Background: The COVID-19 pandemic posed an unparalleled challenge to worldwide public health systems, characterized by its high transmissibility and the initial absence of accessible testing, treatments, and vaccines. The deficiency in public awareness and the scarcity of readily available public health information regarding this century's disaster further intensified the critical need for innovative solutions to bridge these gaps. In response, Shaman Labs1,2, leveraging its deep expertise in forecasting for influenza3, Ebola, and various SARS viruses, initiated the development of country-wide COVID-19 projections within weeks following the WHO's declaration of the pandemic4–6. Almost immediately thereafter, it became necessary to create a sophisticated online platform—a system capable of displaying county-specific COVID-19 forecasts, including daily estimated infections, cases, and deaths. This platform was designed to allow users to select any county, state, or national geography and compare it with another, under various scenarios of social distancing measures. Additionally, the architecture of this system was required to facilitate the regular integration of updated data, ensuring the tool's ongoing relevance and utility. Columbia University's data visualization system aimed to communicate epidemiological forecasts to various stakeholders. At the onset of the COVID-19 pandemic, amid escalating uncertainty and the pressing need for reliable data, Dr. Rundle played a pivotal role in briefing key stakeholders on the unfolding crisis. His efforts were directed towards providing Congressman Ron Johnson, Chairman of the U.S. Senate Committee on Homeland Security & Governmental Affairs, and Congresswoman Anna Eshoo, as well as their staff, with up-to-date projections and analyses derived from the Classic Data Visualization tools. Dr. Rundle’s consultative role extended to a diverse array of institutions including the U.S. Army Corps of Engineers, the U.S. Air Force, and the Federal Reserve Board, as well as advising private entities such as Pfizer, MetLife, and Unilever. His expertise facilitated informed planning and response efforts across various levels of government and sectors, underscoring the critical role of sophisticated data visualization from the earliest stages of the pandemic. This Integrated Learning Experience (ILE) examines the development and implementation of the Time Machine platform, focusing on its application in visualizing and analyzing COVID-19 epidemiological forecasts. The study explores methods for improving forecast data presentation, analysis, and accuracy assessment. Methods: The body of this work unfolds through a series of critical chapters that collectively address the multifaceted functionality and impact of the Time Machine platform. Initially, the work focuses on the construction of the Time Machine platform, a web-based R interactive user interface coupled with cloud-based database system, specifically tailored for the intuitive visualization of epidemiological forecasts, detailing the technical and design considerations essential for enabling users to interpret complex data more effectively. Following this, the implementation of a rigorous data-discovery framework is presented, examining case reporting inconsistencies across different regions, using low-level GitHub and Windows scripting technologies, thereby highlighting the significance of accurate data collection and the impact of discrepancies on public health decisions. The narrative then transitions to the implementation of advanced statistical models, such as strictly proper scoring and weighted interval scoring, to assess the accuracy of the forecasts provided by the Time Machine platform, using a dedicated R library and testing with the help of MS Excel sandbox, underscoring the importance of reliable predictions in the management of public health crises. Lastly, a detailed analysis is conducted, encompassing countrywide data (3142 counties) over an extended period (147 weeks), utilizing Generalized Estimating Equations (GEE) to identify key predictors that influence forecast accuracy, offering valuable insights into the factors that either enhance or detract from the reliability of epidemiological predictions. Results: The deployment of the Classic Data Visualization and the subsequent evolution of the Time Machine platform have significantly advanced epidemiological forecast visualization capabilities. The Time Machine platform was designed with an automated data refresh system, allowing for regular updates of epidemiological forecast data and reported actuals. The project developed tools for monitoring and evaluating the quality of public health reporting, aiming to improve the accuracy and timeliness of data used in public health decisions. Additionally, the research implemented methods for standardizing forecast accuracy assessments, including the normalization of scores to enable comparisons across different geographical scales. These approaches were designed to support both local and national-level pandemic response efforts. The accuracy analyses throughout different phases of the pandemic revealed a 42% improvement in forecast accuracy from Phase 1 to Phase 7. Larger populations (27% increase per unit increase on a base-10 logarithmic scale) and higher county-level activity (45% increase from the lowest to the highest quartile) resulted in better estimations. Additionally, the analysis highlighted the significant impact of reporting quality on forecast accuracy. On the other hand, the study identified the challenges in predicting case surges, showing a 27% decline in accuracy during periods of rising infections compared to declining periods. The regression results highlight the potential benefits of improving data collection and providing timely feedback to forecasting teams. Conclusion: This study demonstrates the potential of advanced data visualization and accuracy measurement techniques in improving epidemiological forecasting. The findings suggest that factors such as urbanicity, case reporting quality, and pandemic phase significantly influence forecast accuracy. Further research is needed to refine these models and enhance their applicability across various public health scenarios.

