Master of Public Health / Department of Diagnostic Medicine/Pathobiology / Justin J. Kastner / Globalization has resulted in closer integration of economies and societies. It has contributed to the emergence of a new world order which involves a vast nexus of global and regional institutions, surrounded by transnational corporations, and non-governmental agencies seeking to influence the agenda and direction of international public policy. Health is a center point of geopolitics, security, trade, and foreign policy. Expansion in the territory of health and an increase in the number of health actors have profound implications for global health governance. Accordingly, the focus of the thesis is on endorsing the three core elements of governance proposed by Ackleson and Lapid, which comprises a system of (formal and informal) political coordination—across multiple levels from the local to the global—among public agencies and private corporations seeking to accomplish common goals and resolve problems through collective action. This shift in global governance has been prominent in the health sector with the formation of numerous public-private partnerships, coalitions, networks, and informal collaborations. In an effort to cope with the proliferation of players in the health sector, the World Health Organization has undergone gradual transformation in its governance framework. It is important to examine the evolution of the governance architecture of the WHO, as well as its effective application in the current global environment maintaining the organization’s legitimacy. This study tries to offer a comprehensive account of the WHO’s history, its successes and failures, as well as challenges and opportunities confronting the organization. Embracing public-private partnerships and formal-informal interactions does not simply fill governance gaps opened by globalization, but helps cluster in narrower areas of cooperation, where the strategic interests of multilateral organizations (e.g., the WHO), states, and transnational actors intersect. Global health problems require global solutions, and neither public nor private organizations can solve these issues on their own. The forms of governance based on the Acklesonian-Lapidian definition assist in accomplishing public health goals through shared decision-making and risk taking.

Thesis advisor: Paul Gray / As birds throughout Asia, Europe, and Africa have been infected with an avian influenza, public health experts everywhere are worried that if spread to humans, the world could face a pandemic with proportions similar to the 1918 Spanish influenza. In the past, the federal government has been more concerned with foreign militaries than foreign diseases. But today, the government has devoted over $7.1 billion to preventing a potential pandemic. While much of this goes to research and the production of vaccinations, money is also allocated to strengthen local infrastructures and control the disease in other countries. The fact that the federal government has put so much time and effort to prevent a disease that has affected few humans worldwide, let alone any Americans, points to a growing belief in human security rather than national security. This thesis will evaluate the concept of human security and argue that U.S. action and public opinion regarding the threat of an avian flu pandemic clearly shows decision-making based on human security. / Thesis (BA) — Boston College, 2006. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: International Studies. / Discipline: College Honors Program.

A negociação do novo Regulamento Sanitário Internacional (RSI) foi um processo complexo que durou dez anos e envolveu preocupações que extrapolam o campo da saúde pública. Este artigo, resultado final da pesquisa de Mestrado desenvolvida no âmbito do Programa de Pós-Graduação do Instituto de Relações Internacionais da Universidade de São Paulo (IRI/USP), busca demonstrar, por meio de vasta pesquisa documental, revisão de literatura e entrevistas com atores, que a agenda de segurança internacional influenciou as negociações do RSI em vigor, contribuindo para o avanço do processo de securitização da saúde pública. Temas de segurança internacional, notadamente o uso intencional ou acidental de agentes químicos, biológicos, radio-nucleares e a potencial ameaça de bioterrorismo foram determinantes tanto do avanço das negociações como da natureza do documento final aprovado, que promoveu mudanças substanciais na regulação internacional da saúde pública. / The negotiation of the new International Health Regulations (IHR) was a complex 10-year-long process and involved concerns which go beyond the public health field. This article, the final result of the Master\'s program at the Institute of International Relations of the University of Sao Paulo (IRI/USP), aims to demonstrate, through vast documental research, literature review and interview with actors, how the international security agenda influenced the IHR negotiations, advancing the securitization process of public health. International security issues, specially the intentional or accidental use of biological, chemical or radio-nuclear agents and the potential threat of bioterrorism were determinant both for the negotiation advancement and the character of the approved final document, which promoted substantial changes in the international public health regulation.

