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In the face of climate change, Health is mobilizing to find solutions and reduce its environmental impact. The CAP (understand, act and share) sustainable hospital toolbox cited in the roadmap for the Ecological Planning of the French Health System offers 3 original, operational and complementary tools to: (1) acculturate professionals in the sector (Plan Health Faire®), (2) build the establishment strategy (2030 Agenda), and (3) take action with healthcare professionals (The Sustainable Units program).

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INTRODUCTION: Seasonal change in patterns of suicidal attempts is not well known in France and may differ from other western countries. We aimed to determine the peak times (days, months and holiday periods) of suicidal attempts in France. METHODS: We carried out a multicentre retrospective epidemiological study, using data from the Organization for Coordinated Monitoring of Emergencies (OSCOUR®) network. We aggregated daily data from January 1, 2010, to December 31, 2019. Variations in suicidal attempts on specific days were investigated by comparing their frequencies (ad hoc Z-scores). RESULTS: 114,805,488 ED encounters were recorded including 233,242 ED encounters regarding suicidal attempts. Men accounted for 45.7%. A significantly higher frequency of ED encounters for suicidal acts were found on Sundays in the months of May-June for both sexes and on New Year's Day for all genders and age groups. An increased risk was also noted on July 14th (National Day) and June 22nd (Summer Solstice). A protective effect was noted on the day after Valentine's Day, on Christmas Day and Christmas time (in particular December 24 and 26). CONCLUSION: Sundays, June, New Year's Day were at increased risk of suicidal attempts in France requiring a strengthening of prevention.

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BACKGROUND: The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM: This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD: We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT: The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS: Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

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La COVID-19 a pressé les gouvernements à intervenir à l'aide de données partielles sur l'efficacité des moyens. Les femmes sont particulièrement touchées car elles sont plus nombreuses à s'occuper des autres. Cette étude a pour but de comprendre l'influence des décisions politiques sur les conditions de vie et de travail des travailleuses de la santé. Une analyse des interventions gouvernementales de santé publique du Québec et des revendications des travailleuses de la santé retrouvées dans les documents journalistiques et les communiqués de presse officiels du gouvernement (13 avril au 1er juillet 2020) a été effectuée. Les résultats démontrent le manque de reconnaissance des autorités face à certains types de care, ainsi qu'une inadéquation dans les moyens de prise en charge pour prendre soin de la population. Le peu de reconnaissance des conditions de vie et de travail lors de décisions politiques engendre une répartition inéquitable des fardeaux associés à la pandémie.

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The fact that the quality of life at work (QWL) in French public health care institutions has deteriorated illustrates the difficulties generated by the incomplete implementation of the governance tools resulting from the Hospital, Patients, Health and Territories Act. The policy of improving QWL is nonetheless quick to iron out the difficulties currently encountered thanks to the lessons learned from the American and British examples and the development of innovative methodological tools.

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The concept of knowledge mobilization (KMb) is prominent in governance frameworks of tri-council funding in Canada. Yet there are a number of conceptual and practical challenges when such ideas are proposed for adoption across large multidisciplinary contexts. This research note introduces the concept of critical knowledge mobilization as a way to understand KMb in large multidisciplinary teams and social gerontology. It begins with a high-level sketch of the historic changes in knowledge production and knowledge sharing, followed by a definition of critical knowledge mobilization and examples of historical ideas and everyday tensions in practice. Building on these, we propose the need to advance and shift the culture of KMb, and to embark on engaged research as a means of innovation. We suggest that a reflexive process of critical KMb can facilitate innovation and promote a culture of knowledge mobilization in Canadian social gerontology.

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The last decade has witnessed an increasing number of reforms of the French healthcare system. The main objectives are to control healthcare costs by reducing spending and pooling resources. This is not achieved without difficulties, the economic criteria sometimes overshadowing humanist and altruistic values. These changes influence the organisation of care, even in paediatrics.