No / The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public health approach to dying, death, and loss. Modeled after the World Health Organization's 1986 Ottawa Charter, our charter includes a call to action. It has the potential to bring about significant change on local, societal, and global levels as exemplified by four projects from three countries. Public health and end-of-life services and organizations need to form partnerships with the community to develop a public health approach to dying, death, and loss. Learning from each other, they will affirm and enhance community beliefs and practices that make death part of life.

Current research tends to describe loneliness among the elderly as an individual issue, focusing on psychological or biological causes and negative effects on health. This dissertation lays the groundwork for an alternative, sociological approach. Drawing on the model developed by Durkheim in his study of suicide, the argument operates on three levels. First, it critically examines the dominant analytical framework for studying loneliness, highlighting the influence of concepts and methods inherited from psychology. Next, it contextualizes loneliness historically, tracing through the archives of international organizations (especially the ILO, the WHO, and the Council of Europe) the emergence of policies that contributed to loosening intergenerational ties and isolating the elderly from the rest of society. Finally, the dissertation introduces an innovative quantitative approach based on data from a major European telealarm provider. These "organic" data, derived from real-life settings rather than conventional survey-based research, reveal the macrostructure of the phenomenon. Taken together, the findings point to the need to reconceptualize loneliness not as mere absence of interpersonal connections but as a misalignment of the individual with group norms, especially norms related to time. This has both theoretical and practical implications in terms of the nature of the phenomenon and the types of interventions needed to address it.

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

本文探討近數十年來非政府組織「為何」（why）在國際社會積極參與國際組織的各項議題，其興起的因素與相關的基礎理論。然而，由於世界衛生組織是一個以主權國家為會員組成的政府間組織，台灣至今還未能成為它的會員國；非政府組織「如何」（how）參與此一國際組織，本文從三個面向來進行分析，第一，非政府組織參與WHO的角色定位；第二，非政府組織對於國際政策諸如醫療、人道救援等的參與策略；第三，討論非政府組織在國際參與過程中與政府的關係；此外，並探討台灣非政府組織國際參與的機會與可能的挑戰。 就理論意義而言，學者將非政府組織與全球化的發展趨勢聯繫起來，關注於非政府組織如何在國際參與各項全球議題（Held & Mcgrew, 2002；Peck, 1998；Scholte, 2000）。就現有的非政府組織研究來看，學界少有將全球議題和國家、非政府組織相連結者（Weiss, 1999；Brown. et.al., 2000；CIVICUS, 1998；MS, 2000），此一研究缺口主要與它在國際政策層面的重要性未獲得密切注意有關。目前有若干學術著作把國家與非國家行動者合併在一起探討，Weiss & Gordenker (1996)在「非政府組織、聯合國及全球治理」（NGOs, The UN, & Global Governance）一書中，從UN與NGO的連結試圖解釋全球治理的問題；Fisher（1998）的「非政府組織與第三世界的政治發展」（NGOs and the Political Development of the Third World）一書探討的NGO與第三世界國家政治發展的關係。本文主要為了突顯NGO的參與對國家主導全球議題等鉅觀社會變遷的影響之外，並以中介角色來理解它與政府和政府間組織如聯合國、世界衛生組織的關連。 在資料蒐集與分析方面，台灣非政府組織在國際上從事醫療及人道救援有其長遠的歷史，然關於這方面的學術研究、討論，卻是近幾年才開始興起。本文採用質性研究的文獻檢閱、深度訪談和參與觀察等研究方法。對此一議題的思考、研究，透過搜集、閱讀以世界衛生組織為研究主題或相關的國內外期刊文章，釐清目前世界衛生組織研究領域的內容，以進一步確定計畫研究範圍、研究主軸與訪談對象。針對非政府組織部分的訪談對象，作者選擇了：台灣國際醫學聯盟等共18個民間團體以及2個政府機構做為研究訪談對象。 研究發現茲分為理論層面和實務層面兩方面對照說明： （一）關於非政府組織在國際參與的角色定位，指涉非政府組織在國際社會所扮演的是一種中介角色；還是第二軌道外交功能、或對政府間國際關係的輔助作用。究實而論，台灣非政府組織參與世界衛生組織之行動，其理論意涵意味著上述三種的角色功能，但本文研究發現政府偏好以動員方式鼓勵非政府組織去參與，而此種「動員式外交」活動究竟能夠收到多大的效果，不無爭議，容易造成台灣NGO在國際發展角色的曖昧不明，引發非政府組織角色定位的疑問。 （二）非政府組織在國際組織系統中並不具有政府的合法性，亦不具有治理上的權威，故而它對於國際事務的影響力，所憑藉的僅為一種策略途徑的運用。從台灣參與的個案，本文發現非政府組織除了運用協商談判的途徑，或與政府協商、或國際組織協商之外，國內非政府組織所運用的途徑，主要為倡議導向的途徑、策略聯盟的途徑以及訴諸直接服務的途徑。 （三）台灣非政府組織積極參與政府間國際組織，理論上可以與外交議題進行連結，因此政府與非政府組織在某些政策層面維持良好的互動。本研究發現台灣非政府組織與政府的互動情形，存在下列的問題：1、第二軌道外交價值觀認知之不同，政府急於加入WHO這種國際政府間組織，但大多NGO卻認為政府不應將外交當作唯一考量，希望能夠加強非政府組織實際參與的實質內涵；2、非政府組織與政府參與國際的方式缺乏共識，非政府組織不認同政府對外之參與模式，反而認為政府應該做好整合資源的工作，協助國內NGO從事國際活動，盡量讓NGO可以發揮各自領域之所長，而不只是經費補助而已；3、台灣NGO與政府的關係可區分為：收編、合作、互補和對抗等類型，其中若干非政府組織與政府傾向於一種合作型的「官民策略」(Government-NGO Participant Strategy)，就加入世界衛生組織的目標而言，兩者維持相互依賴的關係。 / The paper attempts to explore related issue that Non-Governmental Organizations (NGOs) in Taiwan participating in the activities of ‘World Health Organization’ (WHO). In terms of literature review and theory approach, this paper examines why NGOs involved in global issue, and explores NGOs appearance cause and related basic theory. However, WHO is an inter-governmental organization composed of a number of member state, so far Taiwan couldn’t still be allowed to be a member of WHO. Based on qualitative research it also examines NGOs how to participate in such an intergovernmental organization, there are three main analyzing aspects. First, this paper intends to discuss the role and position of a civil organization concerning how to participate in WHO meeting and activities. Second, some of the NGOs discussed here directly provide strategies to attend international policy in WHO areas such as health, and human aid. Third, the diverse relations between NGOs and government institution may be formed with participating different processes of international action. Furthermore, we discuss the opportunities and limitations on participating actions of NGOs in Taiwan.

