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Canadian HIV / AIDS Policy and Law Review. 2002 Dec; 7(2-3):80-84.Health is a fundamental right, not a commodity to be sold at a profit, argues Irene Fernandez in the second Jonathan Mann Memorial Lecture delivered on 8 July 2002 to the XIV International AIDS Conference in Barcelona. Ms Fernandez had to obtain a special permit from the Malaysian government to attend the Conference because she is on trial for having publicly released information about abuse, torture, illness, corruption, and death in Malaysian detention camps for migrants. This article, based on Ms Fernandez presentation, describes how the policies of the rich world have failed the poor world. According to Ms Fernandez, the policies of globalization and privatization of health care have hindered the ability of developing countries to respond to the HIV/AIDS epidemic-The article decries the hypocrisy of the industrialized nations in increasing subsidies to farmers while demanding that the developing world open its doors to Western goods. It points out that the rich nations have failed to live up their foreign aid commitments. The article concludes that these commitments - and the other promises made in the last few years, such as those in the United Nations' Declaration of Commitment on HIV/AIDS - can only become a reality if they are translated into action. (author's)
Perspectives in Health. 2003; 8(2):3-7.This year marks the 25th anniversary of the first International Conference on Primary Health Care in Alma- Ata, Kazakhstan, an event of major historical significance. Convened by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), Alma-Ata drew representatives from 134 countries, 67 international organizations and many non-governmental organizations. China, unfortunately, was notably absent. By the end of the three-day event, nearly all of the world's countries had signed on to an ambitious commitment. The meeting itself, the final Declaration of Alma-Ata and its Recommendations mobilized countries worldwide to embark on a process of slow but steady progress toward the social and political goal of "Health for All." Since then, Alma-Ata and primary health care have become inseparable terms. A quarter century later, it is useful to look back on the event and its historical context – particularly on the theme of "Health for All" in its original sense. For one who was a direct witness to these events, it is clear that the concept has been repeatedly misinterpreted and distorted. It has fallen victim to oversimplification and voguishly facile interpretations, as well as to our mental and behavioral conditioning to an obsolete world model that continues to confuse the concepts of health and integral care with curative medical treatment focused almost entirely on disease. (author's)
The role of health centres in the development of urban health systems: report of a WHO Study Group on Primary Health Care in Urban Areas.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (827):i-iv, 1-38.The WHO Study Group on Primary Health Care (PHC) in Urban Areas has written a report after examining the development of reference health centers in urban areas in various parts of the world. It considers such centers to be a potentially important way to improve urban health services. Reference health centers, with real roots in the community and good links to first level and referral level care, can address the problems of access to health care and intersectoral collaboration. Each center should be based on a general model, but its exact operation depends on local conditions and on a comprehensive situation analysis that considers social and financial factors and the level of organizational development. Each reference center should determine what needs to be done locally with local and national resources. Outside donors should only provide assistance for operational costs and a last resort. To plan services adequately, decision makers must define geographical catchment areas and travel times. These definitions must see to it that services integrate with each other vertically (with services at health post and hospital levels), and horizontally (with government, and nongovernmental, and community projects). A solid epidemiological understanding of major local health problems is essential for expanding PHC through reference health centers. This knowledge comes from an assessment of demographic, morbidity, mortality, and social data an evaluation of coverage of underserved and marginal groups. Reference health centers would be in an ideal position to gather and analyze these data. Innovative ways to obtain the resources for urban PHC are collection of user fees and close supportive links with universities and nongovernmental organizations. The Study Group looks at how reference health centers in Cali, Colombia; Manila, the Philippines; and Newark, New Jersey in the US, developed.
