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DEVELOPMENT DIALOGUE. 1985; (2):56-68.The central question to be addressed when discussing the adequacy and relevance of pharmaceutical action in a country, or in the world generally, is what are the objectives of such pharmaceutical action. The central and overwhelmingly preeminent objective is to restore the health of suffering and sick people. There is consensus among practitioners worldwide that health services in 3rd World countries have followed an urban-centered, hospital-based pattern. The consumption has, therefore, followed a similar pattern. In 1979, the urban hospitals of Thailand, both public and private, accounted for 30% of the total drug consumption, or an estimated US$85 million. The urban population within reach was less than 15% of the total population. The primary health care (PHC) policies adopted at Alma Ata resulted in the establishment of a special PHC unit in 1981 and a number of pharmaceutical studies were undertaken at the time. In 1982, the urban hospitals' share of drug consumption had slightly decreased. Overconsumption of unnecessary products by urban elites leaves the poor majority underserved and bearing very high levels of morbidity for which no treatment is accessible, despite the availability of drugs in the country as a whole. During 1969-81, there has been a 10-fold increase of the pharmaceutical market.
DEVELOPMENT DIALOGUE. 1985; (2):15-37.This paper discusses the principles involved in formulating international standards to regulate the appropriate use of drugs. It focuses particular attention on the role of the World Health Organization (WHO) in organizing this. The following questions are addressed: What is meant by the appropriate use of drugs? What are the main determinants of appropriate drug use that all the main actors agree on? How appropriately are drugs used today? To what extent are the standards agreed on in principle actually observed in practice? Is regulation called for? What kind of regulation is appropriate? What standards would meet the needs of all countries? Appropriate drug use is the provision of drugs to people who really need them and restiction of the supply of drugs to those who don't need them. Primary health care requires a continuous supply of essential drugs. As many as 70% of the pharmaceuticals on the market today are inessential and/or undesirable products, and many pharmaceutical products are marketed today with little concern for the differing health needs and priorities of individual countries. Few countries systematically monitor drug prescribing standards and consumption patterns. There is chronic and serious under-reporting of adverse reactions to drugs. Regulation implies control over the activities of the main drug producers. This requires international initiatives, since an essentially transnational industry is involved. Transnational corporations dominate the world market for drugs. All pharmaceutical products must be approved and registered for use by the competent government authority. All pharmaceutical products shall have full regard to the needs of public health.
DEVELOPMENT DIALOGUE. 1985; (2):5-13.The provision of appropriate medicines of the right kind, quality and quantity, and at reasonable prices is a central concern for any government. Simultaneously, there is increasing recognition of the serious problems inherent in the existing systems of pharmaceutical development, promotion, marketing, distribution and use in all countries and particularly in the 3rd World. The vast majority of people in most 3rd World countries have little or no access to effective and safe medicines. The Dag Hammarskjold Foundation organized a consultation on Another Development in Pharmaceuticals in June 1985. It was based on some papers commissioned for that occasion with a view to developing new approaches to fundamental problems in this field and involving both national and international actors and institutions. The basic concern of these papers was to place the debate on pharmaceuticals in its proper historical, contemporary and future context. The 5 major areas discussed were: 1) man and medicines: a historical perspective; 2) towards a healthy use of pharmaceuticals; 3) towards a healthy pharmaceutical industry by the year 2000; 4) 1st principles for the prescription, promotion and use of pharmaceuticals: towards a code of conduct; and 5) monitoring Another Development in Pharmaceuticals. 90% of the world's production of pharmaceuticals originates in the industrialized countries, which also accounts for 80% of the consumption. 3rd World countries have been supplied with a very inappropriate assortment of products by the pharmaceutical industry. There is a growing demand for improved practices that are conducive to health development. An international harmonization of regulatory standards is needed.
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.