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.

Concept of health education in kindergarten This thesis deals with the concept of a healthy lifestyle for preschool children and of health education in nursery schools. The first part of this work is the definition of "health" and individual determinants of health such as lifestyle, environment and health. The thesis deals with the various components of health education in kindergarten, the movement of children in kindergarten, nutrition, inner comfort and overall environment of the nursery school in the context of the Framework Curriculum for preschool education. The subject of research of this thesis is two-stage evaluation process and questionnaire, which is presented to teachers of kindergartens.

A aprovação da Estratégia Global e do Plano de Ação sobre Saúde Pública, Inovação e Propriedade Intelectual (GSPOA), no âmbito da Organização Mundial da Saúde (OMS), está baseada na percepção da necessidade de melhoria nas condições de acesso dos países em desenvolvimento a medicamentos e outros produtos que atendam às suas necessidades específicas de saúde pública. Para tanto, a GSPOA está dividida em 8 elementos principais, 25 subitens, distribuídos por 108 pontos de ação, que visam aumentar a eficácia na promoção da inovação dentro dos países, através do desenvolvimento institucional, investimento e coordenação de áreas relevantes para a inovação em saúde. Nesse contexto, o escopo da presente investigação doutoral consiste em perscrutar os desafios para a plena implementação da referida política internacional no Brasil. Trata-se de estudo de caso - enquanto método de investigação qualitativa - que tem sua aplicação quando o pesquisador busca uma compreensão extensiva e com mais objetividade e validade conceitual, do que propriamente estatística. Perquiriu-se, destarte, políticas públicas nacionais, observando racionalmente se promoveram alguma alteração efetiva no âmbito interno, relacionadas com a pesquisa e desenvolvimento e ao acesso a medicamentos seguros, eficazes, de qualidade, e, principalmente, a preços acessíveis. Partindo de uma perspectiva crítica, e marcos teóricos consagrados, buscou-se situar a GSPOA num contexto de saúde transnacional em uma era de globalização, e os desafios para implementar mais completamente um direito à saúde, que transcenda medicamentos e exigências individuais, e que promova a reconsideração da relação sistêmica entre pesquisa farmacêutica, interesse comercial e assistência à saúde pública. Observamos que, para o período de 2008-2015, houve um processo de recrudescimento das políticas de inovação na seara da saúde, bem como êxito na promoção de iniciativas relativas à identificação de lacunas, e na formulação de estratégias que priorizam explicitamente a pesquisa e desenvolvimento em doenças negligenciadas de maior incidência no país. No entanto, verificou-se que tais ferramentas ainda são insuficientes para a efetiva superação do hiato tecnológico, e do déficit público referente às importações de insumos para o setor saúde. Um dos principais desafios relacionados com a inovação em saúde seria justamente colocar o sistema universal de saúde em posição de centralidade no âmbito das políticas do Estado. Em suma, tem-se que tais desafios têm origem orçamentário-financeira, normativa e institucional. Orçamentário-financeira porque o subfinanciamento do SUS é histórico, impactando nas demandas de pesquisa e desenvolvimento na seara sanitária. Quanto ao aspecto normativo, contata-se que opções equivocadas, especialmente quando da promulgação da Lei de Propriedade Industrial (nº 9.279/1996), comprometem a instrumentalização de políticas progressistas para que a propriedade intelectual responda melhor às reais necessidades de saúde pública. Em relação ao marco institucional, constatou-se que o diálogo entre os órgãos da Administração Pública, envolvidos na seara do acesso a medicamentos, em suas mais diversas interfaces, tem sua ação prejudicada diante da sobreposição dos interesses econômicos frente à segurança sanitária. A superação de tais entraves, para a plena implementação da GSPOA no Brasil, é deveras imprescindível, numa ação positiva no contexto do direito social à saúde e ao acesso universal a medicamentos / The approval