De nombreuses civilisations ont défi ni la santé de manière holistique. L’OMS en 1948 franchit une étape importante en définissant la santé comme un état de complet bien-être. Toutefois sa dimension statique lui valut de multiples critiques. Une définition plus dynamique a été proposée, soit la santé comme capacité de s’adapter et s’autogérer. De manière analogue, en ce qui concerne la santé mentale une nouvelle définition est proposée, à savoir la santé mentale comme état dynamique d’équilibre interne qui permet aux individus d’utiliser leurs capacités en harmonie avec les valeurs universelles de la société. Cela n’est pas sans importance vu que la compréhension qu’une société peut avoir du concept de santé affecte les politiques de santé, l’organisation sanitaire, les actions de santé publique et la prise en charge des individus en termes de santé et de maladie.

AIM:Our systematic review seeks to understand the linkages and reciprocal relationships between the artificial intelligence (AI) and human rights (HRs) and to unveil the signs of emergence of a new discipline at the crossroads of these two disciplines.BACKGROUND:AI and HRs have evolved in parallel as two fields, with AI technology engineers eventually interested in the consequences of their products on HRs, while more recently HRs experts have been exploring the benefits and threats of AI technologies on the protection and promotion of HRs.METHODS:A broad range of databases within the fields of legal sciences, social sciences, health-care sciences and the more general sciences practitioner base "Web of Science" were explored. Articles were selected according to strict inclusion/exclusion criteria and systematically analyzed regarding their content and authorship.RESULTS:The crossroad between AI and HRs is a dynamic field where researchers from different disciplines have been exploring issues such as autonomous lethal weapons, privacy protection, discriminatory decision-making in the insurance and finance systems, intellectual property, and legal personality of the robots. Signs of the emergence of a new discipline were identified.CONCLUSION:Identifying appropriate strategies to consolidate this emerging discipline seems necessary: one could be the development of academic programs at the crossroad of these two fields.

In a federal state like Switzerland, where health policies are the responsibility of local, regional and federal authorities, implementing a nationally coordinated health promotion program is a political and logistic challenge. The VIA project, presented hereafter, is one of the rare health promotion projects to be coordinated at the national level in Switzerland. Its aim is to promote the health of older people, a population which is heavily affected by chronic diseases. Indeed, in the group aged 65–79 years living at home, 28.8% suffer from one and 25.2% from several chronic diseases; in the over-80 age group, the proportions are 29.6% and 41.3%. The VIA project, a multi-year project, tackles specific issues known to affect the health of the elderly, such as fall prevention, promotion of physical activity and healthy eating as well as social integration through supporting local stakeholders with theoretical knowledge, practical know-how and facilitating networking among various stakeholders. The coordination work was considered useful by most local program-managers: especially considered as useful were network encounters and exchange of experiences among professionals.

L’état de santé des étudiants universitaires est souvent précaire. Les risques susceptibles d’affecter leur santé sont multiples : prises de risques en termes de comportements – sexe, alcool, tabac, drogues, sports extrêmes correspondant à un effet de cohorte. Il y a des risques liés à l’environnement particulier qu’est l’université comme les examens, la nécessité à la performance, l’orientation de carrière, les exigences financières, des éléments pouvant fortement affecter la santé psychique. Les données de littératures montrent que des interventions de prévention et de promotion de la santé ciblées visant des populations d’étudiants ont un impact sur les facteurs de risque et la perception de bien-être. Les universités ont dès lors une responsabilité sociale de promouvoir la santé des étudiants. Les pistes pour le faire sont multiples. Une approche est l’adhésion aux Chartes d’Edmonton et d’Okanagan qui ont défini le concept « Health Promoting Universities » : cela implique d’inscrire au haut de l’agenda universitaire la santé et d’organiser des activités de prévention et de promotion de la santé destinées aux étudiants, d’en assurer la mise en œuvre et l’évaluation, de communiquer à l’interne et à l’externe à ce propos et de coopérer avec les acteurs de la prévention et de la promotion de la santé de la communauté. Toutefois cette démarche devra se faire en considérant des oppositions éventuelles entre libertés individuelles et bien commun, entre autonomie des personnes cibles et responsabilité sociale de l’institution, entre intérêts individuels et justice sociale.