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The roles and responsibilities of Canada's Chief Medical Officers of Health (CMOHs) are contested. On the one hand, they are senior public servants who confidentially advise government on public health matters and manage the implementation of government priorities. On the other hand, CMOHs are perceived as independent communicators and advocates for public health. This article analyzes public health legislation across Canada that governs the CMOH role. Our legal analysis reveals that the presence and degree of advisory, communication, and management roles for the CMOH vary considerably across the country. In many jurisdictions, the power and authority of the CMOH is not clearly defined in legislation. This creates great potential for confusion and conflict, particularly with respect to CMOHs' authority to act as public health advocates. We call on governments to clarify their preferences when it comes to the CMOH role and either amend the relevant statute or otherwise find ways to clarify the mandate of their CMOHs.

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Translating to the Community (T2C) is a social biorepository designed to advance new diagnostic tools and realign community-clinical processes, with the aim to mitigate the short- and long-term impacts of fetal alcohol spectrum disorder (FASD) as well as prenatal alcohol exposure and its co-morbidities and behaviors. In this paper, we describe the evolution of this repository as a new translational partnership to advance a precision-medicine approach to FASD. Key to its evolution was a partnership between academic researchers, Indigenous communities, families, and a regional diagnostic clinic. We further describe the rationale for social biobanking, the type of banking, ethical engagement of families, communities, and clinics, their roles in repository design, governance, translation, and research activities, types of data collected from families, and how the study data are managed, reported, and accessed. The repository design includes biological samples, social-contextual health-survey data, and clinical data (which are linkable to administrative data) from community and clinical cohorts of diagnosed children, children prenatally exposed but not diagnosed, children suspected to have had a prenatal exposure, and related siblings, biological parents, and unrelated children and their parents. From these cohorts and families, potential studies drawing on this data will shed light on various risk factors, social and biological pathways, and service utilization issues, with the aim to implement primary and secondary prevention and intervention strategies.

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Resumen Objetivo: Analizar las aportaciones de incluir un marco analítico de gobernanza en el estudio de políticas en salud. Materiales y métodos: Se realizó una revisión de literatura publicada sobre gobernanza en salud en las bases de datos de EBSCO host. Durante un periodo que abarco de 2007 a 2017. Se usaron los descriptores de gobernanza y salud. Al final de la búsqueda se seleccionaron ocho artículos. Estos se clasificaron en metodológicos (n=5), estudios de gobernanza (n=2) y revisiones sistemáticas (n=1). Resultados: La revisión dio como resultado aportes en el ámbito de la definición, perspectiva, categorías de estudio e indicadores. Las definiciones incluían elementos como actores, normas, procesos y toma de decisión. Las perspectivas utilizadas de gobernanza fueron: analítica, prescriptiva y combinada. Las categorías de estudio son los problemas, actores, normas, puntos nodales y procesos. Los indicadores utilizados fueron objetos de estudio, Actores-poder, instrumentación y valores. Conclusiones: La aplicación de un marco analítico en gobernanza aporta información para identificar los espacios de toma de decisión. Un marco analítico de gobernanza complementa la información y permite una categorización que incluye la diversidad de actores y sus recursos de poder. Estudios en diversos ámbitos han demostrado la utilidad de usar un marco analítico de gobernanza en el estudio de políticas de salud.

Abstract Objective: To analyze the contributions of the analytical governance framework in health systems policies study. Materials and methods: A literature review was published on health governance in the EBSCO host databases. During a period covered from 2007 to 2017, there were used descriptors of governance and health systems. Eight items were selected at the end of the search. They were classified as methodological (n = 5), governance studies (n = 2) and systematic reviews (n = 1). Results: The review resulted in contributions in the scope of the definition, perspective, categories of study and indicators. Definitions included elements such as actors, standards, processes, and decision making. The perspectives used for governance were: analytical, prescriptive and combined. The categories of study are the problems, actors, rules, nodal points and processes. The indicators used were objects of study, Actors-power, instrumentation and values. Conclusions: The application of an analytical framework in governance provides information to identify decision-making spaces. An analytical framework of governance complements information and allows a categorization that includes the diversity of actors and their power resources. Studies in various domains have demonstrated the usefulness of using an analytical framework of governance in the study of policies in health systems.

