<b>Background</b>: Evidence-based policy making (EBPM) has become an article of faith. While critiques have begun to emerge, they are predominately based on theory or opinion. This thesis uses the 2008 case study of tobacco control policy making for Indigenous Australians to analyse empirically the concept of EBPM. <b>Research questions</b>: (1) How, if at all, did the Government use evidence in Indigenous tobacco control policy making? (2) What were the facilitators of and barriers to the use of evidence? (3) Does the case study augment or challenge the apparent inviolability of EBPM? <b>Methods</b>: Data were collected through: (1) a review of primary documents largely obtained under the Freedom of Information Act 1982; and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates and academics. <b>Results</b>: Historically, Indigenous smoking was not problematised because Indigenous people faced other urgent health/social problems and smoking was considered a coping mechanism. High prevalence data acquired salience in 2007/08 in the context of a campaign to reduce disparities between Indigenous and non-Indigenous health outcomes. Ensuing policy proposals were based on recommendations from literature reviews, but evidence contained in those reviews was weak; notwithstanding this, the proposals were adopted. Historical experiences led policy makers to give special weight to proposals supported by Indigenous stakeholders. Moreover, the perceived urgency of the problem was cited to justify a trial-and-evaluate approach. <b>Conclusion</b>: While the policies were not based on quality evidence, their formulation/adoption was neither irrational nor reckless. Rather, the process was a justifiable response to a pressing problem affecting a population for which barriers existed to data collection, and historical experiences meant that evidence was not the only determinant of policy success. The thesis proposes a more nuanced appraoch to conceptualising EBPM wherein evidence is neither a necessary nor a sufficient condition for policy. The approach recognises that rigorous evidence is always desirable but that, where circumstances affect the ability of such research being conducted, consideration must be given to acting on the basis of other knowledge (e.g. expert opinion, small-scale studies). Such an approach is justifiable where: (1) inaction is likely to lead to new/continued harm; and (2) there is little/no prospect of the intervention causing additional harm. Under this approach, non-evidentiary considerations (e.g. community acceptability) must be taken into account.

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-11-29T12:10:22Z No. of bitstreams: 1 JOÃO ALCIONE CARDOSO SANTOS.pdf: 2045029 bytes, checksum: 7f9f2c4810fbd94b17606435feab0766 (MD5) / Made available in DSpace on 2016-11-29T12:10:22Z (GMT). No. of bitstreams: 1 JOÃO ALCIONE CARDOSO SANTOS.pdf: 2045029 bytes, checksum: 7f9f2c4810fbd94b17606435feab0766 (MD5) Previous issue date: 2016-09-29 / There are major remaining obstacles to consolidation of programs, policies and actions involving assistance, promotion, monitoring and prevention of work related diseases. Changes are needed in the work process covering the health-work relations in all of its complexity. The creation Integrated Attention to Workers’ Health Subsystem (SIASS) structuring base of the Attention to Health and Safety of Federal Civil Workers Policy (PASS) emerges with the task of ensuring sustainability and effectiveness through work management. This dissertation, Occupational Health in the Federal Public Service: Challenges the policies of health care and work safety at the University Hospital context, aims to analyze the effectiveness of the policies on health and safety in implementation by the Federal Government in the context of the University Hospital at the Federal University of Goias (HC/UFG). We sought to understand and analyze the social, economic, technological organization influencing the process of disease in the workers. To support the debate on the existing conceptual differences of workers’ health; health and work; and genre and work, theoretical references of researchers have been studied. We also sought to further the principles, objectives and guidelines of established public policies of health and safety as reference. This study is presented methodologically as a quantitative and qualitative research. The methodological procedure as the objective of this study was an exploratory research. The research location was chosen mainly