London, England, London School of Hygiene and Tropical Medicine, Evaluation and Planning Centre for Health Care, 1985 Winter. 97 p. (EPC Publication No. 8)Many developing countries spend sizeable sums on the purchase of drugs yet an estimated 60-80% of their populations, particulary in rural areas, do not have constant access to even the most essential drugs. The provision of adequate amounts of effective drugs to treat the most important and common disease conditions is crucial if health services are to be effective and credible. Many problems are associated with the provision and utilization of therapeutic drugs in developing countries: inequitable access to cost-effective safe drugs; inequitable production and consumption with market concentration in the hands of a few multinationals encouraging competition based on product differntion and not price; escalating drug costs; inefficient procurement, distribution, management; and irrational prescription and consumption. To combat these problems, the essential drug concept was introduced by the WHO in 1977. In 1981, WHO established a special Action Program on Essential Drugs. This is a worldwide collaborative program that aims at urging member states to adopt national drug policies, as well as helping developing countries procure and use essential drugs. Several countries have implemented some of the suggestions of the Drug Action Program. Though some progress has been made towards achieving an increase in the use and availability of cost-effective drugs, very few countries have succeeded in decreasing the use of unsafe drugs and those of low cost-effectiveness. Effective legislation is a prerequisite to the effective use of drugs. Recommended action for governments of developing countries to involve the private sector include: creating incentive for increased domestice production; controlling promotional practices; and exerting price controls.
[Unpublished] 1984. Paper presented at the Population Association of America Annual Meeting, Minneapolis, Minn., May 3-5, 1984. 37 p.Add to my documents.
Baltimore, Md., Johns Hopkins University Press, 1980. xv, 463 p.Add to my documents.
Journal of Comparative Family Studies. 1980 Autumn; 11(4):517-530.Add to my documents.
Laxenburg, Austria, International Institute for Applied Systems Analysis, 1981. vi, 68 p. (Executive report, no. 4.)Add to my documents.
In: United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]. Population Division. Population of Japan. New York, United Nations, 1984. 200-29. (Country Monograph Series No. 11; ST/ESCAP/269)It has been estimated that, given a projected population increase of over 11 million persons in Japan between 1980-2000, 3 times as much cultivated land will be needed to maintain self-sufficiency in food at the present level of consumption. However, the declining availability of arable land in Japan makes this an impossibility and it will be more logical to attempt to increase productivity per hectare. The country's livestock sector has shown rapid increases in production as a result of rising incomes, and the demand for meat is expected to increase by 2.6% in 1980-90. In the postwar period, consumption of rice has dropped while consumption of fats, oils, meats, poultry, dairy products, and fruit has increased. Increased incomes and a belief in the greater nutritional value of Western foods have altered the traditional diet and processed foods are widely used in urban areas. The average food intake reached 1400 gm for the 1st time in 1972 and has remained at this level. Rural areas have the highest energy supplies from cereals and the lowest supplies from animals. The urban population has the least intake of rice, potatoes, shellfish, and fish and the largest intake of fat and oils, meat, milk, and other dairy products. Improved nutrition is considered to have contributed substantially to the sharp decline in mortality and increase in life expectancy. There are indications that the Japanese population is moving toward increased awareness of the necessity of a balanced intake of nutrients. For example, intake of fats, oils, meat, and salt has decreased in recent years. The government is urged to provide detailed information regarding desirable levels of food intake for various segments of the population.
Population Studies. 1983 Mar; 37(1):5-21.In conventional steady-state growth theory with technical progress exogenous, faster population growth causes lower consumption. This conclusion has influenced national policies. With technical progress endogenous, however, higher population growth causes higher consumption. Steady-state equilibrium analysis is not appropriate for policy decisions, though. Rather, appropriate analysis compares two or more growth rates beginning from equal initial positions, with comparison of the present value of consumption streams per person. In the paper the supply of and demand for knowledge is first analysed and the most plausible technical progress functions are derived. Various population growth rates are then simulated with different specifications and parameters. With virtually every variant, faster population growth shows better consumption with discount rates up to between five and ten per cent above the long-run adjusted riskless rate. With pensions included in the analysis, faster population growth would seem even more beneficial. Even at very high discount rates, lower population growth rates imply present values only a little higher than those for higher population growth rates. The advantage is overwhelmingly with higher population growth in this growth-theoretic analysis. (author's)
Consumption, family size, schooling and labour supply decisions: estimates of a linear expenditure system for Bangladesh.
Hamilton, Ontario, Canada, Program for Quantitative Studies in Economics and Population, McMaster University, 1983. 48 p. (QSEP research report, no. 77)Add to my documents.