Resumo Objetivo: Analisar as contribuyes do quadro analítico da governação em estudo política nos sistemas de saúde. Materiais e métodos: A revisáo da literatura sobre governançã da saúde nas bases de dados de acolhimento EBSCO foi realizada. Ao longo de um período que vai de 2007 a 2017. Sistemas descritores de governançã e de saúde foram usados. No final da pesquisa foram selecionados oito artigos. Estes foram classificados em metodológica (n = 5), os estudos de governo (n = 2) e revisoes sistemáticas (n = 1). Resultados: A revisáo resultou em contribuyes no campo da definyo, perspectiva, as categorias de estudo e indicadores. As definyes incluidas elementos como atores, normas, processos e tomada de decisáo. foram utilizadas perspectivas de governan9a: analítico, prescritiva e combinado. Categorias de estudo sao os problemas, atores, regras e processos pontos nodais. Os indicadores utilizados foram objecto de estudo, atores de potencia, a instrumentação e os valores. Conclusões: A aplica9áo de um quadro analítico para a governan9a fornece informações para identificar áreas de tomada de decição. Um quadro analítico para a governançã complementa a informação e permite uma categorização que inclui a diversidade de atores e seus recursos de poder. Estudos realizados em vários campos tem demonstrado a utilidade de usar um quadro analítico da governação em estudo política nos sistemas de saúde.

Résumé Objectif: Analyser l'inclusion d'un cadre d'analyse de la gouvernance dans l'étude des politiques de santé. Matériel et méthodes: Une revue de la littérature sur la gouvernance en santé a été réalisée dans les bases de données du serveur EBSCO, en prenant en compte la période de 2007 a 2017 et les descripteurs gouvernance et santé. A la fin de la recherche, huit articles ont été sélectionnés et classés comme méthodologique (n = 5), études de gouvernance (n = 2) et revues systématiques (n = 1). Résultats: La revue a mis en évidence des contributions dans les domaines suivants: définition, perspective, catégories d'étude et indicateurs. Les définitions comprenaient des éléments tels que les acteurs, les normes, les processus et la prise de décision. Les perspectives en matiere de gouvernance étaient de type analytique, normatif et combiné. Les catégories d'étude étaient les problemes, les acteurs, les regles, les points nodaux et les processus. Les indicateurs utilisés étaient: objets d'étude, acteurs-puissance, instrumentation et valeurs. Conclusions: L'application d'un cadre d'analyse de la gouvernance fournit des informations pour identifier les domaines de la prise de décision. Un cadre d'analyse de la gouvernance complete l'information et permet une catégorisation qui inclut la diversité des acteurs et leurs ressources de pouvoir. Des études dans divers domaines ont démontré l'utilité d'utiliser un cadre d'analyse de la gouvernance dans l'étude des politiques de santé.

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RESUMO O "giro decolonial" ao adaptar o argumento pós-colonial para a América Latina, compreende que a colonialidade é a face oculta e constitutiva da modernidade. Ao constatar criticamente que o problema do imperialismo é subdesenvolvido pelos seus principais teóricos, lanço as seguintes indagações: é possível pensar na relação entre colonialidade e modernidade, sem a dinâmica da "imperialidade"? Como explicar a reprodução das novas formas de colonialismo sem a consideração das novas formas de imperialismo? Neste artigo, assim, proponho o conceito de Imperialidade como uma lacuna que impede a explicação dos mecanismos de reprodução da colonialidade. Ao entendê-la como lógica do imperialismo, constitutiva e relacional da colonialidade, observo ainda que as estratégias de descolonização devem ser muito mais dirigidas à "Imperialidade" do que à modernidade propriamente dita. A informalidade, invisibilidade e nebulosidade dos mecanismos contemporâneos de Imperialidade reproduzem o imperialismo sem império através da governança sem governo no contexto global.

