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Global biodiversity strategy. Guidelines for action to save, study, and use Earth's biotic wealth sustainably and equitably.
Washington, D.C., WRI, 1992. vi, 244 p.Humanity depends on all other forms of life on Earth and its nonliving components including the atmosphere, ocean, bodies of freshwater, rocks, and soils. If humanity is to persist and to develop so that everyone enjoys the most basic of human rights, it must protect the structure, functions, and diversity of the world's natural systems. The World Resources Institute, the World Conservation Union, and the UN Environment Programme have joined together to prepare this strategy for global biodiversity. The first 2 chapters cover the nature and value of biodiversity and losses of biodiversity and their causes. The 3rd chapter presents the strategy for biodiversity conservation which includes the goal of such conservation and its contents and catalysts and 5 actions needed to establish biodiversity conservation. Establishment of a national policy framework for biodiversity conservation is the topic of the 4th chapter. It discusses 3 objectives with various actions to accomplish each objective. Integration of biodiversity conservation into international economic policy is 1 of the 3 objectives of the 5th chapter--creating an international policy environment that supports national biodiversity conservation. Correct imbalances in the control of land and resources is a clear objective in creating conditions and incentives for local biodiversity conservation--the topic of the 6th chapter. The next 3 chapters are devoted to managing biodiversity throughout the human environment; strengthening protected areas; and conserving species, populations, and genetic diversity. The last chapter provides specific actions to improve human capacity to conserve biodiversity including promotion of basic and applied research and assist institutions to disseminate biodiversity information.
In: The global possible: resources, development, and the new century, edited by Robert Repetto. New Haven, Connecticut, Yale University Press, 1985. 491-519. (World Resources Institute Book)Participants at the Global Possible Conference in 1984 concluded that, despite the dismal predictions about the earth, we can still fashion a more secure, prosperous, and sustainable world environmentally and economically. The tools to bring about such a world already exist. The international community and nations must implement new policies, however. Government, science, business, and concerned groups must reach new levels of cooperation. Developed and developing countries must form new partnerships to implement sustained improvements in living standards of the world's poor. Peaceful cooperation is needed to eliminate the threat of nuclear war--the greatest threat to life and the environment. Conference working groups prepared an agenda for action which, even though it is organized along sectoral disciplines, illustrates the complex linkages that unite issues in 1 area with those in several others. For example, problems existing in forests tie in with biological diversity, energy and fuelwood, and management of agricultural lands and watersheds. The agenda emphasizes policies and initiatives that synergistically influence serious problems in several sectors. It also tries to not present solutions that generate as many problems as it tries to solve. The 1st section of the agenda covers population, poverty, and development issues. it provides recommendations for developing and developed countries. It discusses urbanization and issues facing cities. The 3rd section embodies freshwater issues and has 1 list of recommendations for all sectors. The agenda addresses biological diversity, tropical forests, agricultural land, living marine resources, energy, and nonfuel minerals in their own separate sections. It discusses international assistance and the environment in 1 section. Another section highlights the need to assess conditions, trends, and capabilities. The last section comprises business, science, an citizens.
Oxford, England, Oxford University Press, 1987. xv, 400 p.In this report, the World Commission on Environment and Development does not predict ever increasing environmental decay, poverty, and hardship in a world becoming more polluted and experiencing decreasing resources but sees instead the possibility for a new era of economic growth. This era of economic growth must be based on policies that sustain and expand the environmental resource base. Such growth is absolutely essential to relieving the great poverty that is intensifying in much of the developing world. The report suggests a pathway by which the peoples of the world can enlarge their spheres of cooperation. The Commission has focused its attention in the areas of population, food security, the loss of species and genetic resources, and human settlements, recognizing that all are connected and cannot be treated in isolation from each other. 2 conditions must be satisfied before international economic exchanges can become beneficial for all involved: the sustainability of ecosystems on which the global economy depends must be guaranteed; and the economic partners must be satisfied that the basis of exchange is equitable. Neither condition is met for many developing nations. Efforts to maintain social and ecological stability through old approaches to development and environmental protection will increase stability. The Commission has identified several actions that must be undertaken to reduce risks to survival and to put future development on sustainable paths. Such a reorientation on a continuing basis is beyond the reach of present decision making structures and institutional arrangements, both national and international. The Commission has taken care to base its recommendations on the realities of present institutions, on what can and must be accomplished now; yet to keep options open for future generations, the present generation must begin to act now and to act together. The Commission's proposals for institutional and legal change at the national, regional, and international levels are embodied in 6 priority areas: getting at the sources; dealing with the effects; assessing global risks; making informed choices; providing the legal means; and investing in the future.
