Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century. / A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX.

In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Resumo Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

Abstract In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

The right to water: Impact on the quality of life of rural workers in a settlement of the Landless Workers Movement, Brazil.

Access to water for rural populations is vital not only for personal consumption and hygiene but also for food production, income generation and cultural practices. To deepening the understanding of this issue, this research addressed the access to water in a settlement of the Landless Workers Movement. The perspective of the Human Rights to Water and Sanitation was used as a theoretical framework, assessing how inadequate access to water impacts the quality of rural populations. A qualitative research was used, through participant observation and individual interviews with 12 rural workers, living at the Ulisses Oliveira settlement. The findings reflect that water is not sufficiently available to meet the community's social, economic and cultural needs and that such conditions can lead to a loss of identity. Therefore, access to water must be understood in the light of its political, social and cultural dimensions and the Human Rights to Water and Sanitation can be used as an instrument to public policies.

Social control in the sectors of sanitation and health: a comparative analysis based on the Brazilian legal framework. / O controle social em saneamento e em saúde: análise comparativa com base nos marcos legais federais brasileiros.

Comparison between federal Brazilian legal frameworks in the areas of health and sanitation, from the perspective of participation, is the thread of this work, considering the pioneering of health and its possible influence on sanitation. The comparative effort was made from six analytical criteria: defined social control mechanisms; character given to social control; responsibility, recommendations and support to enable social control; access to information; control over the use of resources; control of the implementation of the resolutions. It was evaluated if the sanitation framework have been helped by health formulations and if have achieved produce more effective practices of social control in the conduct of public policy. The results show that, although it has received some influence from the health area, the water and sanitation framework is more restricted and has less potential to produce more effective practices, since it presents: 1) more restrictive mechanisms because they are not necessarily deliberative; 2) lack of a policy of training counselors and popular education to incentive participation; 3) absence of effective mechanisms for monitoring the use of resources.

A comparação entre os marcos legais federais brasileiros das áreas de saúde e de saneamento, sob a perspectiva do controle social, é o fio condutor deste trabalho, tendo em vista o pioneirismo da primeira e sua possível influência sobre a segunda. O esforço comparativo foi realizado a partir de seis critérios analíticos: mecanismos de controle social definidos; caráter conferido ao controle social; responsabilidade, recomendações e apoio para viabilizar o controle social; acesso à informação; controle sobre o uso dos recursos; controle da implementação das deliberações. Avaliaram-se possibilidades de o marco do saneamento se beneficiar das formulações no campo da saúde e lograr produzir práticas mais efetivas de controle social na condução dessa política pública. Os resultados revelam que, mesmo tendo recebido alguma influência da área de saúde, o marco do saneamento é mais restrito e tem menor potencialidade de produzir práticas mais efetivas, uma vez que apresenta: 1) mecanismos mais restritivos por não serem necessariamente deliberativos; 2) ausência de uma política de formação de conselheiros e de educação popular como incentivo e fortalecimento ao controle social; 3) ausência de mecanismos efetivos voltados para a fiscalização do uso dos recursos.

A Dialectical and Dialogical Approach to Health Policies and Programs: The Case of Open Defecation in India.

A multi-pronged approach to health policy and programs related to open defecation (OD) is proposed via a qualitative study conducted in rural India. A dialogic and dialectic perspective is employed to interpret the key findings from nine focus groups, highlighting the dialectical views toward OD and latrines. Findings indicate that current policy may be too narrow as it does not fully deal with the multiple reasons, including social communication as well as gender, cultural, health and work identity issues, for OD. The results suggest that OD is more complicated than it appears and a multi-pronged, poly-vocal approach to health communication campaigns and policy should be considered.

O controle social em saneamento e em saúde: análise comparativa com base nos marcos legais federais brasileiros / Social control in the sectors of sanitation and health: a comparative analysis based on the Brazilian legal framework

