Hymen reconstruction as pragmatic empowerment? Results of a qualitative study from Tunisia.

Hymen reconstruction surgery (HR), while ethically controversial, is now available in many countries. Little clinical evidence and hardly any surgical standards support the intervention. Nearly as scarce is social science research exploring women's motivations for the intervention, and health care professionals' justifications for its provision.

"With human health it's a global thing": Canadian perspectives on ethics in the global governance of an influenza pandemic.

We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic (CanPREP), in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was based upon an economic rationality and the second upon a humanitarian rationality.

Population and public health ethics in Canada: a snapshot of current national initiatives and future issues.

To date, some work has been undertaken to define a code and stewardship framework for public health ethics. However, gaps in our understanding and application of ethics to the field of population and public health (PPH) remain. This paper presents the approach to building capacity for PPH ethics by three national-level organizations: the Canadian Institutes of Health Research-Institute of Population and Public Health, the National Collaborating Centre for Healthy Public Policy, and the Public Health Agency of Canada.

Establishing public health security in a postwar Iraq: constitutional obstacles and lessons for other federalizing states.

The public health consequences of the conflict in Iraq will likely continue after the violence has subsided. Reestablishing public health security will require large investments in infrastructure and the creation of effective systems of governance. On the question of governance, the allocation of powers in the new constitution of Iraq is critical.

The responsibility of healthcare institutions to protect global health security.

New public threats that can rapidly cross borders are continuing to challenge global health securityand will require unprecedented levels of co-operation. At the international level, the response to this challenge led to the approval of revised International Health Regulations (IHR). This unanimously approved document outlines how countries are to prepare for and respond to public health emergencies of international concern in a manner that does not unnecessarily impact on travel and trade.

Strategies for implementing the new International Health Regulations in federal countries.

The International Health Regulations (IHR), the principal legal instrument guiding the international management of public health emergencies, have recently undergone an extensive revision process. The revised regulations, referred to as the IHR (2005), were unanimously approved in May 2005 by all Member States of the World Health Assembly (WHA) and came into effect on 15 June 2007. The IHR (2005) reflect a modernization of the international community's approach to public health and an acknowledgement of the importance of establishing an effective international strategy to manage emergencies that threaten global health security.

Public health through a different lens.

Although public health in Canada faces concerns similar to those noted by Tilson and Berkowitz in the US, a review we conducted of how public health is financed and delivered in Canada also highlights some key differences. In both systems, public health labours under similar disadvantages: it is invisible when it succeeds; it has overtones of a "nanny state" and it focuses on often unpopular vulnerable populations. Prevention is always at risk of being raided to finance treatment.

A Cautionary Tale of Downloading Public Health in Ontario: What Does It Say about the Need for National Standards for More Than Doctors and Hospitals?

The 2003 SARS outbreak highlighted the importance of maintaining an adequate public health (PH) infrastructure, and cast doubt on the wisdom of basing the system locally without adequate provisions for higher-level oversight and coordination. Structurally, it highlighted the policy legacy of the 1998 Ontario decision to download full responsibility for funding PH services to municipal governments, forcing such services into budgetary competition with the "hard" services traditionally provided by local government. The federal role in PH has traditionally been minimal; PH was never included as a mandatory service in the Canada Health Act, while reform proposals have focused upon such admittedly important directions as pharmacare and home care rather than PH.

The new International Health Regulations and the federalism dilemma.

The recent revision of the International Health Regulations, say Wilson and colleagues, is both long overdue and eminently necessary to face the challenges of an increasingly globalized world.