Sistemas de saúde e participação cidadã: algumas reflexões críticas na perspetiva da sociologia da saúde

Nos últimos dez a quinze anos temos assistido a um aumento do número de iniciativas com a participação da sociedade civil, no sentido de exercer pressão para a reformulação dos direitos sociais. Estes já não são tão vistos como direitos para aceder aos serviços estruturados e administrados pelo Estado (de acordo com o conceito de cidadania de Marshall), mas como uma reivindicação dos cidadãos para terem um papel ativo na definição das políticas públicas e dos serviços. Este debate tem sido muito intenso entre os cientistas sociais desde a década de 1980 e está bastante presente no sistema de cuidados de saúde. Vários estudos têm salientado a forte tensão entre o tecnicismo da medicina e a organização burocrática do sistema de saúde, por um lado, e o modelo de comunicação quotidiana, por outro lado. De facto, um dos temas centrais das reformas dos cuidados de saúde nos últimos 20 anos centrou-se na valorização da experiência e da perspetiva dos cidadãos. O artigo começa com um breve esboço das novas abordagens sociológicas em torno da relação entre os sistemas sociais e o mundo real – nas dimensões micro e macro; estrutura e ação. Assim, apresenta-se o estado da arte atual sobre a participação nos sistemas de saúde ocidentais, resultante da revisão da literatura, destacando as novas estratégias de envolvimento dos doentes bem como as questões relativas às críticas e às limitações. Para terminar, procede-se a uma reflexão acerca da complexidade da relação entre o sistema de cuidados de saúde e as associações de doentes e utentes.

A Relação entre as Relações Públicas e a comunicação no interesse público na APAV

Relatório de estágio apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

Observatório de favelas (Rio de Janeiro): a comunicação institucional e a comunicação para o desenvolvimento

Relatório de estágio apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

Patterns of Associational Life in Western Europe, 1800-2000

Thesis submitted for assessment with a view to obtaining the degree of Doctor of Political and Social Science of the European University Institute

Projecto de parceria entre a ONGD Estímulo e a Rede de Farmácias Portuguesas: a união de esforços entre sectores para a resolução de problemas contemporâneos

Trabalho de projeto apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

A violência doméstica no seio da relação conjugal e a sua relação com o estatuto da mulher na sociedade

Domestic violence is one of the most serious problems that contemporary society faces. Domestic violence that specifically occurs between spouses is a particular case of domestic violence that has caused a high number of victims - mostly women - putting thus an enormous challenge to states with regard to combating this problem. In this thesis we intend to proceed with the study of this phenomenon in the Angolan context. The objective of this study is trying to understand how such violence is manifested in Angola, what factors may be at it’s source and what effects can be observed on the victims, their families and in society itself. Being the Angolan people strongly linked to traditions and customs, it seemed interesting to also address the issue of domestic violence under customary law. In addition to the problem of the study itself, we proceed to exposure and analysis of how the state and civil society have intervened in this matter. At the end of this study, we conclude that despite the fact that the issue of domestic violence has received more attention in recent years from the public entities and society in general, there is still a long way to go. This path involves not only more actions of the state but also a change of mentality, which can enable the break with social stereotypes in adopting a different behavior over the issue under review and internalizing that human dignity is the basic principle of any state that proclaims democratic rights.

A cooperação transfronteiriça como oportunidade de desenvolvimento das regiões de fronteira. Da Raia Ibérica à euroregião Galiza-Norte de Portugal

Tese de Doutoramento em Geografia Humana.

Potencial geopolítico da língua portuguesa para Timor-Leste

Dissertação de mestrado em Relações Internacionais

The de facto independence of regulatory agencies and its consequences for policy making and regulatory outcomes

