20,938 research outputs found

    Implementing Health Impact Assessment as a Required Component of Government Policymaking: A Multi-Level Exploration of the Determinants of Healthy Public Policy

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    It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level. The three integrated articles of this dissertation provide insights into specific aspects of the policy process as they relate to HIA. Chapter one details a case study of purposive information-seeking among public servants within Ontario’s Ministry of Education (MOE). Situated within Ontario’s Ministry of Health (MOH), chapter two presents a case study of policy collaboration between health and ‘non-health’ ministries. Finally, chapter three details a framework analysis of the political factors supporting health impact tool use in two sub-national jurisdictions – namely, QuĂ©bec and South Australia. MOE respondents (N=9) identified four components of policymaking ‘due diligence’, including evidence retrieval, consultation and collaboration, referencing, and risk analysis. As prospective HIA users, they also confirmed that information is not routinely sought to mitigate the potential negative health impacts of education-based policies. MOH respondents (N=8) identified the bureaucratic hierarchy as the brokering mechanism for inter-ministerial policy development. As prospective HIA stewards, they also confirmed that the ministry does not proactively flag the potential negative health impacts of non-health sector policies. Finally, ‘lessons learned’ from case articles specific to QuĂ©bec (n=12) and South Australia (n=17) identified the political factors supporting tool use at different stages of the policy cycle, including agenda setting (‘policy elites’ and ‘political culture’), implementation (‘jurisdiction’), and sustained implementation (‘institutional power’). This work provides important insights into ‘real life’ policymaking. By highlighting existing facilitators of and barriers to HIA use, the findings offer a useful starting point from which proponents may tailor context-specific strategies to sustainably implement HIA at the sub-national government level

    Building body identities - exploring the world of female bodybuilders

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    This thesis explores how female bodybuilders seek to develop and maintain a viable sense of self despite being stigmatized by the gendered foundations of what Erving Goffman (1983) refers to as the 'interaction order'; the unavoidable presentational context in which identities are forged during the course of social life. Placed in the context of an overview of the historical treatment of women's bodies, and a concern with the development of bodybuilding as a specific form of body modification, the research draws upon a unique two year ethnographic study based in the South of England, complemented by interviews with twenty-six female bodybuilders, all of whom live in the U.K. By mapping these extraordinary women's lives, the research illuminates the pivotal spaces and essential lived experiences that make up the female bodybuilder. Whilst the women appear to be embarking on an 'empowering' radical body project for themselves, the consequences of their activity remains culturally ambivalent. This research exposes the 'Janus-faced' nature of female bodybuilding, exploring the ways in which the women negotiate, accommodate and resist pressures to engage in more orthodox and feminine activities and appearances

    The Professional Identity of Doctors who Provide Abortions: A Sociological Investigation

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    Abortion is a medicalised problem in England and Wales, where the law places doctors at the centre of legal provision and puts doctors in control of who has an abortion. However, the sex-selection abortion scandal of 2012 presented a very real threat to 'abortion doctors', when the medical profession's values and practices were questioned in the media, society and by Members of Parliament. Doctors found themselves at the centre of a series of claims that stated doctors were acting both illegally and unethically, driven by profit rather than patient needs. Yet, the perspectives of those doctors who provide abortions has been under-researched; this thesis aims to fill that gap by examining the beliefs and values of this group of doctors. Early chapters highlight the ambiguous position of the abortion provider in Britain, where doctors are seen as a collective group of professionals motivated by medical dominance and medical autonomy. They outline how this position is then questioned and contested, with doctors being presented as unethical. By studying abortion at the macro-, meso- and micro-levels, this thesis seeks to better understand the values of the 'abortion doctor', and how these levels shape the work and experiences of abortion providers in England and Wales. This thesis thus addresses the question: 'What do abortion doctors' accounts of their professional work suggest about the contemporary dynamics of the medicalisation of abortion in Britain?'. It investigates the research question using a qualitative methodological approach: face-to-face and telephone interviews were conducted with 47 doctors who provide abortions in England and Wales. The findings from this empirical study show how doctors' values are linked to how they view the 'normalisation of abortion'. At the macro-level doctors, openly resisted the medicalisation of abortion through the position ascribed to them by the legal framework, yet at the meso-level doctors construct an identity where normalising abortion is based on further medicalising services. Finally, at the micro-level, the ambiguous position of the abortion provider is further identified in terms of being both a proud provider and a stigmatised individual. This thesis shows that while the existing medicalisation literature has some utility, it has limited explanatory power when investigating the problem of abortion. The thesis thus provides some innovative insights into the relevance and value of medicalisation through a comprehensive study on doctors' values, beliefs and practices

    Clinicians' experiences of using the MCA (2005) with people with intellectual disabilities

