Introduction Occupational Epidemiology (OE) has played a vital role in producing improvements in the working population’s health. Nonetheless, anecdotal evidence indicates that OE in the UK is facing many challenges and the research workforce, funding, and output in this area are declining. This study aims to: investigate the nature and evolution of these key contributors to success; identify the external social, political, economic and any other factors which frame and contextualise these challenges and the facilitators; use this contextualisation to explain and evaluate how and why the identified challenges and facilitators influenced the OE field development compared to other similar fields; and explore how far they may explain the ebb and flow of research activity in OE in comparison with other health disciplines. Methods A sequential, mixed-method approach was undertaken in four phases. These included interviews with key UK-based OE researchers; a survey of UK-based OE researchers to test out themes that emerged from the first phase; a bibliometric analysis comparing trends and characteristics of UK-based OE published studies with those in public health epidemiology (PHE); and a documentary review of annual reports of three health research funding bodies including: the Medical Research Council, the Cancer Research Campaign, and the Health and Safety Commission. Results The lack of human and financial resources was found to be of utmost concern to the OE community, which increased over time and negatively affected researchers’ abilities to conduct further and higher quality studies. The bibliometric study revealed that the number of PHE publications and researchers increased substantially while the numbers for OE remained fairly constant. Furthermore, it was found that in PHE much higher levels of collaboration and adoption of newer methods such as the use of molecular and genetic techniques were applied. Widening research collaboration and the adoption of newer methods were encouraged by funding bodies because both are perceived to contribute to research efficiency and commercialisation of research ideas. These have been adopted more widely by other fields, thus helping them to develop and improve their status, which was not the case for OE. Furthermore, fewer influential representatives from the field of OE were found within funding bodies, which had played a major role in directing resources to research within health fields and hence influencing their development. Conclusions Social, economic, and political factors such as the exclusion of occupational health (OH) from the National Health Service, deindustrialisation, and neoliberal government policies within public and higher education institutions particularly that focus on economic contribution of science, and research auditing and efficiency, most likely, have the greatest influence on funding decisions of research in OH and other health disciplines. These issues have significantly instigated obscurity of OH and hence OE within the agendas of both the government and the funding bodies. Henceforward, the development of the OE field has become adversely affected compared to other health research fields. Finally, this thesis confirms that the rise and fall of a particular health research field is heavily influenced by specific past and contemporary social, economic and political factors. Engaging in social, economic and political matters, being open to new advances in research, and optimising networking opportunities with other disciplines, key researchers, policy-makers and other pertinent stakeholders and institutions may potentially facilitate progress in OE and other health research fields.

This thesis seeks to contribute to the knowledge base about social policy in the United States, using long-term care (LTC) financing policy reform as an illustrative example. Specifically, this thesis explores LTC financing reform efforts during three U.S. Presidential administrations: Bill Clinton (1993-2001), George W. Bush (2001-2009), and Barack Obama (2009-2010). Within this historical framework, the LTC provisions of the Health Security Act of 1993, the development of the Community Living Assistant Services and Supports or 'CLASS' Act during the Bush Administration, and the legislative success of the CLASS Act as a part of the Patient Protection and Affordable Care Act of 2010 provide comparable cases to compare the drivers of social policy. Drawing on the explanatory frameworks of the welfare state such as ideology, historical institutionalism, and an actor-centered approach to policy analysis, this thesis argues that successful path-departing legislation is difficult to achieve due, in part, to the presumed high costs of social programs and the complex institutional framework of the American political system. Policy outcomes result from the interaction between the complex processes and dynamics of the political system through which policy change (or the failure to change) actually occurs. The fact that the CLASS Act was politically successful, yet administratively inoperable as designed, reinforces the argument that social policy outcomes in the United States are reflective of a complex, enduring struggle of competing ideologies. This continual struggle, coupled with a heightened concern over cost control and fiscal austerity, helps to ensure that policies which are legislatively successful within the institutional architecture of the American political system are unlikely to produce major expansions of the welfare state. Social change is therefore highly difficult to achieve, even in the face of significant unmet social needs. Comprehensive reform of U.S. LTC financing arrangements will remain an elusive goal for the foreseeable future. Instead, incremental, highly pro-market solutions are likely to be the types of policies promoted in the years of ahead.