This research seeks to identify what accountability frameworks were in place for the home and community care sector in the Canadian province of Ontario, how home and community care agencies in Ontario responded to accountability demands attached to government service funding (specifically through Community Care Access Centre (CCAC) contracts and Local Health Integration Network (LHIN) Multi-Service Accountability Agreements (MSAAs) and what, if any, effect accountability frameworks had on service delivery. This study uses a multi-phase parallel mixed methods approach. First, an environmental scan and document analysis was conducted to identify accountability frameworks and identify key characteristics of accountability demands. Next, 114 home and community care agencies in Ontario were surveyed and 20 key informant interviews were conducted with executives from 13 home and community care agencies, two CCACs and two LHINs. Data from these different methods were combined in the analysis phase. Home and community care agencies face multiple accountability requirements from a variety of stakeholders. We found that government agencies relied most heavily on regulatory and expenditure policy instruments to hold home and community care organizations to account. Organizational size and financial dependence were significantly related to organizational compliance to accountability demands attached to CCAC contracts and MSAAs. In addition to the theorized potential organizational responses to external demands (compliance, compromise, avoidance and defiance), this study found that organizations engaged in internal modification where internal practices are changed to meet accountability requirements. Smaller, more poorly resourced organizations that were highly dependent on LHINs or CCACs were more likely to internally modify organizational practice to meet accountability demands. Although MSAAs and CCAC contracts supported a quality culture amongst organizations, internal organizational changes, such as redirecting time towards reporting requirements and away from care, and cutting innovative practices and programs, were reported to have a negative impact on the quality of service delivery. Government reliance on contract-based accountability for funded home and community care services, while politically advantageous, has the potential to seriously and negatively affect the quality of home and community services delivered. Policy makers need to carefully consider the potential impact on quality of service delivery when developing and implementing accountability policy.

Background: In many countries, a significant proportion of medicines traded and consumed are of poor or variable quality. Meanwhile, failures in appropriately framing and responding to the problem have led to a proliferation of public health and governance challenges. Objective: To examine the issues exacerbating the trade and consumption of medicines of poor or variable quality, as well as present locally relevant strategies. Methods: Analytic triangulation was applied to the synthesis of publicly available documents. Results: Where economic and regulatory environments are less structured, supply chain security strategies that fixate on ‘counterfeits’ often fail in limiting the prevalence of poor quality medicines. In addition to a multivariate drug quality classification chart, three quality frameworks are presented for examining appropriate policy strategies in mediating drug quality. Conclusion: These tools can assist stakeholders in determining more locally relevant and context-specific strategies, while interrogating the proposition for greater transparency vis-à-vis drug quality.

Background: In many countries, a significant proportion of medicines traded and consumed are of poor or variable quality. Meanwhile, failures in appropriately framing and responding to the problem have led to a proliferation of public health and governance challenges. Objective: To examine the issues exacerbating the trade and consumption of medicines of poor or variable quality, as well as present locally relevant strategies. Methods: Analytic triangulation was applied to the synthesis of publicly available documents. Results: Where economic and regulatory environments are less structured, supply chain security strategies that fixate on ‘counterfeits’ often fail in limiting the prevalence of poor quality medicines. In addition to a multivariate drug quality classification chart, three quality frameworks are presented for examining appropriate policy strategies in mediating drug quality. Conclusion: These tools can assist stakeholders in determining more locally relevant and context-specific strategies, while interrogating the proposition for greater transparency vis-à-vis drug quality.

Objective: To determine the dental treatment needs of Canadians and how they are distributed. Methods: A secondary analysis of data from the Canadian Health Measures Survey was undertaken. Weights were applied to make the data nationally representative. Bivariate and multivariate regressions were used to identify predictors of need. Sensitivity, specificity, positive and negative predictive values were calculated to compare self-reported and clinically determined needs. Results: Of the 34.2% who required dental treatment, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. A discrepancy was found between clinical and self-reported needs. Conclusions: Roughly 12 million Canadians have unmet dental needs. A number of factors are predictive of having unmet dental conditions. Program and policymakers now have information by which to assess if their programs match the dental needs of Canadians.

Objective: The main objective was to examine characteristics associated with cigarette access behaviours among underage current youth smokers. Methods: This cross-sectional study used self-reported data collected from 29,296 students in Grades 9 to 12 who participated in the 2008-09 Youth Smoking Survey (YSS), and data from the 2008-09 DMTI-EPOI (Enhanced Points of Interest) data file. Multilevel logistic regression analyses were used to jointly examine whether student characteristics and the number of tobacco retailers surrounding schools were associated with the odds of a current youth smoker accessing cigarettes from: (a) a retailer source, (b) a family member, and (c) a friend or someone else. Results: Among underage current smokers, the majority reported usually buying their own cigarettes from a retailer (44.1%), and getting cigarettes from a friend or someone else (42.2%). Significant between-school random variation was identified for youth cigarette access from a retailer source, and from a friend or stranger. Males were more likely to buy their own cigarettes from a retailer (OR 2.08, 95% CI 1.74-2.48), whereas females were more likely to access cigarettes from a family member (OR 0.68, 95% CI 0.53-0.88), or a friend or someone else (OR 0.52, 95% CI 0.44-0.61). Binge smoking was associated with buying cigarettes from a retailer (OR 0.65, 95% CI 0.48-0.86). Youth with a smoking parent or guardian (OR 2.95, 95% CI 2.02-4.31) were more likely to get cigarettes from a family member. Youth who reported that they sometimes (OR 2.80, 95% CI 1.94-4.04), or usually or always (OR 3.15, 95% CI 2.17-4.58) share cigarettes with others was associated with accessing cigarettes from a friend or someone else. Each additional tobacco retailer surrounding a school was associated with an increased likelihood of youth purchasing their own cigarettes from a retailer (OR 1.04, 95% CI 1.01-1.07). Conclusion: Tobacco point-of-sale restrictions are inadequate as youth can still procure cigarettes from both retailers and social sources. Future studies should explore beyond individual-level factors and examine what influences cigarette access behaviours in the broader school context. Such insight will inform the development of new school-level tobacco control initiatives that can more effectively prevent youth from acquiring cigarettes.

