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The last four decades have seen universal health coverage (UHC) become a central part of the global agenda. Despite this centrality, a large proportion of academics still focus solely on health schemes in the Global North, and the remaining few that have evaluated interventions in developing countries have rarely considered the inequities and power dynamics that exist within health systems in a comprehensive and interrelated way. This study adopted a qualitative approach, primarily based on 223 semi-structured interviews, to explore stakeholder perceptions on the implementation of the Community-Based Health Insurance Scheme (CBHIS) in Ethiopia. In doing so, this research offers a bold contribution to understanding the extent to which efforts to achieve UHC in the regions of Tigray and Oromia can be considered equitable, particularly when gender and ethnicity are examined. It explores how implementation can diverge from programme design by investigating the role of health workers, as street level bureaucrats, in the day-to-day delivery of the scheme. It also contextualises findings through the theoretical lenses of patient-centredness, the five dimensions of access, and the notions of gender-based power dynamics. This study shows that although the CBHIS has contributed to increasing access to healthcare services for many, particularly those residing in rural areas, such progress has been partially hindered by complex implementation challenges. Low awareness levels and high health worker workloads, combined with a shortage of medication and diagnostic equipment in public health facilities, amongst other issues, have resulted in a scheme that is not always able to meet the expectations of its members. Furthermore, CBHIS decision-makers were confronted with the challenge of striking a balance between equity and financial sustainability. This study contributes to understandings about how individuals navigate health insurance programmes, how front-line stakeholders interpret policy directives, and how authorities respond to emerging and shifting implementation challenges.

Childhood obesity, although a preventable condition, remains a major global public health concern. Despite tremendous efforts, researchers and policymakers have been unable to turn the tide on children’s weight gain. In recent years, Health Geographers have increasingly acknowledged the role of place in determining children’s levels of extracurricular physical activity, thereby influencing their body shapes. This recognition has not, however, led to a full understanding of the triad connecting the built environment to children’s physical activity and body composition. My dissertation therefore aimed to fill this gap by comprehensively uncovering the dynamics at work in this triad. An explanatory sequential mixed-methods research design was adopted, combining the strengths of quantitative spatial epidemiology and the qualitative exploration of children’s context-specific lifeworlds in London. The integration of findings obtained through these different research lenses showed that the built environment was severely implicated in determining the body composition of young citizens. This effect, however, was not direct, as out-of-school activity emerged as the crucial pivot mediating the built environmental-body composition relation. Through numbers and narratives, the myriad ways in which the environment, activity and body shape interacted were unveiled. First, I demonstrated the need to disentangle extracurricular physical activity and body mass metrics into their prime components. Having done so, I established that active school travel constitutes a primary pathway in tackling the overweight and obesity epidemic, due to its fat-mass-reducing effect and close associations with the built environment. Integration of quantitative and qualitative evidence showed how proximity to school, traffic safety, the provision of safe and well-maintained pavements and crossroads, and parental perceptions were crucially involved in this relationship. Having contributed to the translation of these findings into policy and practice through concrete policy recommendations, this research constitutes a bold step towards the creation of activity-inciting, leptogenic environments for children.