This dissertation focuses on the practice of regulatory governance, throughout the study of the functioning of formally independent regulatory agencies (IRAs), with special attention to their de facto independence. The research goals are grounded on a "neo-positivist" (or "reconstructed positivist") position (Hawkesworth 1992; Radaelli 2000b; Sabatier 2000). This perspective starts from the ontological assumption that even if subjective perceptions are constitutive elements of political phenomena, a real world exists beyond any social construction and can, however imperfectly, become the object of scientific inquiry. Epistemologically, it follows that hypothetical-deductive theories with explanatory aims can be tested by employing a proper methodology and set of analytical techniques. It is thus possible to make scientific inferences and general conclusions to a certain extent, according to a Bayesian conception of knowledge, in order to update the prior scientific beliefs in the truth of the related hypotheses (Howson 1998), while acknowledging the fact that the conditions of truth are at least partially subjective and historically determined (Foucault 1988; Kuhn 1970). At the same time, a sceptical position is adopted towards the supposed disjunction between facts and values and the possibility of discovering abstract universal laws in social science. It has been observed that the current version of capitalism corresponds to the golden age of regulation, and that since the 1980s no government activity in OECD countries has grown faster than regulatory functions (Jacobs 1999). Following an apparent paradox, the ongoing dynamics of liberalisation, privatisation, decartelisation, internationalisation, and regional integration hardly led to the crumbling of the state, but instead promoted a wave of regulatory growth in the face of new risks and new opportunities (Vogel 1996). Accordingly, a new order of regulatory capitalism is rising, implying a new division of labour between state and society and entailing the expansion and intensification of regulation (Levi-Faur 2005). The previous order, relying on public ownership and public intervention and/or on sectoral self-regulation by private actors, is being replaced by a more formalised, expert-based, open, and independently regulated model of governance. Independent regulation agencies (IRAs), that is, formally independent administrative agencies with regulatory powers that benefit from public authority delegated from political decision makers, represent the main institutional feature of regulatory governance (Gilardi 2008). IRAs constitute a relatively new technology of regulation in western Europe, at least for certain domains, but they are increasingly widespread across countries and sectors. For instance, independent regulators have been set up for regulating very diverse issues, such as general competition, banking and finance, telecommunications, civil aviation, railway services, food safety, the pharmaceutical industry, electricity, environmental protection, and personal data privacy. Two attributes of IRAs deserve a special mention. On the one hand, they are formally separated from democratic institutions and elected politicians, thus raising normative and empirical concerns about their accountability and legitimacy. On the other hand, some hard questions about their role as political actors are still unaddressed, though, together with regulatory competencies, IRAs often accumulate executive, (quasi-)legislative, and adjudicatory functions, as well as about their performance.

Address by Michea¡l Martin to the Conference - Legislating for Tobacco Free Society

