Background: India has the highest number of undernourished children worldwide. Understanding trends, predictors, and consequences of child undernutrition is important to inform strategy for addressing this public health crisis. Methods: We used data from four National Family Health Surveys (1992-93, 1998-99, 2005-6, 2015-16 NFHS) to examine trends of undernutrition before and after the 2005 implementation of the National Rural Health Mission, India’s flagship public health initiative (Aim 1). We used the 2016 NFHS to build a predictive model that identifies infants at-risk for child undernutrition (Aim 2). Lastly, we used data from the 2005 and 2012 India Human Development Surveys to investigate the consequences of early childhood undernutrition (Aim 3). Results: NRHM was more effective at addressing acute than chronic undernutrition but its prioritization on high focus states resulted in an increase of acute undernutrition among children living in normal focus states. We demonstrate that it is feasible to predict 5-year risk of child undernutrition at the time of birth. Child undernutrition is associated with adverse physical and cognitive outcomes during pre-adolescent years, with female undernourished children experiencing the worst outcomes. Higher female education in the household helps overcome gender and nutrition-based disadvantage among Indian children. Conclusion: There is an urgent need to reduce nutrition-related disparities among Indian children. Short-term strategy could include a predictive model that can be used to more effectively provide resources and intervention to the most disadvantaged population. Long term strategy should focus on elevating women’s status through improved female education in India.

O desenvolvimento da tecnologia da informação e das comunicações em todo o mundo propicia condições para que a comunidade internacional possa vir a se relacionar sem enfrentar os obstáculos oferecidos pelas barreiras geográficas ou temporais, bem como possa vir a atuar diretamente na defesa de seus interesses, acrescentando novas formas de disciplina do seu comportamento além dos tradicionais mecanismos normativos oferecidos pelo Estado. O direito fundamental de livre acesso à informação por intermédio da tecnologia digital deve ser garantido em igualdade de condições a todos os indivíduos, na qualidade de participantes da sociedade global, em obediência aos princípios e disposições contidos na Declaração Universal dos Direitos Humanos, bem como da Declaração do Direito do Desenvolvimento e sua atualização na Declaração do Milênio. Ocorre, que, os países em desenvolvimento não participam dos beneficios da evolução tecnológica e por não estarem conectados à rede mundial, estão alijados do processo e excluídos do acesso à informação transmitida por via digital. Os Estados, que originalmente foram considerados os únicos sujeitos de direito na ordem internacional, não se mostram mais aptos a gerir, com eficácia, os interesses da sociedade, tornando-se incapazes de oferecer as condições necessárias para o exercício pleno da cidadania. O presente estudo visa ampliar os limites da discussão acadêmica a respeito dos efeitos produzidos pelo avanço tecnológico e pela globalização transpondo o debate para a ordem jurídica internacional. O exame dos documentos produzidos pela Cúpula Mundial da Sociedade da Informação, organizada pela UIT, por intermédio da ONU, demonstra que os representantes dos países membros, juntamente com a iniciativa privada e a sociedade civil foram capazes de produzir Declarações de Princípios e Planos de Ação contendo regras de utilização da tecnologia da informação e das telecomunicações de forma a eliminar as desigualdades, e criando a possibilidade de que a humanidade possa, finalmente, vir exercer seu direito ao desenvolvimento. Ademais, criação do Fórum de Governança da Internet, como decorrência da Cúpula Mundial da Sociedade da Informação, evidencia que as regras para a utilização da rede mundial dos computadores permanecem sob a responsabilidade da comunidade internacional, restando, portanto, demonstrado que atuação da sociedade civil, através de mecanismos próprios para proteger seus interesses, repercute diretamente na esfera internacional e merece ser levada em consideração no estudo das fontes de Direito Internacional. / The development of information technology and communications all over the world created the ideal conditions for the international community to the improvement of relationship without any of the obstacles caused by geographical or chronological barriers, and turned possible to civil society to act directly in the defense of its own interests, adding new forms of ruling its behaviors besides the traditional legal mechanisms offered by the State. The free and direct access to information in digital format must be guaranteed in equal conditions as a fundamental right to all individuals, in their condition of members of global society, in accordance with the principles and provisions established by the Universal Human Rights Declaration, as well as of the Declaration of the Right to Development, dully amended by the Millennium Declaration. Nevertheless, the developing countries cannot benefit from technological revolution and since they cannot not connect to the Internet they are maintained apart from this process and therefore are prevented to exercise their right of access to information transmitted in digital format. On the other hand, the States that originally were considered the sole subjects of rights in the international order are not capable anymore to efficiently manage the interests of civil society and therefore cannot offer the necessary conditions to the plain exercise of citizenship. This paper intends to wide the limits of the academic discussion already in place analyzing the effects of the technological revolution and globalization enlarging the debate to the level of the international legal order. The exam of the documents produced by World Summit of Information Society, organized by ITU, dully authorized by UN, demonstrates that the representatives of the member States, jointly with the private sector and the civil society, were able to prepare the Declaration of Principles, Plan of Action and other related documents disciplining the use of information technology and communications in order to eliminate the differences and conduct the human beings to the plain exercise to of their right to development. Furthermore, the establishment of the Internet Governance Forum as a consequence of the World Summit of Information Society provides strong evidences that the rules for Internet access shall remain in the hands of Non Governmental Organizations and moreover demonstrates that the utilization by civil society of specific legal mechanisms in order to protect its own interests, may generate important consequences for the international legal order and therefore deserves to be examined as a phenomenon affecting the sources of International Law.