because the University Hospital (HC/UFG) has the largest number of absences due to sickness in the Federal University of Goias. A proportional stratified probability sampling of simple random type was performed. The study population consisted of 986 effective workers linked to the Unitary Judicial Regime and 131 workers were selected to participate. As for the data collection, two questionnaires were especially developed with objective and subjective questions. One questionnaire was used for the technical and administrative staff of the University Hospital/ UFG, and the other was applied to the managers at SIASS/ UFG. The review of specialized literature, documental research, and field research, all contributed with the reflection and analysis of data. A discussion was sought out about the perception aspects of technical and administrative staff; managers of SIASS/UFG, as the executing agency of the institution analyze the development and implementation of PASS. Regarding the profile of those involved in the research, there’s a prevalence of women with 79% aged between 41 and 60 years, with 71% prevalence of qualified education, 90% did not undergo periodic examinations, and 56%of respondents with double employment bond. The analysis of data infers that the implementation of Federal Health Care Policy is unsatisfactory relating to Public Workers in the University Hospital/UFG regarding health promotion and work safety, and it has been unable to cope with sickness of the workers. / Persistem grandes obstáculos à consolidação de programas, políticas e ações envolvendo assistência, promoção, vigilância e prevenção dos agravos relacionados ao trabalho. São necessárias mudanças nos processos de trabalho que contemplem as relações saúde-trabalho em toda a sua complexidade. A criação do Subsistema Integrado de Atenção à Saúde do Servidor (SIASS), base estruturante da Política de Atenção à Saúde e Segurança do Trabalho do Servidor Público Federal (PASS), surge com a tarefa de garantir sustentabilidade e efetividade através do gerenciamento de trabalho. A presente dissertação, Saúde do Trabalhador no Serviço Público Federal: desafios para uma política de atenção à saúde e segurança do trabalho no contexto de hospital universitário tem o objetivo de analisar a efetividade da política de atenção à saúde e segurança do trabalho em implementação pelo governo federal no contexto do hospital universitário da Universidade Federal de Goiás (HC/UFG). Buscou-se compreender e analisar os fatores sociais, econômicos, tecnológicos, organizativos que influenciam o processo de adoecimento desses servidores. Para subsidiar o debate sobre as diferenças conceituais existentes sobre a saúde do trabalhador, saúde e trabalho e gênero e trabalho, estudou-se referenciais teóricos de pesquisadores da área. Buscou-se ainda os princípios, objetivos e diretrizes das políticas públicas instituídas de Saúde e Segurança como referência. Este estudo se apresenta metodologicamente como uma pesquisa quanti-qualitativa. O procedimento metodológico quanto ao objetivo nesse estudo foi pesquisa exploratória. A escolha deste local para ser pesquisado ocorreu devido à unidade Hospital das Clínicas/UFG possuir o maior número de afastamentos por adoecimentos no âmbito da Universidade Federal de Goiás. Foi realizada uma amostragem probabilística estratificada proporcional do tipo aleatória simples. A população do estudo foi constituída de 986 servidores do quadro efetivos, vinculados ao Regime Jurídico Único e selecionados 131 servidores participantes. Para o instrumento de coleta de dados utilizou-se dois questionários especificamente desenvolvidos para este estudo, elaborados com questões abertas e fechadas para aplicação de um questionário aos servidores técnico-administrativos do Hospital das Clínicas/UFG e outro questionário específico aplicado aos gestores do SIASS/UFG. A revisão da literatura especializada, a pesquisa bibliográfica, a pesquisa documental e a pesquisa de campo contribuíram na reflexão e na análise dos dados. Procurou-se discutir os aspectos relativos à percepção dos servidores técnico-administrativos da PASS e ainda como os gestores do SIASS/UFG, enquanto órgão executor da instituição, analisam o desenvolvimento/implementação da PASS. O perfil dos pesquisados há predominância de mulheres com 79%, faixa etária entre 41 e 60 anos com 71%, predominância de escolaridade qualificada, 90% não realizaram exames periódicos e duplo vínculo de servidores técnicos 56% dos pesquisados. A analise dos dados permitem inferir que a implementação da Política de Atenção à Saúde do Servidor Público Federal, no contexto do Hospital Universitário/UFG é insatisfatória como instrumento de promoção à saúde e segurança do trabalho e não tem sido capaz de enfrentamento do processo de adoecimento dos servidores.