Thank you Chairman I would like to extend a warm welcome to our keynote speakers, David Byrne of the European Commission, Derek Yach from the World Health Organisation, and Paul Quinn representing Congressman Marty Meehan who sends his apologies. When we include the speakers who will address later sessions, this is, undoubtedly, one of the strongest teams that have been assembled on tobacco control in Europe. The very strength of the team underlines what I see as a shift – a very necessary shift – in the way we perceive the tobacco issue. For the last twenty years, we have lived out a paradox. It isn´t a social side issue. I make no apology for the bluntness of what I´m saying, and will come back, a little later, to the radicalism I believe we need to bring – nationally – to this issue. For starters, though, I want to lay it on the line that what we´re talking about is an epidemic as deadly as any suffered by human kind throughout the centuries. Slower than some of those epidemics in its lethal action, perhaps. But an epidemic, nonetheless. According to the World Health Organisation tobacco accounted for just over 3 million annual deaths in 1990, rising to 4.023 million annual deaths in 1998. The numbers of deaths due to tobacco will rise to 8.4 million in 2020 and reach roughly 10 million annually by 2030. This is quite simply ghastly. Tobacco kills. It kills in many different ways. It kills increasing numbers of women. It does its damage directly and indirectly. For children, much of the damage comes from smoking by adults where children live, study, play and work. The very least we should be able to offer every child is breathable air. Air that doesn´t do them damage. We´re now seeing a global public health response to the tobacco epidemic. The Tobacco Free Initiative launched by the World Health Organisation was matched by significant tobacco control initiatives throughout the world. During this conference we will hear about the experiences our speakers had in driving these initiatives. This Tobacco Free Initiative poses unique challenges to our legal frameworks at both national and international levels; in particular it raises challenges about the legal context in which tobacco products are traded and asks questions about the impact of commercial speech especially on children, and the extent of the limitations that should be imposed on it. Politicians, supported by economists and lawyers as well as the medical profession, must continue to explore and develop this context to find innovative ways to wrap public health considerations around the trade in tobacco products – very tightly. We also have the right to demand a totally new paradigm from the tobacco industry. Bluntly, the tobacco industry plays the PR game at its cynical worst. The industry sells its products without regard to the harm these products cause. At the same time, to gain social acceptance, it gives donations, endowments and patronage to high profile events and people. Not good enough. This model of behaviour is no longer acceptable in a modern society. We need one where the industry integrates social responsibility and accountability into its day-to-day activities. We have waited for this change in behaviour from the tobacco industry for many decades. Unfortunately the documents disclosed during litigation in the USA and from other sources make very depressing reading; it is clear from them that any trust society placed in the tobacco industry in the past to address the health problems associated with its products was misplaced. This industry appears to lack the necessary leadership to guide it towards just and responsible action. Instead, it chooses evasion, deception and at times illegal activity to protect its profits at any price and to avoid its responsibilities to society and its customers. It has engaged in elaborate ´spin´ to generate political tolerance, scientific uncertainty and public acceptance of its products. Legislators must act now. I see no reason why the global community should continue to wait. Effective legal controls must be laid on this errant industry. We should also keep these controls under review at regular intervals and if they are failing to achieve the desired outcomes we should be prepared to amend them. In Ireland, as Minister for Health and Children, I launched a comprehensive tobacco control policy entitled “Towards a Tobacco Free Society“. OTT?Excessive?Unrealistic? On the contrary – I believe it to be imperative and inevitable. I honestly hold that, given the range of fatal diseases caused by tobacco use we have little alternative but to pursue the clear objective of creating a tobacco free society. Aiming at a tobacco free society means ensuring public and political opinion are properly informed. It requires help to be given to smokers to break the addiction. It demands that people are protected against environmental tobacco smoke and children are protected from any inducement to experiment with this product. Over the past year we have implemented a number of measures which will support these objectives; we have established an independent Office of Tobacco Control, we have introduced free nicotine replacement therapy for low-income earners, we have extended our existing prohibitions on tobacco advertising to the print media with some minor derogations for international publications. We have raised the legal age at which a person can be sold tobacco products to eighteen years. We have invested substantially more funds in health promotion activities and we have mounted sustained information campaigns. We have engaged in sponsorship arrangements, which are new and innovative for public bodies. I have provided health boards with additional resources to let them mount a sustained inspection and enforcement service. Health boards will engage new Directors of Tobacco Control responsible for coordinating each health board´s response and for liasing with the Tobacco Control Agency I set up earlier this year. Most recently, I have published a comprehensive Bill – The Public Health (Tobacco) Bill, 2001. This Bill will, among other things, end all forms of product display and in-store advertising and will require all retailers to register with the new Tobacco Control Agency. Ten packs of cigarettes will be banned and transparent and independent testing procedures of tobacco products will be introduced. Enforcement officers will be given all the necessary powers to ensure there is full compliance with the law. On smoking in public places we will extend the existing areas covered and it is proposed that I, as Minister for Health and Children, will have the powers to introduce further prohibitions in public places such as pubs and the work place. I will also provide for the establishment of a Tobacco Free Council to advise and assist on an ongoing basis. I believe the measures already introduced and those additional ones proposed in the Bill have widespread community support. In fact, you´re going to hear a detailed presentation from the MRBI which will amply illustrate the extent of this support. The great thing is that the support comes from smokers and non-smokers alike. Bottom line, Ladies and Gentlemen, is that we are at a watershed. As a society (if you´ll allow me to play with a popular phrase) we´ve realised it´s time to ´wake up and smell the cigarettes.´ Smell them. See them for what they are. And get real about destroying their hold on our people. The MRBI survey makes it clear that the single strongest weapon we have when it comes to preventing the habit among young people is price. Simple as that. Price. Up to now, the fear of inflation has been a real impediment to increasing taxes on tobacco. It sounds a serious, logical argument. Until you take it out and look at it a little more closely. Weigh it, as it were, in two hands. I believe – and I believe this with a great passion – that we must take cigarettes out of the equation we use when awarding wage increases. I am calling on IBEC and ICTU, on employers and trade unions alike, to move away from any kind of tolerance of a trade that is killing our citizens. At one point in industrial history, cigarettes were a staple of the workingman´s life. So it was legitimate to include them in the ´basket´ of goods that goes to make up the Consumer Price Index. It isn´t legitimate to include them any more. Today, I´m saying that society collectively must take the step to remove cigarettes from the basket of normality, from the list of elements which constitute necessary consumer spending. I´m saying: “We can no longer delude ourselves. We must exclude cigarettes from the considerations we address in central wage bargaining. We must price cigarettes out of the reach of the children those cigarettes will kill.” Right now, in the monthly Central Statistics Office reports on consumer spending, the figures include cigarettes. But – right down at the bottom of the page – there´s another figure. Calculated without including cigarettes. I believe that if we continue to use the first figure as our constant measure, it will be an indictment of us as legislators, as advocates for working people, as public health professionals. If, on the other hand, we move to the use of the second figure, we will be sending out a message of startling clarity to the nation. We will be saying “We don´t count an addictive, killer drug as part of normal consumer spending.” Taking cigarettes out of the basket used to determine the Consumer Price Index will take away the inflation argument. It will not be easy, in its implications for the social partners. But it is morally inescapable. We must do it. Because it will help us stop the killer that is tobacco. If we can do it, we will give so much extra strength to health educators and the new Tobacco Control Association. This new organisation of young people who already have branches in over fifteen counties, is represented here today. The young adults who make up its membership are well placed to advise children of the dangers of tobacco addiction in a way that older generations cannot. It would strengthen their hand if cigarettes move – in price terms – out of the easy reach of our children Finally, I would like to commend so many public health advocates who have shown professional and indeed personal courage in their commitment to this critical public health issue down through the years. We need you to continue to challenge and confront this grave public health problem and to repudiate the questionable science of the tobacco industry. The Research Institute for a Tobacco Free Society represents a new and dynamic form of partnership between government and civil society. It will provide an effective platform to engage and mobilise the many different professional and academic skills necessary to guide and challenge us. I wish the conference every success.