Plan of action for the eradication of harmful traditional practices affecting the health of women and children in Africa.
[Unpublished] 1987. 14 p.The traditional and harmful practices such as early marriage and pregnancy, female circumcision, nutritional taboos, inadequate child spacing, and unprotected delivery continue to be the reality for women in many African nations. These harmful traditional practices frequently result in permanent physical, psychological, and emotional changes for women, at times even death, yet little progress has been realized in abolishing these practices. At the Regional Seminar of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Africa, held in Ethiopia during April 1987, guidelines were drawn by which national governments and local bodies along with international and regional organizations might take action to protect women from these unnecessary hazardous traditional practices. These guidelines constitute this "Plan of Action for the Eradication of Harmful Traditional Practices Affecting the Health of Women and Children in Africa." The plan should be implemented within a decade. These guidelines include both shortterm and longterm strategies. Actions to be taken in terms of the organizational machinery are outlined, covering both the national and regional levels and including special support and the use of the mass media. Guidelines are included for action to be taken in regard to childhood marriage and early pregnancy. These cover the areas of education -- both formal and nonformal -- measures to improve socioeconomic status and health, and enacting laws against childhood marriage and rape. In the area of female circumcision, the short term goal is to create awareness of the adverse medical, psychological, social and economic implications of female circumcision. The time frame for this goal is 24 months. The longterm goal is to eradicate female circumcision by 2000 and to restore dignity and respect to women and to raise their status in society. Also outlined are actions to be taken in terms of food prohibitions which affect mostly women and children, child spacing and delivery practices, and legislative and administrative measures. Women in the African region have a critical role to play both in the development of their countries and in the solution of problems arising from the practice of harmful traditions.
Washington, D.C., Pan American Health Organization, 1985. 172 p. (PAHO Scientific Publication 492.)At present, aging is the most salient change affecting global population structure, mainly due to a marked decline in fertility rates. The Pan American Health Organization Secretariat organized a Briefing on Health Care for the Elderly in October 1984. Its purpose was to enable planners and decision-makers from health and planning ministries to exchange information on their health care programs for the elderly. This volume publishes some of the most relevant papers delivered at that meeting. The papers are organized into the following sections: 1) the present situation, 2) services for the elderly, 3) psychosocial and economic implications of aging, 4) training issues, 5) research and planning issues, and 6) governmental and nongovernmental policies and programs.
[Family health selected list of publications] Sante de la famille liste de publications selectionnees.
Geneva, Switzerland, World Health Organization, Division of Family Health, 1985. 15 p. (FHE/85.3.)This list of 1978-1984 publications and documents of the World Health Organization (WHO) covers subjects that have been given priority on the regional and global levels relating to family health. The sections are divided into 1) Family Health, 2) Maternal and Child Health, 3) Maternal and Child Care, 4) Infant and Young Child Nutrition, 5) Nutrition, and 6) Health Education. Publications listed with a price, and back numbers of periodicals, are for sale and can be obtained through a bookseller, from any of the stocklists shown at the end of this document, or directly from the WHO distribution and sales office.
Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
Health and health services in Judaea, Samaria and Gaza 1983-1984: a report by the Ministry of Health of Israel to the Thirty-Seventh world Health Assembly, Geneva, May 1984.