Tobacco use is responsible for 5.4 million deaths every year worldwide and a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil is widely regarded as an international leader in tobacco control. The country has prohibited most forms of advertising; however, the cigarette pack remains a primary source of tobacco marketing. The current study sought to examine how tobacco packaging influences brand appeal and perceptions of health risk among female youth in Brazil. A between-subjects experiment was conducted in which 640 Brazilian females between the ages of 16 to 26 years participated in an online survey. Each participant was asked to view and rate a series of cigarette packages that were digitally altered to correspond to one of three experimental conditions: (1) “standard” branded cigarette packages, (2) the same packs with all brand imagery removed (“plain packaging”), or (3) the same packs with all imagery and brand descriptors removed. Participants rated the packages on perceived appeal, taste, smoothness, health risk, ease of quitting, desirability to be seen smoking, preference to try, and smoker attributes through single pack ratings and two-pack comparisons. A pack offer was used as a behavioural measure of general appeal. Linear and logistic regression modeling was used to test for differences between and within experimental conditions. Branded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. Results of the study also indicated that packages marketed as lighter, through use of lighter coloured pack imagery, and descriptors referring to lighter colours and flavours, were more likely to be rated favourably. Over 52% of participants accepted a pack offer at the end of the study, and of those who selected a pack, more than three-quarters chose a branded pack over a plain pack. Overall, the findings suggest that plain packaging and removing descriptors from cigarette packs, including those that refer to flavours, may help to reduce the appeal of smoking, and consequently reduce smoking susceptibility among young women in Brazil.

Provision of aid has long been influenced by the political priorities of donors, and there is substantial evidence that the administrative rules and regulations of donor organisations create problems for recipient countries. For as long as this fact has been understood, there have been efforts to address it: most recently, spear-headed by the Paris Declaration on Aid Effectiveness and its associated efforts. This thesis seeks to deepen understanding of this tension by examining the aid relationships in the health sector using analytical frameworks drawn from governance, political economy and health policy. Part 1 ‘defines the territory’ by describing the aid effectiveness challenges faced in the sector in qualitative and quantitative terms. Part 2 seeks to understand why these challenges persist by examining the political and institutional forces which affect provision of aid from (following Reich) ‘above, within and below’. I begin by looking at the ‘high’ political forces affecting aid provision by locating health aid as an instrument of international relations. Then, I look in greater detail the central tension in governance of health aid: the ‘push’ and ‘pull’ between efforts to promote greater coherence and the reality of diversity. Finally, I explore the internal (institutional) forces within aid agencies which affect a particular dimension of aid provision: the length of donor commitments. Part 3 presents in-depth case study research which demonstrates how the political forces from above, within and below play out in practice. The emerging conclusion is that the aid effectiveness agenda, as set out in the Paris Declaration, is only ever likely to be partially successful, for two reasons. First, because global health governance is inherently iterative, dynamic and diverse it cannot be regulated through further global processes (such as aid effectiveness). Second, the aid effectiveness agenda is structured around simple concepts and solutions which (while useful for global advocacy purposes) are no match for the political, institutional and economic complexity which characterises the aid relationship at country level. Indeed, the diversity that global health creates at country level has to be managed by recipient countries themselves, according to their timetable, and in a way tailored to their own context and circumstances.

This thesis extends and refines a growing body of literature that has highlighted the impact of Catholic social principles on the development of welfare state provision. It suggests that Catholic social teaching is intent on preserving the role of the traditional family, and keeping power out of the hands of the state. Much of this literature, however, is concerned with European experience (Esping-Andersen, 1990; Castles, 1993; van Kersbergen, 1995). More recently Smyth (2003) has augmented this research through an examination of the influence of Catholic social thought on Australian welfare policy. He concludes that the Australian Church, at least up to the 1970s, preferred a �welfare society� over a �welfare state�, an outlook shared by the wider Australian community. Following the lead of Smyth, this thesis extends the insights of the European research through an examination of Catholic Church resistance to ALP proposals to introduce national health schemes in the 1940s and the 1970s. These appeared to satisfy the Church�s commitment to the poorest and most marginalised groups in the community. Why, then, did the Australian Church resist the proposals? The thesis concludes that there are at least two possible ways of interpreting Catholic social teaching � a preconciliar interpretation that minimises the role of the state, and a postconciliar interpretation that allows for an active, albeit limited, state. The adoption of either is informed by socio-political factors. The thesis, then, concludes that the response of the Church in the 1940s and the 1970s was conditioned by socio-political and historical factors that inclined the Australian Catholic Church towards a conservative view of welfare.

Thesis (Ph.D.)--University of Adelaide, School of Social Sciences, Discipline of Gender and Labour Studies, 2004. / "January 2004" Includes bibliographical references (leaves 297-313).

Diss. Uppsala : Uppsala universitet, 2006.