Resumo A comparação entre os marcos legais federais brasileiros das áreas de saúde e de saneamento, sob a perspectiva do controle social, é o fio condutor deste trabalho, tendo em vista o pioneirismo da primeira e sua possível influência sobre a segunda. O esforço comparativo foi realizado a partir de seis critérios analíticos: mecanismos de controle social definidos; caráter conferido ao controle social; responsabilidade, recomendações e apoio para viabilizar o controle social; acesso à informação; controle sobre o uso dos recursos; controle da implementação das deliberações. Avaliaram-se possibilidades de o marco do saneamento se beneficiar das formulações no campo da saúde e lograr produzir práticas mais efetivas de controle social na condução dessa política pública. Os resultados revelam que, mesmo tendo recebido alguma influência da área de saúde, o marco do saneamento é mais restrito e tem menor potencialidade de produzir práticas mais efetivas, uma vez que apresenta: 1) mecanismos mais restritivos por não serem necessariamente deliberativos; 2) ausência de uma política de formação de conselheiros e de educação popular como incentivo e fortalecimento ao controle social; 3) ausência de mecanismos efetivos voltados para a fiscalização do uso dos recursos.

Abstract Comparison between federal Brazilian legal frameworks in the areas of health and sanitation, from the perspective of participation, is the thread of this work, considering the pioneering of health and its possible influence on sanitation. The comparative effort was made from six analytical criteria: defined social control mechanisms; character given to social control; responsibility, recommendations and support to enable social control; access to information; control over the use of resources; control of the implementation of the resolutions. It was evaluated if the sanitation framework have been helped by health formulations and if have achieved produce more effective practices of social control in the conduct of public policy. The results show that, although it has received some influence from the health area, the water and sanitation framework is more restricted and has less potential to produce more effective practices, since it presents: 1) more restrictive mechanisms because they are not necessarily deliberative; 2) lack of a policy of training counselors and popular education to incentive participation; 3) absence of effective mechanisms for monitoring the use of resources.

Hygienic Requirements of Urban Living Environment in the Russian Federation and in Italy: a comparison.

AIM: Urban planning tries to contain and regulate the uncontrolled growth of cities, encouraging their sustainable development at environmental, social and health levels. In the present work, the authors compare the regulatory frameworks of the Russian Federation and of Italy, with particular attention paid to the urban aspects of living spaces. METHODS: Considering the extant normative production in the two countries, the authors examine national legislation for Italy and federal legislation for Russia, mainly taking into account the following aspects: urban planning tools and environmental and sanitary protection of living spaces. RESULTS: Hygienic-sanitary requirements regarding living environment in Russia are essentially expressed by two regulatory systems (SNiP and SanPiN), while in Italy they are regulated by the D.M. 07/05/1975. The main principles of urban planning in Russia are expressed by federal standards, while in Italy they are incorporated in the Municipal General Plan (PRG) and in the various local regulations, where all the superordinate regulations are summarized. Finally, aspects related to environmental quality in both countries are governed by various specific laws (federal and state); a complex system of rules that take into account potential impacts on health and the environment. CONCLUSIONS: The authors reckon that clear and updated regulatory tools should be developed, especially in Italy that lags behind, regarding the building and urban hygiene, relying on the most recent acquisitions of international scientific literature in order to guarantee the highest standards in Public Health safeguard.

Doing implementation research on health governance: a frontline researcher's reflexive account of field-level challenges and their management.

BACKGROUND: Implementation Research (IR) in and around health systems comes with unique challenges for researchers including implementation, multi-layer governance, and ethical issues. Partnerships between researchers, implementers, policy makers and community members are central to IR and come with additional challenges. In this paper, we elaborate on the challenges faced by frontline field researchers, drawing from experience with an IR study on Village Health Sanitation and Nutrition Committees (VHSNCs). METHODS: The IR on VHSNC took place in one state/province in India over an 18-month research period. The IR study had twin components; intervention and in-depth research. The intervention sought to strengthen the VHSNC functioning, and concurrently the research arm sought to understand the contextual factors, pathways and mechanism affecting VHSNC functions. Frontline researchers were employed for data collection and a research assistant was living in the study sites. The frontline research assistant experienced a range of challenges, while collecting data from the study sites, which were documented as field memos and analysed using inductive content analysis approach. RESULTS: Due to the relational nature of IR, the challenges coalesced around two sets of relationships (a) between the community and frontline researchers and (b) between implementers and frontline researchers. In the community, the frontline researcher was viewed as the supervisor of the intervention and was perceived by the community to have power to bring about beneficial changes with public services and facilities. Implementers expected help from the frontline researcher in problem-solving in VHSNCs, and feedback on community mobilization to improve their approaches. A concerted effort was undertaken by the whole research team to clarify and dispel concerns among the community and implementers through careful and constant communication. The strategies employed were both managerial, relational and reflexive in nature. CONCLUSION: Frontline researchers through their experiences shape the research process and its outcome and they play a central role in the research. It demonstrates that frontline researcher resilience is very crucial when conducting health policy and systems research.