A negociação do novo Regulamento Sanitário Internacional (RSI) foi um processo complexo que durou dez anos e envolveu preocupações que extrapolam o campo da saúde pública. Este artigo, resultado final da pesquisa de Mestrado desenvolvida no âmbito do Programa de Pós-Graduação do Instituto de Relações Internacionais da Universidade de São Paulo (IRI/USP), busca demonstrar, por meio de vasta pesquisa documental, revisão de literatura e entrevistas com atores, que a agenda de segurança internacional influenciou as negociações do RSI em vigor, contribuindo para o avanço do processo de securitização da saúde pública. Temas de segurança internacional, notadamente o uso intencional ou acidental de agentes químicos, biológicos, radio-nucleares e a potencial ameaça de bioterrorismo foram determinantes tanto do avanço das negociações como da natureza do documento final aprovado, que promoveu mudanças substanciais na regulação internacional da saúde pública. / The negotiation of the new International Health Regulations (IHR) was a complex 10-year-long process and involved concerns which go beyond the public health field. This article, the final result of the Master\'s program at the Institute of International Relations of the University of Sao Paulo (IRI/USP), aims to demonstrate, through vast documental research, literature review and interview with actors, how the international security agenda influenced the IHR negotiations, advancing the securitization process of public health. International security issues, specially the intentional or accidental use of biological, chemical or radio-nuclear agents and the potential threat of bioterrorism were determinant both for the negotiation advancement and the character of the approved final document, which promoted substantial changes in the international public health regulation.

Infectious diseases attract a lot of mediatic, cultural and political attention. But are those diseases like Ebola, or ‘disease x’ actually what kills us? Since 1946, the WHO is the most authoritative figure in the fights against infectious disease outbreaks. So how does the WHO maintain this power and authority after tremendous budget cuts, competition for authority, and a shift to non-communicable disease epidemiology? This thesis uses a mixed-methods approach of quantitative analysis of ‘Disease Outbreak News’ reports, and qualitative analysis of key WHO literature, to develop the alternative narrative answering those questions. This thesis found that the WHO activities surrounding the collection and distribution of data create a political and institutional environment in which the WHO seems to be the only logical solution to prevent them. Additionally, the narrative put forth by the WHO prioritizes the ‘alert and response’ and operational capabilities of the organization to further expand authority in outbreak response. This study concludes that the WHO, through the collection and distribution of knowledge, and efforts to increase operational capability as seen through the Global Outbreak Alert and Response Network (GOARN), seeks to maintain normative authority and power as an international organization. / M.A. / Globalization of trade and travel has only increased the fear of infectious disease transmission. There is a great demand for a global health security system that is alert and capable. Based on this ‘threat’ the WHO justifies their role as global health leader. The Global Outbreak Alert and Response Network (GOARN) is the system that currently acts as the operational arm of the WHO, monitoring and coordinating response to infectious disease outbreaks globally. Despite the critical role of GOARN, its day-to-day endeavors remain unexplored by the public health field. This thesis analyzes how the WHO uses GOARN and its surveillance capabilities to collect and transform data as a method to maintain normative authority, and projects a powerful narrative as the leader of ‘alert and response’. In a competitive environment with limited financial resources, the WHO has adapted in terms of surveillance and operational capability to maintain its leadership and authority in the global public health field.

