Política publica de saúde: análise da agenda do Estado do Rio de Janeiro

Esta tese analisa a política de saúde no estado do Rio de Janeiro, focando nas modificações estruturais produzidas pela adoção da contrarreforma de natureza neoliberal. O marco temporal da análise é partir de 2006, com a eleição de Sérgio Cabral governador do estado. Num contexto histórico mais amplo, buscamos compreender os processos que conduziram as escolhas políticas desde a hegemonia da política neoliberal no Brasil na década de 1990, até a situação atual. Da análise das prioridades do governo estadual centradas na adoção de novos modelos de gestão e seus resultados, conclui-se, do ponto de vista financeiro e social, que a proposta de contrarreforma na saúde continua direcionando a política para ampliar a participação privada no setor público, que permite a transferência de recursos públicos para ente privados. Entretanto a eficiência da gestão privada se mostrou falaciosa, os quesitos de qualidade, eficiência e economicidade na assistência à saúde, usados para justificar ideologicamente a contrarreforma, não foram alcançados. Ao contrário a gestão privada ampliou os gastos operacionais em saúde e não foi capaz de manter constante a oferta de serviços.

Federalismo e gestão metropolitana: subsídios para o planejamento territorial dos serviços de saúde.

Esta tese analisou o planejamento, a gestão e a configuração do sistema de saúde na região metropolitana do estado do Rio de Janeiro. Tem com base o referencial teórico do federalismo e apoiou-se em pesquisa qualitativa de caráter descritivo. A pesquisa versou sobre aspectos político-institucionais; normativos, organizacionais; práticos e estruturais da rede de serviços de saúde na região. A análise empreendida aponta as características do modelo tridimensional do federalismo brasileiro a Constituição Federal de 1988 transfere o poder de instituir regiões metropolitanas aos estados, mas na prática, anula a capacidade de intervenção nos municípios e reduz o papel político e administrativo dos estados. Entre os desafios apontados pela tese estão: o comportamento autárquico dos municípios; a disparidade existente entre eles; o enfraquecimento do papel de coordenação do governo estadual; a descontinuidade e pouca integração entre políticas públicas para as regiões metropolitanas; a falta de experiência em planejamento regional e intersetorial; a necessidade de institucionalizar um órgão metropolitano que, entre outras funções, estabeleça fundos financeiros, com definição de fontes de receitas e critérios de alocação de recursos regionais. Quanto à política de regionalização da saúde análise da capacidade instalada dos municípios na integração de serviços de saúde regionais , a tese destaca as fragilidades e desigualdades na distribuição da oferta de serviços; a relação concorrencial entre os municípios para incorporar maior força produtiva qualificada, a oferta de serviços especializados, o adensamento e a concentração de serviços e profissionais de saúde no núcleo metropolitano (a cidade do Rio de Janeiro). O trabalho destaca o potencial de atuação do novo pacto de gestão, representado pelo Contrato Organizativo de Ação Pública em Saúde (COAP) e dos Mapas de Saúde como instrumentos político-institucionais na regulação regional e metropolitana da saúde. Apesar disso, sinaliza que avanços na governança regional serão possíveis com a institucionalização de um órgão que tenha autonomia para tomada de decisões regionais. O estudo reforça a importância da revalorização da gestão das regiões metropolitanas e o potencial de conectividade entre as políticas públicas urbanas através da organização de redes de serviços públicos na agenda política em detrimento das práticas municipalistas.