Jerusalem, Israel, Ministry of Health, 1984 Mar. 195 p.Health conditions and health services in Judea, Samaria, and Gaza during the 1967-83 period are discussed. Health-related activities and changes in the social and economic environment are assessed and their impact on health is evaluated. Specific activities performed during the current year are outlined. The following are specific facets of the health care system that are the focus of many current projects in these districts; the development of a comprehensive network of primary care programs and centers for preventive and curative services has been given high priority and is continuing; renovation and expansion of hospital facilities, along with improved staffing, equipment, and supplies for basic and specialty health services increase local capabilities for increasingly sophisticated health care, and consequently there is a decreasing need to send patients requiring specialized care to supraregional referral hospitals, except for highly specialized services; inadequacies in the preexisting reporting system have necessitated a continuting process of development for the gathering and publication of general and specific statistical and demographic data; stress has been placed on provision of safe drinking water, development of sewage and solid waste collection and disposal systems, as well as food control and other environmental sanitation activities; major progress has been made in the establishment of a funding system that elicits the participation and financial support of the health care consumer through volunary health insurance, covering large proportions of the population in the few years since its inception; the continuing building room in residential housing along with the continuous development of essential community sanitation infrastructure services are important factors in improved living and health conditions for the people; and the health system's growth must continue to be accompanied by planning, evaluation, and research atall levels. Specific topics covered include: demography and vital statistics; socioeconomic conditions; morbidity and mortality; hospital services; maternal and child health; nutrition; health education; expanded program immunization; environmental health; mental health; problems of special groups; health insurance; community and voluntary agency participation; international agencies; manpower and training; and planning and evaluation. Over the past 17 years, Judea, Samaria, and Gaza have been areas of rapid population growth and atthe same time of rapid socioeconomic development. In addition there have been basic changes in the social and health environment. As measured by socioeconomic indicators, much progress has been achieved for and by the people. As measured by health status evaluation indicators, the people benefit from an incresing quantity and quality of primary care and specialty services. The expansion of the public health infrastructure, combined with growing access to and utilization of personal preventive services, has been a key contributor to this process.
The role of food safety in health and development. Report of a Joint FAO-WHO Expert Committee on Food Safety.
World Health Organization Technical Report Series. 1984; (705):1-79.This document presents the recommendations of a Joint Food and Agriculture Organization (FAO)-World Health Organization (WHO) Expert Committe on Food Safety. Illness due to contaminated food is perhaps the most widespread health problem in the world and a major cause of reduced economic productivity. The safety of food is affected by food systems, sociocultural factors, food chain technology, ecologic factors, nturitional aspects, and epidemiology. It was the assumption of the Committee that, if food safety is given sufficient priority within national planning, countries can prevent and control foodborne disease, especially pathogen-induced diarrheal syndromes, and interrupt the vicious cycle of diarrhea-malnutrition-disease. Attainment of this objective requires a national commitment and the collaboration of all ministries and agencies concerned with health, agriculture, finance, planning, and commerce as well as the food industry, the biamedical and agricultural scientific community, and the consuming public. Prevention and control interventions should aim to avoid or minimize contamination, to destroy or denature the contaminant, and to prevent the further spread or multiplication of the contaminant. The Committee outlined a series of recommendations for achieving a worldwide reduction in the morbidity and mortality caused by foodborne hazards. Food safety should be considered an integral part of the primary health care delivery system. Food safety should also be regarded as an integral part of the total food system. National food control infrastructures should be strengthened, and regional, national, multinational, and international surveillance of foodborne diseases should be carried out. Each country should aim to develop at least 1 laboratory capable of identifying the etiologic agents of diarrhea and other foodborne diseases. Health workers should be trained to play a role in identifying and monitoring critical control points in food production and preparation. Health education, within the context of the cultural and social values of the community, should inform the public about food safety hazards and preventive measures. Finally, the hazard analysis critical control point approach to prevention is recommended.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(2):130-61.This paper sets forth the number of malaria cases reported in 1973-82 to the World Health Organization (WHO) by region. Excluding Africa, the total number of cases rose from 3.9 million in 1973 to a high of 10.7 million in 1977 and declined to 6.5 million in 1982. It is noted, however, that reporting during this period was often deficient and uneven. The prevalence of malaria has remained relatively unchanged in Africa south of the Sahara, with the exception of urban centers where transmission has been considerably reduced. In the Americas, the number of cases reported has risen steadily since 1973. South East Asia experienced a dramatic increase in malaria cases in 1976, but intensive efforts haveresulted in a decline almost back to the 1973 level. About 28% of the world's population lives in areas where malaria never existed or disappered without specific antimalaria efforts. Another 18% lines in areas where the disease has been eliminated by improvements in health facilities, environmental changes, and specific antimalaria measures. 46%, or 2117 million people, live areas where the incidence of malaria has been reduced to varying degrees, ranging from a slight reduction of the original endemicity to the near elimination of the disease. A final 8%, or 365 million people, live in areas where no specific antimalaria measures are undertaken and the original levels of endemicity remain largely unchanged outside of certain urban centers. In addition to presenting data on malaria cases by world region, tables accompanying this article summarize malaria eradication registration, the importation of malaria cases into malaria-free countries, and the development of resistance to chloroquine.
