Dissertation (D.P.H.)--University of Michigan.

Dissertation (D.P.H.)--University of Michigan.

Thesis (M.P.H.) - University of Queensland, 2006. / Includes bibliography.

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This dissertation explores discourses about culture and illness in the talk of mental health professionals and indigenous healers. It represents an attempt to situate the issue of indigenous healing in South Africa within a particular strand of critical discourse analytic research. In the context of current deliberations on the value, or otherwise, of indigenous healing in a changing health and specifically mental health system, the talk of both mental health practitioners and indigenous healers as they conceptualise “disorder”, and discuss possibilities for collaboration, is chosen as a specific focus for this study. Disputes over what constitutes “disorder” both within mental health, and between mental health and indigenous healing are an important site in which the negotiation of power relations between mental health professionals and indigenous healers is played out. The results of this study suggest that despite the construction of cogent commendations for the inclusion of indigenous healing in mental health, it remains largely marginalised within talk about mental health practice. While this study reproduces to some extent the marginalisation of indigenous healing discourse, it also examines some of the discursive practices and methodological difficulties implicated in its marginalisation. However, in the context of “cultural pride strategies” associated with talk about an African Renaissance, indigenous healing may also function as a site of assertion of African power and resistance in its construction as an essentially African enterprise. At the same time, it may achieve disciplinary effects consonant with cultural pride strategies, in constructing afflictions in terms of neglect of, or disloyalty to cultural tradition. These results are discussed in terms of the methodological difficulties associated with interviewing and discourse analysis of translated texts, which contributes to difficulties with articulating indigenous healing discourse in a way that challenges the dominant psychiatric discourses implicated in its marginalisation within mental health. It concludes with recommendations for future research which addresses indigenous healing discourse in its own terms, and examines its operation as a disciplinary apparatus in South African society.

