This thesis critiques the constructions of girls and young women who are in, or are considered ‘at risk’ of, secure care or custody by exploring the ways in which they are explained and understood by the practitioners who work closely with them. The research was shaped by feminist concerns and aims, and involved in-depth, semi-structured interviews with 50 practitioners working with young women in a range of settings related to criminal justice in Scotland: prison, secure care, social work, and third-sector community services. A key concern of the thesis was to contribute to the growing body of knowledge and understanding about these ‘at risk’ young women. The work that exists in the Scottish, and wider UK, sector offers rich insights into different aspects of the experiences of this marginalised population, but very little of this is focused upon the role of the practitioner, or on practice that is conducted with this group of young women. In adding to this under-researched area, the thesis makes several contributions. Firstly, it supports the work of other feminist scholars through adding to the limited body of UK-specific knowledge regarding young women’s pathways into criminal justice contact. Secondly, it contributes to feminist concerns regarding the different and changing modes of social control to which young women are subjected, finding that practitioner contribution of knowledge to such discourses can serve to exacerbate the responsibility that is placed upon them in working with these young women. Thirdly, the thesis details the aspects of working practice that practitioners viewed as key to their work, and by doing so, gives context to understanding why so many practitioners describe finding young women a ‘difficult’ group with whom to work. Lastly the thesis contributes by its exploration of the personal experiences of practitioners in conducting their work, and the working environment and conditions surrounding these, which are framed in the thesis as gendered emotional labour. The thesis makes the argument that practitioners often experience difficulties not only because they are faced with hearing about or experiencing distressing stories, but because of the precarious situations that many work within, and because of the ways in which gendered risk and gendered vulnerability act as tools of governance, leaving them anxious and uncertain about their own ‘risky decisions’ in these insecure work environments.

Some governments tackle poverty and inequality by creating well-functioning, rules-based distributive programmes. Others redistribute selectively, showering their loyal supporters with goods, services, and money while denying these things to other citizens, even when those other citizens are very poor. What explains this contrast? Why do some governments prefer politically neutral rules-based forms of redistribution while others prefer highly selective clientelistic redistributive arrangements? This dissertation answers the question by developing a new line of theory. I also test that theory against evidence from a number of Latin American countries, most notably Brazil. Although rules-based social policies are a cornerstone of the modern welfare state, we know surprisingly little about the politics behind these policies. In this dissertation I show how, in much of Latin America, the development of rules-based programmes can be traced to the electoral incentives of politicians, and of presidents in particular. Forging clientelistic deals with favoured constituents may be a winning strategy for legislators and local officials, but presidents cannot play that game as well and so tend to prefer less particularistic forms of redistribution. Over the past few decades, rules-based social programmes have emerged for the first time in much of Latin America. However, the reason why these countries have been embracing programmatic redistribution now is not yet clear. Some studies have stressed that the spread of electoral democracy has created incentives for politicians to shift distribution away from powerful groups and towards the poor. For these scholars the emergence of rules-based programmes is a reflection of weakening clientelistic linkages between politicians and voters. Others have argued that, as societies get wealthier, voters have the means to rebel against clientelistic schemes and vote for politicians that favour programmatic distribution. Others still make the point that the rise of left-wing parties is what is driving these transformations. Leftist parties organise and mobilise the poor, who in turn pressure for effective, rules-based distribution. In contrast with these explanations, my analysis attributes the new emphasis on rules to the shifting balance between the powers of legislators and those of presidents in much of Latin America. My argument is that clientelism remains a useful electoral strategy mainly for legislators and in local politics, where the support of well-organised networks of clients can make a difference between winning and losing public office. Presidents, on the other hand, have much larger and more heterogeneous constituencies, which makes investing in small networks of clients prohibitively expensive for them. Furthermore, presidents strive to be seen as strong leaders that are capable of designing effective policies that will be considered fair by the majority of citizens. In the case of presidents, creating rules-based social programmes is the most efficient way to redistribute income in a way that is compatible with their political priorities. I test this theory using a unique dataset of social spending in each of Brazil's 5,570 municipalities. Employing different identification strategies, I find broad support for the argument that legislators and presidents prefer very different kinds of social policies. These differences are systematic and do not depend on a legislator's or on the incumbent president's party affiliation. Even legislators who hail from 'pro-poor' parties on the left of the political spectrum seem to prefer clientelistic forms of redistribution, despite the fact that clientelistic practices can be quite regressive. At the same time, presidents almost always prefer programmatic distributive policies, which are famously progressive, even when they hail from parties on right of the ideological spectrum. These results - the product of numerous interviews and extensive fieldwork conducted in four states over the course of two electoral cycles - help explain why Brazil and other young democracies in Latin America have seen conditional cash transfer programmes and other rules-based income distribution schemes proliferate in the recent decades. As my analysis reveals, these schemes were largely driven by presidents. As presidents gained control over the design and the funding of social policies, they used these powers to create the kinds of programmes that furthered their own electoral interests. That said, inefficient spending on clientelistic arrangements remains a problem in Brazil, as it does in much of the region. This, too, can be explained by my theory: clientelism's staying power reflects the fact that, despite recent reforms, legislators remain powerful. Exploiting that power, legislators have continued to do what they always do, rewarding clients and punishing dissenters, as illustrated by my analysis of the case of Argentina. Latin American presidents may now be gaining the upper hand, but until the power balance shifts decisively in their favour, we are unlikely to see rules-based distribution completely replacing traditional clientelistic arrangements in Latin American or, for that matter, anywhere else.