Le régime juridique relatif à la conservation de la biodiversité dans les zones maritimes internationales est actuellement au cœur des discussions entre États au sein des Nations Unies. En effet, la Convention des Nations Unies sur le droit de la mer, véritable «Constitution des océans», ne permet pas d’assurer une conservation effective de la biodiversité dans la Zone et en haute mer. En 1982, lorsqu’elle a été adoptée, la notion de «biodiversité» n’existait pas encore, la Convention s’y référant alors uniquement de manière indirecte. Certaines ressources comme les ressources génétiques marines ne sont ainsi pas couvertes par la Convention, de même que certaines activités, ou outils de protection tels que les aires marines protégées. De plus, la division des océans en différentes zones aux régimes juridiques distincts et fragmentés ne permet pas aux États de mettre en œuvre leurs obligations conventionnelles de manière efficace. L’adoption d’un nouvel accord de mise en œuvre de la Convention dans le cadre des Nations Unies pourrait permettre, dans une certaine mesure, de pallier ces diverses insuffisances. Cependant, l’issue des négociations reste encore incertaine. Finalement, il conviendra d’observer que seule une approche plus globale, fondée sur la reconnaissance de l’existence d’une obligation générale de conservation de la biodiversité dans les zones maritimes internationales, pourrait permettre de dépasser les limites inhérentes à une approche exclusivement spatiale de la conservation de la biodiversité dans des espaces communs à tous les États, aux régimes distincts voire opposés. / Marine biodiversity conservation beyond national jurisdiction is currently subject of discussions in the United Nations. Indeed, the United Nations Convention on the Law of the Sea, the «Constitution of the Oceans», is not sufficient to protect marine biodiversity efficiently, in the high seas and the Area. In 1982, the word «biodiversity» did not exist yet, so the Convention only refers to marine pollution or biological resources conservation or management. Some resources, as marine genetic resources, are not covered by the Convention, as well as certain activities or conservation and management tools like marine protected areas. The division of the oceans in different maritime zones, moreover, with distinct and fragmented legal regimes, does not allow States to accomplish their conventional obligations dealing with biodiversity conservation. The adoption of a new implementing agreement related to the United Nations Convention on the law of the sea and dealing with marine biodiversity conservation and sustainable use beyond national jurisdiction would clearly improve the cur-rent regime. However, such an agreement could turn not being enough toward this objective, and the achievement of the process of negotiation remains uncertain. Finally, it appears necessary to build a more global approach, resting on the identification of an international general obligation of conservation of marine biodiversity beyond national jurisdiction. Such a global approach helps to overcome the limits of the actual regime of conservation, which is centered on a spatial approach of marine biodiversity conservation in common spaces, having opposed legal regimes.