Cibernautes de la memòria : la construcció de la memòria col·lectiva de la guerra civil espanyola a través de la participació en espais virtuals de comunicació. El cas de la llista de distribució "Guerra Civil Española"

El present treball fa una anàlisi de la construcció, presència i reivindicació de la memòria col·lectiva de la guerra civil espanyola a internet mitjançant l'anàlisi etnogràfic de les interaccions i pràctiques en un espai de comunicació virtual: el de la llista de distribució "Guerra Civil Española". Aquest estudi de cas es contextualitza en el marc d'un doble escenari global i local, el context global de la cultura de la memòria a la societat de la informació i el context local de la dinàmica de la presència de la memòria de la guerra civil a l'entorn social i polític de l'Estat Espanyol al llarg dels darrers 30 anys.

The generation and re-generation of social capital and enterprises in multi-stakeholders social cooperative enterprises: a system dynamic approach

Theories on social capital and on social entrepreneurship have mainly highlighted the attitude of social capital to generate enterprises and to foster good relations between third sector organizations and the public sector. This paper considers the social capital in a specific third sector enterprise; here, multi-stakeholder social cooperatives are seen, at the same time, as social capital results, creators and incubators. In the particular enterprises that identify themselves as community social enterprises, social capital, both as organizational and relational capital, is fundamental: SCEs arise from but also produce and disseminate social capital. This paper aims to improve the building of relational social capital and the refining of helpful relations drawn from other arenas, where they were created and from where they are sometimes transferred to other realities, where their role is carried on further (often working in non-profit, horizontally and vertically arranged groups, where they share resources and relations). To represent this perspective, we use a qualitative system dynamic approach in which social capital is measured using proxies. Cooperation of volunteers, customers, community leaders and third sector local organizations is fundamental to establish trust relations between public local authorities and cooperatives. These relations help the latter to maintain long-term contracts with local authorities as providers of social services and enable them to add innovation to their services, by developing experiences and management models and maintaining an interchange with civil servants regarding these matters. The long-term relations and the organizational relations linking SCEs and public organizations help to create and to renovate social capital. Thus, multi-stakeholder cooperatives originated via social capital developed in third sector organizations produce new social capital within the cooperatives themselves and between different cooperatives (entrepreneurial components of the third sector) and the public sector. In their entrepreneurial life, cooperatives have to contrast the "working drift," as a result of which only workers remain as members of the cooperative, while other stakeholders leave the organization. Those who are not workers in the cooperative are (stake)holders with "weak ties," who are nevertheless fundamental in making a worker's cooperative an authentic social multi-stakeholders cooperative. To maintain multi-stakeholder governance and the relations with third sector and civil society, social cooperatives have to reinforce participation and dialogue with civil society through ongoing efforts to include people that provide social proposals. We try to represent these processes in a system dynamic model applied to local cooperatives, measuring the social capital created by the social cooperative through proxies, such as number of volunteers and strong cooperation with public institutions. Using a reverse-engineering approach, we can individuate the determinants of the creation of social capital and thereby give support to governance that creates social capital.

