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  1. 1
    Peer Reviewed

    On the determinants of mortality reductions in the developing world.

    Soares RR

    Population and Development Review. 2007; 33(2):247-287.

    The goal of this article is to examine the determinants of the improvements in life expectancy in the developing world during the period after World War II. Recent estimates suggest that longevity has been a quantitatively vital component of the overall gains in welfare during the twentieth century, both within and across countries. From a research perspective, pinning down the factors determining the observed reductions in mortality may shed light on the interactions between health, human capital, and income, and on their relative importance for economic development and social change. From a policy perspective, it may help maximize the impact of future health interventions in countries that still lag behind in health improvements. In particular, this knowledge may be fundamental in designing policies to enable sub-Saharan Africa to recover from its present circumstances. (excerpt)
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  2. 2

    World development report 1993. Investing in health.

    World Bank

    New York, New York, Oxford University Press, 1993. xii, 329 p.

    The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.
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  3. 3

    Europe's ageing population: trends and challenges to 2025.

    de Jouvenel H

    Guildford, England, Butterworths, 1989. 54 p.

    This report examines the trends of demographic ageing in Europe up to 2025. By that date one European in four could be aged 65 or over. With trends continuing towards the contraction of working life, severe imbalances may occur in individual life cycles, in the structure of the workforce, and in socioeconomic provision for an ageing population. The report further considers the potential impacts of these emerging imbalances on living conditions, consumption patterns, and socio-medical/health care provision for the old. Finally, a range of responses are outlined to the challenges of possible intergenerational conflict surrounding the nexus of issues related to demographic ageing.
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  4. 4

    An analysis of social consequences of rapid fertility decline in China.

    Liu Z; Liu L

    POPULATION RESEARCH (BEIJING). 1988 Dec; 5(4):17-30.

    Rapid fertility decline in China has brought about 2 direct effects: 1) the natural increase of the population has slowed down, and 2) the age structure has changed from the young to the adult type. These 2 effects have caused a series of economic and social consequences. Rapid fertility decline increases the gross national product per capita and accelerates the improvement of people's lives. Rapid fertility decline slows population growth and speeds up the accumulation of capital and the development of the economy. Since 1981, accumulation growth has exceeded consumption growth. Fertility decline alleviates the enrollment pressure on primary and secondary schools, raises the efficiency of education funds, and promotes the popularization of education. The family planning program strengthens the maternal and child health care and the medical care systems. As the result of economic development, the people's nutritional levels are improving. The physical quality of teenagers has improved steadily. The change in the age structure will alleviate the tension of rapid population growth and benefit population control in the next century. Fertility decline forces the traditional attitude toward childbearing from "more children, more happiness" to improved quality of children. The rapid fertility decline has caused a great deal of concern both inside and outside China about the aging of the population. The labor force, however, will continue to grow for the next 60 years. At present, China's population problems are still those of population growth.
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  5. 5

    Design of the 1986 National Mortality Followback Survey: considerations on collecting data on decedents.

    Seeman I; Poe GS; McLaughlin JK

    PUBLIC HEALTH REPORTS. 1989 Mar-Apr; 104(2):183-8.

    This is a review of the design and methodology of the U.S. National Mortality Followback Survey. The survey "was conducted by the National Center for Health Statistics on a national probability sample of adult deaths in the United States in 1986. Data were collected on (a) socioeconomic differentials in mortality, (b) prevention of premature death by inquiring into the association of risk factors and cause of death, (c) health care services provided in the last year of life, and (d) the reliability of certain items reported on the death certificate. In addition to demographic characteristics of the decedent available from the death certificate and the questionnaire, information was secured on cigarette smoking practices, alcohol use, food consumption patterns, use of hospital, nursing home, and hospice care, sources of payment for care, duration of disability, and assistance with activities of daily living." (EXCERPT)
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  6. 6

    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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  7. 7
    Peer Reviewed

    International cross-section analysis of the determination of mortality.

    Gravelle HS; Backhouse ME

    Social Science and Medicine. 1987; 25(5):427-41.

    An essential ingredient in the evaluation of policies concerning health services is knowledge of the impact of health services and other factors on the health of the population. One method for obtaining this information is from the regression analysis of international cross-section data on mortality rates, health service provision, income levels, consumption patterns, and other variables hypothesised to affect population health. The investigation of the determinants of population health is in many ways akin to the estimation of production functions which describe the relationship between the output of goods or services and the mix of inputs used in their production. The purpose of this paper is to use this analogy to discuss, and provide examples of, the problems which arise with the statistical investigation of mortality rates. Issues raised include simultaneous equation bias, multicollinearity, selection of explanatory variables, omitted variable bias, definition and measurement of variables, functional forms, lagged relationships and temporal stability. These problems are illustrated by replication and re-analysis, using new data, of the well known study by Cochrane, St. Leger and Moore. (EXCERPT)
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  8. 8

    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

    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

    The Republic of Zambia.

    Hakkert R; Wieringa R

    International Demographics. 1986 May; 5(5):1-9.

