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Mortality and health policy: highlights of the issues in the context of the World Population Plan of Action.
In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 37-79. (International Conference on Population, 1984.; ST/ESA/SER.A/91)This paper reviews the major issues that have emerged in the analysis of mortality and health policy since the 1974 World Population Conference. The 1st part summarizes current mortality conditions in the major world regions and evaluates progress toward achieving the goals of the World Population Plan of Action. It is noted that the current mortality situation is characterized by continued wide disparities between the more developed and less developed regions, especially during the 1st year of life. The 2nd part focuses on the synergistic relationship between health and development, including social, economic, and health inequalities. It is asserted that mortality rates in developing countries are a function of the balance governments select between development strategies favoring capital accumulation and concentrated investments on the 1 hand and strategies oriented toward meeting basic needs and reducing inequalities in income and wealth. Data from developed countries suggest that economic development does not necessarily lead to steady gains in life expectancy. Some variations in mortality may reflect changes in family relationships, especially women's status, that are induced by social and economic development, however. The 3rd part of this paper analyzes the effect of health policies on mortality, including curative and preventive programs and primary health care. The lack of community participation is cited as a key factor in the weak performance of primary health care in many developing countries. In addition, there is strong evidence that the concepts and technologies of modern medicine must be adapted to existing systems of disease prevention and care to gain acceptability. The 4th section, on the implementation of health policies, discusses health care management, planning, and financing. It is noted that successful implementation of health policies is often hindered by scarcity, inadequate allocation, and inefficient utilization of health resources. Finally, more effective means to cope with rising costs of health care are needed.
In: Demographic trends in the European region: health and social implications, edited by Alan D. Lopez and Robert L. Cliquet. Copenhagen, World Health Organization, Regional Office for Europe, 1984. 5-67. (WHO Regional Publications, European Series No. 17; Project RMI/79/P05)This chapter presents an overview of recent demographic trends in Europe and discusses the implications of these trends for health and social services. The discussion is based on reports received from 15 of the 33 Member States of the European Region of the World Health Organization. The components of demographic change analyzed included population growth and structure, family formation, fertility, mortality, and population movement. Increases in the number and proportion of the elderly were noted and the traditional excess of births over deaths is expected to change in future years. Population aging is expected to continue to be a principal concern for the social services sector. The increasing emphasis on caring for rather than attempting to cure chronic illnesses among the aged suggests a need for more nursing homes and home-help services. Anticipation of future morbidity and mortality patterns implies a need to focus on specific risk groups, e.g. migrants, adult males, and those from lower socioeconomic groupings. With regard to fertility, adolescent sexual activity and the low use levels of contraception among teenagers comprise areas where greater service provision is necessary. In addition, there is a need for more vocational training for women, improved child care facilities, and full-time employment opportunities better suited to the needs of workers with dependent children. As a result of smaller families, increased divorce rates, the discrepancy between male and female survival, and greater regional mobility, markedly higher numbers of single individuals can be expected. Rapidly evolving changes in family formation, social norms, and underlying demographic trends will continue to alter European societies in the years ahead. The interrelationships between health and demographic phenomenon must continue to be probed to form a basis for future health and social planning.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):296-302.The international Conference on Population, held in Mexico City in August 1984, met to review past developments and to make recommendations for future implementation of the World Population Plan of Action. Despite the several ifferences of opinion, the degree of controversy was minor for an intergovernmental meeting of this size. The 147 government delegations at the Conference reached overall agreement on recommendations for future international commitment to expanding population efforts in the future. This review examines the recommendations of the Mexico Conference with regard to health, family planning, women in development, research, and realted issues. The total 88 recommendations wre intended to reaffirm and refine the World Population Plan of Action adopted in Bucharest in 1974, and to strengthen the Plan for the next decade. Substantial improvement in development was noted including fertility and mortality declines, improvements in school enrollement and literacy rates, as well as access to health services. Economic trends, however, were much less encouraging. While the global rate of population growth has declined slightly since 1974, world population has increased by 770 million during the decade, with 90% of that increase in the developing countries. Part of the controversy at the Conference focused on the remarkable change of position by the US delegation, which largely reversed the policies expressed at Bucharest. The US delegation stated that population was a neutral issue in development, that development is the primary requirement in achieving fertility decline. Several recommendations emphasized the need to integrate population and development planning, and called for increased national and international efforts toward the eradication of mass hunger, illiteracy, and unemployment; achievement of adaquate health and nutrition levels; and improvement in women's status. The need for futher development of management, training, information, education and communication was recognized. A clear call to strenghten global efforts in population policies and programs emerged.