L’initiative qui a conduit à l’élaboration de cette thèse provient d’un désir d’explorer plus en détail le contenu, les objectifs et la portée de la réforme de la comptabilité de l’État en Algérie. Le cadre juridique et réglementaire comptable actuel souffrait depuis son édification de nombreuses insuffisances et limites qui devaient être complétées avec les nouvelles modalités juridiques et techniques inspirées des standards et des bonnes pratiques internationales. La nouvelle réforme comptable vise à fonder une comptabilité tridimensionnelle de l’État consacrée par de nouvelles normes comptables nationales, un plan comptable de l’État (PCE) et de nouvelles modalités de contrôle et de responsabilité des acteurs. L’analyse de l'état actuel de la réforme, à l’épreuve de la nouvelle gouvernance financière publique, marquée par les exigences de transparence, de performance et de bonne gouvernance, vise à proposer des solutions pour l'amélioration du système national d’une part, et à étudier le rôle de la réforme budgétaire et des normes comptables internationales (IPSAS) dans l’adaptation du nouveau cadre comptable, pour que la comptabilité soit davantage un instrument d'information, de décision et d’appréciation de la situation financière et patrimoniale de l’État, d’autre part. Vu la complexité des formes et de l’étendue des chantiers de la réforme, la transformation comptable recommandée peut prendre une approche globale, qui sera concentrée non seulement sur l'application du cadre législatif et réglementaire (LOLF), c’est-à-dire sur la mise en place de la nouvelle comptabilité, sur la production de comptes publics sincères, fidèles et réguliers, objet de certification et de valorisation par la Cour des comptes, mais également sur la modernisation de la fonction comptable et l’intégration du cadre de la gestion budgétaire et comptable aux fins de la réforme de l’État. / The initiative which led to drawing up this thesis arises of a wish to explore, in more detail, the content, objectives and scope of the Algerian State accounting reform. The current legal and regulatory framework suffered, since its implementation, from many deficiencies and limits which should be completed by new legal and technical procedures based on standards and international good practices. The new accounting reform aims at establishing a three-dimensional State accounting, realized by new national accounting standards, a State accounting plan (SAP) and new ways of control and players responsibility. The analysis of the current state of reform, proof against the new public financial governance, marked by the requirements of transparency, performance and good governance, aims at proposing solutions for the enhancement of the national system, on the one hand, and to study the role of budget reform and international public sector accounting standards (IPSAS) in adapting the new accounting framework, so that accounting becomes more a tool for information, for decision and assessment of the financial and patrimonial situation of the State, on the other hand. Given the complexity of the forms and extent of reform projects, the recommended accounting transformation can take an overall approach which will be concentrated not only through the enforcement of the legislative and regulatory framework (LOLF), or through the implementation of the new accountancy, or the production of true, correct and regular public accounts, which are subjects of certification and valuation by the Court of Auditors, but also through the modernization of the accounting function and the integration of the budgetary and accounting management framework for the purpose of the State reform.

L’autonomie de la volonté est un principe relatif à la liberté des parties quant au choix de la loi applicable au contrat international. Cependant, ce principe est limité par les règles d’ordre public, et plus généralement les dispositions impératives, réduisant l’étendue de cette autonomie. Afin de perfectionner la mise en application de ces règles tout en garantissant une certaine prévisibilité, il s’avère important d’étudier en détail l’origine et la nature des règles d’ordre public. Une étude comparée avec le droit international privé égyptien s’avère nécessaire pour perfectionner les mécanismes actuels. Le débat conceptuel actuel met en évidence le rôle de la coopération internationale, outre les intérêts purement étatiques, ce qui suscitera un nouvel ordre public transnational, voire supranational. / The freedom of choice is a principle referring to the freedom of the parties concerning the choice of the law ruling the international contract. However, this principle is limited by public policy, which reduce the extent of this freedom. In order to improve the application of these rules with a minimum of predictability, it is important to study in detail the origin and nature of the rules of public policy. A comparative study with Egyptian private international law is needed to take advantage from all current mechanisms. The current conceptual debate highlights the role of international cooperation, in addition to purely State interests, which will tend to create a new transnational, or even supranational, public policy.

Esta tese busca analisar os limites e possibilidades do regime da responsabilidade internacional do Estado como garantia da Ordem Pública Internacional, procurando demonstrar os riscos da implementação unilateral da responsabilidade. Inicialmente, através da análise do desenvolvimento normativo do instituto da responsabilidade internacional do Estado, a partir do pós-Segunda Guerra Mundial, buscamos apontar os principais indicadores do momento de transição paradigmática do sistema internacional contemporâneo, ao revelarem-se tanto as bases de identidade desse sistema quanto os traços de transformação que o atravessam. Partimos da hipótese de que as mudanças normativas operadas no instituto da responsabilidade internacional, no período em estudo, têm sido orientadas, em sua maioria, no mesmo sentido das transformações valorativas verificadas no âmbito do Direito Internacional Público como um todo. O que, já adiantamos, significa dizer, em apertada síntese, mudanças no sentido de um direito interestatal ? relacional e bilateral ? para um direito da comunidade internacional no seu conjunto. Tendo, então, em mente a realidade de descentralização em que se concretizam as normas internacionais, nossa segunda hipótese é de que esses avanços normativos não têm par no plano institucional e que essa lacuna gera à comunidade internacional os riscos da implementação unilateral da responsabilidade. Especificamente, analisamos o conceito, os valores, a legitimidade e as consequências substanciais e instrumentais do instituto da responsabilidade internacional do Estado como garantia da ordem pública internacional, focando a projeção da noção de comunidade internacional no seu regime, e os obstáculos normativos e sistêmicos que a sua proteção enfrenta em um sistema internacional descentralizado.