    In 1964, at independence, Zambia's economic future looked brighter than that of most other developing countries. Its copper production accounted for 8% of total world production, and only neighboring Zaire outpaced it in the production of cobalt. Its Central Province around Kabwe held rich deposits of both zinc and lead; uranium deposits also had been found, but their projected yield remained undetermined. Since 1974, the decline in the price of copper and the increase in the price of oil have played havoc with Zambia's balance of payments. Copper, which accounted for 40% of the gross national product (GNP) and 98% of all foreign exchange in 1964, shrank to 12% of the GNP in 1978 while still generating most of the foreign exchange. As a result, imports were cut back markedly from $1.5 billion in 1973 to $690 million in 1983. Although this trend is beginning to make a U-turn, Zambia's economic situation is grave. In 1984 the GNP continued to register negative growth and inflation stood at 25%. With its urbanization rate doubling from 21% in 1964 to 43% in 1985, Zambia is now the most urbanized country south of the Sahara. Zambia's 1985 population is estimated to be 6.8 million. Between 1963 and 1969, the average annual population growth rate was 2.5: it was 3.1% between 1969-80. The current birthrate of about 48/1000 is expected to decline only marginally in the next 15 years, but the death rate is declining more rapidly -- from 19/1000 in the late 1960s to 15/1000 in 1985. Life expectancy is expected to rise from the current 51 years to about 58 years. As a result of the high growth rate, Zambia's population is young, with a median age of about 16.3 years. Traditional African values stress the importance of large families. Zambia's total fertility rate was 6.9 in 1985. According to the World Bank, only 1% of married women of childbearing age in 1982 used contraceptives. Although tribal links are weakening, Zambia still counts 73 officially recognized tribes. Together, they speak about 40 different dialects. Zambia now apportions over 15% of its national budget to education. Despite some noticeable progress, the public health structure remains deficient. Principal health problems include malaria, tuberculosis, and, in Northern Province and Luapula Province, sleeping sickness and river blindness. About 2/3 of the labor force, an estimated 2.2 million persons in 1982, still work in agriculture. Female labor force participation is lower in Zambia than in many African nations.
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  11. 11

    ["Zero growth" of population and its consequences for the West] Nulevoi rost naseleniya i ego posledstviya dlya stran Zapada

    Oskolkova O

    Memo: Mirovaya Ekonomika i Mezhdunarodnye Otnosheniya. 1985; (8):41-54, 159.

    The consequences of the decline in fertility in Western Europe and Northern America are analyzed. The author first describes current demographic trends and suggests that the trend toward population decline is probably irreversible. Consideration is given to determinants of fertility such as industrialization, urbanization, women's economic activity, educational standards, health services, social security, demographic policy, and income. Factors affecting Western fertility are identified as inflation, unemployment, and spiritual impoverishment. The existence of various schools of thought in Western countries concerning the implications of these trends is noted. These include the fear of the environmental impact of further population growth and the fear of the consequences of population decline. The author concludes that a period of stable population growth will mean a decline in the available labor force, an increase in the age of the labor force, an increase in the number of pensioners, a change in the structure of demand, and other problems for capitalist societies. (summary in ENG)
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  12. 12

    [Colombia in statistics, 1985] Colombia Estadistica 85.

    Colombia. Departamento Administrativo Nacional de Estadistica [DANE]

    Bogota, Colombia, DANE, 1984 Dec. 580 p.

    This volume contains recent and earlier statistics on a variety of social and economic topics in Colombia. The work opens with a description in Spanish and English of general background on the geography, population, economy, and government and administrative structure of Colombia, followed by geographic and economic profiles of each of the country's 23 departments, 4 intendencies, and 5 commisaries. Chapter 3, on demography, provides population figures from censuses dating back to 1770; age and sex distributions from the 1951, 1964, and 1973 censuses; results of studies of the population resident in private housing; data on birth registration between 1976-82; and discussion of various aspects of the demography of Latin America. The following chapters consider educational status, illiteracy, and educational needs and facilities at the primary, secondary, and higher level; labor force participation rates by sex and geographic areas and unemployment; results of the National Food, Nutrition, and Housing Survey of 1981; health resources and services; the civil and criminal justice systems; and information on elections and returns for various elections. The remaining 14 chapters provide data on significant areas of economic activity, including agriculture and animal husbandry, manufacturing and industry, construction and housing, prices, salaries and income, public finance, national accounts, mining and energy, social organization including cooperatives and community action groups, transportation, external commerce, internal commerce, tourism, and communications.
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  13. 13

    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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  14. 14

    [Statistical yearbook for Asia and the Pacific, 1982] Annuaire statistique pour l'Asie et le Pacifique, 1982.

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

    Bangkok, Thailand, U.N. Economic and Social Commission for Asia and the Pacific, 1984. xxviii, 575 p. (ST/ESCAP/235)

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  15. 15

    [Demography and medical consumption] Demographie et consommation medicale

    Cordier A

    Revue Francaise Des Affaires Sociales. 1984 Jun; 38 Suppl:103-25.

    The relationship between demographic variables and the costs of health care in France is examined from a macroeconomic perspective. Factors discussed include age and sex structure and family size. (ANNOTATION)
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  16. 16

    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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