Economic valuation of natural resources: a handbook for coastal resource policymakers

Professionals who are responsible for coastal environmental and natural resource planning and management have a need to become conversant with new concepts designed to provide quantitative measures of the environmental benefits of natural resources. These amenities range from beaches to wetlands to clean water and other assets that normally are not bought and sold in everyday markets. At all levels of government — from federal agencies to townships and counties — decisionmakers are being asked to account for the costs and benefits of proposed actions. To non-specialists, the tools of professional economists are often poorly understood and sometimes inappropriate for the problem at hand. This handbook is intended to bridge this gap. The most widely used organizing tool for dealing with natural and environmental resource choices is benefit-cost analysis — it offers a convenient way to carefully identify and array, quantitatively if possible, the major costs, benefits, and consequences of a proposed policy or regulation. The major strength of benefit-cost analysis is not necessarily the predicted outcome, which depends upon assumptions and techniques, but the process itself, which forces an approach to decision-making that is based largely on rigorous and quantitative reasoning. However, a major shortfall of benefit-cost analysis has been the difficulty of quantifying both benefits and costs of actions that impact environmental assets not normally, nor even regularly, bought and sold in markets. Failure to account for these assets, to omit them from the benefit-cost equation, could seriously bias decisionmaking, often to the detriment of the environment. Economists and other social scientists have put a great deal of effort into addressing this shortcoming by developing techniques to quantify these non-market benefits. The major focus of this handbook is on introducing and illustrating concepts of environmental valuation, among them Travel Cost models and Contingent Valuation. These concepts, combined with advances in natural sciences that allow us to better understand how changes in the natural environment influence human behavior, aim to address some of the more serious shortcomings in the application of economic analysis to natural resource and environmental management and policy analysis. Because the handbook is intended for non-economists, it addresses basic concepts of economic value such as willingness-to-pay and other tools often used in decision making such as costeffectiveness analysis, economic impact analysis, and sustainable development. A number of regionally oriented case studies are included to illustrate the practical application of these concepts and techniques.

Marine eutrophication review. Part 1: Quantifying the effects of nitrogen enrichment on phytoplankton in coastal ecosystems; Part 2: Bibliography with abstracts

Professionals who are responsible for coastal environmental and natural resource planning and management have a need to become conversant with new concepts designed to provide quantitative measures of the environmental benefits of natural resources. These amenities range from beaches to wetlands to clean water and other assets that normally are not bought and sold in everyday markets. At all levels of government — from federal agencies to townships and counties — decisionmakers are being asked to account for the costs and benefits of proposed actions. To non-specialists, the tools of professional economists are often poorly understood and sometimes inappropriate for the problem at hand. This handbook is intended to bridge this gap. The most widely used organizing tool for dealing with natural and environmental resource choices is benefit-cost analysis — it offers a convenient way to carefully identify and array, quantitatively if possible, the major costs, benefits, and consequences of a proposed policy or regulation. The major strength of benefit-cost analysis is not necessarily the predicted outcome, which depends upon assumptions and techniques, but the process itself, which forces an approach to decision-making that is based largely on rigorous and quantitative reasoning. However, a major shortfall of benefit-cost analysis has been the difficulty of quantifying both benefits and costs of actions that impact environmental assets not normally, nor even regularly, bought and sold in markets. Failure to account for these assets, to omit them from the benefit-cost equation, could seriously bias decisionmaking, often to the detriment of the environment. Economists and other social scientists have put a great deal of effort into addressing this shortcoming by developing techniques to quantify these non-market benefits. The major focus of this handbook is on introducing and illustrating concepts of environmental valuation, among them Travel Cost models and Contingent Valuation. These concepts, combined with advances in natural sciences that allow us to better understand how changes in the natural environment influence human behavior, aim to address some of the more serious shortcomings in the application of economic analysis to natural resource and environmental management and policy analysis. Because the handbook is intended for non-economists, it addresses basic concepts of economic value such as willingness-to-pay and other tools often used in decision making such as costeffectiveness analysis, economic impact analysis, and sustainable development. A number of regionally oriented case studies are included to illustrate the practical application of these concepts and techniques.

Education and Poverty: Confronting the Evidence

Current U.S. policy initiatives to improve the U.S. education system, including No Child Left Behind, test-based evaluation of teachers, and the promotion of competition are misguided because they either deny or set to the side a basic body of evidence documenting that students from disadvantaged households on average perform less well in school than those from more advantaged families. Because these policy initiatives do not directly address the educational challenges experienced by disadvantaged students, they have contributed little-and are not likely to contribute much in the future-to raising overall student achievement or to reducing achievement and educational attainment gaps between advantaged and disadvantaged students. Moreover, such policies have the potential to do serious harm. Addressing the educational challenges faced by children from disadvantaged families will require a broader and bolder approach to education policy than the recent efforts to reform schools. © 2012 by the Association for Public Policy Analysis and Management.