Refletir sobre saúde do homem é pensar sobre saúde coletiva, bem como sobre a forma que as pessoas vivenciam o processo saúde-doença-cuidado e se organizam tanto para enfrentamento, quanto prevenção de agravos e demais vulnerabilidades que interferem na qualidade de vida. A maneira com que homens e mulheres cuidam de sua saúde difere inclusive pela forma que são socializados de acordo com gênero a que pertencem. Estudos sobre a realidade brasileira revelaram que os homens costumam buscar os serviços de saúde quando já sofrem com alguma doença ou acidente. Objetivando estimular a ampliação e qualificação da atenção a saúde masculina no âmbito do Sistema Único de Saúde, especialmente na atenção primária, o Ministério da Saúde instituiu por meio da Portaria n. 1944/2009, a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH). E passados sete anos de sua proposição, como está a implementação desta política em Ponta Grossa? Será que estão sendo desenvolvidas ações para fortalecimento da PNAISH no âmbito da atenção básica? Para além, qual a percepção dos enfermeiros e gestores envolvidos sobre a atenção integral à saúde do homem no município? Quais as perspectivas e os desafios enfrentados para atenção à saúde deste público e para implementação da referida política? Desta forma, o presente estudo teve como objetivo principal analisar a implementação da PNAISH em Ponta Grossa – Paraná. Considerando a complexidade do objeto, que perpassa a interdisciplinaridade, foi realizado um estudo de caso com abordagem quanti-qualititativa, por meio da associação de métodos (triangulação): revisão bibliográfica, estudo documental, observação, entrevista com profissionais de saúde (questionário) e gestores. Os dados foram tratados e analisados de forma continuada, à luz da análise de conteúdo, emergindo como categorias de análise os cinco eixos da PNAISH: acesso e acolhimento; saúde sexual e reprodutiva; paternidade e cuidado; doenças prevalentes na população masculina; prevenção de violências e acidentes. Como resultado são apresentados também alguns desafios e perspectivas sobre tal implementação, especialmente no tocante ao gênero e masculinidades. Ficou evidente a partir realização da presente investigação que apesar de terem sido desenvolvidas algumas ações que atingem a especificidade da população masculina entre 20 e 59 anos, ainda assim, a política de saúde do homem não parece compor a agenda da saúde em Ponta Grossa. Desta maneira, faz-se necessário investir na instrumentalização das equipes, divulgação da PNAISH e mobilização das equipes e dos homens; além do favorecimento ao acesso e acolhimento destes aos serviços, especialmente no âmbito da atenção básica – haja vista que no município ainda existem as barreiras socioculturais, institucionais e relacionais citadas na literatura sobre o tema. / To reflect on men’s health is to think about public health, and on the way that people experience the health-disease-care process and organize both coping and disease prevention and other vulnerabilities that affect life quality. The way men and women care their health differs, wich includes the way they socialize, according to the gender they belong to. Studies based on Brazilian reality revealed that men often seek health services when they are already suffering from some disease or accident. Aiming to stimulate the expansion and qualification of attention to male health under the National Health System, especially in primary attention, the Ministry of Health established by Decree n. 1944/2009, the National Policy to Integral Attention to Men's Health (Política Nacional de Atenção Integral à Saúde do Homem - PNAISH). And after seven years his proposition, as is the implementation of this policy in Ponta Grossa? They are being developed actions to strengthen the PNAISH scope of primary care? In addition, the perception of nurses and managers involved on the comprehensive health care of man in the city? Which are the perspectives and challenges to health care and this public implementation of the policy? Thus, the present study mainly objective was to analyze the implementation of PNAISH in Ponta Grossa - Paraná. Considering the complexity of the object, which runs through interdisciplinarity, we conducted a study case with quantitative and qualititative approach through triangulation: literature review, document study, observation, interviews with health professionals (questionnaires) and managers. The data was processed and analyzed continuously under the light of analysis content, emerging as categories of analysis the five axes of PNAISH: access and host; sexual and reproductive health; paternity and care; diseases prevalent in the male population; prevention of violence and accidents. As results also presented some challenges and perspectives on such implementation, especially with regard to gender and masculinities. It stayed evident from completion of this investigation that although they were developed some actions that affect the specificity of the male population between 20 and 59 years, yet the health policy of the man does not seem to make up the health agenda in Ponta Grossa. Thus, yet still need to invest in the capacitation of the work teams and dissemination of PNAISH mobilization of mend besides, favoring both access to and reception of these services, especially in the context of primary care - given the fact that the municipality there are still socio-cultural, institutional and relational barriers cited in the literature on the subject. It was the exploitation.

