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  1. 1
    098958

    The effects of income on food and nutritional status in the Middle Eastern area (1960-1985).

    Younis SJ

    Ann Arbor, Michigan, University Microfilms International, 1993. 132 p. (Order No. 9410654)

    Dramatically increased oil prices significantly and rapidly increased the income of most middle eastern countries after 1973. The author reports on the effect of the income growth on food and nutrition status. He looks at per capita income, food consumption, population per physician, crude birth and death rates, infant mortality rate, child death rate, and life expectancy over 1960-85 for the oil exporting countries Algeria, Libya, and Saudi Arabia, the labor exporting countries Egypt, Morocco, Tunisia, and Yemen, and the agriculture producing countries Jordan, Sudan, Syria, and Turkey. The analysis found the income elasticities of wheat, rice, and corn consumption to be less than one for all countries. The income elasticities for egg, beef, and poultry were more than one for most of the countries. Crude birth and death rates, and child and infant mortality rates decreased with increasing income, while population per physician and life expectancy increased. Only Morocco showed insignificant results for most of the analysis.
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  2. 2
    083258

    Blaming and punishing the poor achieves nothing.

    Ratanakul P

    WORLD HEALTH FORUM. 1993; 14(2):115-7.

    Dr Martin's argument in favor of a new approach to ethics in health care is founded on excessive generalization and the linking of factors that are not clearly related. Dr. Martin accuses humanity in general of destroying its ecological support system when so much of the blame should be placed on governmental and business interests. Demographic changes are cited as the explanation for the 2-tier health care system in the US, when it is documented that the factors responsible are greed among doctors and drug companies, profiteering by hospitals and insurance companies, large-scale wastage, fraud, excessive medicalization, and a failure of the democratic system to ensure the well-being of all the people. The US is the only developed country without a national health care program. The world's population needs to be controlled, but most demographic studies indicate that the best way to achieve this is not to allow people to die prematurely but to give proper attention to the educational and economic development of women and to provide care for the aged. In his search for the root causes of our present difficulties, Dr. Martin is on the right track when he mentions national and regional egotism. Immense social harm would result if an elite had the power to choose who should live and who should die. One of the hallmarks of civilization is the conviction that each human life is precious. The ethics of benevolence or compassion are still valid, and there is no justification for Dr. Martin's proposals. Probably not even Machiavelli would have approved of his argument, for it is certainly not in our common interest in the longterm to have a compassionless world.
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  3. 3
    083253

    Only democracy and debate can provide tolerable solutions.

    Riis P

    WORLD HEALTH FORUM. 1993; 14(2):123-4.

    Many national health services focus on the economically competent individual, rather than on society as a whole. They also tend to overlook the drain which the health economy represents on ecological systems. The injustices in health care and the global overconsumption of resources could eventually lead to equity of suffering. In the conflict, examined by Jean Martin, between the individual and the mass of people, patients have fought for the right to be at the center of health service endeavors. However, the notion that what is good for individuals and their families reflects sound health policy, is not a sufficient ethical principle for a fair and ecologically sound health policy. In recent times, market forces have come to be seen as a kind of panacea also in health care. However, if they are used in the heath field, the losers will continue to include the poor, the chronically ill, and the old. The balance between market forces and public responsibility for health care is economically crucial in the welfare state. People have always been obliged to accept that society takes precedence over individuals. The proposal to rely on enlightened despotism based on clear-sighted, incorruptible, and concerned citizens could well produce disaster. History shows that only democracy, despite its inadequacies, can provide tolerable solutions in the longterm. Change can only be achieved via citizens and their freely elected political leaders. There are positive signs, for instance, a growing acceptance of the need to eliminate inequity and abuse of the environment. Young people are increasingly aware that overpopulation and pollution are a threat to their lives. The factors of overwhelming significance are overpopulation and overconsumption, both of which will have to be reduced in the world's resource balance.
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  4. 4
    063896

    Development, government policy, and fertility regulation in Brazil.

    Faria VE; Potter JE

    Austin, Texas, University of Texas, Texas Population Research Center, 1990. 19, [11] p. (Texas Population Research Center Paper No. 12.02)

    This paper offers a new perspective on the fertility decline in Brazil, and argues that a number of government policies have had substantial unintended and unanticipated effects on the rapid changes in reproductive behavior that have taken place since 1960. The four policy areas we focus on are consumer credit, telecommunications, social security, and health care....We address the question of how Brazilian development yielded values and norms consistent with controlled fertility. We claim to have identified significant institutional changes that had a direct and immediate bearing on the way people thought about sex and reproduction, and that facilitated the massive adoption of modern contraception. Our approach to the role of the state differs from that of most Brazilians in that we focus on the unintended effects of real policies rather than the intended effects of a non-policy....[Data are from] the 1980 Northeastern Brazil Survey of Maternal Child Health/Family Planning.... This paper was originally presented at the 1990 Annual Meeting of the Population Association of America (see Population Index, Vol. 56, No. 3, Fall 1990, p. 400).
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  5. 5
    065735

    Population growth and policies in mega-cities: Mexico City.

