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Multiple factors account for inequality in health outcomes and in access to healthcare in the UK, including ethnicity and length of residence in the country. This thesis explores the subjective experiences of a group of recent low-income international migrants who live in Brighton and Hove and have used local health services to seek care for a range of illnesses and conditions. The project was formulated in collaboration with Brighton and Hove City Council and the then NHS Brighton and Hove (now Brighton and Hove Clinical Commissioning Group), using local professional knowledge and experience to recruit participants and collect narratives from a ‘hard to reach' social group. The theoretical background of this thesis draws on ‘lived' experience in the context of illness. Analysis of qualitative interviews, using narrative typologies derived from the work of Frank (1991), revealed both the commonalities across and the specificities of illness experiences, and highlighted a multi-factorial web of bio-psychosocial and economic factors at play. The interviews overwhelmingly fitted with a chronic, ‘chaos' typology, in which diagnoses were commonly contested. The particularities of recent migrant status impacted upon participants' illness experiences and healthcare use. Migrants made comparisons with health systems in their countries of origin and managed healthcare through social networks. The findings from the data analysis around patient experience showed that the overall experience was negative, characterised by disappointment, with communication and access problems as recurrent themes. These outcomes may be explained by both direct and indirect discrimination. Direct discrimination and stigma were perceived by many participants in the attitudes and practices of staff, which some participants linked to their own ethnicity, immigration status and faith. From this study it is possible to hypothesise that healthcare practices and policy may give rise to some of the perceptions of discrimination.

Decentralisation policies have been adopted by most countries in Sub-Saharan Africa in the expectation of improved service provision. The benefits expected are two-fold: a) decentralisation will lead to better coordination and collaboration between different parts of the state at the local level and b) decentralisation will lead to increased consultation and responsiveness of local governments to their citizens. In this thesis I seek to explain why these benefits are realised in some contexts and not others. In most parts of Sub-Saharan Africa, the predominant form of decentralisation is a combination of devolution and deconcentration. Often these two policies are ambiguous and sometimes contradictory. What are the processes through which such mixed systems work? This thesis attempts to understand how mixed systems of devolution and deconcentration work in practice through a comparative study of Five Municipal Health Directorates in Ghana. The study explores the three sets of relationships that are critical for decentralisation to work well in such mixed systems a) between the Health Directorate and the District Assembly administration, b) between the Health Directorate and the elected members of the District Assembly and c) between the Health Directorate and selected civil society organisations working on health. The work is based on detailed qualitative interviews in the five municipalities. The main finding is that informal ties between the Health Directorate and the three sets of actors mentioned above are helpful in explaining why coordination and consultation seem better in some municipalities than others. Four kinds of ties are found to be important: ethnic/tribal links, family/kinship/neighbourhood relations, political party affiliations, and old-school networks. These ties between Municipal Health Directorates and senior officers of the Municipal Assemblies were found to facilitate Municipal Health Directorates' access to District Assemblies' Common Fund, which was controlled by the Municipal Assemblies. The existence of these ties between Municipal Health Directorates and elected Assembly members of Municipal Assemblies were found to enhance the quality of Municipal Health Directorates' policies and helped to gain public support. Finally, such ties between Municipal Health Directorates and leaders of selected Civil Society Organisations that mobilised around HIV and AIDS programmes were found to facilitate implementation of Municipal Health Directorates' policies around HIV and AIDS. The thesis' contribution is that it shows that informal linkages between different local bodies and between local government and civil society organisations seem important for improved coordination and collaboration among various actors, and better consultation with elected representatives of citizens and leaders of CSOs for effective service delivery at the local level.

