Este trabalho ambiciona compreender a origem e o funcionamento do sistema de prestação de serviços de saúde a todos os brasileiros sem distinção, e, para tanto, esmiúça as origens a partir do qual sua organização se ergueu. São estudadas as formas de federalismo existentes desde o seu surgimento no Estado Moderno, e o desenvolvimento das limitações aos poderes centrais e dos entes federados, com ênfase na maneira sob as quais as responsabilidades foram e são divididas ou compartilhadas, bem assim como a maneira pelas quais suas balizas foram estabelecidas e modificadas no decorrer do tempo. O direito à saúde no Brasil é colocado no centro do debate e as formas como foi exercido, bem assim como as suas deficiências, foram todas observadas durante a investigação do processo que originou a criação de um formato inédito, amplamente respaldado pela participação popular. Esta legitimidade impressa ao que se denomina Direito Sanitário foi de crucial relevância para o enfrentamento do federalismo sob o prisma do direito à saúde, que se denomina atualmente federalismo sanitário, e é referência para a compreensão das políticas públicas que sucederam sua construção e exercício efetivo. A partir daí, foi possível proceder na avaliação da divisão das responsabilidades entre os integrantes do sistema, a forma de efetivação da divisão, sua vinculação estrita ao sistema federativo e aferir sobre a pertinência de que o federalismo sanitário seja reconhecido como a forma de responsabilização compartilhada nos termos em que o sistema único de saúde foi estruturado. Diante da conclusão a que se chegou, são apreciadas as decisões proferidas pelo Supremo Tribunal Federal. Por fim, são avaliadas de modo a que se conclua pela tese construída, que rechaça a responsabilização solidária da forma como compreendida pelo STF, por não se harmonizar com a estrutura federativa estabelecida para cumprimento do dever de assistência à saúde pelo Estado Brasileiro. / This work aims to understand the origin and functioning of the provision of health care system to all Brazilians without distinction, and, therefore, deeply analyzes the sources from which its organization arose. Existing forms of federalism are studied since its emergence in the Modern State, and the development of limitations to the central authorities and federal agencies, emphasizing the way in which the responsibilities were and are divided or shared, as well as the way the that their beacons have been established and modified over time. The entitlement to health in Brazil is placed in the center of the debate and the ways in which it was exercised, as well as its shortcomings were all observed during the investigation of the process that led to the creation of an unprecedented format, widely supported by popular participation. This printed legitimacy to what is called Health Law was of crucial importance to face the federalism through the prism of the right to health, which is now called health federalism, and is a reference to the comprehension of public policies that followed its construction and effective exercise. From there, it was possible to proceed in assessing the division of responsibilities between system integrators, how to effect the division, their strict adherence to the federal system and check on relevance of the health federalism is recognized as a form of shared accountability in terms in the unified health system was structured. Before the conclusion arrived at, they are appreciated judgments given by the Supreme Court. Finally, are evaluated so that it is determined by the built thesis, which rejects the joint accountability of how understood by the Supreme Court, by not harmonize with the federal structure established to comply with the health care obligation by Brazil.

Hundreds of state regulations were passed during the “managed care backlash” of the late 1990s and early 2000s. Many of these anti-managed care regulations eased or eliminated constraints on patient utilization of health care services imposed by managed care organizations. Other regulations gave managed care providers more flexibility in the way they practiced care or helped patients appeal denials of claims. Despite the effort undertaken to pass these regulations, limited research exists on whether the regulations achieved their goal. To fill this gap, this study takes advantage of the variety of regulations enacted during the managed care backlash of the late 1990s and early 2000s to investigate their impact on patient-reported quality of care and mortality for managed care enrollees. The results indicate the regulations did improve patient-reported outcomes, but to varying degrees and only in the latter period of the backlash. Specifically, managed care enrollees who lived in states that adopted moderate-intensity regulations between 2000 and 2004 reported relatively better improvements in access to care and confidence in their provider than did managed care enrollees in states with low-intensity backlash regulations. The positive effect on access to care was similar in states that adopted high-intensity regulations. However, no positive effect was found for any outcome in the first period (1996-2000). These results show that states with the most intense regulatory backlash did not realize better patient-reported outcomes. Instead, states that pursued moderate-intensity backlash regulations experienced relatively better outcomes for their managed care enrollees.