Background and importance: Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. Objective: The aim of this Ph.D. was to explore issues relating to the prices and usage of generic medicines in high- and middle-income countries in five articles. This was done using quantitative and qualitative methods, including price and Herfindahl-Hirschman indexes, difference-in-differences regression analyses, semi-structured stakeholder interviews, and literature reviews. As a Ph.D. "thesis by papers", each of the five articles should be read as a stand-alone piece. However, the thesis presents an overarching narrative, outlined at the end of Chapter 1. Novelty and empirical contribution: My original contributions to knowledge are: (i) updated analyses of generic drug policies, prices, and usage rates in high-income countries, based on a large, representative sample of generic medicines from 2013 (Chapters 2 and 3); (ii) evidence on the impact of a pharmaceutical tendering system on medicines prices, demand, and competition over a 15-year period (Chapter 4); (iii) quantitative data on the impact of therapeutic tendering on drug spending and prices (Chapter 5); and (iv) qualitative data on how a country can move from a fragmented health-care system to a single-payer one, using tendering as the basis for a comprehensive drug-benefit plan (Chapter 6). Key findings: The prices and market shares of generics varied widely across Europe. For example, prices charged by manufacturers in Switzerland were, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. However, the results varied depending on the choice of index, base country, unit of volume, method of currency conversion, and therapeutic category. The results also differed depending on whether one looked at the prices charged by manufacturers or those charged by pharmacists. The proportion of prescriptions filled with generics ranged from 17% in Switzerland to 83% in the United Kingdom. The results of the first two studies indicated that the countries which used tender or tender-like systems to set generic drug prices in retail pharmacies (ie, Denmark, Germany, the Netherlands, and Sweden) had among the lowest prices among the countries included in the studies. Tendering can be an effective policy to procure essential medicines at low prices, based on analysis of data from South Africa and Cyprus. For instance, the average prices of antiretroviral therapies, anti-infective medicines, small-volume parenterals, drops and inhalers, solid-dose medicines, and family-planning agents dropped by roughly 40% or more between 2003 and 2016 in South Africa. Many tender contracts in South Africa remained competitive over time, based on the Herfindahl-Hirschman results, with some notable exceptions. However, the number of different firms winning contracts decreased over time in most tender categories. Also, there were large discrepancies between the drug quantities the health ministry estimated it would need to meet patient demand and the quantities the ministry went on to procure during tender periods. In South Africa, the introduction of therapeutic tendering was associated with an estimated 33% to 44% reduction in the prices of solid-dose drugs in 2014. National governments in countries aiming to introduce national health systems (eg, Cyprus and South Africa) will need to adapt their tendering systems and other pharmaceutical policies during transition periods. Future research directions: More research is needed to better understand the drivers of differences in generic drug prices between countries. It is also important to examine why there are large differences in the prices of drugs in various therapeutic areas, both within and between countries. Also, data from more countries, especially low- and middle-income ones, are needed to determine which features of tendering systems are associated with lower prices. Future studies should re-examine the South African therapeutic tendering system once data from more post-intervention periods are available, possibly using other research designs like interrupted time-series models (ie, segmented regression analysis). Policy implications: Price indexes are useful statistical approaches for comparing drug prices across countries, but policymakers should interpret price indexes with caution given their limitations. This thesis offers useful data for policymakers using, or planning to introduce, tendering systems, especially in countries aiming for universal health coverage, like Cyprus (Chapter 6) and South Africa (Chapters 4 and 5).