WORLD HEALTH FORUM. 1993; 14(4):390-5.About 80% of the world's people depend largely on traditional plant-derived drugs for their primary health care (PHC). Medicinal plants serve as sources of direct therapeutic agents and raw materials for the manufacture of more complex compounds, as models for new synthetic products, and as taxonomic markers. Some essential plant-derived drugs are atropine, codeine, morphine, digitoxin/digoxin, and quinine/artemisinin. Use of indigenous medicinal plants reduces developing countries' reliance on drug imports. Costa Rica has set aside 25% of its land to preserve the forests, in part to provide plants and other materials for possible pharmaceutical and agricultural applications. The Napralert database at the University of Illinois establishes ethnomedical uses for about 9200 of 33,000 species of monocotyledons, dicotyledons, gymnosperms, lichens, pteridophytes, and bryophytes. Sales of crude plant drugs during 1985 in China equaled US$1400 million. Even though many people use medicinal plants, pharmaceutical firms in industrialized nations do not want to explore plants as sources of new drugs. Scientists in China, Germany, and Japan are doing so, however. Screening, chemical analysis, clinical trials, and regulatory measures are needed to ensure safety of herbal medicines. WHO has hosted interregional workshops to address methodologies for the selection and use of traditional medicines in national PHC programs. WHO, the International Union for the Conservation of Nature and Natural Resources, and the World Wide Fund for Nature developed guidelines for conservation of medicinal plants. Their 2-pronged strategy includes prevention of the disappearance of forests and associated species and the establishment of botanical gardens. WHO's Traditional Medicine Programme hopes that people will apply known and effective agroindustrial technologies to the cultivation and processing of medicinal plants and the production of herbal medicines and the creation of large-scale networks for the distribution of seeds and plants.
Conservation of West and Central African rainforests. Conservation de la foret dense en Afrique centrale et de l'Ouest.
Washington, D.C., World Bank, 1992. xi, 353 p. (World Bank Environment Paper No. 1)This World Bank publication is a collection of selected papers presented at the Conference on Conservation of West and Central African Rainforests in Abidjan, Ivory Coast, in November 1990. These rainforests are very important to the stability of the regional and global environment, yet human activity is destroying them at a rate of 2 million hectares/year. Causes of forest destruction are commercial logging for export, conversion of forests into farmland, cutting of forests for fuelwood, and open-access land tenure systems. Other than an introduction and conclusion, this document is divided into 8 broad topics: country strategies, agricultural nexus, natural forestry management, biodiversity and conservation, forest peoples and products, economic values, fiscal issues, and institutional and private participation issues. Countries addressed in the country strategies section include Zaire, Cameroon, Sao Tome and Principe, and Nigeria. The forest peoples and products section has the most papers: wood products and residual from forestry operations in the Congo; Kutafuta Maisha: searching for life on Zaire's Ituri forest frontier; development in the Central African rainforest: concern for forest peoples; concern for Africa's forest peoples: a touchstone of a sustainable development policy; Tropical Forestry Action Plans and indigenous people: the case of Cameroon; forest people and people in the forest: investing in local community development; and women and the forest: use and conservation of forestry resources other than wood. Topics in the economic values section range from debt-for-nature swaps to environmental labeling. Forestry taxation and forest revenue systems are discussed under fiscal issues. The conclusion discusses saving Africa's rainforests.
In: Earth summit. Conversations with architects of an ecologically sustainable future, by Steve Lerner. Bolinas, California, Commonweal, 1991. 25-38.The public debate on the environment leading to the 1992 Earth Summit in Brazil has been restricted to global climate change instead of global change. The Summit should be part of an ongoing process and not a framework convention followed by protocols. Separate conventions for biodiversity and deforestation are likely to emerge, even though one convention integrating both biodiversity and deforestation is needed. Many environmental and development issues overlap, suggesting a need for an international group to coordinate these issues. Negotiating separate conventions for the various issues is costly for developing countries. Rapid population growth contributes to environmental degradation, but no coordinated effort exists to reduce it. The US continues to not support the UN Population Fund which, along with threats of US boycotts and disapproval, curbs initiatives to reduce population. At present population and economic growth rates, an environmental disaster will likely happen in the early 2000s. Developing countries, which also contribute greatly to global warming, will not take actions if industrialized nations do not initiate reductions of greenhouse gases. Developed countries emit the most greenhouse gases, have been responsible for most past emissions, and have the means to initiate reductions. Of industrialized nations, the US stands alone in setting targets to reduce carbon dioxide. Unlike some European nations, the US does not have an energy policy. The US abandoned public transportation for the automobile while Europe has a strong public transportation system. The World Bank has improved greatly in addressing global environmental issues, but only 1% of its energy lending is for energy efficiency. The Bank knows that projects implemented by nongovernmental organizations are more successful than those implemented by governments, yet it continues to lend money to governments. Humans need to redesign existing linear systems to be like nature's circular systems in which by-products are starting products for another reaction.