[Methodology of assessing and evaluating public health risk in legal regulation of sanitary epidemiologic well-being of population].

The authors describe method to assess and manage risk for public health in system of legal regulation of sanitary epidemiologic well-being of population. Scheme of assessment and management of occupational risks is presented.

[Results of sanitary epidemiologic examination of sanitary protective zone projects (discussion).

The authors defined main transgressions of law in sanitary epidemiologic well-being of population during sanitary epidemiologic examination of project materials for sanitary protective zones for enterprises, constructions and other objects, and during determination of their final dimensions.

[On risk-oriented model of sanitary epidemiologic surveillance in occupational hygiene].

In 2015, Federal Service on surveillance in consumers rights protection and public well-being set a task to organize planned work of regional agencies on basis of risk-oriented model of control and supervision. Based on results of pilot project in Rospotrebnadzor Department of Perm area and St-Petersburg, the article covers methodic approaches to classification of objects liable to surveillance in occupational hygiene. The classification considers possibility of sanitary law violation, severity of this violation consequences and number of workers exposed to risk factors including hazardous work conditions. The authors specified recommendations on periodicity and forms of planned inspections considering evaluation of potential risk for human health, determined problems that require solution in implementation of risk-oriented model of surveillance.

Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India.

While sanitation interventions have focused primarily on child health, women's unique health risks from inadequate sanitation are gaining recognition as a priority issue. This study examines the range of sanitation-related psychosocial stressors during routine sanitation practices in Odisha, India. Between August 2013 and March 2014, we conducted in-depth interviews with 56 women in four life stages: adolescent, newly married, pregnant and established adult women in three settings: urban slums, rural villages and indigenous villages. Using a grounded theory approach, the study team transcribed, translated, coded and discussed interviews using detailed analytic memos to identify and characterize stressors at each life stage and study site. We found that sanitation practices encompassed more than defecation and urination and included carrying water, washing, bathing, menstrual management, and changing clothes. During the course of these activities, women encountered three broad types of stressors-environmental, social, and sexual-the intensity of which were modified by the woman's life stage, living environment, and access to sanitation facilities. Environmental barriers, social factors and fears of sexual violence all contributed to sanitation-related psychosocial stress. Though women responded with small changes to sanitation practices, they were unable to significantly modify their circumstances, notably by achieving adequate privacy for sanitation-related behaviors. A better understanding of the range of causes of stress and adaptive behaviors is needed to inform context-specific, gender-sensitive sanitation interventions.

[Hygiene, hygienism and public health policy in late 19th century France]. / Hygiène, hygiénisme et politique de la santé publique à la fin du XIXème siècle en France.

In France the desire to expand public health developed mainly because of the hygienist movement which prevailed in the 19th century. This paper aims to show how medical doctors committed themselves deeply at the Chambre des députés and Sénat with the objective of creating the legislation to control sanitary standards which was written between 1870 and 1914.

Disinfection in the laboratory: theory and practice in disinfection policy in late C19th and early C20th England.

This article examines the relationship between theory and practice in nineteenth century English public health disinfection practice. Disinfection undertaken by local authorities and practised on objects, spaces and people became an increasingly common public health practice in the last quarter of the nineteenth century, and was part of a newly developed public health system of 'stamping out' disease as described by Hardy. Despite disinfection's key role in public health policy, it has thus far not received significant investigation or historiographical attending. This article explores the development of disinfection policy at local level, highlighting that despite commentators assumptions that increasingly exacting standards of disinfection required professional oversight rather than that of the 'amateur' public, there was a significant gap between laboratory based knowledge and evidence derived from practical experience. Laboratory conditions could not replicate those found in day-to-day disinfection, and there were myriad debates about how to create a mutually understandable scientific standard for testing. Despite increasing efforts to bring local disinfection in line with new ideas promulgated by central government and disinfection researchers, the mismatches between the two meant that there was greater divergence. This tension lay at the heart of the changes in disinfection theory and practice in the second half of the nineteenth century, and illustrate the complexities of the impact of germ theory on public health policy.