Asset-based approaches to welfare may be seen as part of a broader trend towards individual responsibility and private provision. With pressures on pension systems and the concentration of wealth in owner-occupied housing, there is debate about the potential of equity release as a source of funding in later life. However, very little is known about the role that it plays in practice. Using a mixed methods approach, this thesis fills that gap by exploring older people’s use of equity release products and finds that they play a limited role in meeting income needs as so few people use them. Among those that do, they play different roles for different groups and make an important difference to the living standards of those with middle incomes and medium to high levels of housing wealth. However, they make less of a difference to home owners with lower incomes and more limited housing assets. The research concludes that equity release has the potential to provide financial security but questions whether it can really function as an adequate safety net for those in need. Governments have encouraged people to accumulate housing assets partly so that they can be more self-reliant, yet have done little to help them decumulate their assets. It is suggested that governments could do more to make equity release more accessible to those at the lower end of the income and housing wealth distribution, but this should not be at the expense of asset-excluded groups.

This is a case study of the development of plans for a piece of legislation and of the part played in that process by interest or pressure groups. It examines the wording of the National Health Service Act, 1946 and, in contrast, the health services of 1939. The main events of 1939 to 1946 are surveyed together with a review of the interest groups and their views. The main evidence of the study shows the development of plans for a National Health Service from the first plan put forward by Mr. E. Brown as Minister of Health (the plan of his officials rather than himself) through the 'White Paper of 1944 and the Revised White Paper of 1945 (both prepared by Mr. H.U. Willink as Minister) to the final plan adopted in the Act of 1946. Studied section by section the plan adopted by Mr. Sevan is shown as a development of the previous plans, together with changes necessary by the arrival of a new and powerful interest group, the Labour Party, rather than any dogmatic expression of party views. This analysis brings out quite clearly the following pattern. In the first place an official’s plan (Brown Plan) was prepared as a necessary basis for discussion with the groups. (Mr. Brown discarded it and therefore was unable to make any definite progress). As a result of these discussions, another plan (the White Paper) was drawn up as a basis for more detailed discussion (or negotiation). Bit by bit a plan emerged from this further discussion which seemed to command general agreement among the main groups. This, plan, the revised White Paper plan, was being translated into legislation when the general election of 1945 brought a change of government. Mr. Bevan, the new Minister, adopted the previous plan and applied to it, as far as he considered necessary to ensure his party's support, the views of the Labour Party. The result was the National Health Service Act, 1946. In a final section some suggestions for a wider study on the role of interest groups in the drafting of legislation are made.