    United Nations. Department of International Economic and Social Affairs. Population Division

    New York, New York, United Nations, 1991. vi, 34 p. (Population Policy Paper No. 32; ST/ESA/SER.R/105)

    This review of elements affecting the population policy of Mexico City, the largest city in the world, is part of a series on formulation, implementation and evaluation of population policies of mega-cities as they follow the World Population Plan of Action of the UN World Population Conference, 1984. The main sections of the report are demographic factors and projections, economy, strategies of decentralization, issues and sectors, and resources and management. Mexico city is expected to have 27 million in 2000. Growth by migration accounts for doubling every 20 years, as natural increase declines. While Mexico City's economy has in recent decades grown because of industrial development, in the future increasing proportions of people will work in the informal sector. Air pollution, the worst documented in the world, due to photochemical smog, and traffic congestion are the city's most serious issues. These are being addressed by a contemplated retro-fit of automobiles with pollution control devices, state bus lines and a metro system. Decentralization has been approached by the National Urban Plan of 1978 and the National Development Plan of 1983-1988 among other efforts, but lack of a central authority, and the failure of the government to respond to the 1985 earthquake by relocating housing cost doubt of the likelihood of results. Counteracting systems such as subsidies for water, food electricity and diesel fuel for urban residents, and inadequate tax incentives for companies moving elsewhere are also in effect. Land speculation combined with illegal settlement of communal lands have hampered planning, but the earthquake cleared extensive areas for parks and low income apartments. Water supply is another major problem, with per capita usage equal to U.S. levels because of losses from the aging system. Health care and other services are allotted mainly on income lines because of political factors. Resources and regulation are in a pitched battle between the Federal District (the City) and Mexico State which soon will make up the majority of the population, but receives poorer services at greater expense relative to the City.
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  6. 6
    055687

    Report of the Regional Information, Education and Communication Conference, Coconut Grove, Florida, December 6-10, 1987.

    International Planned Parenthood Federation [IPPF]. Western Hemisphere Region [WHR]

    New York, New York, IPPF, WHR, 1988. [2], 36 p.

    The purpose of the Regional Information, Education, and Communications Conference, held in Florida in December 1987, was to examine new ideas in information, education, and communication (IEC) with regard to reaching 3 general audiences -- adolescents, the family planning consumer, and the public-at-large -- and to explore the application of these ideas at the family planning association level. An abridged version of the discussions is included in these proceedings. In the session devoted to using the life planning methodology to reach adolescents, several countries gave presentations on their adolescent programs. Grenada, Mexico, Guatemala, Suriname, Chile, and Panama all have special programs for adolescents. The programs include a wide range of medical, educational, and recreational activities. The objective of the session addressing consumer marketing techniques in the family planning field was to encourage family planning organizations to use the consumer marketing approach of matching and promoting their services in relation to consumer needs and preferences. Conference participants were divided into 4 working groups to discuss consumer marketing of clinics. Each group focused on 4 questions: Why are clinics underutilized; what can be done to improve clinic services to that they lend themselves to better marketing; what ideas can be suggested for more effective marketing and promotion of clinic services; and what assistance, if any, should the regional office provide in helping family planning associations embark on clinic marketing programs. The working groups concluded that the principal reasons clinics are underutilized are poor geographical location, inadequate scheduling of visiting hours, and insufficient public information on clinics and the services they provide. The working groups suggested several measures that family planning associations could take to increase utilization of clinic services: offer a diversity of services at low prices; commercialize promotional materials; attend to the comfort of patients and provide incentive to "spread the word;" and determine the problems of each clinic and design a plan on how to offer quality services in an organized manner. The last session of the conference dealt with the importance of public information programs for the family planning associations in creating a positive public image and improving relations with governments.
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  7. 7
    048254

    Consumer perceptions of health care services: implications for academic medicine.

    Ware JE Jr; Wright WR; Snyder MK; Chu GC

    JOURNAL OF MEDICAL EDUCATION. 1975 Sep; 50(9):839-48.

