http://hdl.handle.net/1842/1691 Tue, 21 May 2013 03:49:29 GMT 2013-05-21T03:49:29Z http://hdl.handle.net/1842/6496 Title: Policy, identity and practice: a study of how policy decisions regarding the welfare of chdren with disabilities are formulated within the Portuguese welfare state Authors: Gulyurtlu, Sandra Sibel Cabrita Abstract: This thesis seeks to explore how key decision-makers within the Portuguese civil service formulate decisions regarding policies orientated at children with disabilities. It breaks the issue down by focusing on three main perspectives - the decisionmaker, the policy framework and children with disabilities. The decision-maker was analysed in the context her/his professional identity. By combining social identity theory (self-categorisation) and identity theory (role-identification) and interview data, this thesis found that the basis for decision-making was the way in which the term "children with disabilities" was identified and conceptualised by the decisionmaker, as well as the associated approaches, rules and guidelines at both the national and international level. It found a variable balance of influences between the concepts of parenting and families, the norms of the Portuguese welfare system and the emergent international thinking regarding children with disabilities. Through the use of a multi-method approach which incorporated interviews, vignettes and documentary analysis this thesis captured the approaches of each decision-maker. This thesis found that children with disabilities were predominantly viewed as dependants. The familialist structure of the Portuguese welfare state introduces the notion of a "disabled family", whereby the family carries the responsibility of addressing the challenges associated with children's disability and state support is directed at the family. In addition, this thesis found that "normalisation" was the predominant approach to disability, regardless of intended approach of each decision-maker. This study concluded that a combination of rehabilitative and integrative policy impulses in a context of limited and incomplete information and guidelines from international organisations have influenced this approach. Thu, 02 Jul 2009 00:00:00 GMT http://hdl.handle.net/1842/6496 2009-07-02T00:00:00Z http://hdl.handle.net/1842/6453 Title: Obesity: a historical account of the construction of a modern epidemic Authors: Fletcher, Isabel Abstract: This thesis describes the development of the idea of an 'obesity epidemic' that figures prominently in contemporary public health discourse. It uses conceptual approaches from Science and Technology Studies and the history of medicine to analyse changing ideas about obesity, particularly as formulated and mobilised by British researchers from the 1960s onwards, to show how excess body weight became understood as a significant public health problem in this period. The thesis begins by describing the post-war refocusing of medical attention in developed countries from infectious diseases, the rates of which are falling, to chronic disease such as heart disease, diabetes, cancer and stroke. Heart disease, in particular, became seen as an 'epidemic'. After World War II, increase research funding by the American government made possible the development of a new research method - the long-term prospective epidemiological study - and a new way of understanding chronic diseases as caused by risk factors such as high blood pressure, cigarette smoking and high blood cholesterol. Excess body weight was includes in this list of risk factors, and so became an object in increased medical attention. The thesis then outlines how a new public health coalition was formed around obesity in the 1970s by British biomedical researchers working on topics in the fields of nutrition, diabetes and coronary heart disease. It describes the development of what I call the 'individual paradigm' of obesity which characterises the condition as an individual problem that leads to heart disease and mechanical complaints and is treatable by weight loss diets. It then describes two key features of British obesity science in the 1980s and 1990s. The first of these is the adoption of the Body Mass Index and the standard cut-off points that are used to define overweight and obesity, which together facilitate the collection and dissemination of data on changes in average body weights, The second is the energy balance model of weight regulation, which served to unify the diverse disciplinary approaches to biomedical research incorporated into this new knowledge, but which could not account for the high rates of failure acknowledged as occurring with conventional treatments such as weight loss diets, anorectic drugs and bariatric surgery. The thesis describes how researchers in the field of obesity science than extended their institutional research to participate in the production of a series of reports for the World Health Organization, including one on the global epidemic of obesity published in 2000. This new platform, combined with data produced by prospective studies, enabled them to disseminate a new understanding of obesity and overweight - what I call the 'environmental paradigm' - which characterises it as a global health problem associated with an increased risk of many diseases and caused by structural factors such as inappropriate diet and sedentary lifestyles. Despite refocusing attention of structural determinants of ill health, however, public health experts were constrained by considerations of political practicality and commercial interest when calling for preventive measures in the areas of diet and physical activity. The thesis concludes by considering the different ways in which scholars have theorised the epidemiological transition from infectious to chronic disease. Drawing on approaches from the health inequalities literature, it argues that the conventional framings of chronic disease epidemiology have tended systematically to obscure structural links between obesity and other forms of diet-related ill health on the one hand, and relative poverty on the other. Fri, 29 Jun 2012 00:00:00 GMT http://hdl.handle.net/1842/6453 2012-06-29T00:00:00Z http://hdl.handle.net/1842/6445 Title: Recruiting foreign nurses for the UK: the role of bilateral labour agreements Authors: Plotnikova, Evgeniya Abstract: This thesis is about policy instruments for the regulation of international labour mobility. It focuses on the use of government-to-government agreements on the cross-border movement of nurses, negotiated between source and destination countries. This research is a qualitative case study of agreements signed in the early 2000s between the UK and Spain, South Africa, the Philippines and India. It aims to understand the role of these agreements in British policy as perceived by actors in the destination country. It addresses three questions: 1) What types of agreements did the British government negotiate? 