HYGIE. 1992; 11(2):6-7.The World Alliance for Breastfeeding Action (WABA) based in Penang, Malaysia has selected August 1-7, 1992 to be World Breastfeeding Week worldwide. The US coordinator is in Flushing, New York. WABA is a group of organizations and individuals who communicate among themselves to identify ways to inform others that breast feeding is a right of all children and women. WABA aims to identify a week each year to promote breast feeding since many countries are experiencing a decrease in breast feeding. The 1992 theme for World Breastfeeding Week is the WHO/UNICEF Baby-Friendly Hospital Initiative. WABA, WHO, and UNICEF suggest various activities for community organizations, individuals, hospitals, and clinics to observe before and during the week. All groups could form a World Breastfeeding Week Committee. Hospitals could go a step further and form a Baby-Friendly Hospital Committee. They could evaluate their practices by completing the Self Appraisal Questionnaire. Hospitals could also implement all 10 steps to successful breast feeding so they can receive the Baby-Friendly Hospital designation during the celebration week. Health facility managers should tell staff about the International Code of the Marketing of Breast Milk Substitutes and invite them to look for code violations in the facility and the community. Community groups or individuals could arrange for various competitions such as posters, breast-feeding slogans, and essays. The could also try to gain the support of retail store operators by encouraging them to implement the Code and set up a Baby-Friendly work environment for employees. They could invite children to take part in the week by doing a puppet show or participating in a coloring contest. Community organizations and individuals could encourage the local newspaper to do either an article about breast feeding or print a photo with an eye-catching caption.
Lancet. 1998 May 23; 351(9115):1561.Leaders of the world's 8 major government powers who met at the Group of Eight (G8) Summit in Birmingham, UK, during May 15-17, endorsed an international initiative to control malaria and other parasitic diseases. The leaders agreed to improve mutual cooperation on infectious and parasitic diseases, and offered support for the new World Health Organization (WHO) initiative "Roll Back Malaria" to reduce levels of malaria-related mortality by 2010. UK Prime Minister Tony Blair was, however, the only leader to pledge new funding, in the amount of US$100 million, for the initiative. The other G8 countries fought the inclusion of specific targets in the final joint G8 document and made no new commitment to fund the malaria initiative. The Japanese government's report on global parasite control for the 21st century outlined 4 strategies for controlling malaria, soil-transmitted nematode infections, schistosomiasis, filariasis, and other parasitic infections. The strategies include international cooperation for implementing parasite control and research to provide a scientific basis for such control. Roll Back Malaria will begin in Africa. G8 support was less enthusiastic for France's Therapeutic Solidarity Initiative to establish a fund for HIV treatment regimens which are appropriate to conditions in the developing world.
PEOPLE AND THE PLANET. 1997; 6(1):10-1.Dr. Nafis Sadik, Executive Director of the UN Population Fund, notes that in the wake of the 1994 International Conference on Population and Development (ICPD), governments have been persuaded to abandon demographic targets and instead set specific social goals such as reductions in maternal, child, and infant mortality, and improvements in education, especially for girls. Progress is being made with regard to health and education, with all countries having set target dates for the enrollment of all children in school. The meaning of basic health services for all remains unclear. Progress is also being made against female genital mutilation and sexual violence, and improving women's status and the delivery of reproductive health care. Most countries could, however, do a lot more, and greater public support and resources are needed for programs. India, Brazil, Egypt, and Peru are cited as examples of countries which have begun to change policy following the ICPD. Developing countries and donors, with the exception of the US in 1996, have made efforts to increase their levels of spending on reproductive health services; the US has reduced its aid budget by 35%.
AIDS ANALYSIS ASIA. 1995 Jul-Aug; 1(4):2.The United Nations Children's Fund (UNICEF) has launched a study, "Progress of Nations," of standards of health, education, nutrition, and progress for women. It reveals that many rich nations have records on health, nutrition, and women's rights that are much worse than those of poorer countries. Economic growth does not necessarily result in a better standard of living for the majority of people. "Progress of Nations" uses specific indicators to gauge achievements, then ranks each country accordingly; it also states how much individual nations are contributing to the global aid budget, and where funds are being spent. A table lists countries chronologically in order of introduction of education about sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS). Singapore (1986), Sri Lanka (1986), Japan (1987), China (1989), Thailand (1989), Hong Kong (1990), Malaysia (1991), and Viet Nam (1991) have done so. As of early 1993, Bhutan, Cambodia, Indonesia, India, Lao Republic, Nepal, Pakistan, and the Philippines had not incorporated sex education into school curriculums. One section examines the fertility decline since 1963 in all countries and the unmet need for family planning. In Thailand and Indonesia, where population growth has been reduced dramatically over the last 30 years, 12% and 14% of married women aged 15-49 years want to stop having children or to postpone the next pregnancy for at least 2 years, but are not using contraception.