ABSTRACT In an adaptation of the postcolonial argument for Latin America, the giro decolonial [decolonial shift] suggests that coloniality is the hidden and constitutive face of modernity. By critically claiming that the problem of imperialism is under developed by its main theorists, I would like to ask the following series of questions: can the relationship between coloniality and modernity be considered without the dynamic of "imperality"? How can the reproduction of new forms of colonialism be accounted for without a consideration of the new forms of imperialism? In order to address such questions, I therefore propose the concept of imperality as a void hindering an explanation for the mechanisms propagating coloniality. By understanding it as the logic of imperialism, which is an integral part of, and directly related to, coloniality, I further observe that the strategies of decolonization should be targeted at "imperiality" rather than modernity itself. The informality, invisibility, and nebulosity of the contemporary mechanisms of imperiality reproduce an empire-less imperialism in the global context by means of government-less governance.

RÉSUMÉ Le "virage décolonial", en adaptant l'argument postcolonial à l'Amérique latine, suggère que la colonialité constitue la face caché et constitutive de la modernité. Si l'on part de la constatation critique de ce que le problème de l'impérialisme est sous-estimé par ses principaux théoriciens, les questions suivantes se posent: est-il possible de penser la relation entre colonialité et de la modernité sans y inclure la dynamique de l'"impérialité"? Comment expliquer la reproduction des nouvelles formes de colonialisme sans prendre en compte les nouvelles formes d'impérialisme? Dans cet article, je proposerai ainsi le concept d'Impérialité en tant que lacune empêchant l'explication des mécanismes de reproduction de la colonialité. Si l'on entend cette impérialité comme logique de l'impérialisme constitutive et indissociable de la colonialité, on verra que les stratégies de décolonisation doivent s'adresser d'abord à elle plutôt qu'à la modernité proprement dite. L'informalité, l'invisibilité et la nébulosité des mécanismes contemporains de l'impérialité reproduisent dans le contexte global un impérialisme sans empire au moyen d'une gouvernance sans gouvernement.

RESUMEN El "giro decolonial", al adaptar el argumento poscolonial a América Latina, comprende que la colonialidad es la cara oculta y constitutiva de la modernidad. Una vez constatado críticamente que el problema del imperialismo ha sido poco desarrollado por sus principales teóricos, planteo las siguientes cuestiones: ¿Es posible concebir la relación entre colonialidad y modernidad sin la dinámica de la "imperialidad"? ¿Cómo explicar la reproducción de las nuevas formas de colonialismo sin tener en consideración las nuevas formas de imperialismo? Por tanto, en este artículo, propongo el concepto de imperialidad como una laguna que impide explicar los mecanismos de reproducción de la colonialidad. Al entenderla como lógica del imperialismo, constitutiva y relacional de la colonialidad, observo además que las estrategias de descolonización deben estar mucho más dirigidas a la "imperialidad" que a la modernidad propiamente dicha. La informalidad, la invisibilidad y la nebulosidad de los mecanismos contemporáneos de imperialidad reproducen el imperialismo sin imperio a través de la gobernanza sin gobierno en el contexto global.

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The ability to minimise the harmful impact of biological threats relies on our capacity to rapidly detect unusual events, including the accidental or deliberate release of pathogenic or toxic agents, and immediately implement control measures. The development of this capacity for each country is the aim of the International Health Regulations (IHR) (2005), a legally binding document adopted by 196 States Parties, including all Member States of the World Health Organization (WHO). Each country's animal health sector contributes to the implementation of the IHR through surveillance, disease reporting and its response to zoonotic diseases, foodborne diseases and other events that emerge at the interface between human and animal health. The World Organisation for Animal Health (OIE) Performance of Veterinary Services (PVS) Pathway allows countries to undertake a comprehensive evaluation of their Veterinary Services and identify areas that need improvement. The OIE and WHO have conducted an in-depth analysis of the differences and synergies between the tools used by WHO to monitor the implementation of the IHR and the OIE PVS Pathway, revealing a wide range of similarities, complementarities and synergies. Taking advantage of the outcomes and outputs from the assessment and gap analysis tools used in the IHR Monitoring Framework and the OIE PVS Pathway, and exploiting the strength of these institutional frameworks, WHO and the OIE have jointly developed methods to facilitate communication between the animal health and human health sectors. This enhanced dialogue improves operational coordination and more efficiently informs policy-makers on strategic investments to strengthen their preparedness for controlling the spread of zoonotic diseases.