The present study was designed to examine the extent to which perfectionism and social problem solving add to the prediction model of nonsuicidal self-injury (NSSI), independent of suicide risk, in a sample of 386 ethnoracially diverse college students. Moreover, the authors were interested in whether social problem solving, beyond perfectionism, would account for additional variance in their prediction model. Results indicated that social problem solving did account for significant variance in the prediction model of NSSI, above and beyond perfectionism. Moreover, on controlling for suicide risk, a possible confound for NSSI behaviors, social problem solving was found to account for an additional 4.0 percent of unique variance in the prediction of NSSI, beyond that accounted for by perfectionism. The present findings have theoretical implications for the literature on perfectionism and social problem solving, specifically in relation to NSSI. In addition, the present findings have practical implications for social workers who work with college students engaging in NSSI behaviors.

The concern of this dissertation is planning theory and practice; its purpose is to make planning more responsive to the problems of the city. The premise that the study is built on is that social planning must be in harmony with the nature of its subject matter, and that social problems is its subject matter. The supposition is that if we grasp the nature of social problems and build planning theory and practice on these insights, planning efforts will be more relevant and more effective. The approach is a theoretical one; social problems are the starting point. After urban problems--and poverty in particular--are examined from an historical perspective, a social systems framework is presented to clarify how problems are generated and maintained as well as to explain how responses to problems are shaped. The inquiry into the nature of social problems then draws upon sociological theory. This theoretical literature is found to focus on either the objective elements of social problems or on the subjective, that is, the process by which persons come to judge whether a condition is a social problem. Structural aspects of problems are not an important concern of the theorists. However, in this study a problem is considered as social only when its causes lie outside of individuals--when the sources or origins can be found in existing structural or institutional arrangements. Problems are conceptualized as having two dimensions: objective and subjective ones. Social problems--specifically, their objective and subjective dimensions--are related to social planning. It is contended that planning must deal with the objective elements of social problems, including structural aspects, as well as with the subjective dimensions. Or, in other words, social planning must (1) treat the structural causes of problems and also (2) address itself to the values, beliefs, definitions, etc. that obstruct social change. In addition to this theoretical linkage of social problems and social planning, the dissertation situates planning in the context of a general theory of social reality. Drawing upon the work of Berger and Luckmann (1966), planning is conceptualized as a process in which reality is socially constructed. These theoretical concepts--the objective and subjective dimensions of socia1 problems as the object of social planning and social planning as the social construction of reality-provide the basis for the model which is developed. Three components of the model are treated. First, characteristics of the process are discussed, and it is contended that the social planning process must be “task-oriented,” "experimental,” “cybernetic,” dialogic, and collaborative. Second, roles and phases in the process are discussed and illustrated. : Consistent with the theoretical framework in which knowledge is considered as socially distributed, citizen, planner, and decision maker have roles in each of the planning phases. Since no one has a complete view of social reality, each is seen as having a distinct contribution to make in the task of defining the problem and its solution. Thus, resolving social problems requires that citizen, planner, and decision maker collaborate and learn from one another. The planner's role is elaborated as the third aspect of the model. By planner is meant an interdisciplinary team whose role encompasses two main functions: (1) technical tasks that have traditionally belonged to the planner, and (2) interactional tasks. Although other planning theorists have outlined interactional tasks for the planner, his role in the collaborative model is “to promote mutual learning through dialog.” This role, similar to that of a process consultant, is considered unique to the collaborative planning model. Although components of the model resemble those of other models, taken together, the characteristics of the planning process, planning phases, and planning roles differ from any other model. And importantly, the planning model grows out of a theoretical analysis of social problems as well as a broad theoretical framework. The model is normative in nature, and although it is not tested empirically, it is evaluated at a theoretical level. The collaborative model and seven other planning models are assessed in terms of whether they are responsive to the nature of social problems. It is contended that the collaborative model is the only one that is responsive to the nature of social problems. This dissertation--its theoretical concepts and conceptual model-is seen as a contribution to an emerging planning paradigm--one that holds the promise that we can learn to deal effectively with the problems that confront our cities.

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Typescript (photocopy) Includes bibliographical references.

Thesis (M.A.)-- Wheaton College Graduate School, 2005. / Abstract. Includes bibliographical references (leaves 91-99).