La protection de la santé par l’instauration d’une sécurité sanitaire dépend largement d’une organisation du marché pharmaceutique et de l’instauration d’un marché pharmaceutique commun. En Afrique de l’Ouest, particulièrement au sein de l’UEMOA, l’absence d’un tel marché facilite l’essor du marché illicite du médicament et empêche une libre circulation des produits de santé entre les États membres. Pourtant, le développement économique implique un système de santé efficace et sécurisé. Progressivement, émerge une prise de conscience des États membres de l’UEMOA de la nécessité de conjuguer leurs efforts pour une meilleure protection de la santé ; l’intégration juridique ainsi recherchée pouvant se réaliser au travers de plusieurs moyens : l’harmonisation, l’unification et l’uniformisation. L’harmonisation est le moyen d’intégration juridique que l’UEMOA a choisi pour mettre en place des normes plus efficaces et plus élaborées. Le rapprochement par harmonisation des réglementations pharmaceutiques devient ainsi un objectif primordial, en vue de l’instauration d’une sécurité sanitaire dans la zone communautaire. Pourtant, cette harmonisation, pour atteindre son objectif d’amélioration des systèmes pharmaceutiques, suppose un cadre juridique élaboré. Un processus d’harmonisation est alors mis en place et concrétisé par l’adoption de plusieurs instruments juridiques communautaires : directives, règlements et décisions. Cependant, l’UEMOA n’est pas la seule organisation sous-régionale qui vise pour objectif l’harmonisation du droit pharmaceutique dans la zone. D’autres organisations régionales et sous-régionales telles que la CEDEAO et l’UA, dont sont membres les États de l’UEMOA, visent également un rapprochement par harmonisation du domaine pharmaceutique. S’ajoutent alors aux difficultés de fonctionnement, au niveau interne et communautaire, des obstacles externes liés à l’appartenance des États de l’UEMOA à ces deux organisations. Ces obstacles vont compromettre l’efficacité du processus d’harmonisation. Il s’ensuit alors une nécessité de revoir le choix de l’instrument juridique de rapprochement, quitte à s’aventurer vers un rapprochement mixte des réglementations pharmaceutiques par une combinaison de deux moyens d’intégration juridique : l’harmonisation et l’unification. / Health protection, the setting up of health security highly depend on an organization of the pharmaceutical market by the establishment of a common pharmaceutical market. In West Africa, particularly within WAEMU, the absence of such of market eases the rise in illicit drug market and impedes a free movement of health products between States. Yet, economic development involves an effective and secured health system. WAEMU’s member States awareness is emerging gradually, hence the necessity to join forces for better health protection ; therefore the long-awaited legal integration can be done through several means ; harmonization, unification, standardization. Harmonization is the means of legal integration that WAEMU has chosen to set up more effective and elaborate standards. Reconciliation through the harmonization of pharmaceutical regulations therefore becomes a key objective, with a view to setting up health security within the community zone. Yet, this harmonization, to achieve its objective of improving pharmaceutical systems, implies an elaborate legal framework. A process of harmonization is therefore set up and materialized by the adoption of several community legal instruments : guidances ; regulations, decisions. However, it should be noted that WAEMU is not the only sub-regional organization that has objective the pharmaceutical right harmonization. Other regional and sub-regional organizations such as ECOWAS, AU, of which WAEMU States are member, target also a reconciliation by the harmonization of the pharmaceutical area. In addition to the operating difficulties, at internal and community level, there are some external impediments related to the belonging of WAEMU States to those both organizations. Those obstacles will jeopardize the effectiveness of the harmonization process. Consequently, it is necessary to reconsider the choice of reconciliation legal instruments, even if that means venturing into a mixed reconciliation of pharmaceutical regulations through a combination of two means of legal integrations : harmonization and unification.