    The importance of consumer perceptions of health care services in relation to behavioral outcome was assessed in 903 household interviews in rural Illinois. The interview scale was designed to measure evaluation of health care in the area, beliefs about physician behavior, reasons for postponing doctor visits, and general attitudes toward health care services. The 18 factor scores that measured consumer perceptions were found to explain a significant amount of the variance in terms of the behavioral outcomes of number of physician visits during the preceding year, whether or not the respondent scheduled a medical check-up when not sick during the prior year, whether annual dental visits were made, and whether there had been a change in physician as a result of patient dissatisfaction. Covariates such as health status or ability to pay less significant than perceptual measures. Of particular significance were measures of patient perceptions regarding the conduct of physicians and other health care providers in relation to their patients, especially continuity and humaneness of care. Quality of care factors that emerged as significant were thoroughness, preventive measures, surgical conservatism, female health care, use of medication, information giving, and use of the health care system. These findings indicate that the perceptions of consumers of health care should be given greater emphasis in the planning and evaluation of health care systems. The authors are currently involved in further refinement and validation of rating scales that emphasize the consumer viewpoint.
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  8. 8
    044817

    Implications of changing age structure for current and future development planning.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    Bangkok, Thailand, United Nations, Economic and Social Commission for Asia and the Pacific [ESCAP], 1987. 10 p. (Population Research Leads No. 25)

    The Asian and Pacific region's decline in fertility and mortality over the past 2 decades has resulted in large shifts in the age composition of national populations, which affects planning in nearly every social and economic sector. For the region as a whole, the crude birthrate is estimated to have remained at 40/1000 population until about 1970, declining to 27/1000 in the 1980-85 period. This rapid decline in fertility has complicated population policy formulation and the integration of population factors into development planning. The demonstration that government programs could alter demographic trends meant that population no longer could be treated simply as an exogenous variable in development planning. The combination of previously high fertility and declining mortality, which particularly affected the survival rates of infants and children, resulted in a small increase in the proportion of the population of the region below age 15, from 37% in 1950 to 41% in 1970. By 1985, the latter proportion dropped to 35% because of declining fertility. Due to the previously high fertility and more recent declines, the proportion of the population in working-age groups increased from 56% in 1975 to 61% in 1985 and is projected to reach 65% by 2000. Providing employment for this rapidly increasing population of labor-force age is a major challenge for countries of the region over the next several decades. For those few countries in the Asian and Pacific regions who had low birth and death rates by 1960, the current issue is demographic aging. As the rate of population growth per se decreases in importance as a planning goal, other aspects of population, such as spatial distribution, take on more significance. The rising marriage age and organized family planning programs were the primary causes of fertility decline in the region, although the decline was limited in South Asia where large pockets of high fertility (a total fertility rate in the range of 5-7) remain. The contribution of rising marriage age to further fertility decline is approaching the limit, except in the countries of South Asia where the marriage age continues to be below 20 years. In most of the countries of the region, the potential also exists for a 2nd generation "baby boom" resulting from a changing age structure. This would in turn slow down the pace of fertility decline unless compensated by a rapid fall in fertility of younger married women caused by successful implementation of family planning programs and other associated socioeconomic changes. Aside from the straightforward implications of demographic change, changes in age structure also imply changes in consumption patterns. Thus, planning for production, consumption, investment, and distribution always should incorporate changes in age structure.
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  9. 9
    048458

    Report on the basic survey of population and development in Southeast Asian countries: India.

    Asian Population and Development Association

    Tokyo, Japan, Asian Population and Development Association, 1986 Mar. 115 p.

    The findings of a 1985 survey concerning population and development problems in India are reported. The survey covered a sample of 280 households in two regions. In the first two chapters, an overview of population dynamics and health issues in India is presented, and various aspects of urbanization are discussed. Tables in the third chapter provide information on the survey sample, including age distribution, place of birth, income and occupational status, consumption of selected durable goods, educational status, delivery of health services, family planning practice, family characteristics and size, married women in the labor force, and migration. A sample of the questionnaire used is included.
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  10. 10
    268894
    Peer Reviewed

    The pharmaceutical industry and health in the third world.

    Taylor D

    Social Science and Medicine. 1986; 22(11):1141-9.