[Nairobi, Kenya], United Nations Environment Programme [UNEP], 1990. , 42 p. (UNEP Regional Seas Reports and Studies No. 123)The UN Environment Programme (UNEP) ocean program is studying global marine environments to form a policy to protect the oceans. This report examines the marine environment of the Indian Ocean, Bay of Bengal, the Arabian Sea, and the Andaman Sea. Bacteria and viruses comprise the most important contaminants in the South Asia seas. They enter marine life which humans eat and then develop diarrhea. Pathogens enter the seas through untreated sewage which causes much eutrophication. Zooplankton contain considerable concentrations of heavy metals and pesticides. None of the zooplankton samples drawn from seas around India in 1978, 1981, 1983, and 1985 contained mercury, however. Yet mercury and other heavy metals are present in fish species in at least the Ganges River estuary, Andaman Sea, the Karachi harbor in Pakistan, and seas around Bangladesh. Common chlorinated pesticides found off the coast of India include DDT, aldrin, dieldrin, and BHC. Industrial development is increasing the levels of other contaminants such as solid waste and synthetic detergents. Coastal erosion is common in South Asia. Considerable siltation occurs at the head of the Bay of Bengal. Several urban areas are reclaiming the sea using materials from solid wastes and garbage, but these materials leach which causes public health problems. In India, nuclear power plants operate near the coast where they release 50% of the generated heat to the coastal environment. Dredge materials from harbors in India are dumped offshore which resulted in almost complete depletion of fisheries near these harbors. Tourism poses a threat to coastal environments due to the increase in nonbiodegradable solid waste such as cans, plastics, and empty bottles. Oil tanker disasters, bilge washings, and discharge of ballast water contribute to the sizable amount of oil pollution in the Indian ocean. Exploitation damages coral reefs, mineral deposits, mangroves, and marine life.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 13 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The World Health Organization's (WHO's) Control of Diarrheal Diseases Program (CDD) is seeking ways to prevent diarrhea and has identified breastfeeding as an important factor. CDD has developed activities in both its research and services components. In the research component, results from recent studies, some of which received support from the program, have shown the strong protective effect of breastfeeding against diarrheal morbidity and mortality. Exclusively breastfed infants are at lower risk of experiencing diarrhea than infants who are partially breastfed, and those who are partially breastfed are at lower risk than those who are not breastfed. Breastfeeding, which also may reduce the severity of the diarrheal illness, has a powerful effect on the risk of diarrhea-associated death. CDD's priorities for research support in the area of infant feeding were reviewed at an April 1988 meeting. Further research that the program feels is needed falls into 2 broad categories: trials of hospital and community-based interventions that aim to promote exclusive breastfeeding in the 1st 4-6 months of life; and evaluation of approaches for implementing tested breastfeeding promotion interventions in the context of national diarrheal disease control programs. CDD's services component has as its basic responsibility collaboration with countries in developing national control programs. It applies the results of research and involves activities in planning, oral rehydration solution (ORS) supply, training, communication, monitoring, and evaluation. It is in the area of training that specific recommendations on breastfeeding have been made. These recommendations are outlined. The training courses are being used to train approximately 5000 supervisory and management staff a year. The program plans to monitor the effectiveness of the training and develop future activities based on that information.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988].  p.. (USAID Contract No. DPE-3040-A-00-5064-00)In 1986 the European Regional World Health Organization (WHO) Office convened a meeting of health workers' organizations to develop a strategy for implementing breastfeeding promotion. The elements in this strategy are outlined along with the reasons why some countries have seen increases in breastfeeding and a discussion of the possible ways international organizations can help. The "International Code of Marketing of Breast-Milk Substitutes" constitutes the clearest mandate for an "action program" in the field of breastfeeding. It provides a framework for action and for the formulation of a breastfeeding promotion strategy. Further, the "Code" identifies the obligations of both governments and health workers. According to the Resolution recommending the "Code," one of the obligations of governments is to report regularly to WHO on the progress in 5 areas of infant nutrition: encouragement and support of breastfeeding; promotion and support of appropriate weaning practices; strengthening of education, training, and information; promotion of health and social status of women in relation to infant and young child feeding; and appropriate marketing and distribution of breast milk substitutes. The WHO member states in the European Region have taken their reporting obligation seriously; 71 reports from 29 of the 32 members states have been received. The picture that emerges is one of large diversity with regard to breastfeeding both among and within countries. The European Strategy outlines 7 priority areas for action: the basic attitude of health workers; maternity ward routines; the formation of breastfeeding mothers' support groups; ways to support employed mothers who want to breastfeed; research in breastfeeding; commercial pressure on health workers; and the need for advocacy of breastfeeding. The promotion of breastfeeding is the cumulative effect of activities from several different disciplines that becomes evident in the statistics as an increase in breastfeeding. Factors that contribute to an increase in breastfeeding, based on the Scandinavian experience, are outlined. In regard to establishing a breastfeeding policy, the various activities that can encourage and support breastfeeding fall into 3 categories: making breast milk available to the baby by influencing the material conditions of breastfeeding; increasing knowledge either about human milk or about lactation management as well as about changing attitudes and behavior; and assuring the quality of the milk itself. Ideally, an organization with an advisory and to some degree an executive, decision-making function coordinates these activities.