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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.
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.
PLANNED PARENTHOOD IN EUROPE: REGIONAL INFORMATION BULLETIN. 1986 Autumn; 15(2):3-13.This paper, prepared for European planned parenthood associations, reviews the range of political and ethical reactions to new reproductive technologies. Planned parenthood federations are committed to ensure that women and human living material are protected both from unethical scientific manipulation and exploitation for profit and that candidates for infertility treatment are given appropriate counseling. Within these limits, research into the causes and treatment of infertility has been encouraged. On the other hand, so-called pro-life forces challenge research in this area on the grounds that the sanctity of human life may be violated. A more recent development has been the emergence of feminist opposition to reproductive research on the grounds that it threatens to lead to the expropriation of women as childbearers. The potential removal of reproduction from people is viewed as a further devaluation of women's status and concern is voiced that pre-embryo screening may take the form of benign eugenics. Feminists further argue that in vitro fertilization services are disproportionately available to white, middle-class women. Finally, it is feared that the incorporation of sex preselection into the population programs of Third World countries will become possible as a logical extension of current importation to developing countries of chemical contraceptives (eg Depo-Provera) regarded as unsuitable for use in the US. In the face of such arguments, both from pro-life and feminist forces, planned parenthood federations are urged to be clear about potential uses and abuses of the new reproductive technologies.
[Record of the second meeting of the WHO Collaborating Centers on AIDS] Deuxieme reunion des centres collaborateurs de l'OMS pour le SIDA: memorandum d'une reunion de l'OMS.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1986; 64(2):221-31.Participants at the 2nd meeting of World Health Organization (WHO) collaborating centers on AIDS (acquired immune deficiency syndrome) held in Geneva in December 1985 reported on progress since the 1st meeting in September 1985 and made a number of recommendations for future action in the areas of information, education, and prevention; reference reactants and tests of anti-HTLV-III antibodies; epidemiologic evaluation; and research on vaccines and antiviral agents. It was recommended that ministries of health, education, and social services provide the public with timely and accurate information on AIDS, that physicians, nurses, and similar personnel inform the ill and the public about AIDS and its prevention, and that school age children and young people be informed about AIDS and how to avoid infection. Systems of registration of AIDS cases should be implemented in order to provide the WHO and member states with data on the international level. Standardization and availability of serologic tests is also required. Instructions for avoiding infection should be provided for health personnel and others caring for AIDS patients, for individuals providing personal services to the public, and to ensure adequate methods of disinfection. Instructions for preventing AIDS should discuss sexual and parenteral transmission as well as perinatal transmission. Specific recommendations for education and family placement for children with AIDS have already been published. Instructions should be provided for prisons and similar estabilshments. Requiring international travellers to provide certificates attesting to their AIDS-free status is not justified as a preventive measure. The significant existing demand for reference reactants including human serums with anit-HTLV-III antibodies and controls is being addressed by several institutes in different countries, but it would be premature to furnish reference reactants other than serums. The WHO collaborating centers should furnish materials for purposes of training in diagnostic techniques. Existing tests for diagnosis and confirmation should be imporved and new tests should be developed, with particular attention to simple methods appropriate for use in developing countries. It will be necessary to establish international biological standards for the HTLV-III virus, but the required specifications are not yet known. Technical cooperation and epidemiological evaluation must be planned separately, based on the different prevalence of infections and technical expertise of different countries. A clinical definition of AIDS is needed for countries lacking resources needed to apply the Centers for Disease Control/WHO definition. Surveillance methods and laboratories can be installed with WHO assistance, to help evaluate the extent of AIDS infection in different countries. Later technical cooperation in the areas of continued surveillance and laboratory capacities will depend on results of the initial evaluation in each country. Research is currently underway in several countries of possible vaccines and drugs. Careful preclinical studies should be done to evaluate the toxicity of an agent before clinical studies are conducted. Convenient animal models should be sought for future research. 3 annexes to this report specify methods of disinfection; general principles of preventing transmission of the AIDS virus through parenteral exposure or following donation of organs, sperm, or other tissue; and a proposed definition of clinical cases of AIDS.
Journal of the National Medical Association. 1985 Dec; 77(12):963-5.The goal of "Health for All by the Year 2000," adopted by the World Health Organization, will be pure rhetoric if all sectors involved are not sensitized to the problem of famine in many countries in Africa and other 3rd world nations. The medical profession should be made aware of this goal, both on national and international fronts. The case of Ethiopia is discussed as a valid example of a "diseased third world," focusing on the famine, other medical problems, and the health system. The last emperor of Ethiopia, Haile Selassie, was swept away by the 1974 revolution. The major cause of his downfall was the 1973 famine, which the emperor wanted to conceal from the outside world. A military government took over, espousing Marxist ideology and aligning itself with the Soviet Union. Famine has been endemic for decades; the last famine in 1973 claimed over 300,000 lives. The country never totally recovered from the effects of that drought, and as early as 1981-82, major relife organizations were warned of another looming crisis. Some of the causes of the current crisis include the absence of rain for 3 consecutive years that paralyzed agriculture, poor and primitive farming practices, and deforestation. It is estimated that the land area covered by forest has dropped from 16 to 3.1% over the last 20 years. This has adversely affected the moisture-retentive capacity of the soil. Other man-made contributory factors are the civil war, the resulting dislocation of the population, and administrative mismanagement. 10 million people now face starvation; 300,000 have already died, and 1000 per day continue to die. The attention of the international community is justifiably focused on the immediate task of providing food. Yet, the full medical aspect of the famine and its consequences have not been adequately handled. Assuming that international aid will effectively prevent further loss of life, the survivors will face a host of health problems, epidemics in particular. Most of the feeding camps and various refugee centers are overcrowded; elementary sanitary facilities are lacking. There is a critical shortage of vaccines and other medical supplies. The vast majority of the Ethiopian population suffers from various preventable communicable diseases. The leading 10 causes of morbidity diagnosed in 1976 were venereal diseases, helminthiasis, bacillary and amebic dysentery, gastroenteritis, leprosy, malaria, tuberculosis, schistosomiasis, trachoma, and influenza. WHO reports that health expenditures represent only 5.7% of the total budget and that only 20% of the population are vaccinated against smallpox, yellow fever, DPT (diptheria, pertussis, tetanus), measles, tuberculosis, and polio.