Refletir sobre saúde do homem é pensar sobre saúde coletiva, bem como sobre a forma que as pessoas vivenciam o processo saúde-doença-cuidado e se organizam tanto para enfrentamento, quanto prevenção de agravos e demais vulnerabilidades que interferem na qualidade de vida. A maneira com que homens e mulheres cuidam de sua saúde difere inclusive pela forma que são socializados de acordo com gênero a que pertencem. Estudos sobre a realidade brasileira revelaram que os homens costumam buscar os serviços de saúde quando já sofrem com alguma doença ou acidente. Objetivando estimular a ampliação e qualificação da atenção a saúde masculina no âmbito do Sistema Único de Saúde, especialmente na atenção primária, o Ministério da Saúde instituiu por meio da Portaria n. 1944/2009, a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH). E passados sete anos de sua proposição, como está a implementação desta política em Ponta Grossa? Será que estão sendo desenvolvidas ações para fortalecimento da PNAISH no âmbito da atenção básica? Para além, qual a percepção dos enfermeiros e gestores envolvidos sobre a atenção integral à saúde do homem no município? Quais as perspectivas e os desafios enfrentados para atenção à saúde deste público e para implementação da referida política? Desta forma, o presente estudo teve como objetivo principal analisar a implementação da PNAISH em Ponta Grossa – Paraná. Considerando a complexidade do objeto, que perpassa a interdisciplinaridade, foi realizado um estudo de caso com abordagem quanti-qualititativa, por meio da associação de métodos (triangulação): revisão bibliográfica, estudo documental, observação, entrevista com profissionais de saúde (questionário) e gestores. Os dados foram tratados e analisados de forma continuada, à luz da análise de conteúdo, emergindo como categorias de análise os cinco eixos da PNAISH: acesso e acolhimento; saúde sexual e reprodutiva; paternidade e cuidado; doenças prevalentes na população masculina; prevenção de violências e acidentes. Como resultado são apresentados também alguns desafios e perspectivas sobre tal implementação, especialmente no tocante ao gênero e masculinidades. Ficou evidente a partir realização da presente investigação que apesar de terem sido desenvolvidas algumas ações que atingem a especificidade da população masculina entre 20 e 59 anos, ainda assim, a política de saúde do homem não parece compor a agenda da saúde em Ponta Grossa. Desta maneira, faz-se necessário investir na instrumentalização das equipes, divulgação da PNAISH e mobilização das equipes e dos homens; além do favorecimento ao acesso e acolhimento destes aos serviços, especialmente no âmbito da atenção básica – haja vista que no município ainda existem as barreiras socioculturais, institucionais e relacionais citadas na literatura sobre o tema. / To reflect on men’s health is to think about public health, and on the way that people experience the health-disease-care process and organize both coping and disease prevention and other vulnerabilities that affect life quality. The way men and women care their health differs, wich includes the way they socialize, according to the gender they belong to. Studies based on Brazilian reality revealed that men often seek health services when they are already suffering from some disease or accident. Aiming to stimulate the expansion and qualification of attention to male health under the National Health System, especially in primary attention, the Ministry of Health established by Decree n. 1944/2009, the National Policy to Integral Attention to Men's Health (Política Nacional de Atenção Integral à Saúde do Homem - PNAISH). And after seven years his proposition, as is the implementation of this policy in Ponta Grossa? They are being developed actions to strengthen the PNAISH scope of primary care? In addition, the perception of nurses and managers involved on the comprehensive health care of man in the city? Which are the perspectives and challenges to health care and this public implementation of the policy? Thus, the present study mainly objective was to analyze the implementation of PNAISH in Ponta Grossa - Paraná. Considering the complexity of the object, which runs through interdisciplinarity, we conducted a study case with quantitative and qualititative approach through triangulation: literature review, document study, observation, interviews with health professionals (questionnaires) and managers. The data was processed and analyzed continuously under the light of analysis content, emerging as categories of analysis the five axes of PNAISH: access and host; sexual and reproductive health; paternity and care; diseases prevalent in the male population; prevention of violence and accidents. As results also presented some challenges and perspectives on such implementation, especially with regard to gender and masculinities. It stayed evident from completion of this investigation that although they were developed some actions that affect the specificity of the male population between 20 and 59 years, yet the health policy of the man does not seem to make up the health agenda in Ponta Grossa. Thus, yet still need to invest in the capacitation of the work teams and dissemination of PNAISH mobilization of mend besides, favoring both access to and reception of these services, especially in the context of primary care - given the fact that the municipality there are still socio-cultural, institutional and relational barriers cited in the literature on the subject. It was the exploitation.

Philosophiae Doctor - PhD / The rhetoric of primary health care, health promotion and health service integration is ubiquitous in health policy development in post-apartheid South Africa. However the form in which oral health promotion elements have actually been incorporated into other areas of health care in South Africa and the extent to which they have been implemented, remains unclear. The central aim of this research was to critically analyse oral health promotion elements in health policies in South Africa and determine the extent to which they have been implemented. The study set out to test the hypothesis that oral health promotion is fully integrated into South African health policy and practice. / South Africa