    This paper considers the impac of the pharmaceutical industry of Third World health care, indicating the broad outlines of current debate in the field. It examines the structure and characteristics of the pharmaceutical industry and the markets for its products. It then discusses the nature of the health problems particular to the poorer, nonindustrialized communities and the relevance of drugs and their makers. Possible ways towards and more productive pattern of relationships are explored. A major impetus for the development of the pharmaceutical industry was an econmic crisis which drove the industry to attempts at diversification. Other important factors were also at work: migration from rural to urban areas; development of technology; and disconery of the causes of disease. The developing countries account for only 15-20% of global drug consumption as measured in manufacturers' price terms. Overall, most countries in the world spend on average 0.7-0.8% of their GNPs on medicaines. A number of elements are likely to prove common to any successful process of helth and wealth development. These include: increases in literacy rates; the establishment of accepted systems of social and political organization; the creation of effective transport and communication systems; the provision of clean water supplies and sanitation provisions; and the build-up of effective primary and 2ndary health care. The role of medicines and vaccines in deprived communites is 3-fold: they can help prevent illnesses, e.g. as with immunization; pharamaceuticals may be directly curative; they may alleviate pain and other sumptoms. As far as improvement of the access of poor world rural and peri-urban populations to essential drugs is concerned, 3 of the most vital necessary conditions are: the establishment of universally available primary health care facilities; an efficient, secure system of transporting medicines from factories, airports, and docks to health facilities; and proper purchasing agreements.
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  11. 11
    030970

    The demand for primary health care services in the Bicol region of the Philippines.

    Akin JS; Griffin CC; Guilkey DK; Popkin BM

    [Unpublished] 1985. Presented at the Annual Meeting of the Population Association of America, Boston, Massachusetts, March 28-30, 1985. Also published in: Economic Development and Cultural Change 34(4):755-82. 1986 Jul. 26, [21] p.

    Mortality is assumed to be strongly reduced by medical care, however, the effects of medical services on health are often underestimated because some of the same factors which lead to an increased demand for primary health care (PHC) services are also associated with increased morbidity and mortality. Consequently, understanding the determinants of the demand for medical services is important for evaluating health outcomes. This paper estimates the parameters of a simple model of the demand for health services using data from the Bicol Multipurpose Survey data from the Philippines. The parameters of the demand for key components of PHC--outpatient, prenatal, delivery, well-child, and infant immunizations--are estimated. Findings suggest that the quality of the care may be very important, but that economic factors as deterrents to using medical care--inaccessibility, cash costs, and lack of income--may not be of paramount importance. Finally, it is shown that the provision of free services in rural areas may not insure that the services reach the poorest people. (author's modified)
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  12. 12
    037659
    Peer Reviewed

    Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.

    Makhoul N

    Social Science and Medicine. 1984; 19(4):373-84.

    This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practiced by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health which mass movements strive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the reassessment and implementation of health care priorities in developing countires with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between "stage theory" and modern consumption-production Malthusiansim. Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. In the context of underdevelopment, increased productivity is at the necessary cost of public health. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading "Basic Needs" orientation in the assessment and implementation of health care priorities derives. Marx said that "countries of developing capitalism suffer not only from its development but also from its underdevelopment." (author's modified)
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  13. 13
    026259

    The economic consequences of declining population growth.

    Maillat D

    In: Council of Europe. Proceedings of the European Population Conference 1982 (Strasbourg, 21-24 September 1982). Strasbourg, France, Council of Europe, 1983. 291-313.

    The possible drawbacks and adverse effects of the current population trend of the fall in fertility and steady aging of the population were analyzed. Areas in which links may exist between the economy and population trends, which, in a European context, appeared most pertinent were chosen. It is generally considered that a reduction in the number of births well result in a reduction in certain areas of public expenditure. Thus, the "numbers" effect would appear to be favorable as far as public finance is concerned. Reduction in education expenditure could offset the increase in health expenditure. The education sector is rapidly affected by a decline in the number of births, and the impact of demographic fluctutations is felt for many years as the cohorts grow older. Germany, where the birth rate has fallen markedly, provides valuable information about what can happen in such a case and illustrates the need to adapt education facilities. Focus is on the number of pupils, demand for teachers it is possible that education costs may be somewhat reduced, health costs and social security contributions will definitely increase. The relationship between health expenditures and age can be depicted by means of a U-shaped curve. The largest consumers of medical care and advice are children under the age of 1 year and adults over the age of 65. A sudden fall in the birth rate may reduce health expenditure, but since the aging of the population continues inexorably, what is saved on the youngest will be used to care for the oldest. The underlying tendency imposed by the changes in the structure of population until the end of the century will be to reinforce the upward trend in expenditure. Social security expenditure clearly will be much more strongly affected by demographic trends than other forms of expenditure. There is no demographic reason why overall household consumption should fall since, assuming that there are no economic fluctuations, per capita income is likely to increase. With a declining population growth, the building of housing to meet demographic needs will also diminish. Since such facilities as schools, hospitals, housing, and transport, are generally planned from a longterm standpoint, decisions to build may be delayed, possibly indefinitely, because of variations in population size. If present demographic conditions persist, all regions should, in the long run and to varying degrees, experience population decline. The demographic conditions in which Europe is going to live will not necessarily damage production capacity, but they will make it more difficult to develope and adapt that capacity.
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