of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA) within the framework of the World Health Organization (WHO) is based on the perception of the need to improve the access conditions of developing countries to medicines and other products that meet your specific public health needs. To this end, GSPOA is divided into 8 main elements, 25 sub-items, distributed by 108 action points, aimed at increasing efficiency in promoting innovation within countries, through institutional development, investment and coordination of areas relevant to innovation in health. In this context, the scope of this doctoral research consists of examining the challenges for the full implementation of this international policy in Brazil. It is a case study - as a method of qualitative research - that has its application when the researcher seeks an extensive understanding and with more objectivity and conceptual validity, than properly statistical. National public policies have been sought, rationally observing whether they have promoted any effective changes at the internal level related to research and development and access to safe, effective, quality and, above all, affordable medicines. From a critical perspective, and with established theoretical frameworks, the aim was to situate the GSPOA in a transnational health context in an era of globalization, and the challenges to more fully implement a right to health, which transcends medicines and individual demands, and promotes the reconsideration of the systemic relationship between pharmaceutical research, commercial interest and public health assistance. We note that, for the period 2008-2015, there was a process of strengthening innovation policies in health, as well as successful initiatives to identify gaps, and the formulation of strategies that explicitly prioritize research and development in neglected diseases of greater incidence in the country. However, it was verified that such tools are still insufficient for the effective overcoming of the technological gap, and of the public deficit regarding imports of inputs for the health sector. One of the main challenges related to health innovation would be precisely to place the universal health system in a position of centrality within the scope of State policies. In summary, these challenges have a budgetary-financial, normative and institutional origin. Budgetary-financial because SUS underfunding is historical, impacting the demands of research and development in the sanitary seara. Regarding the normative aspect, it is suggested that misguided options, especially when promulgating the Industrial Property Law (No. 9.279 / 1996), compromise the use of progressive policies so that intellectual property responds better to the real needs of public health. In relation to the institutional framework, it was found that the dialogue between the Public Administration organs, involved in the area of access to medicines, in its most diverse interfaces, is affected by the overlapping of economic interests in relation to health security. The overcoming of such obstacles, for the full implementation of the GSPOA in Brazil, is indeed essential, in a positive action in the context of the social right to health and universal access to medicines

Essa pesquisa tomou por objeto a explicação de trabalhadores da Secretaria Municipal de Saúde de São Paulo para o aumento da sífilis congênita na região em que trabalham - instâncias administrativas da Coordenadoria de Saúde Norte e da Supervisão Técnica de Saúde Santana-Tucuruvi-Jaçanã-Tremembé. No Brasil, a sífilis congênita, indicador de qualidade da assistência ao pré-natal, tem apresentado nos últimos anos um acentuado crescimento. Em São Paulo, na região Tremembé e Jaçanã, o crescimento se acentuou a partir de 2008, concomitante à adoção pela SMS do modelo de gestão por Organizações Sociais para a maioria das unidades da Atenção Básica. Utilizou-se como marco teórico o Estado, compreendido como instituição inseparável do modo de produção capitalista, que mede a relação de reprodução do capital e as políticas estatais, como instrumentos dessa mediação. O objetivo do estudo foi identificar a explicação de trabalhadores da Secretaria Municipal para o aumento da sífilis congênita a partir da adoção do modelo de gestão por Organizações Sociais, uma vez que a justificativa para a adoção desse modelo foi a promessa de melhor eficiência e eficácia dos serviços. Metodologia. Trata-se de pesquisa qualitativa de caráter descritivo-analítico, que utilizou a técnica de entrevista para obtenção dos dados e o método da análise de conteúdo para a análise dos depoimentos. Os resultados mostraram que os trabalhadores da Administração Direta