發展。醫療衛生正是其中一個脈絡，本研究將就此提出新視角。 / The analyses on Hong Kong medical and hygienic history often split into two time slots, one from the beginning as the British colony until 1941 and the other from 1945 to the present, mostly overlooking the period of Japanese occupation from 1942 to 1945. Although there are plenty of books for general readers, for examples, memoirs of British troops and Chinese guerillas, and oral history records about the Japanese occupation in Hong Kong, this period has not yet received due academic treatment. This dissertation, therefore, studies the neglected medical history of Hong Kong under the Japanese occupation using Honkon Nippō (Hong Kong News) as the main reference. / Approaches to the discussion on prewar Hong Kong medical history apparently depend on two theories, namely the “colonial medicine and the “colonial modernity. The former perspective believes that colonial powers forced colonized societies to follow the European modernity, while the latter stresses the positive effects brought by colonizers and formations of own unique modernity among colonies. Before the Japanese occupation, both traditional Chinese medicine (TCM) and Western medicine (WM) enjoyed fair status, with the TCM gaining overwhelming support from the Hong Kong society and the latter receiving administrative advantages from the colonial government. After the WWII, however, both the Hong Kong society and the government recognized the WM to be the mainstream therapy, and thus, the TCM was only praciticed at the bottom level of society without official acknowledgement. Nevertheless, this did not represent the elimination of the TCM and merely revealed the development of WM surpassing the TCM. The reason should be traced back to the period of Japanese occupation when the government sustained the policy of the British colonial government to spread the WM, causing circulation of a large amount of medical knowledge in the society and a trend of scientific drug using. All these factors benefited to the popularization of WM in Hong Kong society after WWII. / This study fills in a missing link of previous research and rethinks the implication of the “history of Japanese occupation. Indeed, the history is painful but one should not subjectively omit it because this period connected the development of Hong Kong between prewar and postwar era. This study sheds new light on medical history as well as history of Japanese occupation. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 李威成. / "2012年8月". / "2012 nian 8 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 193-201). / Abstract in Chinese and English. / Li Weicheng. / 論文摘要 --- p.i / Abstract of thesis entitled --- p.ii / 鳴謝 --- p.iii / 圖表目錄 --- p.vi / Chapter 第一章 --- 導論 --- p.1 / Chapter 第一節 --- 研究動機與目的 --- p.1 / Chapter 第二節 --- 文獻回顧 --- p.5 / Chapter 第三節 --- 研究方法 --- p.12 / Chapter 第四節 --- 論文架構 --- p.17 / Chapter 第五節 --- 研究意義 --- p.19 / Chapter 第二章 --- 戰前香港的醫療衛生發展 --- p.20 / Chapter 第一節 --- 殖民地政府的醫療衛生事業沿革 --- p.21 / Chapter 第二節 --- 民間的醫療衛生常識 --- p.29 / Chapter 第三節 --- 戰前香港醫療衛生與日本人 --- p.37 / Chapter 第四節 --- 《香港日報》的創辦與發展 --- p.43 / Chapter 第五節 --- 小結 --- p.49 / Chapter 第三章 --- 日治香港政府的醫療衛生概觀 --- p.51 / Chapter 第一節 --- 日治政府醫療管理與醫生註冊 --- p.52 / Chapter 第二節 --- 疾病控制與防疫運動 --- p.67 / Chapter 第三節 --- 環境衛生與糞便處理 --- p.76 / Chapter 第四節 --- 區制、戶籍登記與醫療衛生制度 --- p.87 / Chapter 第五節 --- 小結 --- p.97 / Chapter 第四章 --- 從《香港日報》看日治時期醫療衛生常識的傳播 --- p.99 / Chapter 第一節 --- 副刊專欄與醫藥新知 --- p.100 / Chapter 第二節 --- 公共衛生資訊的提供 --- p.116 / Chapter 第三節 --- 小結 --- p.133 / Chapter 第五章 --- 從《香港日報》看日治時期治療藥物的供應 --- p.135 / Chapter 第一節 --- 《香港日報》中的藥物廣告 --- p.136 / Chapter 第二節 --- 流通市面的藥物 --- p.155 / Chapter 第三節 --- 贈醫所及個人醫師的角色 --- p.165 / Chapter 第四節 --- 小結 --- p.173 / Chapter 第六章 --- 總結日治時期的影響──香港醫療的延續與前進 --- p.175 / Chapter 第一節 --- 醫療體制的過渡 --- p.175 / Chapter 第二節 --- 從日治醫療史看日治歷史性質 --- p.187 / Chapter 附錄(一) --- 日治期間各分區新舊名稱轉換、區長副區長及區會員數目表列 --- p.191 / Chapter 附錄(二) --- 香督令第二十一號(1942年)[節錄] --- p.192 / Chapter 附錄(三) --- 香督令第十六號(1944年) --- p.193 / 參考書目 --- p.194

Breast and prostate cancers are the most commonly diagnosed forms of cancer in women and men in the United States. The federal government has played an active role in dedicating resources toward breast and prostate cancers since the early 1990s, when policy actors successfully lobbied Congress to adopt policies that increased awareness and spending. Using theories of social construction, I argue that the key to their success was the ability of these policy actors to socially construct the illnesses of breast and prostate cancers into politically attractive public issues that appealed to federal policymakers. Through the use of embedded collective case study and content analysis of newspaper coverage and congressional data, this dissertation demonstrates how the social constructions of these illnesses impacted the way that breast and prostate cancers were treated as they moved through the policy process. The way in which social construction influenced the types of policies that were adopted to deal with these illnesses is also examined. Because social construction is a multidimensional and dynamic process, several different elements of this process were examined in this dissertation: the ways that policy actors attracted attention to these illnesses, how gender influenced advocacy efforts, the symbolic aspects of these illnesses, and the way the illnesses were defined on systemic and institutional agendas. Since this dissertation examines two different policy issues, the similarities and differences in breast and prostate cancer policymaking were analyzed. I found that discussing breast and prostate cancers in relation to their social constructions provides support for the importance of symbolism and non-rational policy-making processes. / by Jocilyn Martinez. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

published_or_final_version / Public Administration / Master / Master of Social Sciences

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Public Administration / Master / Master of Social Sciences