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Chronic disease and clinical bureaucracy in post-war Britain
Author: Martin D. Moore

Through a study of diabetes care in post-war Britain, this book is the first historical monograph to explore the emergence of managed medicine within the National Health Service. Much of the extant literature has cast the development of systems for structuring and reviewing clinical care as either a political imposition in pursuit of cost control or a professional reaction to state pressure. By contrast, Managing Diabetes, Managing Medicine argues that managerial medicine was a co-constructed venture between profession and state. Despite possessing diverse motives – and though clearly influenced by post-war Britain’s rapid political, technological, economic, and cultural changes – general practitioners (GPs), hospital specialists, national professional and patient bodies, a range of British government agencies, and influential international organisations were all integral to the creation of managerial systems in Britain. By focusing on changes within the management of a single disease at the forefront of broader developments, this book ties together innovations across varied sites at different scales of change, from the very local programmes of single towns to the debates of specialists and professional leaders in international fora. Drawing on a broad range of archival materials, published journals, and medical textbooks, as well as newspapers and oral histories, Managing Diabetes, Managing Medicine not only develops fresh insights into the history of managed healthcare, but also contributes to histories of the NHS, medical professionalism, and post-war government more broadly.

Author: Mary Venner

The reconstruction of Kosovo after 1999 was one of the largest and most ambitious international interventions in a post conflict country. Kosovo was seen by many international actors as a ‘green fields’ site on which to construct the government institutions and practices they considered necessary for future peace and prosperity. For a while Kosovo was close to being a laboratory for the practice of institution building and capacity development. This book looks beyond the apparently united and generally self congratulatory statements of international organisations and donors to examine what actually happened when they tried to work together in Kosovo to construct a new public administration. It considers the interests and motivations and the strengths and weaknesses of each of the major players and how these affected what they did, how they did it, and how successful they were in achieving their goals. Although in general the international exercise in Kosovo can be seen as a success, the results have been uneven. Some public administration institutions perform well while others face ongoing challenges. The book argues that to a significant extent the current day performance of the Kosovo government can be traced to the steps taken, or sometimes not taken, by various international actors in the early years of the international intervention.

Médecins Sans Frontières, the Rwandan experience, 1982– 97

Throughout the 1990s, Médecins Sans Frontières (MSF) was forced to face the challenges posed by the genocide of Rwandan Tutsis and a succession of major outbreaks of political violence in Rwanda and its neighbouring countries. Humanitarian workers were confronted with the execution of close to one million people, tens of thousands of casualties pouring into health centres, the flight of millions of others who had sought refuge in camps and a series of deadly epidemics. Where and in what circumstances were the MSF teams deployed? What medical and non-medical assistance were they able to deliver? Drawing on various hitherto unpublished private and public archives, this book recounts the experiences of the MSF teams working in the field. It also describes the tensions (and cooperation) between international humanitarian agencies, the crucial negotiations conducted at local, national and international level and the media campaigns. The messages communicated to the public by MSF’s teams bear witness to diverse practical, ethical and political considerations. How to react when humanitarian workers are first-hand witnesses to mass crimes? How to avoid becoming accomplices to criminal stratagems? How to deliver effective aid in situations of extreme violence?

This book is intended for humanitarian aid practitioners, students, journalists and researchers with an interest in genocide and humanitarian studies and the political sociology of international organisations.

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Stories about international organisations, non-State actors, and the formation of customary international law
Sufyan Droubi and Jean d’Aspremont

International lawyers relish telling stories about customary law, its contents, and its modes of ascertainment. There is hardly a question of international law that has continuously attracted as much passionate story-telling as customary international law. The present volume contributes to such scholarly self-indulgence. Yet, it does so by presupposing that there exists an approach to custom-forming that is adverse to the central role of international organisations and non-State actors and which it calls the dominant orthodoxy. According to this projected

in International organisations, non-State actors, and the formation of customary international law
Jarle Trondal, Martin Marcussen, Torbjörn Larsson, and Frode Veggeland

3436 Unpacking international organisations:2833Prelims 22/3/10 14:56 Page 65 4 The OECD Secretariat Many years ago the Organisation for Economic Co-operation and Development (OECD) was primarily an ‘economic’ organisation. Although many people will associate the OECD with its thorough economic analysis and frequent warnings regarding real estate bubbles, overheated labour markets, financial crises and unsustainable public spending, the OECD frames public discourse on a wide range of supplementary themes. Few people know, for instance, that the OECD is a

in Unpacking international organisations
Jarle Trondal, Martin Marcussen, Torbjörn Larsson, and Frode Veggeland