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-22T14:51:02Z No. of bitstreams: 1 Priscila Larangeira Carvalho.pdf: 5761393 bytes, checksum: 8fed8a6dfcc8e65d04b881eed0e53508 (MD5) / Made available in DSpace on 2015-04-22T14:51:02Z (GMT). No. of bitstreams: 1 Priscila Larangeira Carvalho.pdf: 5761393 bytes, checksum: 8fed8a6dfcc8e65d04b881eed0e53508 (MD5) Previous issue date: 2013-07-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This dissertation discusses a research on the current role played by Psychologist in public health policies, particularly in the case of Substitute Network of Mental Health, Emerging closing (intervention) Hospital (Psychiatric) Nursing Home Anchieta. As a goal, try to understand where the "locus" in which professional psychology was inserted through the activities offered in Public Policy Health System (SUS), the city of Santos. Characterized as qualitative, exploratory development features, and the methodology used in the survey included: bibliographic (about SUS implementation in Santos, with an emphasis on mental health); consultation documents and files (the Municipal Health Santos, publicly available), information gathering (together with mental health professionals - through stories about his professional experience and operation services - during the period studied), and interviews (semi structured interviews with criteria: employment - public servant; academic - psychologist, and the service time - more than three years). Consisted of field research involving 12 subjects, divided into: 10 interviews and 02 reports, composing the content to be judged against the objectives. The analysis of the data collected in the interviews was carried out from the exhaustion of content and meaning of their narratives; thematic diversity of these narratives were structured three main data analysis, in obedience to the general objective and specific research: Attention Model - NAPS versus Anchieta; Blurred Role of the Psychologist in the interior of this model, and the Absence of Prevention in Mental Health. We conclude by proposing an alert to the class, aiming to offer support for reflection on new political contexts and health, in the field of Mental Health, which may go beyond the call of emergencies. / A presente dissertação aborda uma investigação sobre o atual papel ocupado pelo Psicólogo nas políticas públicas de saúde, em particular no caso da Rede Substitutiva de Saúde Mental, emergente do fechamento (intervenção) do Hospital (Psiquiátrico) Casa de Saúde Anchieta. Como objetivo, busca-se compreender qual o "locus" no qual o profissional de Psicologia foi inserido, mediante as atividades ofertadas nas Políticas Públicas de Saúde (SUS), no município de Santos. Caracterizada como qualitativa, seu desenvolvimento possui cunho exploratório, sendo que a metodologia utilizada pela pesquisa contou com: levantamento bibliográfico (sobre implantação do SUS em Santos, com ênfase na área da saúde mental); consulta de documentos e arquivos (da Secretaria Municipal de Saúde de Santos, disponíveis publicamente); coleta de informações (junto a profissionais da saúde mental - por meio de relatos a respeito de sua experiência profissional e do funcionamento de serviços - no decorrer no período estudado); e entrevistas (semi estruturadas, tendo como critério: vínculo empregatício ¿ servidor público; formação acadêmica ¿ psicólogo; e o tempo de serviço ¿ superior a três anos). Constou do campo de investigação a participação de 12 sujeitos, subdivididos em: 10 entrevistas e 02 relatos, que compôs o conteúdo a ser analisado à luz dos objetivos propostos. A análise dos dados coletados nas entrevistas foi realizada a partir do esgotamento de conteúdo e sentido de suas narrativas; da diversidade temática dessas narrativas foram estruturados três eixos principais de análise dos dados, em obediência ao objetivo geral e aos específicos da pesquisa: Modelo de Atenção - NAPS versus Anchieta; Indefinição do Papel do Psicólogo no interior desse modelo; e a Ausência da Prevenção em Saúde Mental. Conclui-se propondo um alerta à classe, visando ofertar subsídios para a reflexão sobre novos contextos políticos e de saúde, no campo da Saúde Mental, que possam ir além do atendimento das emergências.