reconhecem a piora da qualidade na assistência à saúde da região e a associam ao crescimento dos casos de sífilis congênita. Atribuem à piora, tanto da qualidade da atenção quanto do quadro epidemiológico, explicações identificadas com o âmbito institucional e com o âmbito individual. No âmbito institucional, destaca-se a priorização das metas quantitativas e o encerramento contratual das Organizações Sociais gerando insegurança e insatisfação do trabalhador, além de relatos sobre a qualidade da assistência antes da adoção desse modelo de gestão. Já no âmbito individual, aponta-se a 9 mulher no centro do crescimento da sífilis congênita e o homem e o jovem no centro do crescimento da sífilis congênita. Explicação para o crescimento da sífilis congênita recaiu também nas características da própria doença e na redução do Estado. Discute-se que essas explicações para o aumento da sífilis congênita, tanto no âmbito institucional, sem o questionamento do modelo de gestão por Organizações Sociais adotado para o município, como na perspectiva dos indivíduos, particularmente nas suas precárias condições de vida, parecem identificadas com o posicionamento desses trabalhadores que indica que a realidade epidemiológica da doença na região é um fenômeno inevitável e imutável. Considera-se por fim que as explicações dos sujeitos estão coerentes com os argumentos do Plano Diretor de Reforma Administrativa do Estado mostrando que as estratégias de convencimento social utilizadas para implantação do modelo privatizante da gestão alcançou os espaços que foram objeto de politização durante a reforma sanitária. / The object of this research is the explanation of the workers of the Health Department of São Paulo city for the congenital syphilis increase in the area they work administrative instance of the Northern Health Coordination and of the Santana-Tucuruvi-Jaçanã-Tremembé Health Technical Supervision. In Brasil the congenital syphilis is an indicator of prenatal care assistance quality that has been sharply increasing in the last years. In the area of Tremembé and Jaçanã in São Paulo, the sharp increase has been occurring since 2008 concomitant with the adoption of the Health Social Organization administrative model by the Health Department for the majority of the Primary Health Care units. Considering our theoretical framework we advocate that the State is an inseparable institution from the capitalist mode of production that mediates the relation between the capital reproduction and the state policies, which are instruments of this mediation. The objective of the study was to identify the explanation of the Health Department workers for the congenital syphilis increase activated by the Health Social Organization administrative model adoption. The justification of the adoption of this model was the promise of efficiency and efficacy enhancement of the health care services. Methodology: This is a descriptive-analytical qualitative research that used interviews to collect data. The content analysis method was used for the testimonials analysis. The results show that the workers recognized the decrease of the health assistance quality in the area and associated that to the growth of the congenital syphilis cases. Considering the assistance quality and the epidemiology scenario, the subjects attributed explanations identified as belonging to the institutional sphere and to the individual sphere. In the institutional sphere, there is prioritization of quantitative goals, end of Health Social Organization contract generating workers insecurity and dissatisfaction, and reports about the quality of the assistance before the Health Social Organization administrative model. In the individual sphere, women in the center of the congenital syphilis growth, and men and youth in the center of the congenital 11 syphilis growth are highlighted. The characteristics of the congenital syphilis and the State reduction are also taken as explanations for the disease growth. We discuss that these explanations for the increase of congenital syphilis seem to be consistent with the workers positioning, which regards to the inevitability and immutability of the epidemiological scenario, both in the institutional sphere and the individual perspective. They do not question the Health Social Organization administrative model adopted by the city nor the precarious life condition of the individuals. We consider that the subjects explanations are coherent with the State Administrative Reform Plan argument, showing that the social convincing strategies to implant the private administration model have reached the spaces that were object of politicization during the sanitary reform.