The complexity of issues in health care in the United States--specifically insurance coverage, access, affordability, quality of care, and financing--requires effective new models for governing, in which governmental and non-governmental organizations seek to solve problems collaboratively rather than independently. This research explores collaborative governance as a model to form new partnerships among for-profit, nonprofit, and public organizations in an effort to create community-based, locally governed health care entities in Oregon through coordinated care organizations (CCOs). A key question is whether collaboration, through CCOs, brings together government and non-governmental organizations to solve "intractable problems" by establishing new public-private partnerships in Medicaid. The research focuses on the formation of CCOs, including the influence of local, political, institutional, and historical contexts, planning processes, and governance structures. The hypothesis is that conditions, norms, governance structures and processes, and the presence or absence of a combination of these factors, facilitate or impede participation and decision-making, and over time, successful system integration by these new complex organizations. This study developed insights into similarities and differences among CCO governance structures by investigating three CCOs. Findings from the case study suggest that the following key factors influence the collaborative governance process among government and non-governmental organizations within CCOs: prior history of conflict or cooperation; open, transparent, and inclusive processes for stakeholders; face-to-face dialogue, trust building, and shared understanding; and high-functioning governing boards. Results also indicate that maintaining stakeholder participation can be challenging due to time and cost, power imbalances and competing interests among stakeholders, and mistrust and lack of facilitative leadership. The results suggest that collaborative governance is a strategic approach for the allocation of limited resources across public, private, and nonprofit organizations to deliver services to Oregon's Medicaid population. The significance of this study is that it identified starting conditions that facilitate and hinder the ability of CCOs to effectively solve problems through governance mechanisms. Oregon's CCOs offer an example of multiple layers of governing institutions--federal, state, and county--using formal authority to influence a specified set of outcomes, the Triple Aim, in a specific policy domain: provision of health care services for underserved Oregonians. Results of the study can help inform a larger, more fundamental question in public administration about contemporary governance: whether government through collaborative governance can create the "conditions for rule and collective action" through public-private partnerships to achieve policy goals (Stoker, 1998). Further research is needed to better understand whether local community-based organizations such as CCOs offer a sustainable model to address policy issues in other arenas by which there is "more government action and less government involvement" (Agranoff & McGuire, 2003). This study contributes to the theory of collaborative governance and may inform future policy decisions about CCOs in Oregon and, more broadly, ongoing national health care reform efforts.

The issues surrounding health care and health care policy are of great concern to politicians and the public alike. Government efforts in restructuring medicare, the "jewel" of Canada's social safety net, also affects the medical profession. It has been argued that this once powerful and dominant profession is experiencing a decline in its powers and authority. Is this decline inevitable or can the medical profession adapt to government reforms in such way as to maintain and even strengthen its power base? This dissertation examines the themes of professional autonomy and professional resistance. The changing composition, and possibly the decline, of the medical profession's clinical, economic, and political autonomy, is analyzed through an historical case study of the British Columbia Medical Association (BCMA). Minutes from the BCMA's Board of Directors and Executive, along with interviews with doctors active in BCMA politics, and a media review, are used to generate a portrait of the social forces influencing medical politics in British Columbia from 1964 to 1993 and of the BCMA's relations with the various provincial governments of that period. The negotiating strategies of the BCMA and the decisions behind these strategies are the focal point for an examination of professional resistance, an area neglected in sociology. The dissertation looks at the external and internal conflicts that impact on the resistance tactics of the BCMA and at the various successes and defeats the medical profession experiences in its bid to maintain professional autonomy. During the time period under study, government intervention becomes more frequent and invasive. The BCMA has the least success in protecting the political dimension of professional autonomy and most success in controlling aspects of clinical autonomy. The vast variety of resistance strategies at its disposal distinguishes it from labour groups and most other professions. Forced to accept measures it once fought against, the BCMA's efforts become focused on ensuring that reform measures are under the control of doctors (rather than government) to the greatest extent possible. Although the BCMA has lost aspects of professional autonomy, it remains one of the few professional organizations today that can force compromise from the state. / Arts, Faculty of / Sociology, Department of / Graduate