Education and training in human rights has been set as a priority by the United Nations. Health and human rights are closely related. Training professionals from various backgrounds in human rights might ultimately contribute to improve the health of individuals and communities. We present the 5 years’ experience with a 3-week residential Global Health and Human Rights Course developed at the University of Geneva and implemented with the support/participation of international organizations (IOs) and non-governmental organizations active in the health and human rights sector. Over the years, roughly 150 students from 43 nationalities, with many different educational backgrounds, attended the course. The male/female ratio was 1/5. The adopted educational approach was multifold and comprised lectures from academics and experts with field experience, group work, individual case studies, journal clubs, and site visits. Evaluation data show that site visits at IOs were highly appreciated as well as networking opportunities among students, with academics and experts with field experience. The variety of topics discussed was, at times, “too much”; yet, it allowed students to measure the extent of the challenges the field is facing. The adopted active learning approach facilitated the exchange of experiences among students and allowed them to get acquainted with different cultural sensitivities. The Global Health and Human Rights Summer-School of the University of Geneva allowed its participants, coming from all over the world, to identify challenges of the interlinked fields of health and human rights, reflect upon their underlying causes, and imagine possible solutions. Sharing our experience will hopefully help passionate educators around the world to develop similar programs.

Over the past century, the proportion of Swiss residents aged 65 or older rose from 5.8% to 17.8%; during the same period, the proportion aged over 80 rose from 0.5% to 5.0%. Although the majority of older people in Switzerland enjoy good health, disease prevalence rises with age. Almost half (49%) of people over 65 living at home report at least one chronic illness. Among the 65- to 79-year-olds living at home, 25.2% suffer from several chronic diseases; among people in the 80s, this figure reaches 41.3%. People aged over 80 are also particularly at risk for falls (30%). In addition, between 15% and 25% of the elderly suffer from at least one mental illness. Close to 30% of healthcare costs are attributable to people over the age of 75, who make up only 8% of the total population. Given the public health importance of the issue a health promotion project targeting the elderly – the VIA Project -, based on successful local programs, is being implemented throughout the country. The overall goal of the VIA project is to promote the health of older people and to strengthen their self-determination and independence.

In Switzerland, health care, disease prevention and health promotion policies are the responsibility of three government tiers: the federal authorities, the cantons, and the communes acting in a decentralized framework. During the 1990s and the first decade of the 21st century, the federal state elaborated strategic frameworks for disease prevention and health promotion. The lack of systematic data collection was partly alleviated by the creation of an Observatory of health (OBSAN) that produces reports for the cantons on the basis of a cyclic federal survey. A federal law on health promotion and prevention reached a very advanced stage, but closely failed to muster the consensus needed to pass. The trend towards more governance and coordination at the federal level is not univocal. On one hand, some recent or upcoming decisions, for example in the matter of the regulation of land use or fiscal policy, would tend to reinforce the centralized competencies. On the other hand, we can observe a definite trend of funding cuts at the federal level, along the lines of a more general intention to “untangle” financial and political responsibilities back to the Cantons. The development of equitable and sensible disease prevention and health promotion policies in a decentralized framework carries its unique set of risks and opportunities.

In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies. Yet, the cantons are in most health matters independent in their decisions, thus defining as a matter of fact their own health priorities. We examined and analysed the content of the disease prevention and health promotion plans elaborated during the last decade in six French-speaking cantons with different political contexts and resources, but quite similar population health data, in order to identify the set health priorities. The plans appear significantly inhomogeneous in their structure, scope and priorities. Most of the formal documents are short, in the 16 to 40 pages range. Core values such as equity, solidarity and sustainability are explicitly put forward in 2/6 cantonal plans. Priority health issues shared by all 6 cantons are "physical activity/sedentariness" and "nutrition/food." Mental health is explicitly mentioned in 5 cantonal plans, whereas tobacco and alcohol consumptions are mentioned 4 times. Less attention has been given to topics that appear as major public health challenges at present and in the future in Switzerland, eg, ageing of the population, rise of social inequalities, increase of vulnerable populations. Little attention has also been paid to issues like domestic violence or healthy work environments. Despite some heterogeneity, there is a common base that should make inter-cantonal collaborations possible and coordination with national strategies easily feasible.

The World Health Organization has recognized the shortage of competent public health workforce as a major problem worldwide and claimed an urgent need for action. Training public health personnel, effective in an educational perspective, yet with public health relevance in mind, remains a challenge for university-based programs. We present evaluation data of the 25-year experience of a project-centered, problem-oriented, on-job Master in Public Health program at the University of Geneva. Several data collection strategies were used. First, achievement of learning objectives was investigated through content analysis of students’ reports on personal project, through problem-solving final examinations and through self-reported progress on a professional profile. Second, possible public health impact was estimated through analysis of implemented project. Third, yearly discussions with the successive cohorts use the SWOT grid (strengths, weaknesses, opportunities and threats) to investigate the students’ perception of the program. Learning objectives were mainly acquired through community health projects realization, partly also through group work, exercises, readings and lectures. Self-reported progress on a professional profile showed significant acquisitions in all tested public health competencies. All students were able to implement at least one of their planned projects. Students’ perception considered the project/problem-centered approach as positive, but underlined the importance of time constraints and heavy workload in an on-job training program. In our experience a project-centered, problem-based Master program in Public Health allowed students to achieve new competencies and communities to benefit from project implementation addressing public health issues.

