Health regions in Canada are primarily associated with the rationalization of conventional, historically expensive provincial health care systems. At the same time, it is unclear what contribution health regions make to advancing health system reform, particularly health-promoting activities. This work sets out to understand the relationships between regionalization and health-promoting activity by studying two health regions in Canadian provinces that have different approaches to regionalization (British Columbia and Ontario). I use a constructivist grounded theory methodology (Charmaz, 2006) to analyse data from nineteen key informant interviews with senior management working in the two regional health authorities and in provincial health organizations. The iterative analysis of the empirical data and the review of corporate documents from both regional organizations result in the identification of three core themes grounded in the data. The dominant theme emerging from the analysis is identified as place-making referring to a region’s ability to facilitate health-promoting activity by making the region a place with special meaning and resonance for the populations served. The other two themes are creating space within organizations for health-promoting activity and developing networks. The former refers to a region’s willingness and ability to operationally support health-promoting activity and the latter refers to efforts undertaken to establish relationships with other organizations in the health-promotion and healthcare networks. I conclude that these three themes characterize critical components of a therapeutic region. A therapeutic region suggests a conceptualization of regional health authorities (RHAs) in which priority is given to health-promoting activities, alongside an entrenched curative healthcare agenda (the medical model). A therapeutic region is conceived of as a region that implements policies and develops structures aimed at achieving improvements in the overall health status of the population it serves. In this research I develop a four-cell matrix to frame the theory of therapeutic regions. One axis represents a continuum of place-making, while the second axis reflects a continuum depicting how regions develop the two other themes -- one extreme represents a piecemeal or patchwork approach, and the other an integrated strategic approach. The implications of this research relate to practice and policy. The practice of improving the health of the population served requires regions to open pathways, and remove longstanding barriers by making place-making core to all community engagement and develop health-promoting activity within their organizations and their networks. Policy-makers need to bring clarity to the regions’ role in health-promoting activity. This research indicates that health-promoting activity, innovation and progress occur when a region has the ability to manage both conventional, curative health care and health-promoting activities. Whether that is through direct governance or new ways to bring together decision-making, service co-ordination and evaluation is a subject for future work. / Graduate

Les réseaux de surveillance en santé humaine reposent souvent sur des professionnels de santé (fournisseurs) volontaires organisés en réseau, qui rapportent les cas de maladie observés dans leur patientèle. Les caractéristiques de ces fournisseurs, leur répartition spatiale et leur participation ne peut pas être contrôlée: ils ne constituent pas un échantillon aléatoire. La représentativité est un point important lorsque l'information collectée n'est pas exhaustive, elle assure que le réseau fournit une représentation précise de la population touchée. Dans cette thèse, on s'intéresse aux méthodes de réduction du biais des estimations produites par un réseau de surveillance reposant sur des données fournies par un échantillon de professionnels de santé volontaires. Les travaux reposent sur l'expérience en France du réseau de médecin généralistes Sentinelles. L'estimateur de Horvitz-Thompson a été utilisé pour réduire le biais des estimations grâce à la définition des probabilités d'inclusion reposant sur la différence d'activité des médecins participants et non-participants. Nous avons également étudié l'impact de l'échantillonnage spatial des médecins grâce à des données simulées. Nous montrons l'utilisation de poids de sondage incluant la densité médicale locale permet de s'affranchir des variations temporelle et spatiale des fournisseurs. Enfin, les différentes méthodes de redressement proposées ont été appliquées pour l'estimation annuelle de l'efficacité du vaccin anti-grippal. Les différents travaux montrent l'apport de méthodes statistiques appropriées à l'utilisation de données collectées en médecine générale pour informer précisément les acteurs de santé publique. / Disease surveillance networks are usually based on a group of health professionals or institutions which monitor one or more diseases. These data providers report cases seen among their patients. The characteristics of these providers, their spatial distribution and their participation to the network cannot be controlled: they are not a random sample of health professionals. Representativeness must be considered in networks where collected information are not exhaustive. It ensures that the network could provide an accurate representation of the population affected by the disease. In this thesis, we are interested in estimation methods for data produced by a surveillance network based on voluntary participation. The different works are based on the experience of the French practice-based Sentinelles network.The Horvitz-Thompson estimator was used to reduce the bias of incidence estimates. Inclusion probabilities were based on the difference in activity of participating and non-participating general practitioners in surveillance. We also study the impact of the spatial sampling of professionals participating to a surveillance network. By a simulation study, we show that sample weights based on local medical density eliminates the temporal and spatial variations of the providers. We ultimately applied these adjustments to estimate influenza vaccine effectiveness using data provided by GPs participating to the French Sentinelles network.These works show the contribution of appropriate statistical methods for epidemiological data collected in primary care to accurately inform public health authorities.

Asbestos, a fibrous mineral with excellent chemical and physical properties and a very wide application, especially in civil engineering, is now known to be a proven human carcinogen and therefore its utilization was forbidden. It causes asbestosis, pleural hyalinosis, acute exudative pleuritis, lung cancer and pleural mesothelioma. Recently, many reconstructions of school facilities took place and are still taking place across the Czech Republic. This causes the drilling and cutting of asbestos and thus the release of fibres into the atmosphere and the interiors of buildings. Many reconstructions were also executed in South Bohemia, where panels containing asbestos were handled. This was a cause of concern not only for teachers, the employees of the schools affected, but also for the parents of children attending schools containing asbestos materials. A whole number of bodies in mutual cooperation participated in the disposal of asbestos in schools in the Czech Republic. It is thus very necessary and useful for public health officers and the above-listed entities involved, to have information about how their approach to the given problem and the whole solution of the problem was assessed by the teachers. The thesis consists of two parts: theoretical and investigative. The work deals with the evaluation of the solution to the problem of asbestos by authorities involved in the school from the teachers' point of view. The theoretical part deals with selected chemical pollutants in the work environment. It also focuses on the pollutant asbestos in general. Lastly, another chapter is devoted to the issue of the assessment of health risks, which is very closely related to pollutants in the work environment. The practical part contains the results that emerged from interviews with teachers. In the discussion, the results are compared with online articles and specialist literature. The necessary data for the research part of the thesis was obtained through qualitative research interviews with educators from the elementary school Máj I. Through the evaluation of the interviews, I answered the research questions and identified several hypotheses that could be tested in future quantitative research. In this thesis, I aimed to identify the level of cooperation of stakeholders in addressing the issue of asbestos disposal in the school concerned in the South Bohemian Region. Research suggests that the solution to the problem of asbestos in the school was judged largely positively by the teachers. They particularly praised the approach of the Municipality of České Budějovice. They criticized the errors made by the OHL ŽS and Mapoz Zliv companies regarding the reconstruction and also the company Sita cz, which carried out the sanitation works, after whose intervention the teachers lacked many things. Educators confused the competences of the regional health authorities with the competences of the Health Institute, and therefore the general public should get acquainted with the competences of these bodies in order to facilitate the communication between the different entities and the public, not only in the asbestos issue.