There is a lack of knowledge on how alternative forms of sports facility provision influences end user's sports and physical activity behaviour, and the consequent impact this has on their health, well-being and social capital. To address this knowledge gap, this thesis has undertaken a multi-level analysis of the sport delivery system. It examines if strategic priorities and objectives pursued by different types of sport and fitness facilities, that are being influenced by macro level forces, along with their characteristics and ownership, influences individuals sport participation behaviour with a potential consequent impact on the policy outcomes of health, well-being and social capital. In the UK recently, sport policy objectives have focussed on increasing the population s participation in sport and physical activity to enhance a range of outcomes including health, well-being and social capital. Over the last three decades, there has also been significant changes in sport provision with the growth of private sector facilities, and public sector facilities being outsourced to private management. However, there is no evidence of the effectiveness of these alternative arrangements in delivering the policy objectives. There is limited knowledge on how different agents and actors in the sport delivery system function collectively to achieve these objectives or not, and a multi-level analysis of the sport delivery system i.e., from policy, through facilities, to end users does not exist. This gap in knowledge is addressed in this thesis through the adoption of a mixed methods case study of Leicestershire and Rutland Sport-County Sport Partnership (LRS-CSP) region in the midlands of England. The sport participation of individuals who use differently owned and managed sport and fitness facilities in the LRS-CSP region is examined, and the impact this has on their health, well-being and social capital, from macro level (policy), meso level (facilities), and micro level (end users) perspectives. Data collected at these levels involves, semi-structured interviews with the regional managers (macro level) who are responsible for the development and provision of sport in the region, a quantitative survey involving the facility managers (meso level) who are responsible for the day-to-day activities of the facilities, and quantitative survey and focus groups of end users in the region (micro level). Surveys done at the meso and the micro level are matched to the facilities of a variety of different ownership and characteristics to explore the influence this might have on individuals participation frequency and the impact this has on their health, well-being and social capital. The results show that government and public sport agencies priorities towards the sports sector which operate at the macro level of the sport delivery system influence the strategic objectives pursued by different types of sport and fitness facilities that are responsible for sport provision at the meso level of the sport delivery system. Public sport agencies and government bodies through their policies seem to have a significant influence over public sector including LMC facilities strategic decision making. However, this is not the case for the private sector facilities. Neither the strategic objectives of facilities nor their ownership and characteristics are shown to have a significant difference on the users sport participation behaviour, nor on the sport policy outcomes of their health, well-being and social capital. The largest influence on sport participation seems to be when individuals engage in sport with those they meet at the facility, indicating that facilitation of the co-creation of social capital among individuals could play a bigger role in increasing participation levels. Along with this, results also show that sport participation has a direct positive influence on individuals health which then enhances their well-being and social capital. This thesis contributes towards the long-standing debate about the relative value of different ownership types that span the public, private, and LMCs and their relationship with performance . The findings of the thesis suggest that, providing general availability of space for sport and fitness activities and by facilitating a network of opportunities with others and across activities is important in achieving the policy outcomes of improved participation and the consequent positive impact this has on health, well-being and social capital, and should be given priority in sport provision.

<p>The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context.</p><p>The study included samples from the general population and patients with GHD from four European populations: England & Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database). </p><p>A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments. </p><p>This thesis reports QoL-AGHDA normative values for the populations of England & Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment. </p><p>For use in health economic evaluations, models for generating utilities (QoL-AGHDA_utility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices.</p><p>QoL-AGHDA_utility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDA_utility deficit before treatment and a gain after starting GH replacement. </p><p>The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology. </p>

The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context. The study included samples from the general population and patients with GHD from four European populations: England &amp; Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database). A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments. This thesis reports QoL-AGHDA normative values for the populations of England &amp; Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment. For use in health economic evaluations, models for generating utilities (QoL-AGHDAutility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices. QoL-AGHDAutility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDAutility deficit before treatment and a gain after starting GH replacement. The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology.

Originally presented as the author's Thesis (doctoral)--Universität Bremen, 2005/2006. / Includes bibliographical references (p. 421-460) and index.