Le droit à la santé ne fait pas partie du catalogue des droits garantis par la Convention européenne des droits de l’homme. En raison de sa nature essentiellement libérale, la Convention vise avant tout à assurer une protection effective à l’échelle européenne des droits de nature civil et politique. Il en résulte que la Cour européenne des droits de l’homme se montre particulièrement prudente lorsqu’il s’agit de s’aventurer sur le terrain économique et social, lequel relève essentiellement de la compétence des États et de leur politique législative. Toutefois, sous l’impulsion des requêtes portées devant elle, la Cour a rapidement découvert que les droits conventionnels présentent un volet sanitaire qui en conditionne parfois l’exercice effectif. Forte de son dynamisme interprétatif, la Cour européenne des droits de l’homme a progressivement élaboré un corpus juridique portant sur des questions sanitaires qu’elle distille dans sa jurisprudence au gré des affaires soumises à son contrôle. Afin d’adapter la Convention aux réalités sociales, le juge européen s’est employé dans unpremier temps à consacrer une obligation de protection de la santé des individus les plus nécessiteux. Au-delà de ces aspects, la Cour européenne des droits de l’homme s’est engagée dans une redéfinition du mode d’exercice du droit à la santé. Elle se positionne progressivement sur le terrain de la promotion de la santé, faisant ainsi du juge européen unacteur essentiel à la construction d’un droit européen à la santé. / The European Convention on Human Rights (ECHR) does not guarantee the Right to health. Because of its largely liberal nature, the ECHR aims at ensuring an effective protection of civil and political rights at European level. The European Court of Human Rights (ECoHR) has shown caution when dealing with the economic and social field, which is essentially theresponsibility of States and their legislative policy. With significant cases and applications increasing, the Court has found that conventional rights have a health component, which sometimes conditions the actual exercise of those rights. Thanks to its dynamic interpretation, the ECoHR has built up a significant legal corpus on health issues. In order to reflect socialrealities, the European judge initially developed an obligation to protect the health of the most needy individuals. Beyond these aspects, the ECoHR has committed itself to a redefinition of the way in which the right to health must be exercised. The Court is thus progressively positioning itself in terms of health promotion. By doing this, the European judge becomes an important key player in the development of a European right to health.

The object of this thesis which deals with ?Food quality and sales control system? is to inform about the current legislative as regards the productin and business food chain. In the theoretical part the laws and bills of the Czech Republic are summarized that relate to meat and meat product production. Also the European legislative is elaborated here which needs to be followed by all Czech producers. Further on, the thesis deals with different quality regulation systems that are used to ensure safe food production. The practical part includes the veterinary control in the particular food store. There I focused on how the control of the meat and meat products quality is carried out. In all the production and processing sections it is important to prevent the contamination. In the whole production plant it is important to follow strict security and sanitary rules. The asset of the thesis has been the gain of theoretical and practical overview of the production plant activity including the control authorities.

La qualité des soins a progressivement été intégrée dans l’ordre juridique français. Elle est désormais reconnue de manière indirecte comme un droit du patient et un objectif à atteindre pour les professionnels et les établissements de santé.Toutefois, le champ de la qualité des soins ne bénéficie pas d’un cadre juridique propre. Un droit souple de la qualité des soins a parallèlement émergé pour répondre principalement à l’inadaptation du droit dur à ce domaine et plus largement à la pratique médicale au regard notamment de la rapidité de son évolution. Ces « instruments » de droit souple se distinguent des règles de droit dur, traditionnellement définies comme obligatoires et assorties d’un régime de sanctions de l’autorité publique.Le champ de la qualité des soins obéit ainsi à un régime normatif gradué s’étendant du droit dur au droit souple, ce qui implique désormais de définir l’articulation entre les différents dispositifs et leurs effets juridiques.En effet, l’amélioration de la qualité des soins est également freinée par la surproduction des dispositifs et la crainte des professionnels de voir leur responsabilité engagée à la suite de leur participation à ces démarches.Des évolutions réglementaires, organisationnelles et opérationnelles visant d’une part à élaborer un régime juridique dédié aux données issues de ces démarches et, d’autre part, à préciser les rôles et compétences de chaque acteur afin notamment de coordonner l’ensemble des dispositifs semblent indispensables. En revanche, une législation spécifique portant sur la protection des professionnels n’est pas souhaitable. / Quality of care has gradually been incorporated into French law. It is now recognized indirectly as a patient's right and a goal for professionals and health institutions to achieve.However, the quality of care domain does not have its own legal framework. Soft law concerning care quality has emerged in parallel as a principle response to the hard law’s inadequacy in this domain, and to a wider extent, with special regard to the fast evolution in medical practice. These « soft law » instruments are different from their hard law counterparts which are traditionally defined as mandatory and are accompanied by a regime of sanctions issued by public authority.In this way the care quality domain conforms to a graduated regulatory system which extends from hard law to soft law. This now entails defining the articulation between the different instruments and their legal effects.In fact, improvements to care quality are being slowed by the overproduction of measures and professionals’ fears of being held liable as a result of their participation in these processes.It seems indispensable that regulatory, organizational, and operational changes should both target the development of a legal regime dedicated to data from these approaches, as well as the clarification of the roles and skills of each player especially as concerns the entirety of the measures. In contrast, specific legislation targeting the protection of professionals is not desirable.