M. Tech. Environmental Health / The purpose of the study was to determine the knowledge and perception of the Environmental Health Practitioner regarding enforcing environmental health legislation and the procedures which must be followed in terms of building control. The objectives of the study were: to determine the knowledge of the Environmental Health Practitioner regarding enforcing environmental health legislation on building plans; to determine the perceptions of the Environmental Health Practitioner towards their roles and responsibility to enforce environmental health legislation through building control; to determine the perceptions of the Environmental Health Practitioner regarding the working relationship between environmental health and building control; and to compare the practical application when building plans are scrutinised by Environmental Health Practitioner with the legal requirements needed to prevent environmental health hazards.

This thesis advances a feminist critique of Canadian legal responses to disputes over frozen in vitro embryos and embryo donor anonymity. It argues that current laws that provide spouses or partners with joint control over the use and disposition of embryos created from their genetic materials, that mandate the creation of agreements setting out these parties intentions in the event of a disagreement or divorce and that protect donor anonymity without providing mechanisms to allow donors, recipients and donor offspring to voluntarily exchange information do not adequately account for the lived experiences of women who undergo in vitro fertilization treatment or who serve as embryo donors. This thesis provides recommendations for how Canadian laws and policies might better support the express objectives and intentions of Canadian federal and provincial statutes to protect the rights, interests and health of women who seek to build their families through assisted reproductive technologies.

This thesis identifies and analyzes the legal barriers faced by ethno-racial psychiatric consumer/survivors in Ontario, through an analysis of the Consent and Capacity Board (CCB). I employ interdisciplinary research to test the hypothesis that factors such as race, ethnicity, culture, poverty and social exclusion are not fully addressed by the CCB. To critique the CCB, I developed a theoretical framework using the grounded theory approach, in combination with tenets of disability theory, critical race theory and intersectionality. I used the theoretical framework to analyze qualitative research involving twenty interviews of stakeholders including lawyers, psychiatrists, CCB adjudicators, mental health service providers and ethno-racial psychiatric consumer/survivors. The analysis revealed the procedural, systemic/structural and discretionary barriers within the CCB’s pre-hearing, hearing and post-hearing process. Barriers were the result of cultural misunderstandings, misdiagnosis, complex familial relationships, culturally inappropriate care, institutional racism, poverty, discrimination and the CCB’s “color blind approach.” I conclude with prioritized recommendations.

While a significant amount of research has been produced in Canada on direct-to-consumer advertising (DTCA) of prescription drugs in general, very little work has been undertaken specifically with regard to the role of social media and emerging Internet technologies. While Health Canada has reaffirmed that existing DTCA regulations apply to new Internet and social media technologies, there are several unique features of these technologies that make the application of existing regulations an uncertain process. Further, given the difficulties Health Canada has faced in directly regulating DTCA in traditional media, there is significant skepticism around whether government regulators have the resources or political will to effectively monitor new digital media. Consequently, independent third party oversight and industry self-regulation may play an important role in regulating digital channels. Finally, regulators should not simply be limited to regulating online DTCA; social media is equally available to government for use in health promotion.

This thesis identifies and analyzes the legal barriers faced by ethno-racial psychiatric consumer/survivors in Ontario, through an analysis of the Consent and Capacity Board (CCB). I employ interdisciplinary research to test the hypothesis that factors such as race, ethnicity, culture, poverty and social exclusion are not fully addressed by the CCB. To critique the CCB, I developed a theoretical framework using the grounded theory approach, in combination with tenets of disability theory, critical race theory and intersectionality. I used the theoretical framework to analyze qualitative research involving twenty interviews of stakeholders including lawyers, psychiatrists, CCB adjudicators, mental health service providers and ethno-racial psychiatric consumer/survivors. The analysis revealed the procedural, systemic/structural and discretionary barriers within the CCB’s pre-hearing, hearing and post-hearing process. Barriers were the result of cultural misunderstandings, misdiagnosis, complex familial relationships, culturally inappropriate care, institutional racism, poverty, discrimination and the CCB’s “color blind approach.” I conclude with prioritized recommendations.

While a significant amount of research has been produced in Canada on direct-to-consumer advertising (DTCA) of prescription drugs in general, very little work has been undertaken specifically with regard to the role of social media and emerging Internet technologies. While Health Canada has reaffirmed that existing DTCA regulations apply to new Internet and social media technologies, there are several unique features of these technologies that make the application of existing regulations an uncertain process. Further, given the difficulties Health Canada has faced in directly regulating DTCA in traditional media, there is significant skepticism around whether government regulators have the resources or political will to effectively monitor new digital media. Consequently, independent third party oversight and industry self-regulation may play an important role in regulating digital channels. Finally, regulators should not simply be limited to regulating online DTCA; social media is equally available to government for use in health promotion.