BMJ. British Medical Journal. 1993 Sep 18; 307(6906):723-6.The Catholic Church approves the use of natural family planning (NFP) methods. Many people think only of the rhythm method when they hear NFP so they perceive NFP methods to be unreliable, unacceptable, and ineffective. They interpret the Catholic Church's approval of these methods as its opposition to birth control. The Billings or cervical mucus method is quite reliable and effective. Rising estrogen levels coincide with increased secretion of cervical mucus, which during ovulation is relatively thin and contains glycoprotein fibrils in a micelle like structure aiding sperm migration. Ultrasonography confirms that the day of most abundant secretion of fertile-type eggs white mucus is the day of ovulation. Once progesterone begins to be secreted, cervical mucus becomes thick and rubbery and acts like a plug in the cervix. Other symptoms associated with ovulation include periovulatory pain and postovulatory rise in basal body temperature. A WHO study of 869 fertile women from Australia, India, Ireland, the Philippines, and El Salvador found 93% could accurately interpret the ovulatory mucus pattern, regardless of education and culture. The probability of pregnancy among women using the cervical mucus method and having intercourse outside the fertile period was .004. The probability of conception increased the closer couples were to the fertile period when they had intercourse (.546 on -3 to -1 peak day and .667 on peak day 0), regardless of education and culture. The failure rate of NFP among mainly poor women in Calcutta, India, equal that of the combined oral contraceptive (0.2/100 women users yearly). Poverty was the motivating factor. NFP costs nothing, is effective (particularly in poverty stricken areas), has no side effects, and grants couples considerable power to control their fertility, indicating the NFP may be the preferred family planning method in developing countries. Prejudices about NFP should be dropped and worldwide dissemination of NFP information should occur.
JOURNAL OF THE INDIAN MEDICAL ASSOCIATION. 1992 Oct; 90(10):254-6.The Chair of the Subject Committee on Health and Family Welfare of the Government of West Bengal and a Member of the West Bengal Legislative Assembly questions WHO's reasoning for testing an AIDS vaccine on Asians or any people in developing countries when most AIDS cases are in the US and Europe. Plus Asia is the least affected continent. WHO has skipped time-consuming laboratory trials to test the AIDS vaccine in humans in Brazil, Rwanda, Thailand, and Uganda. No case reports of full-blown AIDS cases have been published in Indian medical journals, and few people in India have seen an AIDS patient. WHO officials at the South-East Asian headquarters do not directly answer questions. Developed countries tend to dictate what actions developing countries should take to prevent and control the spread of AIDS. Since they are the source of AIDS in developing countries, they should help developing countries improve the health of their people, but let developing countries plan their own AIDS programs. The Indian legislator considers posters claiming AIDS is spread through breast milk, salvia, and urine and reports on estimated AIDS cases and HIV-infected cases to be propaganda. He contends that their purpose is to instill fear. Other questions include the vagueness of AIDS' clinical symptoms, not all AIDS cases are infected with HIV, and cofactors are responsible for the destruction of immune system cells. The legislator disapproves developed countries' unifactorial approach to combat AIDS (i.e., AIDS vaccine), which provide them commercial benefits and allows them to politically dominate developing countries. First and foremost, India needs to identify its priorities and combat AIDS accordingly. It should train clinicians to identify suspected AIDS cases and high risk groups, promote risk reduction behavior, and provide laboratories to do HIV serodiagnostic tests.
Baltimore, Maryland, Johns Hopkins University Press, 1990. lxxiii, 421 p.The World Bank's Population and Human Resources Department regularly publishes a set of world population projections based on its data files. This 1989-90 report has projections for the world and for regions, income groups of countries, and 187 countries. World Bank staff made projections to the point where populations reach stability. In almost all cases, they made only 1 projection. Projection tables for 1985-2030 exist for each country's population. Each country also has tables on birth rate, death rate, net migration, natural increase, population growth, total fertility rate, life expectancy, infant mortality rate, and dependency ratio. The report shows that from 1985-90 population growth was 1.74%, and projected 1990 world population size was 5.3 billion. By 2025, 84.1% of the world's population will be living in developing countries. 58% of the population now lives in Asia. The population of Africa is growing faster than that of Asia, however, (3 vs. 1.9%). By 2000, the population of Africa will be second only to that of Asia, yet in 1989-1990, it is behind that of Asia, Europe and the USSR, and the Americas. The current dependency ratio (67) is expected to decline to 53 by 2025. The highest current dependency ratio belongs to Kenya (120). In developed countries with aging populations, the dependency ratio will rise from 50-58. China will most likely to continue to be the most populous country for about 200 years. India will continue to contribute more to population growth than any other country in the world. Yet the Federal Republic of Germany loses 100,000 people yearly. Total fertility rates are the greatest in Rwanda, the Yemen Arab Republic, Kenya, Malawi, and the Ivory Coast (all >7.2). Afghanistan and 3 western African countries have the shortest life expectancies (about 40 years). These trends illustrate the need to alter population growth.