Targets for health for all. Targets in support of the European regional strategy for health for all.
Copenhagen, Denmark, WHO, Regional Office of Europe, 1985. x, 201 p.This book sets out the fundamental requirements for people to be healthy, to define the improvements in health that can be realized by the year 2000 for the peoples of the European Region of the World Health Organization (WHO), and to propose action to secure those improvements. Its purposes are as follows: propose improvements in the health of the people in order to achieve health for all by the year 2000; indicate where action is called for, the extent of the collective effort required, and the lines along which it should be directed; provide a tool for countries and the Region to Monitor progress toward the goal and revise their course of action if necessary. The targets proposed are intended to indicate the improvements that could be expected if all the will, knowledge, resources, and technology already available were pooled in the pursuit of a common goal. The target levels set are based on historical trends in the fields concerned, their expected future evolution, and the knowledge available on the probable effects of intervention. These levels are intended to inspire and motivate Member States when they are determining their own priorities, targets, and capabilities and thus the degree to which they can contribute to reaching the regional targets. The base year for all the targets in 1980. The year 2000 is the completion data retained for all targets related to health improvements. Targets related to lifestyles, the environment and care respectively have 1990 or 1995 as their date of completion unless specific problems justify the allocation of a later year. Targets embodying measures to bring about the changes in research and health development support should be reached before 1990. The aim is to give people a positive sense of health so that they can make full use of their physical, mental, and emotional capacities. A well informed, well motivated, and actively participating community is a key element to the attainment of the common goal. The focus of the health care system should be on primary health care -- meeting the basic health needs of each community through services provided as close as possible to where people live and work, readily accessible and acceptable to all, and based on full community participation. Health problems transcend national frontiers.
New York, United Nations, 1984. 108 p. (Population Studies, No. 85; ST/ESA/SER.A/85)The 3 parts of this report on world, regional, and international developments in the field of population, present a summary of levels, trends, and prospects in mortality, fertility, nuptiality, international migration, population growth, age structure, and urbanization; consider some important issues in the interrelationships between economic, social, and demographic variables, with special emphasis on the problems of food supply and employment; and deal with the policies and perceptions of governments on population matters. The 1st part of the report is based primarily on data compiled by the UN Population Division. The 2nd part is based on information provided by the Food and Agriculture Organization of the UN (FAO) and the International Labor Organization (ILO), as well as that compiled by the Population Division. The final part is based on information in the policy data bank maintained by the Population Division, including responses to the UN Fourth Population Inquiry among Governments. In 1975-80 the expectation of life at birth for the world was estimated at 57.2 years for both sexes combined. The corresponding figure for the developed and developing regions was 71.9 and 54.7 years, respectively. In 1975-80 the birthrate of the world was estimated at 28.9/1000 population and the gross reproduction rate was 1.91. These figures reflect considerable decline from the levels attained 25 years earlier: a crude birthrate of 38/1000 population and a gross reproduction rate of 2.44. World population grew from 2504 million in 1950 to 4453 million in 1983. Of the additional 1949 million people, 1645 million, or 84%, accrued to the less developed countries. The impact of population growth on economic development and social progress is not well understood. The governments of some developing countries still officially welcome a rapid rate of population growth. Many other governments see cause for concern in the need for the large increases in social expenditure, particularly for health and education, that accompany a young and growing population. Planners are concerned that the rapidly growing supply of labor, compounded by a trend toward rapid urbanization, may exceed that which the job market is likely to absorb. In the developed regions the prospect of a declining, or an aging, population is also cause for apprehension. There is a dearth of knowledge as to the impact of policies for altering the consequences of these trends. Many policies have been tried, in both developed and developing countries, to influence population growth and distribution, but the consequences of such policies have been difficult to assess. Frequently this problem arises because their primary objectives are not demographic in character.
Global distribution of schistosomiasis: CEGET/WHO Atlas. Distribution Mondiale de la schistosomiase: Atlas CEGET/OMS.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(2):186-99.Schistosomiasis, the most prevalent of the water-borne diseases, is endemic in 74 tropical developing countries and infects over 200 million persons in rural and agricultural areas. However, recent advances in diagnostic techniques, new antischistosomal drugs, and accumulated understanding of the epidemiology of the infection offer improved prospects for schistosomiasis control. Morever, adaptation of quantotative parasitologic techniques for the diagnosis of schistosomiasis will make more data available for use in national control programs. The World Health Organization (WHO) has been instrumental in providing reliable reference material on the geographic distribution of schistosomiasis and, on the basis of a survey of Member States, collaborated with Centre d'etudes de geographic tropicale (CEGET), in the development of an Atlas. This volume consists of topographic relief maps that identify the presence of absence of schistosomiasis by village or locality. There are wide variations in the prevalence, intensity of infection, ans species of parasite according to ecologic differences, snail intermediate hosts, and occupational and cultural norms. The Atlas also highlights the relationship of water resource development projects to schistosomiasis endemicity. Attention to such data may lead to the selection of project areas known not to be endemic. More sophisticated geographic analyses based on land form, soil and geologic characteristics, ground water level, and agricultural land use have been used predictively in Japan. The Atlas is expected to serve as a reference point to evaluate the global progress in schistosomiasis control.