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Indigenous Knowledge Systems and their underlying ethical qualities guide social interaction and the process by which Indigenous children learn what it means to be a person within family and community life. Using the Learning by Observing and Pitching In (LOPI) framework as a starting point, this paper explores a case study of a death in the Cowichan Tribes community to illuminate four ethical qualities (relationality, reciprocity, responsibility, respect) associated with (1) the social organization of the community guided by a sense of community consciousness and (2) Indigenous concepts of time and space. Using the social organization of the community and Indigenous concepts of time and space as broad themes, we aim to illustrate how culturally determined ethical qualities guide every social interaction and thus inform human development and learning, broadly. By including ethics that guide social relationships in the LOPI framework, educators and researchers may gain a deeper understanding of how children learn in communities and how their participation in community activities informs their sense of self. [Translation from English by Mercè Rius.]

This paper has as its objective the generation of a debate over different alternatives of models of oversight and monitoring of fundamental rights of people suffering mental disorder. The Consent and Capacity Board of the province of Ontario, Canada will be considered. The Board is one of the oldest and leading administrative tribunals in the area of mental health. The paper will analyse the place of the Board in the Canadian legal system and the fundamental distinctions with similar Canadian mental health tribunals. The Board's administrative structure and jurisdiction will be examined, as well as its procedures and mechanisms of review of its decisions.

Science is a complex human activity that is modeled by a myriad of factors beyond the researcher's control, especially in the medical sciences, where human and economic resources, as well as bioethical and regulatory factors play an important role. Bioethical and regulatory factors are similar between the US, Canada and Mexico, however these countries differ markedly in their economic and human resources: In Canada and the US there are government institutions (CIHR and NIH, respectively) to specifically provide funding to health research, while in Mexico the principal source of funding for all sciences is the National Council for Science and Technology (CONACYT). The NIH budget for clinical research alone during 2002 was over 7 US billion dollars; the CIHR funding for health research projects was approximately 300 US million dollars, while the support from CONACYT for research and infrastructure in health was aproximately 70 US million dollars. In the year 2000, the US had 8.17 researchers in all areas per 1,000 habitants--of the economically active population (EAP)--, Canada had 5.78 and Mexico 0.55 researchers. These factors impact greatly the scientific productivity: While Canada and the US contributed in 1991-1998 with 31.4% of the world's scientific productivity--measured as the number of articles published--, Latin America contributed with only 2.4% of the world's productivity. This paper also discusses other factors that model science, scientific inquiry, and scientific activity such as, the role of the industry, the media and scientific journals. How these factors influence the Medical Sciences in North America is exemplified herein.

Once the parameters to design and assess a Mental Health System have been put forward it's necessary to operationalize them into quality indicators and outcome measures. These indicators allow us to compare processes and results with other systems and services, they let us do the economic assessment and the allotment of resources, they give way to treatment guidelines and external evaluation, generating a new type of organizations evidence-based. This paper reviews the conceptual aspects of performance indicators and its use in some developed countries. It also discusses their usefulness, at the input, the process and the outcome level, to treat patients and to organize Mental Health Services and Systems. Despite therapists not benefiting directly from the use of this type of indicators, its importance should not be disregarded in order to organize a Mental Health System for large populations.

This work stems from a brief visit in 1993 to the Canadian health services as part of the PAHO International Health Training Program and the subsequent research, discussion, and analysis relating to that experience. By no means is this paper an exhaustive account of the system, but rather a close look at one of its aspects: financing. The main objective is to identify some of the virtues and limitations of a health system that is considered one of the most efficient, effective, and equitable in the world. Although the Canadian health system is financed by the federal government and the provincial governments, cost containment is a constant concern, since factors such as the growing use of highly complex technologies, hospital care, and long-term treatment of chronic and degenerative illnesses tend to increase costs. The progressive reduction in the federal budget has lead to more efficient use of resources and the rationalization of installed capacity. At the same time, the relative simplicity of the system's operation has permitted administrative costs to be kept low. In addition, alternative forms of care, such as local centers for community-based care, care at home and in special institutions to promote the maximum level of self-sufficiency, and the use of volunteers, have been devised in order to partially control cost increases. The people's participation in planning and decision-making permit them to guide the development of the health services. Nevertheless, given the current situations, it is essential that the system be modified to prepare it for the challenges the twenty-first century will bring.

This paper discusses recent trends concerning the commercialization of pesticides in Mexico and focuses on organophosphates and their potential health risk impact. It points out the existing lack of knowledge on health effects associated to chronic exposure to organophosphate pesticides. A need for both toxicological and epidemiologic studies of chronic exposure is identified. Regulatory programs for pesticides in Mexico and the United States are also compared. The paper also addresses the possibility of effective enforcement of environmental and health regulations in Mexico as a result of more rigorous surveillance under NAFTA.

In this paper are discussed essential issues about the concept, characteristics and general functions of sanitary regulation, as well as the principles and main lines of action contained in the Program of Modernization of the Sanitary Regulation, which is being implemented by the Ministry of Health of Mexico. In addition, some considerations are offered regarding the supporting role of such a program, in the context of the free trade era that Mexico is undergoing. After 40 years of an outdated sanitary regulation based in a non-functional licensing concept, the new and improved scheme relies on several ammendments to the General Health Law. Thus, the present approach, focuses on a set of flexible, simple and efficient rules, strengthened by proven scientific and technical procedures.

The three countries that have signed the North American Free Trade Agreement (NAFTA) have focused particular interest and concern on the potential impact that this agreement will have on the environmental health, based on the premise that economical development should not detriment neither the environment nor the human health. In this paper, the NAFTA is presented as an opportunity to improve environmental and occupational health in Mexico and assumes that the study of the potential impact of NAFTA could help to find the solutions of the former and actual environmental health problems. From this perspective, the north-border maquila industry is analyzed as a case study for the purpose of identifying and predicting the impact of NAFTA on environmental and the occupational health. Preventive as well as control measurements are suggested. The general characteristics of the U.S.-Mexico border and the maquila industry are presented. The lack of both social investment and urban planning along with population and economical growth are described. An explanation of the impact that these factors have had on the environmental and occupational problems is discussed. Special emphasis is given to the human health problems including that of water, air and soil contamination by industrial toxic residues. Also, some possible health impact of NAFTA are outlined. Finally a sustainable developmental intervention is suggested, based on NAFTA as an opportunity to take advantage of coming structural changes that will improve the environmental health conditions at the northern-border and in the entire country.

In 1974 the report called "A new perspective on the health of Canadians" known as the Lalonde report was published. In that report health determinants were defined, and importance was given to factors outside of the health care system to improve and to preserve health. In this paper we analyse the methodology and the conceptual ambiguities observed on the development of that model, as well as the negatives consequences for the health care system that could derived from it. Finally we propose our point of view of the health care system as a public policy which should be responsible of producing services of prevention, diagnosis and treatment, at a reasonable cost.

The purpose of this paper is to present the basic principles needed to implement a national strategy for quality assurance in medical care in Mexico. The first part is devoted to a review of the basic concepts of quality of care with the aim of analyzing the evolution of the discussion of the concept of "quality assurance". This review constitutes the reference frame of the description of the historical evolution of quality assurance in different parts of the world. Finally, the experiences regarding quality assurance in Mexico are discussed and several basic proposals for the design of a national quality assurance strategy are presented.