Suchergebnisse

O objetivo deste ensaio é (des)alinhar notas que extrapolam a ideia de práticas pedagógicas feministas das ações coletivas do Sertão do Pajeú Pernambucano. Procura-se trazer à baila uma reflexão dialógica sobre os saberes feministas dissidentes elaborados por esses grupos a partir de suas próprias questões e desafios. Os apontamentos trazidos percorrem cenários, fontes e elaborações de uma crítica possível dos processos de interlocução entre a universidade e as ações coletivas. Assim, abre-se vereda para pensar sobre as dissidências dos saberes feministas, por meio da escuta e aprendizagem com as proposições desses coletivos.Saberes Feministas Dissidentes. Outras Epistemologias. Ações Coletivas FeministasWomen on the move: notes on dissident feminist knowledge in the micro-region of Sertão do Pajeú, PernambucoAbstractThe objective of this essay is to (mis)align notes that extrapolate the idea of feminist pedagogical practices from the collective actions in Pernambuco's Sertão do Pajeú. The goal is to bring into the conversation a dialogical reflection about the dissident feminist knowledge elaborated by these groups from their own questions and challenges. The resulting prompts course through scenarios, sources, and developments of a possible critique on the processes of interlocution between the university and the collective actions. Thus, a path is open for the thinking about the dissidence in the feminist knowledge, through listening and learning from the propositions of these collectives.Dissident Feminist Knowledge. Other Epistemologies. Feminist Collective Actions.

As a cross-sectoral issue, the promotion of health needs to be addressed across all policies. In Portugal, as more competencies are being transferred to local governments, the integration of health considerations into municipal plans remains a challenge and guidance on how to develop an integrated municipal health strategy is absent. The aim of this study is to describe the conceptual and methodological approach that informed the development of an integrated and multisectoral municipal health strategy in the City of Coimbra. Its design followed a population health approach with a geographic lens, looking at how the population's health outcomes and health determinants were geographically distributed across the municipality, as well as the extent to which policies from multiple sectors can address them. The planning cycle followed an iterative workflow of five actions: assessing, prioritizing, planning, implementing, and monitoring. Following a participatory planning approach, several participatory processes were conducted involving local stakeholders and citizens (e.g., population-based surveys, workshops, Delphi, collaborative sessions) to identify problems, establish priorities, and define measures and actions. The strategic framework for action integrates 94 actions across multisectoral domains of municipal intervention: sustainable mobility and public places, safe and adequate housing, accessible healthcare, social cohesion and participation, education and health literacy, and intersectoral and collaborative leadership. Findings shed light on important aspects that can inform other municipal strategies, such as the adoption of a place-based approach, focused on geographic inequalities, health determinants and stakeholder participation, and the application of a health in all policies framework.

There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999–2003) and during the economic crisis (2008–2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.

Background: The recent economic and financial crisis in Portugal urged the Portuguese Government in April 2011 to request financial assistance from the troika austerity bail out program to get aid for its government debt. The troika agreement included health reforms and austerity measures of the National Health Service (NHS) in Portugal to save non-essential health care costs. This research aimed to identify potential barriers among the elderly population (aged 65 and above) to healthcare access influenced by the economic crisis and the troika agreement focussing on the Memorandum of Understanding on Specific Economic Policy Conditionality (MoU) in Lisbon metropolitan area, Portugal. Methods: The qualitative study is including 13 semi-structured interviews of healthcare experts, municipality authority, health care providers, negotiator of the troika agreement, hospital managers, health economists and elderly. A content analysis was performed to evaluate the interviews applying Nvivo2011 software. The barriers identified were clustered towards the five areas of the 'Conceptual framework on health care access' by Levesque et al. (Int J Equity Health 12:18, 2013). Results: Healthcare access for the elderly was found inadequate in four areas of the framework: availability; appropriateness; approachability; and affordability. The fifth area on acceptability was not identified since the study neither followed a gender nor ethnic specific purpose. The main identified barriers were: current financial situation and pension cuts; insufficient provision and increased user fees in primary care; inadequate design and availability of hospital care service; lack of long-term care facilities; increased out-of-pocket-payment on pharmaceuticals; limitations in exemption allowances; cuts in non-emergent health transportation; increased waiting time for elective surgery; and poor unadapted housing conditions for elderly. Conclusions: The health reforms and health budget cuts in the MoU implemented as part of the troika agreement ...