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-06T11:00:43Z No. of bitstreams: 1 Ray_Muller_EPSJV_Mestrado_2012.pdf: 858304 bytes, checksum: f5e74c295a80032f8b09e111f13f034c (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-06T12:07:56Z (GMT) No. of bitstreams: 1 Ray_Muller_EPSJV_Mestrado_2012.pdf: 858304 bytes, checksum: f5e74c295a80032f8b09e111f13f034c (MD5) / Made available in DSpace on 2014-11-06T12:07:56Z (GMT). No. of bitstreams: 1 Ray_Muller_EPSJV_Mestrado_2012.pdf: 858304 bytes, checksum: f5e74c295a80032f8b09e111f13f034c (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Laboratório de Formação Geral na Educação Profissional em Saúde / Este trabalho busca analisar a trajetória do Movimento de Promoção da Saúde a nível internacional, em termos de reconfiguração da atenção em saúde, através da inclusão dos determinantes sociais em sua abordagem. Esta reconfiguração também ocorreu no Brasil, tendo a Promoção da Saúde se materializado enquanto política social no documento do Ministério da Saúde: Política Nacional de Promoção da Saúde, no ano de 2006. Através de levantamento bibliográfico e análise de documentos, busca traçar um paralelo entre o modo como a Promoção da Saúde é implementada no Brasil, em um cenário de reformulação do neoliberalismo, e a instauração de consenso em torno de um projeto societário que atende aos interesses do capital e mobiliza a sociedade civil, por meio da pedagogia da hegemonia. Busca também ressaltar a importância do Movimento de Promoção da Saúde na medida em que rompe com o paradigma biomédico do cuidado em saúde, e a possibilidade deste projeto ser utilizado visando conquistar apoio para um projeto político que mantém as relações de exploração intocadas. / This study analyses the path of the Health Promotion Movement, in the world, through the reconfiguration of health care, by including the social determiners in its approach. This reconfiguration also happened in Brazil, and Health Promotion could take form as a social policy in the Health Ministry document: The National Policy of Health Promotion, in 2006. It also draws a parallel between the way Health Promotion establishes in Brazil, during the neoliberalism reformulation; and the consensus establishment around a society project that serves the capital interests, while mobilizes civil society by the hegemony pedagogy. It seeks to emphasize the relevance of Health Promotion Movement as a biomedical paradigm of health care break up, and its possible application as a mean to gather support to a political project that keeps untouched the exploitation relationships. It will be done from literature and documents review.

Orientador: Antonio Carlos Zuffo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Civil, Arquitetura e Urbanismo / Made available in DSpace on 2018-08-23T17:04:32Z (GMT). No. of bitstreams: 1 Teixeira_MariadaPurificacao_D.pdf: 11959076 bytes, checksum: 0a34d6e94c0591a179882a28673e53c7 (MD5) Previous issue date: 2013 / Resumo: É fato que a maioria das cidades brasileiras, atravessadas em suas áreas urbanas, rurais e até mesmo áreas protegidas, por rios, cresceram de forma desordenada ao longo destes cursos d'água. As razões para esta despreocupação com o patrimônio ambiental são históricas e encontram suas raízes em inúmeras condicionantes. Este trabalho não pretende abarcar tão vasta contextualização. Ocupa-se de identificar que este cenário de não ordenamento do território por um viés mais integral, tem legado ao País um passivo ambiental hídrico, mas também, um grande passivo social, decorrente da apropriação insustentável deste recurso natural. Emerge, então, antigo desafio administrativo e gerencial, prevalente no planejamento municipal brasileiro, relacionado ao binômio da apropriação dos recursos naturais x a qualidade de vida nas cidades. Partindo-se deste entendimento, é defendida a hipótese de que o passivo social deva ser incorporado de forma mais sistemática aos contextos decisórios municipais. E, favorecer que a tomada de decisão por parte das administrações municipais, tenha condições de incorporar medidas mitigadoras mais agressivas, também para esta modalidade de danos. Desta forma, defende-se a promoção da saúde no ambiente urbano como estratégia consensual de modo à melhor viabilizar políticas públicas municipais. O objetivo deste trabalho é relevar a apropriação dos vazios urbanos com foco no ambiente promotor de saúde, no escopo das microbacias hidrográficas. Esta hipótese é entendida como a possibilidade de encaminhar conciliação entre o planejamento estratégico e a participação da sociedade na tomada de decisão. A estruturação metodológica adotada na pesquisa consiste em proposição inovadora que integra a instrumentalização oriunda da pesquisa social à estruturação de problemáticas multicriteriais. Esta estruturação metodológica é apresentada como um potencial alternativa para a incorporação de dados qualitativos e quantitativos, em processos de tomada de decisão, que envolvem, simultaneamente, variáveis ambientais e sociais. O modelo proposto apresenta ferramental metodológico digno de destaque: construção de cenário investigativo; contexto investigativo; referencial teórico e conhecimento técnico da realidade; bases para discussão das linhas gerais de argumentação; bases para discussão das linhas específicas de argumentação; mapeamento cognitivo do contexto investigativo; estruturação de indicadores do ambiente urbano promotor de saúde; estruturação de escala de preferência dos indicadores do ambiente urbano promotor de saúde; bases diagnósticas da