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)Breastfeeding is on the decline in most countries, despite the fact it can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. The World Health Organization (WHO) and the UN International Children's Emergency Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding. In the most developed countries, breastfeeding has increased despite generally unsupportive hospital environments, the availability of clean water, and the fact that breastfeeding was virtually a lost practice in these countries 40 years ago. An increased awareness of the benefits, some of which are outlined, coupled with mother-to-mother support are most likely to have influenced this increase. The guidelines developed by WHO/UNICEF seek to put into practice specific recommendations agreed upon by pediatricians, obstetricians and gynecologists, nutritionists, nurses, midwives, and other health care providers in national and international forums. The main points of the guidelines are as follows: every facility providing maternity services should develop a policy on breastfeeding, communicate it to all staff, define specific practices to implement the policy, and ensure that all staff are adequately trained in the skills necessary to ensure implementation of the policy; facilities for 24-hour rooming-in, initiation of breastfeeding immediately after delivery, and demand-feeding are essential in every maternity ward; every pregnant mother should be informed fully about how breast milk is formed, the proper way to nurse a child, and the benefits of breastfeeding; and harmful practices, such as the use of bottles and teats for newborn infants, should be eliminated during this early period and exclusive breastfeeding maintained for at least 4-6 months from birth. These activities, when fully implemented, will ensure that every mother/infant couple reached prenatally, at birth, and postnatally gets off to a good start. Then, other support services will be more effective. These standards have been successful in the field and have had a positive impact on the rates of breastfeeding. A need exists for collaboration and an interdisciplinary approach to the promotion, protection, and support of breastfeeding, and, hopefully, this workshop is the first of a series of technical consultations.
Technical Working Group D report: government and donor support for breastfeeding in health and health-related programs.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 3 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The focus of the working group was to design a general strategy for government and donor support for breastfeeding promotion in health-related and other nonmaternity health programs. As a start, it is important to examine the reasons why government and donor agencies accept or reject programs to support. 3 steps must be followed for governments to accept breastfeeding: statistics showing declines in breastfeeding within the country need to be gathered; the benefits to the country of promoting breastfeeding would have to be demonstrated; and the link between increased breastfeeding and the decrease in child morbidity and mortality also would have to be demonstrated along with the fact that breastfeeding promotion programs can be done. Both economic arguments and data are necessary. For donor agencies to accept and promote breastfeeding enthusiastically, the benefits of breastfeeding should be shown to be synergistic with benefits from other donor priorities. 2 particular gaps in breastfeeding promotion that would be likely to garner donor support are training and communications. Regional centers for breastfeeding information, advanced training, even newsletter publication would be invaluable. Further, donor agencies could support projects like a review of textbooks and the effective distribution of donor publications.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The US Agency for International Development (USAID) and the Institute for International Studies in Natural Family Planning are at work to find ways to remove barriers to family planning breastfeeding promotion efforts. Barriers include lack of or conflicting measures of program success along with lack of information on the breastfeeding/fertility relationship. The 2 organizations have taken the following steps to assist family planning organizations to increase their promotion and support of breastfeeding: identify current activities and potential barriers to breastfeeding promotion; develop guidelines for breastfeeding support and promotion; assess feasibility and impact of the guidelines; and disseminate the guidelines. Much remains to be done to integrate family planning and breastfeeding. The keys to success are: generating and communicating information which can be used readily by both the population and health policymakers in family planning programs; developing and disseminating guidelines and prototype materials which can be adapted to program needs; identifying, implementing, and evaluating programmatic ways to promote breastfeeding in community and clinical settings; and involving the population community -- at the local, national, and international levels, and in research, service delivery, policy, and training -- in an ongoing dialogue about the relationship of family planning and breastfeeding.