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[Hunger and disease in less developed countries and en route to development (the Third World). Proposal for solutions] Hambre y enfermedades en los paises menos adelantados y en vias de desarrollo (Tercer Mundo). Propuesta de soluciones.
Anales de la Real Academia Nacional de Medicina. 1984; 101(1):39-96.The extent, causes, and possible solutions to problems of hunger, inequality, and disease in developing countries are discussed in this essay. Various frameworks and indicators have been proposed for identifying the poorest of nations; currently, 21 African, 9 Asian, and 1 American nation are regarded as the poorest of the poor. The 31 least developed countries, the 89 developing countries, and the 37 developed countries respectively have populations of 283 million, 3 billion; infant mortality rates of 160, 94, and 19/1000 live births; life expectancies of 45, 60, and 72 years; literacy rates of 28, 55, and 98%; per capita gross national products of $170, and $520, and $6230; and per capita public health expenditures of $1.70, $6.50, and $244. Developing countries in the year 2000 are expected to have 4.87 billion of the world's 6.2 billion inhabitants. The 3rd world contains 70% of the world's population but receives only 17% of world income. 40 million persons die of hunger or its consequences each year. Economic and social development is the only solution to problems of poverty and underdevelopment, and will require mobilization of all present and future human and material resources to achieve maximum possible wellbeing for each human being. Among principal causes of underdevelopment in the 3rd World are drought, illness, exile, socioeconomic disorder, war, and arms expenditures. Current food production and a long list of possible new technologies would be adequate to feed the world's population, but poor distribution condemns the world's people to hunger. Numerous UN agencies, organizations, and programs are dedicated to solving the problems of hunger, underdevelopment, and disease. In 1982, 600 billion dollars were spent in armanents, of $112 for each of the world's inhabitants; diversion of these resources to development goals would go a long way toward solving the problem of underdevelopment. The main problem is not lack of resources, but the need to establish a new and more just economic and distributive order along with genuine solidarity in the struggle against underdevelopment. Several steps should be taken: agricultural production should be increased with the full participation of the developng nations; the industrialized or petroleum-producing nations should aid the poor states with at least .7% and up to 5% of their gross national products for the struggle against drought, disease, illiteracy, and for the green revolution and new agropastoral technologies; prices paid to poor countries for raw materials should be fair; responsible parenthood, education, women's rights, clean drinking water, environmental sanitation and primary health care should be promoted; the arms race should be halted, and the North-South dialogue should be pursued in a spirit of goodwill and cooperation.
Welfare indicators and health: the selection and use of socioeconomic indicators for monitoring and evaluation.
Bulletin of the Pan American Health Organization. 1984; 18(1):69-80.PAHO's plan of action for attaining the goal of health for all by 2000 calls for evaluating improvements in well-being--partly because health is included within the general framework of well-being and partly because nonhealth factors conditioning health status should be used to assess and explain health levels. Accordingly, the plan sets forth 8 indicators that, together with other appropriate indicators, can be used for such evaluations. These 8 indicators include demographic information (population classified according to age, sex, geographic distribution, and socioeconomic status); general fertility; illiteracy; unemployment; poverty; availability of calories and proteins; per capita gross domestic product and the structure of gross national product; and the proportion of the population living in marginal conditions. The purpose of this article is to examine each of these indicators, assess its value, and suggest how the data relating to it should be organized and broken down. Among other things, the author stresses the need to obtain demographic data of a socioeconomic nature; the importance of breaking down the information obtained in terms of population subgroups--by age, sex, geographic location, and socioeconomic status; and the need to go beyond average values, which tell little about overall welfare problems, so as to develop values for appropriate subgroups, which can indicate quite a lot. Other points noted include the need to group fertility data according to the mother's age and number of children; the ability of data on malnutrition to serve as an indicator of available calories and proteins; the possibility of equating 2 indicators (extreme poverty and marginal living conditions); the need to supplement data on unemployment rates with information about the duration of unemployment and the extent of underemployment; and the marginal utility of per capita gross domestic (or national) product information for the purpose of assessing deficiencies in public welfare. The piece also makes various points relating to research on the connections between health and nonhealth components of well-being. Specifically, it notes that socioeconomic information unrelated to health should not be reported by the health sector; that the mandatory socioeconomic indicators listed are sufficient for purposes envisaged; that any indicators added to those on the plan's list should bear a close relationship to health; that any research undertaken should be micro rather than macro in nature; that such research requires high quality statistical work; and that the value of this research for health policies will depend largely on how the results are presented to and interpreted by policymakers. (author's modified)