2) Why did the British government negotiate these agreements? and 3) What functions did these agreements perform? Employing the notion of ‘policy tools’ as an organising concept, this thesis’s analytical framework draws on political sociology and the conception of policy instruments as being composed and brought into existence by actors and their power relations in multilevel policy contexts. This study is based on documentary analysis and elite interviews with experts in international organisations, officials in the Department of Health (England), recruitment officers in the source countries, and professional nursing organisations and trade unions in the UK. This thesis argues that government-to-government agreements between the UK and supply countries emerged from a discourse on the ethical recruitment of health workers which was framed in the language of human rights. One of the roles of these agreements was to contain contradictory and conflicting interests between and within institutional actors involved in the international recruitment of nurses on both sides of the migration process. More broadly, the research addresses and advances the discussion of the policy instrumentation approach, and contributes to the understanding of the choice of policy tools and their performance in an ambivalent policy context. Fri, 29 Jun 2012 00:00:00 GMT http://hdl.handle.net/1842/6445 2012-06-29T00:00:00Z http://hdl.handle.net/1842/6418 Title: Capable of change? The impact of policy on the reconciliation of paid work and care in couples with children Authors: Graham, Helen Marion Abstract: This research examines the impact of work-family reconciliation policies on gender inequality in the labour market, and on the division of paid work and care in the household. Policies designed to help families meet their work and care responsibilities have undergone considerable reform over the last fifteen years. The research aims to understand how this has affected the way that earning and caring are divided between mothers and fathers, and the implications of this for mothers’ labour market outcomes. The research compares two cohorts; the National Child Development Study (NCDS) tracks individuals born in 1958, and the British Cohort Study (BCS) those born in 1970. These cohorts experienced the key childbearing years of their early thirties on either side of a fairly sharp discontinuity in work-family reconciliation policy. The research aims to link this difference in policy environments to differences the way that couples in each cohort divide paid work and care, and in the labour market behaviour of mothers and the penalties they face when they are in employment. Logistic regression models are employed to quantify the magnitude and significance of the impact of cohort membership on the work and care outcomes of interest, controlling for other variables that affect these outcomes. Some case-level analysis of the data is also carried out; individuals representing typical family arrangements are highlighted, to demonstrate the relevance of the theoretical model and assist with hypothesis generation. Case stories illustrate the interplay of individual circumstances with policy and other external factors, in a way that is difficult to achieve using statistical methods. A key finding is that the younger cohort is less likely to report equal sharing of childcare than the older cohort, even after controlling for other factors that might influence the division of labour. This is also in spite of the finding that mothers in the younger cohort are more likely to be in work. This suggests progress to some extent, in that mothers perhaps find it easier to be in employment. However at the same time it represents a regressive step at the household level, as they not only continue to shoulder the majority of the care work, but are even more inclined to do so. Analysis of pay and status gaps also yields interesting results. The findings suggest that the penalty to motherhood in terms of labour market status accrues by virtue of the interrupted human capital accumulation that results from periods out of the labour market or working part time. However, the motherhood penalty in pay persists even after controlling for other wage determinants, suggesting that these gaps are a direct result of motherhood itself and not of the labour market behaviour changes that occur as a result. The research contributes theoretically and substantively to the wider literature on this topic. It brings together human capital perspectives with theories of gender, power and resources, and of the impact of policy on family life, and uses Amartya Sen’s capability approach to reconcile and move forward these ideas. It also contributes to the practical understanding of the impact of policy on the way that families reconcile work and care, and in particular the implications of policy for gender equality. Finally, its methodological contribution is in the use of a narrative approach to large-scale quantitative data, alongside more conventional statistical techniques, in order to further exploit the detailed, longitudinal data available. Fri, 29 Jun 2012 00:00:00 GMT http://hdl.handle.net/1842/6418 2012-06-29T00:00:00Z