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A demographic dividend of the FP2020 Initiative and the SDG reproductive health target: Case studies of India and Nigeria.
Gates Open Research. 2018 Feb 22; 2:11.Background: The demographic dividend, defined as the economic growth potential resulting from favorable shifts in population age structure following rapid fertility decline, has been widely employed to advocate improving access to family planning. The current framework focuses on the long-term potential, while the short-term benefits may also help persuade policy makers to invest in family planning. Methods: We estimate the short- and medium-term economic benefits from two major family planning goals: the Family Planning 2020 (FP2020)'s goal of adding 120 million modern contraceptive users by 2020; Sustainable Development Goals (SDG) 3.7 of ensuring universal access to family planning by 2030. We apply the cohort component method to World Population Prospects and National Transfer Accounts data. India and Nigeria, respectively the most populous Asian and African country under the FP2020 initiative, are used as case studies. Results: Meeting the FP2020 target implies that on average, the number of children that need to be supported by every 100 working-age people would decrease by 8 persons in India and 11 persons in Nigeria in 2020; the associated reduction remains at 8 persons in India, but increases to 14 persons in Nigeria by 2030 under the SDG 3.7. In India meeting the FP2020 target would yield a saving of US$18.2 billion (PPP) in consumption expenditures for children and youth in the year 2020 alone, and that increased to US$89.7 billion by 2030. In Nigeria the consumption saved would be US$2.5 billion in 2020 and $12.9 billion by 2030. Conclusions: The tremendous economic benefits from meeting the FP2020 and SDG family planning targets demonstrate the cost-effectiveness of investment in promoting access to contraceptive methods. The gap already apparent between the observed and targeted trajectories indicates tremendous missing opportunities. Accelerated progress is needed to achieve the FP2020 and SDG goals and so reap the demographic dividend.
In: The global possible: resources, development, and the new century, edited by Robert Repetto. New Haven, Connecticut, Yale University Press, 1985. 255-98. (World Resources Institute Book)Everyone uses fresh water. Water is the most used substance by industry. Even though industry only makes up 5-10% of current worldwide water use, it contributes a disproportionate amount of toxic contaminants to the water supply. The most important socioeconomic factors of municipal water demand are household income and size. Agricultural demand is the single largest demand for water. In the US, it makes up 83% of annual total water consumption. Water demand has resulted in some of the world's biggest construction and weather modification projects which greatly alter basic ecosystems. Multinational institutions such as the World Bank and the International Development Association support most of these projects in developing countries. We have abused water perhaps more than any other resource. These abuses have caused considerable adverse effects. For example, after farmers in Africa and Asia began irrigating fields, many people fell ill with schistomosiasis. Other waterborne diseases include typhoid fever and diarrheal diseases. Investments in water supplies as well as in wastewater treatment are needed to improve public health. The largest consumers of fresh water in the world are those countries with the largest populations (49% of the world's population) and largest total land area (32% of the this area): China, India, the US, and the USSR. These 4 countries have 61-70% of the world's total irrigated land, but China and India have most of it (54%). Most US water expenditures are for water pollution control. The US has a very efficient agricultural system but the efficiency is technical rather than economic. Most water expenditures in the USSR and India are for irrigation. China spends most of its water resource funds on irrigation and drainage systems. All countries in the world should conduct a rational analysis of fresh water uses, implement rational water pricing policies to conserve water use, and stabilize water supplies such as capturing surface runoff.
In: Resources, environment, and population: present knowledge, future options, edited by Kingsley Davis and Mikhail S. Bernstam. New York, New York/Oxford, England, Oxford University Press, 1991. 25-43. (Population and Development Review. Vol. 16. Supplement)Sustainable development is a relatively new economic term in the common vocabulary. Above all it is important to realize the critical difference between growth and development. In the past growth has been viewed as the ideal and as such all our economic measuring systems are based upon it. However, measuring the circular flow of exchange value makes it impossible to take into account the effect upon the environment that growth has. This old method was suitable in the past because of a misperception that growth is unlimited. A better way of measuring economics is to examine the entropic throughout of matter/energy. This system of measurement is consistent with the 1st and 2nd laws of thermodynamics and consistent with the fact that we live in a finte world with finite resources. Thus, the old system only measures the scale but not the allocation of resources and per capita consumption. While the independence of allocation from distribution is widely known, the independence of allocation from scale is not. No matter how large the population or per capita consumption rate, an optimal allocation will be found for every scale. Yet measuring scale is of critical importance. If a ship is overloaded, it does not matter how evenly distributed the load is, it will sink. Some method must be devised and implemented which will keep economic scale within the limits of ecological carrying capacity. Achieving sustainable development will require some rethinking and a change of priority. Thus, qualitative improvement could be labeled development, and quantitative improvements could be labeled growth. Thus a steady state economy could continue to develop without growing. This is how planet Earth operates and economics is just another open system that must be allowed to develop without growing.
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.
In: Basic needs and development. Edited by Danny M. Leipziger. Cambridge, Mass., Oelgeschlager, Gunn and Hain, 1981. 1-28.Add to my documents.
In: Ghosh PK, ed. Health, food and nutrition in Third World development. Westport, Connecticut, Greenwood Press, 1984. 61-76. (International Development Resource Books No. 6)Chronic malnutrition, in contrast to famine, is a grossly neglected but very serious problem in developing countries. Efforts must be made to acquaint authorities with the seriousness of the problems, to identify the causes of chronic malnutrition, and to develop effective programs to deal with the problem. Chronic undernourishment or subtle hunger receives little attention because 1) nutrition is a relatively new science; 2) those most seriously malnourished, i.e., poor women and children, have little power or influence; and 3) politicians are more likely to support programs with highly visible results, and the results of improving nutrition are subtle and not always immediately detectable. Attention should be directed to the problem by conducting epidemiological studies to demostrate that the growth and development of children is highly dependent on good nutrition. Indices for measuring growth and development are available and studies could be designed to show how these indices vary by social class or by geographical region. Other studies could demostrate how morbidity and mortality rates for nutrition related diseases can be reduced by improving nutrition. Weak points in the food chain which contribute to the problems of chronic malnutrition are delineated and include such factors as low agricultural production, deficient transportation systems, and the low food purchasing power of large segments of the population. Governments should be encouraged to develop national food policies, and the ministries of agriculture, health, education, and social welfare should be encouraged to play a role in combating chronic malnutrition. The protein deficit crisis in developing countries can be averted by 1) increasing the production of animal proteins, fish and marine resources, and food crops, especially protein-rich crops; 2) expanding research programs to improve the protein quality of cereals, to increase the yield of forage crops, and to develop new protein sources; 3) reducing the unnecessary loss of food by improving storage, transport, and processing procedures; 4) promoting the use of formulated protein foods and educating the public about protein production and consumption; 5) developing programs to improve the protein intake of the most disadvantaged segments of the population and to reduce the incidence of infectious diseases which prevent the full utilization of protein by the body; and 6) promoting training in agriculture, food science, and nutrition. A reduction in population growth and an increase in economic growth would also contribute toward a decline in chronic malnutrition.
Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.
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)