A delphy study of the cooperativisation of the social services in the historical territory of Gipuzkoa

This article shows the main results obtained from the Delphi study, which was made of politicians and technicians from the Department of Social Policy in the County Council of Gipuzkoa, concerning the possibility of cooperativizing the provision of social services in this historical territory. With this in mind, the structure of this article is in two different parts. The first part develops the theoretical framework which serves as inspiration for the empirical work, where note is made of the main theoretical proposals that have a bearing on the collective dimension of citizen participation in the management of public services. Among the various models, those which prioritise public participation through social and solidarity economy entities stand out. The second part concerns itself with the presentation of the field research results. To this end, the methodological notes concerning the preparation process for the Delphi analysis are presented first and this is immediately followed by a synthesis of the main results obtained in this study. The article ends with a section of conclusions and future lines of action.

Many ways to say 'no', different ways to say 'yes': Applying Q-Methodology to understand public acceptance of wind farm proposals

This paper explores the nature of public acceptance of wind farms by investigating the discourses of support and objection to a proposed offshore scheme. It reviews research into opposition to wind farms, noting previous criticisms that this has tended to provide descriptive rather than explanatory insights and as a result, has not effectively informed the policy debate. One explanation is that much of this research has been conceived within an unreflective positivist research frame, which is inadequate in dealing with the subjectivity and value-basis of public acceptance of wind farm development. The paper then takes a case study of an offshore wind farm proposal in Northern Ireland and applies Q-Methodology to identify the dominant discourse of support and objection. It is argued that this provides new insights into the nature of wind farm conflicts, points to a number or recommendations for policy functions of an example of how this methodology can act as a potential bridge between positivist and post-positivist approaches to policy analysis.

A Randomized Controlled Trial Evaluation of Time to Read, a Volunteer Tutoring Program for 8-9 Year Olds

Tutoring is commonly employed to prevent early reading failure, and evidence suggests that it can have a positive effect. This article presents findings from a large-scale (n = 734) randomized controlled trial evaluation of the effect of Time to Read—a volunteer tutoring program aimed at children aged 8 to 9 years—on reading comprehension, self-esteem, locus of control, enjoyment of learning, and future aspirations. The study found that the program had only a relatively small effect on children’s aspirations (effect size +0.17, 95% confidence interval [0.015, 0.328]) and no other outcomes. It is suggested that this lack of evidence found may be due to misspecification of the program logic model and outcomes identified and program-related factors, particularly the low dosage of the program.

Using Non-Monetary Deprivation Indicators to Analyze Poverty and Social Exclusion: Lessons from Europe?

Non-monetary indicators of deprivation are now widely used in studying poverty in Europe. While measuring financial resources remains central, having reliable information about material deprivation adds to the ability to capture poverty and social exclusion. Non-monetary indicators can help improve the identification of those experiencing poverty and understand how it comes about. They are most productively used when multidimensionality is explicitly taken into account, both in framing the question and in empirical application. While serious methodological and measurement issues remain to be addressed, material deprivation indicators allow for new insights in making poverty comparisons across countries and analyzing changes over time. (C) 2010 by the Association for Public Policy Analysis and Management.

Econometric Methods and their Applications in Finance, Macro and Related Fields

The volume aims at providing an outlet for some of the best papers presented at the 15th Annual Conference of the African Econometric Society, which is one of the “chapters” of the International Econometric Society. Many of these papers represent the state of the art in financial econometrics and applied econometric modeling, and some also provide useful simulations that shed light on the models' ability to generate meaningful scenarios for forecasting and policy analysis.

