The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.

The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.

yes / Efforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives.

Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 165-174). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

This qualitative research study examines six participant's awareness and understanding of a Treatment Literacy (TL) programme implemented by the Treatment Action Campaign (TAC) in the Western Cape in the period 2001 to 2009. The study investigates what attracted the participants to the TAC; what they learnt and how this was taught; the extent, if any, to which participant's experiences changed their understanding of HIV and AIDS, sexuality, treatment and other health-related practices. To analyse participants' awareness levels, understanding and experiences, I drew on Freire (1970; 1985) and Mezirow (1991; 1994) adult education literature, more specifically literature addressing the social movements and how activists learn and teach in different context (informal and non-formal) such as Newman (1995) and Foley (1999). These perspectives underpin the central argument of the thesis, namely that adult education is contextual and has impact on awareness, understanding and experiences and in this case HIV and AIDS. A primary finding of the study is how the participants in the study perceived the world as central to their learning. Learning is thus a substantially personal experience; however, the development of the individual frequently occurs within a group dynamic. Participants felt that being part of TAC and fighting for access to treatment and helping other people who are either HIV positive or affected by HIV and AIDS, helped them in turn to deal with their own challenges of being HIV positive and affected with HIV and AIDS. Being HIV positive and receiving education from TAC has given participants dignity and the necessary consciousness to obtain control of their life. Participants also reported that the TL programme boosted their confidence and raised their level of awareness and understanding of the topic.

O trabalho reflete acerca dos critérios referentes à avaliação psiquiátrica nas internações e tratamento involuntários. A restrição da liberdade é infração aos direitos do homem e, se ela é justificada em nome da patologia mental, qualificá-la é um imperativo legal e ético. Historicamente, a internação crônica em hospitais psiquiátricos levou à exclusão social e rompimento dos laços significativos da vida pessoal. Nos serviços de emergência ela é muitas vezes determinada em nome de um risco. Assim, é proposta uma análise crítica (à semelhança da desconstrução de Derrida e da genealogia de Foucault) do saber médico-psiquiátrico, que é ferramenta essencial do trabalho clínico. Um panorama dos arranjos dos dispositivos públicos de regulação das internações psiquiátricas involuntárias no ocidente mostra a inter-relação de um modelo médico com um modelo legalista (focado nos direitos dos pacientes), cada qual com seus ganhos e dificuldades. A medicalização da vida humana é um fenômeno do mundo moderno, e é vista como um processo dinâmico, onde a apropriação das categorias médicas por parte dos usuários e familiares também gera empoderamento e mudanças. Vemos como, historicamente, o viés moral da práxis realizada no hospital psiquiátrico é indissociável da construção do saber, e a psicopatologia oficial é de uma nosologia descritiva; mas o trabalho clínico permite outras psicopatologias, mais participativas, centradas na relação do sujeito com o mundo, que possam servir a ele como instrumentos de compreensão e ajuda na experiência vivida. Assim, a categoria da vontade em psicopatologia clássica adota a perspectiva aristotélica de uma deliberação racional, mas a leitura filosófica de Arendt destaca a centralidade da liberdade e da espontaneidade inerentes ao conceito. Esta dicotomia entre vontade livre e determinação traz repercussões para a clínica e para a justiça, como nos casos da avaliação da responsabilidade dos pacientes sobre seus atos. Neste campo, assim como na avaliação do juízo crítico, a ciência não garante a objetividade totalizante, deixando sempre a decisão sobre a internação psiquiátrica involuntária na dependência do político, da moral e da ética que constituem a clínica. / This work is a reflection on the criteria used in psychiatric practice to justify involuntary detention and treatment. The restriction of freedom is an infringement of human rights, and if it is to be justified on the grounds of mental pathology, it must be legally and ethically qualified. Historically, long term internment of people in psychiatric institutions led to social exclusion and the rupture of importante social and personhood ties. Emergency hospitalization is often justified on the grounds of risk. Hence, a critical analysis is offered (along the lines of Derridas deconstruction and Foucaults genealogy), of our current medical-psychiatric understanding, which is the foundation of all clinical work. An overview of the many arrangements for psychiatric involuntary detention on a variety of Western countries demonstrates an interplay between medical and legal (rights based) models. These arrangements all come with benefits and challenges. The medicalization of human life is a modern, world-wide phenomenon, and is viewed as a dynamics process where the appropriation of medical categories by users and their families also produces empowerment and change. We see how, historically, moral bias of practice performed at psychiatric hospitals is inseparable to knowledge construction, and oficial psychopathology is a descriptive nosology, but clinical practice allows other psychopathologies, more participative ones, centered on the relations between the subject and the world, which may help him to understand and survive life experiences. Thus classical pathology adopts a rational aristotelian approach to understanding the concept of Will, while the philosophical view of Arendt emphasizes the centrality of freedom and spontaneity. The inherent dichotomy between free Will and determinism leads to clinical and legal repercussions, in the case of assessing a patients level of responsibility for his actions. In this field, as in the evaluation of a patients level of insight, science does not warrant total objectivity. Hence the decisions about psychiatric involuntary detention will always depend on the basis of the complex interplay between politics, morality and ethics, basis of all clinical work.