La faculté de minimiser l'impact néfaste des menaces biologiques dépend de la capacité des pays à détecter rapidement tout événement inhabituel, en particulier la dissémination accidentelle ou délibérée d'agents pathogènes ou toxiques, et à mettre en œuvre des mesures immédiates pour maîtriser ces événements. Le Règlement sanitaire international (RSI) (2005), un document juridiquement contraignant adopté par les 196 États parties, dont les États membres de l'Organisation mondiale de la santé (OMS) a précisément pour objectif de développer cette capacité dans chaque pays. Le secteur de la santé animale d'un pays participe à la mise en œuvre du RSI à travers une surveillance appropriée, la notification des maladies et l'adoption de mesures en cas de zoonoses, de maladies d'origine alimentaire et de tout autre événement émergeant à l'interface entre la santé humaine et la santé animale. Le Processus relatif aux performances des Services vétérinaires (Processus PVS) de l'Organisation mondiale de la santé animale (OIE) fournit aux pays la possibilité d'entreprendre une évaluation complète de leurs Services vétérinaires et d'identifier les domaines susceptibles d'être améliorés. L'OIE et l'OMS ont analysé de manière approfondie les différences et les synergies entre les outils utilisés par l'OMS pour vérifier la mise en œuvre du RSI, d'une part, et le Processus PVS de l'OIE, d'autre part, ce qui a mis en lumière de nombreuses similitudes, complémentarités et synergies. Sur la base des résultats et des données produites par les outils d'évaluation et d'analyse des écarts du Cadre de suivi du RSI et du Processus PVS de l'OIE, l'OMS et l'OIE ont exploité la puissance de ces cadres institutionnels pour mettre au point conjointement des méthodes visant à améliorer la communication entre les secteurs de la santé animale et de la santé humaine. Ce dialogue renforcé a pour effets d'améliorer la coordination opérationnelle et d'informer plus efficacement les décideurs politiques sur les investissements stratégiques permettant de mettre en place les conditions de préparation nécessaires pour lutter contre la propagation des zoonoses.

La aptitud de reducir al mínimo los efectos perjudiciales de las amenazas biológicas depende de nuestra capacidad para detectar con rapidez episodios inusuales, como la liberación accidental o deliberada de agentes patógenos o tóxicos, e instituir de inmediato medidas de control. El Reglamento Sanitario Internacional (RSI) (2005) es un documento jurídicamente vinculante aprobado por 196 Estados Partes, entre ellos todos los Estados Miembros de la Organización Mundial de la Salud (OMS), que precisamente tiene por objetivo dotar de esta capacidad a todos y cada uno de los países. El sector zoosanitario de cada país contribuye a la aplicación del RSI con actividades de vigilancia, notificación de enfermedades y respuesta ante enfermedades zoonóticas, enfermedades de transmisión alimentaria u otros episodios que puedan darse en la interfaz de la salud humana con la sanidad animal. El proceso de evaluación de las prestaciones de los Servicios Veterinarios (Proceso PVS) de la Organización Mundial de la Salud (OIE) sirve a los países para llevar a cabo una evaluación completa de sus Servicios Veterinarios y determinar aquellos ámbitos en que se requieran mejoras. La OIE y la OMS han analizado a fondo las diferencias y sinergias existentes entre las herramientas que utiliza la OMS para seguir de cerca la aplicación del RSI y el Proceso PVS de la OIE, labor que ha puesto de relieve un buen número de semejanzas, sinergias y aspectos complementarios de diversa índole. Partiendo de los resultados y productos que deparan las herramientas de evaluación y análisis de carencias utilizadas en el Marco de seguimiento del RSI y el Proceso PVS de la OIE, y aprovechando la solidez de estos marcos institucionales, la OMS y la OIE han definido conjuntamente métodos para facilitar la comunicación entre los sectores de la salud humana y la sanidad animal. La existencia de un diálogo más fluido se traduce en una mejor coordinación operativa y permite informar con más eficacia a los planificadores de las inversiones estratégicas necesarias para reforzar las medidas de preparación destinadas a controlar la propagación de enfermedades zoonóticas.