This thesis argues that current treatment in acute public mental health services is counterproductive for the wellbeing of those subject to such services. The consumer/survivor movement activism against the coercive nature of treatment is analysed according to new social movement theory. According to social theorists such as Alaine Touraine, new social movements are characterised by a struggle over identity. Consistent with this theme, what is identified in this thesis as central to the consumer/survivor movement objection to the nature of treatment in acute public mental health services, is the failure of services to respect patient identity as persons. What might account for this failure is analysed in this thesis through an examination of the question of the conceptualisation of the subject in the theory and concepts of psychiatry, in the practice of psychiatry, in mental health law and in government policy. / As a counterposition to the above perspectives, the work of RD Laing, Charles Taylor and Paul Ricoeur are considered in an attempt to develop a conceptualisation of the subject grounded in a historical narrative. Further, Emmanuel Levinas’ and Axel Honneth’s work is drawn on to identify the practical implications of Honneth’s claim for a politics of recognition, which also supports the consumer/survivor movement demand for recognition as subjects in mental health services.

Este trabalho ambiciona compreender a origem e o funcionamento do sistema de prestação de serviços de saúde a todos os brasileiros sem distinção, e, para tanto, esmiúça as origens a partir do qual sua organização se ergueu. São estudadas as formas de federalismo existentes desde o seu surgimento no Estado Moderno, e o desenvolvimento das limitações aos poderes centrais e dos entes federados, com ênfase na maneira sob as quais as responsabilidades foram e são divididas ou compartilhadas, bem assim como a maneira pelas quais suas balizas foram estabelecidas e modificadas no decorrer do tempo. O direito à saúde no Brasil é colocado no centro do debate e as formas como foi exercido, bem assim como as suas deficiências, foram todas observadas durante a investigação do processo que originou a criação de um formato inédito, amplamente respaldado pela participação popular. Esta legitimidade impressa ao que se denomina Direito Sanitário foi de crucial relevância para o enfrentamento do federalismo sob o prisma do direito à saúde, que se denomina atualmente federalismo sanitário, e é referência para a compreensão das políticas públicas que sucederam sua construção e exercício efetivo. A partir daí, foi possível proceder na avaliação da divisão das responsabilidades entre os integrantes do sistema, a forma de efetivação da divisão, sua vinculação estrita ao sistema federativo e aferir sobre a pertinência de que o federalismo sanitário seja reconhecido como a forma de responsabilização compartilhada nos termos em que o sistema único de saúde foi estruturado. Diante da conclusão a que se chegou, são apreciadas as decisões proferidas pelo Supremo Tribunal Federal. Por fim, são avaliadas de modo a que se conclua pela tese construída, que rechaça a responsabilização solidária da forma como compreendida pelo STF, por não se harmonizar com a estrutura federativa estabelecida para cumprimento do dever de assistência à saúde pelo Estado Brasileiro. / This work aims to understand the origin and functioning of the provision of health care system to all Brazilians without distinction, and, therefore, deeply analyzes the sources from which its organization arose. Existing forms of federalism are studied since its emergence in the Modern State, and the development of limitations to the central authorities and federal agencies, emphasizing the way in which the responsibilities were and are divided or shared, as well as the way the that their beacons have been established and modified over time. The entitlement to health in Brazil is placed in the center of the debate and the ways in which it was exercised, as well as its shortcomings were all observed during the investigation of the process that led to the creation of an unprecedented format, widely supported by popular participation. This printed legitimacy to what is called Health Law was of crucial importance to face the federalism through the prism of the right to health, which is now called health federalism, and is a reference to the comprehension of public policies that followed its construction and effective exercise. From there, it was possible to proceed in assessing the division of responsibilities between system integrators, how to effect the division, their strict adherence to the federal system and check on relevance of the health federalism is recognized as a form of shared accountability in terms in the unified health system was structured. Before the conclusion arrived at, they are appreciated judgments given by the Supreme Court. Finally, are evaluated so that it is determined by the built thesis, which rejects the joint accountability of how understood by the Supreme Court, by not harmonize with the federal structure established to comply with the health care obligation by Brazil.