Thesis (M.S.W.)--University of Hong Kong, 1993. / Includes bibliographical references (leaves 111-115).

O trabalho reflete acerca dos critérios referentes à avaliação psiquiátrica nas internações e tratamento involuntários. A restrição da liberdade é infração aos direitos do homem e, se ela é justificada em nome da patologia mental, qualificá-la é um imperativo legal e ético. Historicamente, a internação crônica em hospitais psiquiátricos levou à exclusão social e rompimento dos laços significativos da vida pessoal. Nos serviços de emergência ela é muitas vezes determinada em nome de um risco. Assim, é proposta uma análise crítica (à semelhança da desconstrução de Derrida e da genealogia de Foucault) do saber médico-psiquiátrico, que é ferramenta essencial do trabalho clínico. Um panorama dos arranjos dos dispositivos públicos de regulação das internações psiquiátricas involuntárias no ocidente mostra a inter-relação de um modelo médico com um modelo legalista (focado nos direitos dos pacientes), cada qual com seus ganhos e dificuldades. A medicalização da vida humana é um fenômeno do mundo moderno, e é vista como um processo dinâmico, onde a apropriação das categorias médicas por parte dos usuários e familiares também gera empoderamento e mudanças. Vemos como, historicamente, o viés moral da práxis realizada no hospital psiquiátrico é indissociável da construção do saber, e a psicopatologia oficial é de uma nosologia descritiva; mas o trabalho clínico permite outras psicopatologias, mais participativas, centradas na relação do sujeito com o mundo, que possam servir a ele como instrumentos de compreensão e ajuda na experiência vivida. Assim, a categoria da vontade em psicopatologia clássica adota a perspectiva aristotélica de uma deliberação racional, mas a leitura filosófica de Arendt destaca a centralidade da liberdade e da espontaneidade inerentes ao conceito. Esta dicotomia entre vontade livre e determinação traz repercussões para a clínica e para a justiça, como nos casos da avaliação da responsabilidade dos pacientes sobre seus atos. Neste campo, assim como na avaliação do juízo crítico, a ciência não garante a objetividade totalizante, deixando sempre a decisão sobre a internação psiquiátrica involuntária na dependência do político, da moral e da ética que constituem a clínica. / This work is a reflection on the criteria used in psychiatric practice to justify involuntary detention and treatment. The restriction of freedom is an infringement of human rights, and if it is to be justified on the grounds of mental pathology, it must be legally and ethically qualified. Historically, long term internment of people in psychiatric institutions led to social exclusion and the rupture of importante social and personhood ties. Emergency hospitalization is often justified on the grounds of risk. Hence, a critical analysis is offered (along the lines of Derridas deconstruction and Foucaults genealogy), of our current medical-psychiatric understanding, which is the foundation of all clinical work. An overview of the many arrangements for psychiatric involuntary detention on a variety of Western countries demonstrates an interplay between medical and legal (rights based) models. These arrangements all come with benefits and challenges. The medicalization of human life is a modern, world-wide phenomenon, and is viewed as a dynamics process where the appropriation of medical categories by users and their families also produces empowerment and change. We see how, historically, moral bias of practice performed at psychiatric hospitals is inseparable to knowledge construction, and oficial psychopathology is a descriptive nosology, but clinical practice allows other psychopathologies, more participative ones, centered on the relations between the subject and the world, which may help him to understand and survive life experiences. Thus classical pathology adopts a rational aristotelian approach to understanding the concept of Will, while the philosophical view of Arendt emphasizes the centrality of freedom and spontaneity. The inherent dichotomy between free Will and determinism leads to clinical and legal repercussions, in the case of assessing a patients level of responsibility for his actions. In this field, as in the evaluation of a patients level of insight, science does not warrant total objectivity. Hence the decisions about psychiatric involuntary detention will always depend on the basis of the complex interplay between politics, morality and ethics, basis of all clinical work.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-06-27T18:02:37Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO LÍVIA 15.02.16.pdf: 1521724 bytes, checksum: 8bf247bc14accb37abed30b55bfca71f (MD5) / Made available in DSpace on 2016-06-27T18:02:37Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO LÍVIA 15.02.16.pdf: 1521724 bytes, checksum: 8bf247bc14accb37abed30b55bfca71f (MD5) Previous issue date: 2016-02-02 / CAPES / Reconhecendo a importância do poder judiciário como ferramenta à efetividade dos direitos sociais, dentre os quais estão os direitos humanos, e em especial o direito à saúde, o presente trabalho buscou apresentar um estudo do processo de judicialização da saúde no estado de Pernambuco relacionado aos efeitos direitos e indiretos da Audiência Pública n° 4 do Supremo Tribunal Federal (STF), ou seja, entre os anos de 2009 a 2014, inclusive no que tange aos medicamentos sem registro na Anvisa e de uso fora da bula (off-label). O objetivo, ao se utilizar da quantificação a partir da probabilidade na análise das decisões judiciais, com obtenção de resultados aproximados e não uma verdade absoluta, permite visualizar uma tendência e discutir, a partir de dados da realidade, os vários argumentos e problemáticas