[The necessity of new approaches to the elaboration of the projects for the sanitary (mountainous sanitary) protection districts around the therapeutic and health-promotion facilities, health resorts and their natural medical resources].

The international experience gained during the past two centuries indicates that the most efficient and rational way to ensure the protection of the territories occupied by the therapeutic and health-promotion facilities, spa centres, and health resorts together with their natural medical resources is to set up sanitary (mountainous sanitary) protection districts or zones along the perimeter of these territories. Beginning from 2000, numerous changes and amendments have been annually introduced in the Russian legislation intended to ensure efficacious control over the rational exploitation of the territories of therapeutic and health-promotion value and their natural medical resources. These initiatives have negative effect on the activities of these organizations and the quality of the services they are expected to provide. Taken together these effects lead to the degradation of the spa and health resort business. Bearing in mind the current conditions for economic activities, it is proposed, in contrast to the former global approach, to envisage in the aforementioned projects the establishment of the sanitary (mountainous sanitary) protection districts or zones and determine their borders based on the results of the assessment of their potential for the protection of therapeutic factors and other valuable resources. Equally important is the maximum reduction of the areas of the second and third zones taking into account their relevant objective characteristics. In certain cases, the protective district may coincide with the second zone. As far as the federal health resorts and large territories of special health-promotion value are concerned, some of them may have two or more sanitary (mountainous sanitary) protection districts. Both the owners and the users of these territories should be provided the necessary and sufficient possibilities for the rational nature use at the grounds and in the adjacent water areas suitable for the development of health resort business in the conditions guaranteed by the national legislation.

Issues in access to safe drinking water and basic hygiene for persons with physical disabilities in rural Cambodia.

An estimated 1.6 million people die from diarrheal diseases each year due to lack of access to safe water and sanitation, and persons with physical disabilities face additional barriers. In Cambodia, approximately 5% of the population is disabled, presenting substantial obstacles in accessing these basic services. The purpose of this study was twofold: first, to identify the challenges facing persons with physical disabilities in accessing safe household water and basic hygiene in rural Cambodia; and, second, to use these results to generate policy and practice recommendations for the water and sanitation hygiene sector implementing water treatment system interventions in rural settings. Fifteen field interviews were conducted with persons with physical disabilities. Thematic analysis was used to identify six main themes. The results indicated that environmental barriers to access were greater in the workplace than household settings and those persons with disabilities had greater awareness about safe drinking water compared to basic hygiene. Additionally, lack of physical strength, distance to water, and lack of financial means were noted as common access barriers. The findings support ongoing research and offer insight into the particular challenges facing persons with physical disabilities in rural areas in accessing safe drinking water and basic hygiene.

Sanitation rights, public law litigation, and inequality: a case study from Brazil.

Public law litigation has been used in many places to advance human rights related to health. In Brazil, such lawsuits usually request that the government pay for pharmaceuticals to individuals. But could litigation play a role in shaping public health policies to benefit communities? To explore this question, this paper focuses on lawsuits involving determinants of health, namely water and sanitation public policies. This paper discusses the results of an empirical study of 258 Brazilian court orders, issued in a 10-year period, that address requests for sewage collection and treatment. The data show that the Brazilian judiciary is willing to improve access to sanitation services. However, litigation has addressed fewer than 177 out of the 2,495 Brazilian municipalities that lack both sewage collection and treatment systems, and lawsuits are concentrated in the richer cities, not in the poorest ones. This paper suggests that public law litigation can be used to foster public health policies similar to the way in which structural reform litigation and the experimentalism approach between courts and defendants have influenced public policies and achieved institutional reform in schools and prisons. However, greater effort is needed to target initiatives that would reach the most disenfranchised communities.

Why do water and sanitation systems for the poor still fail? Policy analysis in economically advanced developing countries.

The results of an independent evaluation of 60 case studies of water and sanitation infrastructure projects in India, Mexico, and South Africa, most of them implemented since 2000, demonstrate an ongoing problem of failing infrastructure even in economically advanced developing countries. This paper presents a meta-analysis of those project case study results and analyses whether the design of existing policies or other factors contribute to failures. It concludes that the observed failures are due to well-known reasons and recommends how the implementation of the Dublin-Rio Principles can be improved. (They were introduced twenty years ago to avoid such failures by means of more sustainable planning.).