Determinants of success of Nova SBE’s undergraduate students

Applied Policy Analysis major

Understanding Network Governance: A Case Study Exploration of Active Canada 20/20

Consistent with the governance shift towards network forms of governance, a number of new social movements have formed in response to the declining levels of physical activity in the Western world. One such movement is Active Canada 20/20: A Physical Activity Strategy and Change Agenda for Canada. Network governance is employed as the theoretical framework for this case study exploration of Active Canada 20/20 and the political landscape surrounding its development and implementation. Semi-structured interviews were conducted in addition to document/policy analysis and direct observations. Analysis of the data resulted in three overarching themes – the defining characteristics of network governance, the political landscape, and intersectoral linkages – that interconnect multifariously based the nature of the Canadian federal government and its relationship with the voluntary sector for physical activity. Despite progress in driving Active Canada 20/20 forward, entrenched dynamics of power need to be navigated within the political landscape surrounding network governance.

Étude des débats menant à l’adoption du projet de loi no 38 sur la gouvernance des universités québécoises

Ce mémoire vise à comprendre les enjeux sociaux qui ont animé le champ social de l’enseignement supérieur à l’étape de la formulation du projet de loi no 38 sur la gouvernance des universités et à mettre en évidence le rôle et l'influence des diverses catégories d'acteurs sociaux impliqués dans ces débats, chacun tentant d’imposer sa définition des enjeux en fonction de ses intérêts, de même que les facteurs explicatifs de cette influence (stratégies, ressources, etc.). Les débats qui ont eu lieu autour du projet de loi à l’étude ont été traité comme étant le produit d’un système d'action, lequel permet de classer ces débats selon une typologie des enjeux, correspondant chacun à trois niveaux de l’action sociale : enjeux fondamentaux, enjeux organisationnels et enjeux politiques. L’analyse des débats font état d’un rapport conflictuel entre les acteurs « externes » à l’université et les acteurs associés à la communauté universitaire dont l’objet est l’organisation et l’exercice du pouvoir entre les acteurs et les instances au sein des établissements universitaires.

Le dilemme de la promotion de la santé en Amérique latine : les cas de l’Argentine et du Brésil