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    Section A is a narrative synthesis of the empirical literature of professionals’ knowledge of the MCA and how they apply it when working with people with intellectual disabilities (ID). Eleven papers were identified for inclusion in this review. Four themes, with subthemes, were identified: ‘processes involved’, ‘working with complexity’, ‘knowledge gaps and variability’ and ‘assessor needs’. Methodological strengths and weaknesses are also considered. Findings are discussed in relation to clinical implications and recommendations for future research are outlined. Section B is an empirical study using Interpretative Phenomenological Analysis to explore the experiences of clinicians using the MCA (2005) with people with ID to assess capacity to consent to sex. Eight clinicians, who had completed between 2 and 40-50 (mode=2) MCA assessments regarding consent to sex. Three superordinate themes, with subthemes, are outlined and discussed in relation to the existing literature. Limitations, clinical implications and areas of future research are considered

    Coloniality and the Courtroom: Understanding Pre-trial Judicial Decision Making in Brazil

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    This thesis focuses on judicial decision making during custody hearings in Rio de Janeiro, Brazil. The impetus for the study is that while national and international protocols mandate the use of pre-trial detention only as a last resort, judges continue to detain people pre-trial in large numbers. Custody hearings were introduced in 2015, but the initiative has not produced the reduction in pre-trial detention that was hoped. This study aims to understand what informs judicial decision making at this stage. The research is approached through a decolonial lens to foreground legacies of colonialism, overlooked in mainstream criminological scholarship. This is an interview-based study, where key court actors (judges, prosecutors, and public defenders) and subject matter specialists were asked about influences on judicial decision making. Interview data is complemented by non-participatory observation of custody hearings. The research responds directly to Aliverti et al.'s (2021) call to ‘decolonize the criminal question’ by exposing and explaining how colonialism informs criminal justice practices. Answering the call in relation to judicial decision making, findings provide evidence that colonial-era assumptions, dynamics, and hierarchies were evident in the practice of custody hearings and continue to inform judges’ decisions, thus demonstrating the coloniality of justice. This study is significant for the new empirical data presented and theoretical innovation is also offered via the introduction of the ‘anticitizen’. The concept builds on Souza’s (2007) ‘subcitizen’ to account for the active pursuit of dangerous Others by judges casting themselves as crime fighters in a modern moral crusade. The findings point to the limited utility of human rights discourse – the normative approach to influencing judicial decision making around pre-trial detention – as a plurality of conceptualisations compete for dominance. This study has important implications for all actors aiming to reduce pre-trial detention in Brazil because unless underpinning colonial logics are addressed, every innovation risks becoming the next lei para inglĂȘs ver (law [just] for the English to see)

    Development and evaluation of a treatment package for men with an intellectual disability who sexually offend

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    Sex offending in the general population has been a focus of interest for some time due to the damaging nature of the behaviour, and the need to reduce recidivism. Theoretical and clinical advances (Finke1hor, 1986; HM Prison Service, 1996; Marshall, Anderson, & Fernandez, 1999; Serran & Marshall, 2010) in treatment for sex offenders in the general population have been extended to men with an intellectual disability at risk of sexual offending (Lindsay, 2009). The purpose of this project is to develop and evaluate the SOTSEC-ID version cftrus model. Participants are adult males from 15 different locations across England and Wales, with an intellectual disability or borderline cognitive functioning and who have committed sexual offences. A pilot study clarified assessments and procedures, and individual data over several years is presented. A qualitative study using Interpretive Phenomenological Analysis (JP A) illustrates the 'meaning making' of participants' treatment experience through six major themes. A reliability and validity study assesses the four main quantitative measures, QACSO, SAKA, SOSAS, and VESA, finding limited support for criterion validity for the SOSAS and SAKA, excellent inter-rater reli"ability for all four main measures, and good to excellent inter-rater reliability on all but the SAKA Finally, a quantitative study, in collaboration with the wider SOTSEC-ID group, uses a repeated measures design to compare the QACSO, SOSAS and SAKA across pre-group, post-group and follow. up. Significant main effects and post-hoc comparisons were in the predicted direction for all measures. A range of information on demographic, clinical and criminogenic factors including offending during treatment or follow-up are also presented. A recidivism rate of 12.3% over a year was calculated for the sample. The treatment model and collaborative framework is recommended for wider adoption

    Walking with the Earth: Intercultural Perspectives on Ethics of Ecological Caring

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    It is commonly believed that considering nature different from us, human beings (qua rational, cultural, religious and social actors), is detrimental to our engagement for the preservation of nature. An obvious example is animal rights, a deep concern for all living beings, including non-human living creatures, which is understandable only if we approach nature, without fearing it, as something which should remain outside of our true home. “Walking with the earth” aims at questioning any similar preconceptions in the wide sense, including allegoric-poetic contributions. We invited 14 authors from 4 continents to express all sorts of ways of saying why caring is so important, why togetherness, being-with each others, as a spiritual but also embodied ethics is important in a divided world
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