Les arènes de la normalisation internationale à l'épreuve de la participation : le projet INTERNORM

Our paper presents a pilot project (INTERNORM) funded by the University of Lausanne to support the involvement of not-for-profit organisations in international standard setting bodies such as the ISO. It analyses preliminary results on how a distinct participatory mechanism can influence the institutional environment of technical diplomacy in which ISO standards are developed. It reflects on the contribution of innovative deliberative mechanisms to democratise the field of international standardisation, largely dominated by expert knowledge and market players. It draws upon international relations literature on new institutional forms in global governance and social studies of science on participatory issues in science-society relations. The paper argues that there are significant limitations to the rise of civil society participation in such global governance mechanisms and examines several types of barriers to the involvement of not-for-profit organisations in ISO standard-setting processes. Notre communication porte sur un projet pilote (INTERNORM) financé par l'Université de Lausanne pour favoriser l'implication des acteurs associatifs dans l'élaboration des normes internationales de type ISO. Elle analyse les effets d'un dispositif participatif sur l'environnement institutionnel très particulier de la diplomatie technique ayant cours à l'ISO. Elle présente les résultats intermédiaires d'une réflexion sur l'apport de dispositifs délibératifs pour démocratiser le champ de la normalisation internationale, largement dominé par le savoir expert et les acteurs économiques. Elle situe cette réflexion au croisement des travaux de relations internationales sur les nouvelles formes institutionnelles de la gouvernance de la mondialisation et des études sociales des sciences et des techniques sur la participation dans les rapports science - société. En identifiant plusieurs registres dans lesquels situer les difficultés d'une plus grande implication des acteurs associatifs dans les procédures d'élaboration de spécifications techniques de type ISO, nous posons l'hypothèse qu'il existe d'importantes limites à l'accroissement de la dimension participative de la gouvernance globale.

Recognition and political accommodation: from regionalism to secessionism. The Catalan case

Having lived through a bloody civil war in the 1930s followed by four decades of General Franco’s dictatorship, the Spanish state carried out a transition to a democratic system at the end of the 1970s. The 1978 Constitution was the legal outcome of this transition process. Among other things, it established a territorial model – the so-called “Estado de las Autonomías” (State of Autonomous Communities) – which was designed to satisfy the historical demands for recognition and self-government of, above all, the citizens and institutions of Catalonia and the Basque Country .In recent years support for independence has increased in Catalonia. Different indicators show that pro-independence demands are endorsed by a majority of its citizens, as well as by most of the political parties and organizations that represent its civil society. This is a new phenomenon. Those in favour of independence had been in the minority throughout the 20th century. Nowadays, however, demands of a pro-autonomy and pro-federalist nature, which until recently had been dominant, have gradually lost public support in favour of demands for self-determination and secession. This paper analyses the massive increase in support for secession in Catalonia during the early years of the 21st century. After describing the different theories of secession in plurinational liberal democracies (section 1), we analyse Catalonia’s political evolution over the past decade focusing on the shortcomings with regard to constitutional recognition and accommodation displayed by the Spanish political system. The latter have been exacerbated by the reform process of Catalonia’s Statute of Autonomy (2006) and the subsequent judgement of Spain’s Constitutional Court regarding the aforementioned Statute (2010) (section 2). Finally, we present our conclusions by linking the Catalan case with theories of secession applied to plurinational contexts

The short arm of the law: judicial institutions and local governance in Brazil

This paper estimates the effect of judicial institutions on governance at the local level in Brazil. Our estimation strategy exploits a unique institutional feature of state judiciary branches which assigns prosecutors and judges to the most populous among contiguous counties forming a judiciary district. As a result of this assignment mechanism there are counties with nearly identical populations, some with and some without local judicial presence, which we exploit to impute counterfactual outcomes. Conditional on observable county characteristics, offenses per civil servant are about 35% lower in counties that have a local seat of the state judiciary. The lower incidence of infractions stems mostly from fewer violations of financial management regulations by local administrators, fewer instances of problems in project execution and project managment, fewer cases of non-existent or ineffective civil society oversight and fewer cases of improper handling of remittances to local residents.