The purpose of the present study is, by employing the methods of process-tracing and pattern-matching, to compare the policy-processes with regards to the cases of student and patient mobility. While the case-study approach to EU policy-making from a comparative perspective was introduced in the late 1970s, so far there has not been a study, which compares the cases of student and patient mobility. This gap in the academic literature is important in order to examine what conclusions can be drawn from such a comparison and as a result their consistency with previous theoretical work. In particular, and in contrast to current theoretical themes in the field of European studies and in the policy studies literature more generally, both of which stress policy change as opposed to policy stability, the comparison stresses the latter due to the interests of the most powerful member-states, that is, France, Germany and Britain. The role of interests is manifested with the adoption of the Erasmus Programme and of the European Health Insurance Card, which do not concern the free movement of students and patients. Through a synthesis between liberal intergovernmentalism and the concept of path-dependence it has been possible to create a model in order to explain why those particular policies were chosen when the alternative of free movement was also available. This interest-based account comes in direct opposition with those studies which stress the role of ideas in the policy-process but it also emphasizes the role played by the supranational institutions more specifically the Commission and the court.

The early nineteenth century saw the emergence of institutional psychiatry across Europe. Aware that Sweden had fallen behind in this development, Parliament decreed in 1823 that a number of specialised institutions for the care of the insane were to be established. The Vadstena asylum, opened in 1826, was the first such institution in Sweden.   The aim of this study is to examine medical interpretation of and responses to erotic behaviour in psychiatric practice at the Vadstena asylum in the period 1849-1878. The book places the theme of the erotic, a topical subject in nineteenth-century public debate, in the context of psychiatry as an emerging specialty in Sweden. The book explores how erotic behaviour was conceptualised as disease, and the nature of therapeutic intervention in erotic cases, in order to present a more nuanced image of nineteenth-century medical attitudes to sexuality. By highlighting the superintendency of physician Ludvig Magnus Hjertstedt, and linking his account of an 1845 study tour through Europe to medical practice at Vadstena, the study situates responses to erotic patients in a period when psychiatry claims authority over human sexuality.   In methodological terms, the study applies critical questions inspired by revisionist scholarship to a body of empirical source material. Focusing on a single institution, and conducting in-depth readings of case notes – with regard to language, form, and function – allows the study to highlight the everyday practice of the asylum physician in his encounters with male and female erotic patients, including the use, importance and diagnostic integrity of the concepts nymphomania, erotomania and masturbation. Hjertstedt’s travel journal provides insight into the physician’s medical philosophy, informing the analysis of diagnostic and interpretive procedures, while connecting medical practice at Vadstena to its European paragons.     The results indicate that while the use of specific diagnostic terms to describe erotic behaviour was infrequent, therapeutic and managerial intervention shows that sexual acts and expressions of desire were considered disturbing and dangerous symptoms in both male and female patients. The analysis thus makes visible a gap between psychiatric theory and asylum practice, emphasising uncertainties and complexities inherent in the latter. While erotic behaviour could be considered indicative of illness, it might also be interpreted as a lack of character or a result of insufficient moral instruction. The asylum’s regime of work and moral instruction was designed to restore health as well as sound values and appropriate behaviour in its patients, indicating a medical culture at Vadstena which was both curative and normalising.

Martin Haloun Normality and Normativity Annotation: The thesis Normality and Normativity is concerned with the problems of the relation of normal and abnormal. The analysis of the expression 'normal' is the introduction of the topic followed by the demonstration that there are multiple meanings of the normal that do not always coincide. During the description of the aspects of norm and normal the fundamental relations between facts and prescriptions will have to be taken into account. The full meaning of the notion normal will be demonstrated on the basis of its relation to the pathological and healthy. A definition of health presented in this thesis, which takes into consideration the specifics of the normal, is based on the works of George Canguilhem and Kurt Goldstein. The crucial moment is the understanding of disease as a reaction of an organism to the limitation of the milieu. An important factor is the introduction of vital normativity that is intrinsic to the living being. This conception opposes the influential conception which identifies the state of health with certain physiological criteria - standards of health - advocated among others by Claude Bernard. At the end of the thesis we will shortly overview the norms as formative aspect in a society. The sociological view of norms that is...