WORLD HEALTH FORUM. 1993; 14(2):207-9.An analysis conducted by WHO in 1991 and 1992 indicated that death rates from diseases related to diet and life-style (heart conditions, cancer, and diabetes) have increased significantly in many countries during the past 30 years, largely owing to changes in diet and life-style. 40 high-income countries have diet-related disorders, and as many as 80 middle-income nations may have both undernutrition and overnutrition problems. Undernutrition is widespread in some 50 low-income countries and is associated with a high incidence of stunting and micronutrient deficiencies (especially iron, iodine, and vitamin A). Diet-related deficiencies affect 2000 million people. WHO scientists reviewed data from 26 developed and 16 developing countries from the period 1960-89: 20 countries showed increases ranging up to 160% in death rates from diet-related and life-style-related causes. The biggest decreases were in Australia, Canada, Japan, and the USA where education advised people to limit intakes of fat, saturated fat, and salt as well as to increase exercise and reduce smoking. Data on food availability for 1988-90 showed that an estimated 786 million people in developing countries were chronically undernourished. Hunger and malnutrition affect many of the 123 million people living in 11 countries where the food situation is critical. Some 192 million children <5 years of age suffer from protein-energy malnutrition characterized by retardation of physical growth and lowered resistance to infections. 55 million of these underweight children are in south Asian countries. In these countries, about half of all deaths occur before 5 years of age, and the majority of these deaths are caused by diarrheal disease. It is estimated that up to 70% of diarrhea cases are food-borne in origin. There are 1500 million episodes of diarrhea annually in children <5 years of age, killing 3 million of them.
A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Council's Robert H. Ebert Program on Critical Issues in Reproductive Health and Population, February 12-13, 1990, the Population Council, New York, New York.
New York, New York, Population Council, 1990. x, 185 p.Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail firstname.lastname@example.org.
Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting] Estrategias de control e investigacion de la tuberculosis en el decenio de 1990: memorandum de una reunion de la OMS.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1993 May; 114(5):429-36.Mycobacterium tuberculosis, the pathogenic agent causing tuberculosis, is carried by one third of the world's population. Some 8 million new clinical cases of tuberculosis are diagnosed annually. Pulmonary tuberculosis is the most infectious clinical manifestation, tubercular meningitis is the principal form causing infant death, and tuberculosis may affect various other organs. Untreated tuberculosis has a fatality rate of over 50%. Chemotherapy greatly reduces the rate, but some 2.9 million persons die of tuberculosis each year because of the inadequacy of many national treatment programs. Tuberculosis is the most important cause of death from a single infectious agent in the world. An estimated one fourth of avoidable deaths to adults aged 15-59 in the developing world are attributed to tuberculosis. Tuberculosis is especially prevalent in Africa south of the Sahara and in Southern Asia. Two new obstacles threaten to aggravate the problem: the HIV epidemic and drug resistance. HIV infection is the most serious risk factor yet identified because it converts latent tuberculosis infection into active disease. In Africa almost half of all persons seropositive for HIV are also infected with tuberculosis. Ineffective treatment programs favor the formation of pharmacoresistent strains, and drug resistance has become a major problem in various parts of the world. Effective measures exist to control tuberculosis. Although it does little to protect adults against infectious forms of tuberculosis, the BCG vaccine prevents the most lethal forms. Coverage of infants the BCG is over 80% in the developing world as a whole, but under 60% in sub-Saharan Africa. Chemotherapy can cure almost all cases and convert cases with positive sputum into noninfectious cases, reducing transmission. Normal treatment must be administered over at least 12 months, straining the resources of health services in developing areas. The introduction of a shorter therapy has revolutionized treatment in some national programs, which have achieved cure rates of 80% in new patients. Evaluation of some national programs has demonstrated that well managed short duration chemotherapy is cost effective even under difficult conditions. Progress in controlling tuberculosis has been slower than expected in developing countries because of excessive optimism about the prospects for quick declines as occurred in the industrialized countries, and because of lack of resources. A well organized and vigorous international effort under World Health Organization leadership is required to bring the tuberculosis problem to the world's attention, mobilize assistance on a wide scale, and provide information and direct support to national programs. Research will be needed to adapt proven control techniques to local cultures, develop new drugs, shorten treatment regimens, and encourage greater patient compliance.