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Pathogens represent a considerable and ever-present threat to animal health, agriculture-based economies, food safety, public health and food security. Whatever the origin of the event (natural, accidental or intentional), the standards set by the World Organisation for Animal Health (OIE) enable countries to improve their organisation to reduce the risk, relying mainly on quality Veterinary Services, which can be assessed using the OIE Tool for the Evaluation of Performance of Veterinary Services (PVS). Setting up a surveillance and early detection system in line with OIE standards, underpinned by an animal health network involving a public-private partnership with veterinarians, farmers, hunters, laboratories and wardens of protected areas, makes it possible to deal with the appearance of any pathogens and to intervene rapidly to control and eradicate them. Emergency plans to deal with pathogens with the most serious repercussions on animal health, public health and the economy are vital and must be regularly assessed using simulation exercises in order to identify and implement any adaptations or improvements to them.

Les agents pathogènes constituent une menace considérable et permanente pour la santé animale, les économies fondées sur l'agriculture, la sécurité sanitaire des aliments, la santé publique et la sécurité alimentaire. Quelle que soit l'origine de l'évènement (naturelle, accidentelle ou intentionnelle), la prise en compte des normes de l'Organisation mondiale de la santé animale (OIE) permet aux pays de mieux s'organiser pour diminuer le risque en s'appuyant notamment sur des Services vétérinaires de qualité, ceux-ci pouvant être évalués avec l'Outil pour l'évaluation des performances des Services vétérinaires (PVS) de l'OIE. La mise en place d'un système de surveillance et de détection précoce en cohérence avec les normes de l'OIE, et reposant sur un réseau sanitaire axé sur un partenariat public-privé avec les vétérinaires, fermiers, chasseurs, laboratoires et gardes des espaces protégés, permet de faire face à toute éventuelle apparition d'agents pathogènes et d'intervenir rapidement pour les maîtriser et les éliminer. L'élaboration de plans d'urgence pour les agents pathogènes ayant les répercussions les plus graves pour la santé animale, la santé publique et l'économie est indispensable et ceux-ci doivent être régulièrement évalués par des exercices de simulation permettant d'éventuelles adaptations ou améliorations de ces plans sanitaires.

Los agentes patógenos suponen une amenaza permanente y considerable para la sanidad animal, las economías basadas en la agricultura, la inocuidad de los alimentos, la salud pública y la seguridad alimentaria. Sea cual sea el origen del acontecimiento (natural, accidental o intencionado), el hecho de tener en cuenta las normas de la Organización Mundial de Sanidad Animal (OIE) permite a los países organizarse mejor para reducir el riesgo, apoyándose básicamente en Servicios Veterinarios de calidad, que es posible evaluar con la herramienta de evaluación de las prestaciones de los Servicios Veterinarios (PVS) de la OIE. La instauración de un sistema de vigilancia y detección precoz que sea coherente con las normas de la OIE y descanse en una red sanitaria articulada a partir de la colaboración publicoprivada con veterinarios, productores agropecuarios, cazadores, laboratorios y vigilantes de espacios protegidos permite responder a toda aparición de agentes patógenos e intervenir rápidamente para controlarlos y eliminarlos. Es absolutamente indispensable elaborar planes de emergencia referidos a los agentes patógenos que tienen consecuencias más graves para la sanidad animal, la salud pública y la economía, planes que será preciso evaluar periódicamente mediante simulacros que sirvan para aportarles toda adaptación o mejora que se requiera.