acerca do fornecimento de medicamento por via judicial. Especificamente, buscamos analisar os principais argumentos presentes no debate doutrinário e jurisprudencial acerca da efetividade da saúde por via judicial. São eles: a (in)eficiência das políticas públicas vigentes no país; os limites operacionais do Sistema Único de Saúde (SUS); o processo de recepção de novas tecnologias perante a efetividade operacional do SUS; a política nacional de medicamentos; o caso dos tratamentos sem registro na Anvisa e de uso fora da bula (off-label); e a legitimidade do poder judiciário como ferramenta de efetividade do direito à saúde. Em seguida, buscamos verificar os núcleos de assessoria técnica, a exemplo dos Núcleos de Apoio Técnico em Saúde e dos Núcleos de Ações Judiciais, enquanto ferramentas de mitigação dos efeitos negativos da judicialização da saúde a partir da análise da funcionalidade institucional, não só a partir de concepções teóricas, mas, no caso de Pernambuco, a partir do tratamento quantitativo dos dados da judicialização no estado. Por fim, a partir de dados que se destacaram na realização do estudo quantitativo, nos propomos, numa perspectiva qualitativa e com dimensão exploratória, confrontar as estratégias argumentativas utilizadas pelos magistrados de Pernambuco, quando em situações análogas, proferiram sentenças em sentidos antagônicos, ora deferindo e ora indeferindo o fornecimento de medicamentos sem registro na Anvisa. Contatou-se a necessidade de maior conscientização acerca da problemática da judicialização da saúde a partir da atuação integrada entre as esferas de poder público e da sociedade civil; maior exigência acerca do corpo probatório que individualiza a condição do paciente e a real urgência dos casos; maior especialização das ferramentas de monitoramento e controle das demandas judiciais referentes ao direito à saúde; o fortalecimento e a valorização dos órgãos de apoio técnico aos magistrados e aos demais agentes envolvidos, com atuação administrativa e judiciária, objetivando: ao aumento das soluções administrativas; a indicação acerca da existência de tratamentos substituíveis com mesma eficácia, segurança e qualidade; o combate à utilização do judiciário como veículo de promoção para os laboratórios farmacêuticos; a atualização e qualidade da lista de medicamentos; a preservação do Sistema Único de Saúde; bem como, do combate à vulnerabilidade do judiciário acerca do proferimento de decisões frágeis e perigosas através do crescimento da qualidade técnica das decisões judicias. / Recognizing the importance of the judiciary as a tool to the effectiveness of social rights, among which are human rights, and in particular the right to health, this paper aimed to present a study of the process of judicialisation of the health in the state of Pernambuco related to the direct and indirect effects o the Public Hearing No. 4 of the Federal Supreme Court (STF), in other words, between the years 2009 to 2014, including those related to drugs without registration in Anvisa and of off-label use. The goal, when using the quantification from the probability in the the analysis of judgments, as a way of obtaining similar results and not an absolute truth, displays a trend and discuss, from the reality data, the various arguments and problems brought about providing medication through judicial process. Specifically, we analyze the main keyword present in the doctrinal and jurisprudential debate about the effectiveness of health through the courts. They are: the (in) effectiveness of current public policies in the country; the operational limits of the Unified Health System (SUS); the process of receiving new technology before the operating effectiveness of the SUS; the national drug policy; the case of the treatments without registration at Anvisa and of off-label use; and the legitimacy of the judiciary as effective tool of the right to health. After that, we verified the technical advisory centers, like the Centers of Technical Support in Health and Centers of Lawsuits – as tools of mitigation of the negative effects of judicialisation of health from the analysis of institutional functionality, not only from theoretical concepts, but in the case of Pernambuco, from the quantitative treatment of the data of judicialisation in the state. Finally, from data that have excelled in making the quantitative study, we propose, in a qualitative perspective and with exploratory dimension, confront the argumentative strategies used by magistrates of Pernambuco, when in similar situations, sentenced in antagonistic sense, sometimes deferring and in other times rejecting the supply of medicines which are not registered in Anvisa. We noticed the need for greater awareness of the health judicialisation of issues from the integrated action between the spheres of government and civil society; greater demand regarding the probative body which individualizes the patient's condition and the real urgency of the cases; greater specialization of monitoring and control tools of judicial processes relating to the right to health; the strengthening and enhancement of technical support bodies to the magistrates and other officials involved, with administrative and judicial actions, aiming at: the increase in administrative solutions; the indication of the existence of replaceable treatments with the same efficacy, safety and quality; the combat for the use of the judiciary as a promotional vehicle for pharmaceutical companies; the upgrade and quality of the drug list; the preservation of the Unified Health System; as well as the fight against the vulnerability of the judiciary regarding the fragile and dangerous decisions utterance through the growing of the the technical quality of judicial decisions.