À partir des années 1980, la théorisation de la promotion de la santé et sa mise en place font partie de l’agenda des organisations internationales de santé et de plusieurs gouvernements. Cependant, une certaine tension est observable dans la compréhension de la promotion de la santé, et ce, dès ses débuts. En effet, elle est conçue en général selon une approche comportementale comme stratégie pour le changement de comportements individuels ou collectifs qui met l’accent sur les facteurs de risque et très peu fréquemment conçue selon une approche structurelle, incluant une action sur les déterminants structurels des sociétés responsables de l’état de santé des populations dans une mesure plus importante que les systèmes de soins. Cette recherche qualitative –étude de cas multiples- menée en Argentine et au Brésil, vise à analyser la place et la compréhension de la promotion de la santé dans les politiques nationales de santé de deux pays à travers l’analyse du processus d’élaboration des politiques publiques. Nous viserons à distinguer la promotion de la santé en tant que comportementale ou structurelle et à expliquer les raisons pour lesquelles elle est comprise de telle ou telle autre façon. Finalement, nous essayerons d’identifier les opportunités pour qu’une approche structurelle de la promotion de la santé soit adoptée dans la politique nationale de santé. Les données analysées proviennent d’entrevues semi-structurées (n=28) et de documents divers : sites gouvernementaux sur Internet, documents remis par les interviewés, documents officiels, soit gouvernementaux, soit des organismes de coopération et de financement. Notre cadre conceptuel s’est inspiré des trois modèles : celui du changement des politiques publiques de Sabatier et Jenkins-Smith (1999 ; 2009), celui des courants politiques de Kingdon (1984) et le cadre conceptuel proposé par Walt (1994) pour l’analyse du rôle des organisations internationales. Nous avons identifié deux niveaux d’analyse : l’organisation de l’État et le sous-système de santé. Nous avons aussi tenu compte de l’influence des événements externes et des organisations internationales de coopération technique et de financement. Notre démarche vise à observer, à analyser et à comprendre la façon dont ces niveaux influencent la place et la compréhension de la promotion de la santé dans la politique nationale de santé. La perspective temporelle de plus de douze années nous a permis de mener une analyse sur plusieurs années et de mieux comprendre le changement de la politique de santé à différents moments de son histoire ainsi que l’identification des acteurs et des coalitions les plus importants depuis l’origine des champs de la santé publique dans les deux pays. Les résultats de notre analyse montrent que la promotion de la santé – conçue selon une approche structurelle – ne fait pas encore partie du courant principal de la politique nationale de santé dans aucun des deux pays. Cependant, les explications diffèrent : En Argentine, on observe un sous-système de santé fragmenté avec prédominance du modèle médical ; les actions menées renforcent ce fonctionnement en ne permettant pas la discussion à propos des valeurs sous-jacentes à l’organisation du système de santé ni sur son changement en fonction des besoins de santé du pays. Au Brésil, la réforme sanitaire questionne le modèle préexistant et arrive à instaurer la santé comme droit au niveau de l’État. L’accent mis sur l’organisation des services réduit la compréhension de la promotion de la santé à une « politique nationale de promotion de la santé » qui vise le changement des comportements. L’analyse du rôle des organisations internationales montre deux situations différentes dans les deux pays : pour l’Argentine, il existe une dépendance majeure autant à l’agenda qu’au financement de ces organisations. Le manque d’un agenda national en matière de promotion de la santé fait que le pays adopte l’agenda international avec très peu des questionnements. Dans le cas du Brésil, la situation est bien différente et on observe une capacité importante à négocier avec la coopération internationale. Cela se fait aussi avec un intérêt du pays pour l’adoption de l’agenda des organisations internationales dans le but d’une reconnaissance et de sa participation à des instances internationales. Alors, pour des raisons différentes, les deux pays adoptent l’agenda international de la promotion de la santé avec une approche comportementale. À partir de notre recherche, nous considérons que cinq réflexions doivent guider l’analyse de la promotion de la santé en Amérique latine : 1) Les processus de réforme de l’État des années 1990 et ses conséquences actuelles (type de réforme, valeurs sociétales, arrangements constitutionnels) ; 2) Les processus de réforme des systèmes de santé avec un regard sur la composante de décentralisation (réforme sanitaire ou administrative ?, quel modèle prédomine dans le champ de la santé publique ?) ; 3) La revalorisation des soins primaires de santé de la fin des années 1990 (quel impact dans le pays ?) ; 4) La tendance à la réduction des propositions élargies autant des politiques que des programmes ; et 5) Les défis actuels des systèmes de santé (travailler avec d’autres secteurs pour produire de la santé, pour incorporer et pour mieux maîtriser les déterminants sociaux et structuraux de santé). Les résultats de notre analyse nous permettent d’identifier l’importance du rôle du gouvernement national par rapport au développement et à la compréhension de la promotion de la santé. De plus, cette recherche montre que même s’il existe une influence du contexte et de l’idéologie du gouvernement sur la compréhension de la promotion et l’inclusion des déterminants sociaux de santé, c’est l’organisation de l’État avec ces valeurs de base qui sera déterminante dans la création des conditions pour le développement d’une promotion de la santé structurelle. Alors que la littérature sur la promotion de la santé accorde encore très peu de place au rôle du niveau national et de l’État dans son développement, il est clair que ces derniers ont un impact fondamental sur la place de la promotion de la santé dans la politique et sur la façon de la comprendre et de la mettre en place. Les théories utilisées pour cette recherche nous ont aidée à modéliser notre cadre conceptuel et à mener une démarche d’analyse des politiques publiques. Cette démarche permet d’améliorer les connaissances sur le changement de la politique nationale de santé par rapport à la promotion de la santé en tenant compte des dynamiques gouvernementales, champ peu exploré encore. Ce cadre conceptuel, à la fois souple et rigoureux, pourrait s’avérer approprié pour mener d’autres recherches similaires portant sur la place et la compréhension de la promotion de la santé dans les politiques nationales de santé dans d’autres pays de l’Amérique latine.