3436 Unpacking international organisations:2833Prelims 22/3/10 14:56 Page 156 8 Epistemic dynamics in international bureaucracies Science is much more than the mechanical production of data and analysis. Science has become an institution in itself which is loaded with authority and power. Scientific authority bestows its holder with legitimacy and a communicative platform that reaches far beyond the narrow scientific discipline. Scientific power grants access to constituting basic rules for cause and effect, distinguishing right from wrong, categorising

in Unpacking international organisations
The role of the United Nations Security Council
Alice Martini

This chapter investigates the standardisation and legitimisation of countering extremism at an international level. Based on Critical Discourse Analysis, this work examines the United Nations Security Council’s (UNSC’s) discourse on terrorism, specifically in its relation to extremism. Here, a significant shift took place and the concept of extremism became central to the UNSC’s counter-terrorism activity. It is therefore argued in this work that the concept has problematically been assigned discursively a wide range of meanings. These encompass phenomena that go from physical violence to behaviours and even narratives and ideas. The UNSC has reflected but also mutually constituted this shift in the global discourse on terrorism, broadening and legitimising states’, and its own, exceptional powers. Moreover, in virtue of its legal and political powers, the UNSC has not only produced a discourse on this menace but has also established international legal norms and bodies and enforced them on states of the international community. Describing and discussing these processes, the present chapter thus analyses what is better conceptualised as a Foucauldian dispositif of extremism. Through this, it will be argued, the international organisation enforced a global, standardised governmentality which encompassed the public and political realm but also the private and domestic sphere.

in Encountering extremism
Martin D. Moore

This chapter examines the development of new forms of general-practice-based diabetes management over the last quarter of the twentieth century. Although GPs had retained responsibility for ongoing patient care after 1948, the creation of the NHS consolidated the dominant role of the specialist clinic in post-war diabetes management. During the 1970s and 1980s, however, hospital clinicians and GPs began to devise more formal systems of structured and integrated diabetes care, with GPs assuming greater roles in disease management. For clinicians, deputing responsibilities to GPs offered a way to manage patient loads and increasing demands for surveillance in a context of constrained resources, and enabled consultants to refocus on challenging work. For GPs, new forms of care dovetailed with emerging professional projects connected with distinguishing GPs from hospital practitioners and moving GPs into team-based, proactive preventive health work. By the early 1990s, the Royal Colleges, the British Diabetic Association, the Department of Health, and international organisations all supported the increasing role of primary care practitioners in diabetes care. Medical politics, resource distribution, and epistemic change had once again combined to reshape approaches to diabetes management and reposition it as a form of long-term risk prevention.

in Managing diabetes, managing medicine
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Through the eyes of field teams’ members
Jean-Hervé Bradol and Marc Le Pape

Never before had MSF teams been the direct witnesses of genocide and repeated mass violence on such a huge scale. The method of observation adopted for this book was, as matter of priority, to focus on the work of field teams and reconstruct their perceptions, decisions and actions. The following sources were used: numerous reports submitted to MSF head offices by MSF teams; witness statements published by the Rwandans; public documents from international organisations and research studies based on field surveys. The history of Rwanda is also told through a series of events which shed light on the political dynamics of the 1990s. Lastly, a summary of MSF’s activities in the Great Lakes region since 1980 is also included.

Three very specific questions about Rwanda and the Great Lakes region during the period 1990 to 1997 are formulated:

Where were MSF’s teams working?

What work were they involved in?

Which of the obstacles they encountered became the subject of debate, and which of these went on to be made public?

in Humanitarian aid, genocide and mass killings
Jarle Trondal, Martin Marcussen, Torbjörn Larsson, and Frode Veggeland

3436 Unpacking international organisations:2833Prelims 22/3/10 14:56 Page 37 3 The European Commission The Commission systematically excludes territorial preferences, institutions and concerns from its agenda-setting processes. Departmental, supranational and epistemic behavioural dynamics are likely to reflect the organisational components of the Commission services. This chapter introduces the Commission organisation and personnel. As will be shown in Chapters 6 to 9, the Commission is indeed a compound system of international bureaucracy, balancing

in Unpacking international organisations