Background: In most cases, the work of medical doctors, be they general practitioners or specialists, involves some dimension of health promotion (HP). There is thus ample justification for increasing the awareness of medical students vis-à-vis HP and its relevance for their future practice. Methods: In the context of a major curriculum reform (problem-based learning [PBL]) at the Faculty of Medicine of the University of Geneva in the mid-1990s, several steps were taken to strengthen HP throughout the curriculum and include HP in its key domains as defined by the Ottawa Charter (OC). Results: First, the political dimension of HP was developed in a series of first- and fifth-year lectures and third-year workshops; second, community action was strengthened through a third-year one-month community immersion program; third, the development of personal skills was integrated into second- and third-year PBL cases and into fourth-and fifth-year learning activities in clinical settings as well as second- and third-year HP electives; in terms of reorienting health services, the chosen approach included the development of a HP-specific track in the context of a Certificate of Advanced Studies (CAS) in Community Health and a Master of Advanced Studies(MAS) in Public Health. Furthermore, a supportive intra-university environment was created through a collaborative convention with Health Promotion Switzerland, which is in charge of coordinating HP in Switzerland. Conclusion: In our view, HP teaching for medical students seems all the more relevant given that future medical doctors will have to take care of an increasing number of patients likely to develop chronic non-communicable diseases.

We conducted a systematic review of the scientific literature between 1996 and 2013 on rape in war-ridden Eastern Democratic Republic of Congo (DRC) in order to better understand the interest of the scientific community in describing the magnitude and characteristics of the problem. The literature search was conducted in French and English using several databases (Pubmed, PsycInfo, Sapphire, BDSP, Embase, Rero, and Web of Science) with the key words "rape and DRC" combined with several Medical Subject Headings concepts. Our systematic review yielded 2,087 references, among which only 27 are original studies, that is 20 are based on population surveys and the remaining 7 are original data based on case studies and reviews. Ten studies provided prevalence rates of rape victims, 18 provided specific information on the profile of the victims, 10 reported that most of the perpetrators of rape were military personnel, 14 referred to the negligence of the government in protecting victims, and 10 reported a lack of competent health-care facilities. The awareness of rape in conflict-ridden DRC is still limited as reported in the scientific literature: Published scientific papers are scarce. Yet more research would probably help mobilize local authorities and the international community against this basic human rights violation.

La penurie de main-d'œuvre de sante publique competente represente au niveau mondial un probleme majeur. La situation est particulierement difficile en Afrique sub-saharienne. En 2008, l'Organisation Mondiale de la Sante et de la Global Health Workforce Alliance a lance un appel a propositions pour un programme de formation en sante publique mettant l'accent sur le developpement des personnels de sante et ciblant specifiquement l'Afrique. Notre article presente l’elaboration, la mise en œuvre et l'evaluation d'une Maitrise d’Etudes avancees en sante publique. Le projet a ete developpe en collaboration avec des etablissements universitaires partenaires de dix pays africains francophones et bureaux locaux, le bureau regional et le HQ de l'OMS.

Population health requires visionary policies, competent professionals, strong health systems, sound management, community commitment and each individual’s health awareness. This is especially true for non-communicable diseases (NCDs). What are NCDs and why do they represent a major challenge for health systems worldwide? As defined by the World Health Organization, NCDs (noncommunicable diseases) primarily include cardiovascular disease, cancer, chronic lung disease and diabetes as well as mental illness.

Background: Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported. Objective: This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice. Design: A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011. Results: One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria. The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%). Conclusions: The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.

Due to its nature, extent and consequences, torture is considered a major public health problem and a serious violation of human rights. Our study aims to set the foundation for a theoretical framework of the costs related to torture. It examines existing challenges and proposes some solutions. Our proposed framework targets policy makers, human rights activists, professionals working in programmes, centres and rehabilitation projects, judges and lawyers, survivors of torture and their families and anyone involved in the prevention and fight against this practice and its consequences. We adopted a methodology previously used in studies investigating the challenges in measuring and valuing productivity costs in health disorders. We identify and discuss conceptual, methodological, political and ethical challenges that studies on the economic and social costs of torture pose and propose alternatives in terms of possible solutions to these challenges. The economic dimension of torture is rarely debated and integrated in research, policies and programmes. Several challenges such as epistemological, methodological, ethical or political ones have often been presented as obstacles to cost studies of torture and as an excuse for not investigating this dimension. In identifying, analysing and proposing solutions to these challenges, we intend to stimulate the integration of the economic dimension in research and prevention of torture strategies.