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E. F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 235-47.The work of the WHO in promoting, monitoring, researching, and regulating breastfeeding and infant nutrition is reviewed. WHO has always fostered infant nutrition, but took up the subject of breastfeeding in 1974 at its 27th World Health Assembly with an expression of concern for decline of the practice. Breastfeeding is a learned behavior in humans that must be supported and reinforced: secular factors are converging to decrease breastfeeding in most of the world. The 1974 assembly set up a working group to initiate research, to collect data on infant nutrition and breastfeeding practices, composition of breast milk in different socioeconomic milieu, methods of conducting controlled studies on mortality in relation to feeding, and effects of hormonal contraceptives on lactation. 3 distinct patterns of feeding were found, among the urban poor, economically advantaged, and rural mothers. A 1979 meeting concluded that monitoring of feeding practices is necessary to set up national programs Training workshops were held and instructive materials were developed. Papers presented at the meeting were published. WHO with UNICEF are promoting the health and social status of mothers, such as nutrition, maternity protection, and support of women's organizations. WHO is collaborating with the International Labor Office (ILO) to survey maternity protection in 129 countries. A final issue being addressed is the infant food industry. In 1985, the World Health Assembly reported that the International Code of Marketing, involving labeling, marketing and regulation of infant foods, has been adopted wholly or in part by 141 countries.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E.F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 86-93.The Nursing Mothers' Association was formed in Sweden in the early 1970s, and the group worked to gain access to mass media to influence attitudes through articles and interviews in which they demanded support and encouragement for breastfeeding. A large number of research reports also emerged in the 1970s, demonstrating the benefits and superiority of breastfeeding and breast milk. Further, the active support from international organizations such as WHO and UNICEF was of considerable value as was the controversy leading to the formulation of the Code of Marketing of Breast-milk Substitutes, which helped to focus the interest of the mass media on the issue. Sweden's Board of Health and Welfare appointed an expert group to propose a plan of action, and the group edited a comprehensive textbook on breastfeeding and breast milk to be used as a national guide. The Nursing Mothers' Association developed to a national organization with representatives visiting maternity units and offering to provide advice by telephone after the mother's discharge. 10 years after the rediscovery of breastfeeding there are several hundred thousand mothers with considerable breastfeeding experience. On a limited scale, Sweden has returned to earlier days when young women learned from older and more knowledgeable women. A wealth of personal experience has been gathered and is being conveyed to others in an informal person-to-person manner. Sweden's baby-food industry has adjusted well to the new situation and has accepted a considerable reduction in sales of breast milk substitutes and has complied with the Code. The dramatic increase in breastfeeding in almost all industrialized nations, including Sweden, suggests a strong movement and that breastfeeding is here to stay.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E.F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 94-100.The Department of Health and Social Security (DHSS) in the UK established a Working Party of practicing pediatricians, midwives, and health visitors in June 1973 for the purpose of reviewing the then present-day practice in infant feeding. Published in 1974, the Report added an influential and important stimulus to the return to breastfeeding in the UK. The Report acknowledged to manufacturers that due to new technology the composition of artificial milk feeds more closely resembled that of human milk but stressed that the hazards to health for babies were largely due to the dissimilarities between even modified cows' milk feeds and human milk. There also were many different infant milk products on the market, resulting in a problem of choice for the mother and her professional advisors. Due to the fact that instructions for making up a feed varied from product to product, it was understandable that mistakes were made. The Working Party was convinced that an adequate volume of breast milk meant satisfactory growth and development and recommended that all mothers be encouraged to breastfeed. Further, recommendations for the encouragement of breastfeeding covered many aspects of education. The mass media were recognized as an important educational resource which could emphasize the advantages of breastfeeding. Another group of recommendations referred to artificial milk feeds; all such feeds were to approximate in composition as nearly as possible to human milk. Other recommendations advised against the introduction of solid foods before about 4 months of age and against the addition of sugar and salt to solid foods in the infant's diet. The remaining recommendations covered further research into the principles and practice of infant feeding, a review of legislation concerning the composition of artificial infant milk foods, and the collection of national statistics about infant feeding practice. In regard to implementation, recommendations about education are being put into effect slowly and steadily. The government has endorsed fully the aim and principles of a World Health Organization Code of Marketing of Breast Milk Substitutes, which was adopted in May 1981 by an overwhelming majority at the World Health Assembly. The Code emphasizes the importance of breastfeeding. As attitudes and prejudices die hard, continued education of those in the caring professions and the public is necessary.
