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  1. 1
    Peer Reviewed

    Report of Working Group 1: Promoting the fortification of appropriate foods.

    Matji J

    Food and Nutrition Bulletin. 2001; 22(4):466-.

    Fortification of appropriate foods is an important component of a comprehensive food-based approach toward sustainable control of micronutrient malnutrition, particularly vitamin A deficiency disorders. There are several aspects to be considered and issues to be resolved before investing in food fortification. Key issues discussed by participants included the following: Need for food-consumption survey data to identify micronutrient problems, target groups for interventions, and appropriate food vehicle(s) that could be fortified, including staple foods, complementary foods, and post-weaning foods; Importance of evaluating risks of fortification versus doing nothing and communicating information to policy makers and the scientific community. (excerpt)
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  2. 2

    A strategy for reducing numbers? Response.

    Jolly R

    HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):28.

    UNICEF advocates the reduction of infant/child mortality because it feels that such an action will reduce both fertility and human suffering. It was feared in the beginning, and today as well, that increasing the survival rate for children would cause rapid population growth. However, there is a large body of evidence to the contrary. When such measures are combined with measures to promote and support family planning there are even greater reductions in fertility levels. This is why such organizations as UNFPA, WHO, and UNICEF have advocated this course of action. This strategy is also present in the Declaration of the World Summit for Children. Anyone advocating the reduction in support for programs designed to enhance child survival as a method of population control is confusing the issues, misdirecting environmental attention, and stirring up the debate about international mortality. The evidence clearly shows that family planning without family health, including child health, is much less successful. Further, child mortality, even at high levels does little to slow population growth while such death and suffering greatly burden women and families. While rapid population growth and high population densities in developing countries present serious problems, both are much less important than the high levels of consumption in developed nations. Each child in the industrialized world will, at present levels of consumption, be expected to consume 30 to 100 times more than a child born in the poorest nations. Such suggestions in a time of instant global communication only attempt to set back international morality and tempt those in the international intellectual community to embrace ideas similar to the eugenic principles that led to the holocaust.
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  3. 3

    Public health and the ethics of sustainability. Swellengrebel Lecture.

    King M

    TROPICAL AND GEOGRAPHICAL MEDICINE. 1990 Jul; 42(3):197-206.

    An exposition of the ethical arguments for placing sustainability as a priority in implementation of public health programs is made, considering the definition of sustainability, theories of the demographic transition, the ecological transition, the relationship between sustainability of the ecosystem and the human birth rate, types of ethical conflicts over the issue of child survival interventions, a suggested way of resolving the dilemma and a possible paradigm shift constituting a scientific revolution in the field of international health. Sustainability means maintenance of the capacity to support life in quantity and variety. Although most demographers are familiar with Notestein's classic definition of the demographic transition, many are unaware of the likelihood that many countries will become entrapped in stage 2, to the extent that they destroy their ecosystem and thus their population, the "demographic trap." The 3 stages of the ecological transition are 1) expanding human demands with sustainable yield; 2) excess human demands with consumption of biological reserves; 3) ecosystem collapse and death or exit of the human population. An early sign of the 3rd phase is a rise in infant mortality. Sustainability can be increased by adjusting the environment or by lowering human birth rate, with Chinese rigor in need be, or by adding sustainable elements to the system that outweigh de-sustaining ones. Unfortunately there are too many unremovable constraints, and not enough time to wait for socioeconomic gains to lower birth rates. The current attempt by UNICEF to lower the child death rate to effect a demographic transition is attractive but unsound, since it has been proven that numbers of child deaths do not affect family fertility sufficiently. Reducing child deaths will only make population pressure worse. Ethical principles arguing for lowering child deaths have been articulated in Western culture, but now the challenge of sustainability may outweigh them all. It may be possible to apply sustaining measures to countries where possible, but for others, it is argued that child survival measures should not be instituted. These would only make the demographic transition impossible and prolong human misery for larger numbers. For these societies, only the kind of care Mother Teresa gives is appropriate. Finally, residents of developed countries must assume a "deep green" behavior code, a sustainable consumption level. WHO's definition of health should be updated to "Health is a sustainable state of complete...well-being."
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