sustentabilidade socioambiental do uso e ocupação. Conquistou-se uma plataforma inédita de indicadores do ambiente urbano promotor de saúde no âmbito das cidades brasileiras. A pesquisa apresenta como resultado direto o aplicativo para a classificação de vazios urbanos com foco na promoção da saúde no ambiente urbano. Esta ferramenta permite também: a) classificação dos municípios brasileiros quanto às condições de saúde urbana; e b) qualificação da vulnerabilidade socioambiental de ambientes locais municipais. A pesquisa suscitou o desenvolvimento de plataforma teórica relacionada ao entendimento das microbacias hidrográficas urbanas enquanto unidades de planejamento. E, oferece ainda, contribuições relacionadas à abordagem metodológica para: a) estruturação de problemáticas que envolvam temáticas transversais; b) estruturação de visão de consenso para tratamento multidisciplinar; c) utilização integrada entre instrumental da pesquisa social e estruturação de problemáticas multicriteriais; e, d) inclusão mais efetiva da variável social no contexto decisório / Abstract: It is a fact that most Brazilian cities, traversed in its urban, rural and even protected areas by rivers, grew haphazardly along these waterways. The reasons for this lack of preoccupation with environmental patrimony are historical and are rooted in numerous conditions. The research is not intended to encompass this wide contextualization. The point is to identify this scenario for a more integral view, by considering that to our country, the legacy of water environmental liabilities, and also the great social liabilities, elapses from the unsustainable appropriation of this natural resource. Then, emerges, an old administrative and managerial challenge, prevalent in Brazilian municipal planning, related to the duet: appropriation of natural resources x quality of life in cities. Based on this understanding, is supported the hypothesis that social liabilities should be incorporated more systematically to municipal decision contexts. And encourage that decision-making by municipal administrations, is able to incorporate more aggressive mitigation measures, also for this type of damage. Thus, is advocated the promotion of health in the urban environment as a consensual strategy to better enable municipal public policies. The objective of this work is to reveal the urban unoccupied appropriation with focus on promotion of health in urban environment context, in the watersheds scope. This hypothesis is understood as an ability to reconcile strategic planning and society participation forward decision-making. The methodological structure adopted on the research is an innovative proposition that integrates instrumentation from social research and structuring of multi-criteria problems. This methodological structure is presented as a potential alternative to the incorporation of qualitative and quantitative data in decision-making processes, involving both environmental and social variables. The proposed model presents a prominent methodological tooling: investigative scenario; investigative context, theoretical and technical knowledge of reality; bases for discussion (general lines); bases for discussion (specific lines); cognitive mapping; indicators for promotion of health in urban environment; preference scale indicators for promotion of health in urban environment; occupation diagnostic bases of environmental and social sustainability. We have conquered a new promotion of health indicators platform for urban environment in Brazilian cities. The research presents as a direct result, the application for the classification of urban unoccupied. This tool also allows: a) classification of municipalities regarding the conditions of urban health; and b) qualification of the environmental and social vulnerability of local municipal environments. The research raised the development of theoretical framework related to urban watersheds as planning units. lso, features contributions related to the methodological approach: a) structuring problems involving wide thematic; b) structuring consensus view for multidisciplinary treatment; c) integrated use between instrumental from social research and structuring of multi-criteria problems; and, d) more effective inclusion for social variable in decision context / Doutorado / Recursos Hidricos, Energeticos e Ambientais / Doutora em Engenharia Civil

This thesis investigates approaches to public health in the Czech Republic and compares them to approaches in Norway. The theoretical part outlines key concepts in the field of health, public health, health policy and prevention and explores their diverse interpretation on the level of professional discourse. The empirical part provides a comparative analysis of the development and current state of health systems in both countries, health status of their populations, a general comparison of the approaches to prevention and health policy, as well as an analysis of a concrete example - fight against smoking as a major health risk factor. The aim of the thesis is not only to compare approaches to public health in both countries, but also to understand the complex relationships between the compared cases and the context. Based on this analysis, examples of good practice are identified, and recommendations are formulated which could stimulate further research or serve as a basis for the development of new health policies, prevention programs and campaigns. key words: health, public health, prevention, health policy, health system, health literacy, comparative analysis