POPULI. 1988; 15(4):50-2.Participants in the 1988 Oslo Conference on Sustainable Development explored ways the United Nations system can promote sustainable development by enhancing global economic growth and social development. The deterioration of the environment, and the attendant problems of poverty and resource depletion, demand international cooperation and a new ethic based on equity, human solidarity, and accountability. Priority issues identified by conference participants included the following: developing human resources and fully integrated population policies; protecting the atmosphere and the global climate, ocean, and water resources; halting desertification and countering deforestation; controlling dissemination of dangerous wastes and aiming at the elimination of such toxins; increasing technology cooperation; controlling soil erosion and the loss of species; and securing economic growth, social justice, and a more equitable distribution of income and resources within and among countries as means for alleviating poverty. It was emphasized that poverty alleviation and environmental preservation can be made cost-effective components of development plans and programs and should not be considered as barriers to economic growth.
Rome, Italy, FAO, 1973. 118 p. (FAO Nutrition Meetings Report Series No. 52; WHO Technical Report Series No. 522)The present Joint Food and Agriculture Organization/World Health Organization (FAO/WHO) Ad Hoc Expert Committee met from March 22 to April 2, 1971 to consider energy and protein requirements together and to examine fully this interrelationships so that a diet or a food supply might be assessed simultaneously in terms of its energy and protein content. Its specific tasks were to: examine the characteristics and criteria of the reference man and reference woman; review new data as a basis for revising estimates of requirements and recommended intakes for energy, protein, and essential amino acids; and consider the method of chemical scoring and other methods used in the evaluation of the nutritive value of proteins. The committee was asked to examine the interrelationships between requirements for energy and proteins and to recommend means for the integration of requirement scales for energy and proteins, if that were feasible. Additionally, this committee report includes a discussion of basic concepts, a glossary of terms and units, some background information, as well as identification of practical applications and future research needs. 5 annexes contain: percentiles for weight and height of males and females aged 0-18 years; calculation of the energy values of foods or food groups by the Atwater system; conversion of nitrogen to protein; standard basal metabolic rates of individuals of both sexes; and some values of energy expenditures in everyday activities.
WORLD HEALTH. 1987 Jun; 9-11.The Council for International Organizations of Medical Sciences (CIOMS), a nongovernmental organization, arranges conferences with the World Health Organization (WHO) and UNESCO on new developments in biology and medicine to explore their social, ethical, moral, administrative, economic, and legal implications. The objective is to create international and interdisciplinary forums where the scientific and lay communities can express their views on topics of immediate concern, unhampered by administrative, political, or other considerations. The primary objectives of the Round Table Conference held in Athens in 1987 were: to identify and compare the ethical content of selected health policy issues from the perspectives of different national, cultural, and religious settings; to examine the interaction of ethical factors and other determinants of health policy in the policymaking process; to explore ways to assist countries in dealing with the interaction of ethics and health policymaking; and to evaluate the usefulness of this kind of dialogue. The conference proposed 3 approaches: an examination of the practical problems of making policy decisions; an examination of a series of case studies; and an examination of the fundamental values underlying the interaction of health policy, ethics, and human values underlying the interaction of health policy, ethics, and human values by considering the meanings which life, suffering, and death hold for a number of the world's principal religions and ideologies. WHO's principal theme for this and the next decade -- the goal of health for all by the year 2000 -- was identified as a central issue in considering health policy, ethics, and human values. Participants reviewed 5 case studies, chosen as being of interest to both developed and developing countries: the allocation of resources for primary health care; public policy and hereditary disease; care of low birth weight infants; health care of the elderly; and organ substitution therapy. The discussion highlighted some of the paradoxes in today's approaches to the problems. It was agreed that there should be continued collaborative followup of the issues discussed and that a mechanism should be established that would support regional groupings in a continued inquiry into issues of regional interest. CIOMS will serve as the organizing focal point.