Resumo O Bem Viver dos povos indígenas, isto é, a articulação entre os direitos à terra, à água, à natureza em harmonia com as culturas locais, à dignidade e à vida, corriqueiramente é ferido no Brasil. Em Pernambuco, região Nordeste do país, estado que congrega uma significativa população indígena, os territórios sagrados são o alvo de conflitos sangrentos entre produtores rurais, latifundiários, garimpeiros, madeireiros e os povos tradicionais, sob a displicência ingênua, colonial e, cada vez mais, permissiva do Estado brasileiro. Diante desse cenário, o presente ensaio busca discutir o caso do povo indígena Xucuru, localizado no município de Pesqueira (PE), na Corte Interamericana de Direitos Humanos e suas reverberações não apenas na garantia de direitos aos povos indígenas no país, mas também nos contornos que a luta de outros grupos étnicos de Pernambuco ganha a partir do resultado do pleito. A proposta aqui é pensar, junto com os povos indígenas, sobre as particularidades da luta pelo Bem Viver entre as comunidades de Pernambuco e como o caso Xucuru possibilita uma crítica decolonial a uma concepção universalista no campo do Direito e na efetivação de Direitos Humanos.

O presente relato é fruto das reflexões emergentes do processo de pesquisa Conexão Pindorama, realizada pelo Grupo de Estudos e Pesquisas Macondo: artes, culturas contemporâneas e outras epistemologias, da Universidade Federal Rural de Pernambuco – Unidade Acadêmica de Serra Talhada. As primeiras notas a serem apresentadas aqui, aquilo que chamamos no título de conversas serpenteantes, são exercícios ensaísticos que buscam as articulações entre os modos de narrar indígenas, os desafios impostos pela Lei n° 11.645/2008 em sala de aula e as nossas vivências como professoras e professores em diversos níveis da educação nos sertões pernambucanos. A ideia lançada visa meditar sobre uma práxis de pesquisa contracolonial e confluente (BISPO, 2015) que perpassa a elaboração de outras metodologias, levando em conta intersecções como o manejo da oralidade, da poética e da memória, assim como um olhar acurado para os trânsitos e transbordamentos possíveis entre as fronteiras canônicas da ciência e da arte.

Social, economic, and environmental differences across the European Union significantly affect opportunities to move forward in achieving greater equity in health. Cohesion Policy (CP) funds can contribute positively through investments in the main determinants of health. The aim of this study is to analyze to what extent the planned investments for 2014–2020 are addressing the regional health gaps, in light of the population health index (PHI), a multidimensional measure developed by the EURO-HEALTHY project. The operational programs of all regions were analyzed, namely, the CP planned investments by field of intervention. Analysis of variance was performed to examine whether the regional scores in the PHI dimensions were statistically different across regions with different levels of development (measured by gross domestic product (GDP)). Results show that 98% of regions with worse performances on the PHI are less developed regions. Overall, all regions present planned investments in intervention fields linked to dimensions appraised within the PHI (e.g., employment, income, education, pollution). Yet, more needs to be done to focus regional investments in health determinants where regions still lag behind. The PHI has the potential to inform future CP restructuring, providing evidence to extend the current eligibility criteria to other dimensions beyond the GDP.

Social, economic, and environmental differences across the European Union significantly affect opportunities to move forward in achieving greater equity in health. Cohesion Policy (CP) funds can contribute positively through investments in the main determinants of health. The aim of this study is to analyze to what extent the planned investments for 2014–2020 are addressing the regional health gaps, in light of the population health index (PHI), a multidimensional measure developed by the EURO-HEALTHY project. The operational programs of all regions were analyzed, namely, the CP planned investments by field of intervention. Analysis of variance was performed to examine whether the regional scores in the PHI dimensions were statistically different across regions with different levels of development (measured by gross domestic product (GDP)). Results show that 98% of regions with worse performances on the PHI are less developed regions. Overall, all regions present planned investments in intervention fields linked to dimensions appraised within the PHI (e.g., employment, income, education, pollution). Yet, more needs to be done to focus regional investments in health determinants where regions still lag behind. The PHI has the potential to inform future CP restructuring, providing evidence to extend the current eligibility criteria to other dimensions beyond the GDP

Background The ability to measure regional health inequalities across Europe and to build adequate population health indices depends significantly on the availability of reliable and comparable data at the regional level. Within the scope of the EU-funded project EURO-HEALTHY, a Population Health Index (PHI) was built. This model aggregates 39 indicators considered relevant by experts and stakeholders to evaluate and monitor population health on the regional level within the European Union (269 regions). The aim of this research was to assess the data availability for those indicators. As a subsequent aim, an adequate protocol to overcome issues arising from missing data will be presented, as well as key messages for both national and European statistical authorities meant to improve data collection on population health. Methods The methodology for the study includes three consecutive phases: (i) assessing the data availability for the respective indicators at the regional level for the last year available (ii) applying a protocol for missing data and completing the database and (iii) developing a scoring system ranging from 0 (no data available; worst) to 1 (all data available; best) to evaluate the availability of data by indicator and EU region. Results Although the missing data on the set of the PHI indicators was significant, the mean availability score for the EURO-HEALTHY PHI indicators is 0.8 and the regional availability score is 0.7, which reveal the strength of the indicators as well as the data completeness protocol for missing data. Conclusions This study provides a comprehensive data availability assessment for population health indicators from multiple areas of concern, at the EU regional level. The results highlight that the data completeness protocol and availability scores are suitable tools to apply on any indicator's data source mapping. It also raises awareness to the urgent need for sub-national data in several domains and for closing the data gaps between and within countries. This will ...