Indiana University-Purdue University Indianapolis (IUPUI) / Descriptions about the matting of hair given by medical practitioners show a significant commonality indicating it as a historic health problem prevalent across the globe, however with less clarity about its etiopathogenesis. In southwestern India, the emergence of matting of hair is considered a deific phenomenon; consequently, people worship the emerged matted hair and restrict its removal. Superstitious beliefs impose a ritualistic lifestyle on affected women depriving them of health and well-being, further leading to stigma, social isolation, and marginalization. For unmarried females, the matting of hair can result in dedication to the coercive devadasi custom whereby women end up marrying a god or goddess. To date, the state, academia, and disciplines such as medicine and psychology have paid far too little attention to the social, cultural, and health concerns of the women affected by matted hair. A Heideggerian interpretive phenomenological study was conducted to document the lived experience of women affected by the phenomenon of matting of hair. The subjective accounts of 13 jata-affected women selected through purposive sampling were documented to understand their health and human rights marginalization through harmful cultural practices surrounding matting of hair. Seven distinct thematic areas emerged from the study exemplified their lived experience as jata-affected women. The prevalent gender-based inequity revealed substantial vulnerability of women to health and human rights marginalization through harmful cultural practices. The ontological structure of the lived experience of matting of hair highlighted the unreflective internalization of religious-based discourse of matting of hair. The hermeneutic exploration revealed events that exemplified jata-affected women’s compromised religiosity, and control of their well-being, human development, and ontological security. The religious-based interpretation of matting of hair and associated practices marginalize the health and human rights of affected women through family members, institutions, society, and religious-based systems. The study demonstrates the need for collaborative, evidence-based interventions and for effective domestic as well as global policies to prevent the health and human rights violations of women through cultural practices. The study offered foundational evidential documentation of the phenomenon of matting of hair as a harmful cultural practice that compromises women’s right to health and well-being.