Em 2011, a Agência Nacional de Vigilância Sanitária inseriu como eixo estratégico de sua gestão o envolvimento com as macro políticas sociais brasileiras, especialmente as relacionadas ao desenvolvimento social, com foco na erradicação da extrema pobreza e no avanço da formalização das atividades econômicas relacionadas a produtos e serviços sujeitos à vigilância sanitária. Em 2013 a Agencia publicou uma regulação específica para o microempreendedor individual, para o empreendimento familiar rural e para o empreendimento econômico solidário (RDC n° 49) intitulada de \"Inclusão produtiva com segurança sanitária\". A construção da norma contou com a participação da sociedade, por meio da consulta pública n°37. Objetivos: Analisar criticamente a percepção e as expectativas dos atores sociais participantes da consulta sobre os impactos esperados acerca da RDC e discutir as possíveis convergências dessas expectativas com as ações propostas no I Plano Nacional de Segurança Alimentar e Nutricional (2012/2015). Metodologia: Trata-se de um estudo qualitativo que utilizou os métodos de análise documental e análise de conteúdo temática para analisar os dados secundários da consulta pública °37. Resultados: A partir da descrição das categorias identificadas, os atores sociais foram divididos entre \"grupo a favor\" e \"grupo contrário\", explicitando o caráter antagônico das expectativas dos participantes acerca dos impactos da norma. Além disso, a analise mostrou que existem vários pontos de convergência entre os impactos esperados pelos participantes e as ações propostas no I Plano de Segurança Alimentar e Nutricional (2012-2015). Conclusão: O tema \"Inclusão produtiva com Segurança Sanitária\" provocou uma discussão rica e complexa mostrando que é necessário haver um equilíbrio para que as normas sanitárias sejam coerentes com as especificidades existentes na pequena produção, garantindo, contudo, a segurança sanitária dos alimentos. / In 2011, the National Sanitary Surveillance Agency inserted as a strategic axis of its management the involvement with macro social policies in Brazil, especially those related with social development, focusing on eradication of extreme poverty and on advancing formalization for economic activities related to products and services subject to health surveillance. In 2013 the Agency published a specific regulation for individual microentrepreneur, family farmer and solidarity economic enterprise (RDC n°49) entitled \"Productive Inclusion with Health Security\". The construction of the standard was attended by civil society, through the public consultation n° 37. Objectives: To critically analyze perception and expectations of social actors participants of the consultation on expected impacts of RDC and to discuss the possible convergences of these expectations with the actions proposed in the 1st National Plan for Food and Nutrition Security (2012/2015). Methodology: This is a qualitative study that used the methods of document analysis and the analysis of thematic content to analyze the secondary data of the public consultation n° 37. Results: From the description of categories identified, the social actors were divided between \"favor group\" and \"opposing group\", clarifying the antagonistic character of participants\' expectations about impacts of the norm. In addition, the analysis showed there are several points of convergence between the expected impacts of participants and actions proposed in the I Food and Nutrition Security Plan (2012-2015). Conclusion: The theme \"Productive Inclusion with Sanitary Safety\" has provoked a rich and complex discussion, showing that a balance needs to be struck in order to ensure that health standards are consistent with the specificities of small production, while guaranteeing food safety.