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For several decades, hospitals have been faced with the voluntary departures of nurses. In parallel to this external mobility, internal mobility is also on the rise and is not always initiated by the nurse. This new mode of management has repercussions for professionals, patients as well as for the quality of care.

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OBJECTIVES: To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries. METHODS: We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies. RESULTS: Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment. CONCLUSIONS: Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout.

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A sustainable territorial development process represents a society characterized by its uniqueness to the territory of implementation. This notion of territory constitutes a fact of human nature, the development of which integrates collective and individual wellbeing through an intersectoral and multidisciplinary process. When carrying out joint projects, the partnership dynamic can transform interpersonal relationships and encourage the development of trust at the very core of the sustainable local development process. This trust enables the creation of a collective territorial intelligence, based on individual and sectoral knowledge and on know-how that form a shared, intangible heritage for each of the stakeholders in the sustainable territorial development process; however, as a fact of human nature, this trust remains fragile.

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The closing plenary of the colloquium was an occasion for exchange between the four panelists and the participants. The panelists included Luc Berghmans, a doctor and director of the regional health observatory of Hainaut, Belgium; Louise Bouchard, a sociologist and professor in the Sociology and Anthropology Department, University of Ottawa, Canada; Michel O'Neill, a sociologist and professor at the Faculty of Nursing Sciences, Laval University, Quebec City, Canada; and Philippe Lorenzo, director general of IREPS, the regional bureau for health education and promotion of Picardie in Amiens, France. Louise Potvin, who moderated the plenary, provides the summary that follows. During the colloquium, three main questions were debated: 1. At what point should health be placed at the forefront of local actions, if we wish to promote the values of equity? 2. How should actions at the local, regional, national and global levels be organized and articulated? Who are the partners, and what forms of governance need to be put into place? 3. What are the parameters needed in order to define the roles, tasks and competencies of the implementers of local and regional health programs, the architects of change? Each panelist had to respond to two out of the three questions. We report on the answers that panelists gave to these questions. As it is impossible to verify the exactitude of information given by audience members in support of their viewpoints, only the content of the remarks is given, without mentioning the examples that were provided.

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RESUMEN

La recherche en santé mondiale s'inscrit dans une volonté de mobiliser des connaissances au service d'interventions et de politiques publiques pour l'atteinte équitable du bien-être commun, notamment en matière de santé. Elle joue un rôle primordial en ce sens, en favorisant l'implication des communautés et leur autonomisation et de nombreuses lignes directrices supportent un tel partenariat. Néanmoins, certains enjeux éthiques sont liés au financement de la recherche, aux environnements de recherche, à la priorisation des problématiques de recherche, aux mécanismes d'évaluation éthique posent souvent un problème de justice sociale au niveau de la redistribution des ressources et de la reconnaissance des différences culturelles. Comment alors déterminer quelle est la façon « idéale ¼ d'agir en tenant compte de la globalité des individus et du pluralisme culturel des sociétés pour « bien faire ¼, pour satisfaire l'exigence de l'équité? Une réflexion et une démarche éthique demeurent essentielles, ainsi qu'un dialogue entre les chercheurs du Nord et du Sud, et leurs autres partenaires que sont les décideurs, les responsables locaux et les communautés. Un tel dialogue, établi dans un continuum du développement de projets de recherche à leur pérennité, peut grandement contribuer à limiter les problèmes de justice sociale et à viser un développement plus égalitaire des savoirs scientifiques. Plusieurs chercheurs se sont déjà engagés dans cette voie, et leurs initiatives devraient être encouragées pour mettre les nouveaux savoirs au service des populations.

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