Medium to Long Term Impacts on Former Participants of the Shoulder to Shoulder Global Brigades to Ecuador. International service learning and voluntourism programs in global health evoke benefits for both community and the intervener. While it is clear that the Shoulder to Shoulder Global program at the University of Kentucky provides a service to an economically resource poor community in Santo Domingo, Ecuador, what is unclear is the impact these interprofessional experiences have on the participants that travel with the four times a year health brigades. This study proposes to answer the question of what are the educational, personal and professional impacts that brigade participants experience. Alumni of the Shoulder to Shoulder Global health brigades from 2007 – 2017 were sent a twenty-three question survey to better understand the impact of this program. Seventy-five responses to the quantitative and qualitative questions were received and a chi square analysis was performed of subgroups within the seventy-five respondents. The findings indicate that this program has positively impacted participants in all three areas, with strong evidence to show that the impacts are related to the initial and intermediate outcomes, with more data needed to better assess the long-term program outcomes.

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the implementation of the JSY and the NRHM. Finally, we found that adequacy of health facilities was not associated with the likelihood of mothers in high-focus states having an institutional delivery. In the second essay, I examined whether a key social determinant of health in South Asia- gender inequality, is associated with physical health outcomes among Indian women. I found that the gender inequality expressed as the gendered household practice of seclusion was negatively associated with body weight of Indian women. Further, I found that participation in all household decisions by women of the household was generally not associated with body weight outcomes. The association between gendered household practices and women’s body weight outcomes was generally similar among rural and urban Indian women. In the final essay, I examined whether perinatal food environments (FE), maternal gestational weight gain (GWG) and early childhood weight (ECW) outcomes are associated. I used data on mother-children dyads from the Early Childhood Longitudinal Study – Birth cohort (ECLS-B), Area Resource Files (ARF) and Current Business Practices (CBP). I found that maternal GWG was associated with ECW outcomes. I also found that measures of food environment were associated with ECW outcomes. Specifically, I found that having an additional full-service restaurant per one thousand population in the maternal perinatal county of residence was associated with lower Body Mass Index (BMI) among children at age two years. Finally, I found that GWG did not mediate the association between food environment and ECW outcomes.

Despite the benefits of antiretroviral therapy in treating HIV/AIDS, government responses have varied substantially, from provisions guaranteeing nearly universal access to insufficient provisions providing almost no access. This research seeks to specifically examine primary explanations, such as economic capacity, and emerging explanations, such as the role of electoral accountability and the presence of stigma, and the coordination between the epistemic community and political leadership as potential causes for the variance in the government provision. By controlling for state economic capacity, this research furthers the importance of examining other explanations for state response in light of a public health crisis. While electoral accountability and the role of stigma had marginal impacts, the level of scientific coordination and understanding among the states political leadership had perceptible impacts. This research also tests broader aspects of the political economy such as the role of state capacity and subsequent government crisis response.

Following the Second World War, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) teamed up to construct an international Codex Alimentarius (or “food code”) in 1962. Inspired by the work of its European predecessor, the Codex Europaeus, these two UN agencies assembled teams of health professionals, government civil servants, medical and scientific experts to draft food standards. Once ratified, the standards were distributed to governments for voluntary adoption and implementation. By the mid-1990s, the World Trade Organization (WTO) identified the Codex as a key reference point for scientific food standards. The role of science within this highly political and economic organization poses interesting questions about the process of knowledge production and the scientific expertise underpinning the food standards. Standards were constructed and contested according to the Codex twin goals of: (1) protecting public health, and (2) facilitating trade. One recent criticism of Codex is that these two aims are opposed, or that one is given primacy over the other, which results in protectionism. Bearing these themes in mind, in this dissertation I examine the relationship between the scientific and the ‘social’ elements embodied by the Codex food standards since its inception after the Second World War. I argue that these attempts to reach scientific standards represent an example of coproduction– one in which the natural and social orders are produced alongside each other. What follows from this central claim is an attempt to characterize the pre-WTO years of the Codex through a case study approach. The narrative begins with a description of the predecessor regional group the Codex europaeus, and then proceeds to key areas affecting human health: 1) food additives, 2) food hygiene, and 3) pesticides residues.