Objetive The Health Situation Analysis (ASIS in Spanish) is a methodology that has been implemented recently in Colombia. This study aims at understanding the experience of building, disseminating and using ASIS for decision-making in some territorial entities.Methods Semistructured interviews were applied to officials of the departmental health entities. The information was analyzed according to a set of categories previously established.Results The territorial entities implement ASIS by incorporating the Social Determinants of Health approach; however, the technical, economic and human capacities for the elaboration of this type of analysis are not equitable. Intersectoral and social participation isstill weak and the results do not guide the decision making at territorial level yet.Conclusions The ASIS methodology seeks to position itself as one of the official mechanisms to generate evidence that guides health policy and decision making at national, regional and local levels. There are economic, institutional and political challenges forits consolidation as a useful strategy in health planning. ASIS is a methodology of great relevance for the territorial entities and its implementation should be further strengthened. ; Objetivo El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en algunas entidades territoriales (ET).Métodos Entrevistas semiestructuradas a funcionarios de las entidades departamentales de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente.Resultados Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan latoma de decisiones a nivel territorial.Conclusiones La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación.

Objetivo El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en algunas entidades territoriales (ET).Métodos Entrevistas semiestructuradas a funcionarios de las entidades departamentales de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente.Resultados Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan latoma de decisiones a nivel territorial.Conclusiones La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación. ; Objetive The Health Situation Analysis (ASIS in Spanish) is a methodology that has been implemented recently in Colombia. This study aims at understanding the experience of building, disseminating and using ASIS for decision-making in some territorial entities.Methods Semistructured interviews were applied to officials of the departmental health entities. The information was analyzed according to a set of categories previously established.Results The territorial entities implement ASIS by incorporating the Social Determinants of Health approach; however, the technical, economic and human capacities for the elaboration of this type of analysis are not equitable. Intersectoral and social participation isstill weak and the results do not guide the decision making at territorial level yet.Conclusions The ASIS methodology seeks to position itself as one of the official mechanisms to generate evidence that guides health policy and decision making at national, regional and local levels. There are economic, institutional and political challenges forits consolidation as a useful strategy in health planning. ASIS is a methodology of great relevance for the territorial entities and its implementation should be further strengthened.

Background: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges. Objective: This paper describes the three 2030 time-horizon scenarios developed under the EURO-HEALTHY project, depicting the key factors that may affect the evolution of PH inequalities across European regions. Methods: A three-stage socio-technical approach was applied: i) identification of drivers (key factors expected to affect the evolution of PH inequalities across European regions until 2030) - this stage engaged in a Web-Delphi process a multidisciplinary panel of 51 experts and other stakeholders representing the different perspectives regarding PH inequalities; ii) generation of scenario structures - different drivers' configurations (i.e. their hypotheses for evolution) were organized into coherent scenario structures using the Extreme-World Method; and iii) validation of scenario structures and generation of scenario narratives. Stages ii) and iii) were conducted in two workshops with a strategic group of 13 experts with a wide view about PH inequalities. The scenario narratives were elaborated with the participants' insights from both the Web-Delphi process and the two workshops, together with the use of evidence (both current and future-oriented) on the different areas within the PH domain. Results: Three scenarios were developed for the evolution of PH inequalities in Europe until 2030: 'Failing Europe' (worst-case but plausible picture of the future), 'Sustainable Prosperity' (best-case but plausible picture of the future), and an interim scenario 'Being Stuck' depicting a 'to the best of our knowledge' evolution. These scenarios show the extent to which a combination of Political, Economic, Social, Technological, Legal and Environmental drivers shape future health inequalities, providing information for European policy-makers to reflect upon whether and how to design robust policy solutions to tackle PH inequalities. Conclusions: The EURO-HEALTHY scenarios were designed to inform both policy design and appraisal. They broaden the scope, create awareness and generate insights regarding the evolution of PH inequalities across European regions. ; publishersversion ; published

Objective: To describe the knowledge and beliefs of public policymakers on social inequalities in health and policies to reduce them in cities from different parts of Europe during 2010 and 2011. Design: Phenomenological qualitative study. Setting: 13 European cities. Participants: 19 elected politicians and officers with a directive status from 13 European cities. Main outcome: Policymaker's knowledge and beliefs. Results: Three emerging discourses were identified among the interviewees, depending on the city of the interviewee. Health inequalities were perceived by most policymakers as differences in life-expectancy between population with economic, social and geographical differences. Reducing health inequalities was a priority for the majority of cities which use surveys as sources of information to analyse these. Bureaucracy, funding and population beliefs were the main barriers. Conclusions: The majority of the interviewed policymakers gave an account of interventions focusing on the immediate determinants and aimed at modifying lifestyles and behaviours in the more disadvantaged classes. More funding should be put towards academic research on effective universal policies, evaluation of their impact and training policymakers and officers on health inequalities in city governments