INTEGRATION. 1992 Dec; (34):8-17.In Tokyo, Japan, former president of the World Bank, Robert McNamara, addressed the Global Industrial and Social Progress Research Institute Symposium in April 1992. He reiterated a statement he made during his first presentation as president of the World Bank in September 1968--rapid population growth is the leading obstacle to economic growth and social well-being for people living in developing countries. He called for both developed and developing countries to individually and collectively take immediate action to reduce population growth rates, otherwise coercive action will be needed. Rapid population growth prevents countries from achieving sustainable development and jeopardizes our physical environment. It also exacerbates poverty, does not improve the role and status of women, adversely affects the health of children, and does not allow children a chance at a quality life. Even if developing countries were to quickly adopt replacement level fertility rates, high birth rates in the recent past prevent them from reducing fast population growth for decades. For example, with more than 60% of females in Kenya being at least 19 years old (in Sweden they represent just 23%), the population would continue to grow rapidly for 70 years if immediate reduction to replacement level fertility occurred. Mr. McNamara emphasized than any population program must center on initiating or strengthening extensive family planning programs and increasing the rate of economic and social progress. Successful family planning programs require diverse enough family planning services and methods to meet the needs of various unique populations, stressing of family planning derived health benefits to women and children, participation of both the public and private sectors, and political commitment. McNamara calculated that a global family planning program for the year 2000 would cost about US$8 billion. He added that Japan should increase its share of funds to population growth reduction efforts.
In: The global possible: resources, development, and the new century, edited by Robert Repetto. New Haven, Connecticut, Yale University Press, 1985. 255-98. (World Resources Institute Book)Everyone uses fresh water. Water is the most used substance by industry. Even though industry only makes up 5-10% of current worldwide water use, it contributes a disproportionate amount of toxic contaminants to the water supply. The most important socioeconomic factors of municipal water demand are household income and size. Agricultural demand is the single largest demand for water. In the US, it makes up 83% of annual total water consumption. Water demand has resulted in some of the world's biggest construction and weather modification projects which greatly alter basic ecosystems. Multinational institutions such as the World Bank and the International Development Association support most of these projects in developing countries. We have abused water perhaps more than any other resource. These abuses have caused considerable adverse effects. For example, after farmers in Africa and Asia began irrigating fields, many people fell ill with schistomosiasis. Other waterborne diseases include typhoid fever and diarrheal diseases. Investments in water supplies as well as in wastewater treatment are needed to improve public health. The largest consumers of fresh water in the world are those countries with the largest populations (49% of the world's population) and largest total land area (32% of the this area): China, India, the US, and the USSR. These 4 countries have 61-70% of the world's total irrigated land, but China and India have most of it (54%). Most US water expenditures are for water pollution control. The US has a very efficient agricultural system but the efficiency is technical rather than economic. Most water expenditures in the USSR and India are for irrigation. China spends most of its water resource funds on irrigation and drainage systems. All countries in the world should conduct a rational analysis of fresh water uses, implement rational water pricing policies to conserve water use, and stabilize water supplies such as capturing surface runoff.
WORLD HEALTH FORUM. 1991; 12(4):496-7.WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
INTEGRATION. 1992 Mar; (31):26-31.In 1989, the UN General Assembly agreed to sponsor a conference on environment and development and that the Heads of State would attend this 1st ever Earth Summit in June 1992. The planned agenda included making concrete changes to the basis of our economic life, relations between and among nations, and the outlook for the future. This would result in restructuring world priorities. Despite the 1972 Stockholm Conference on the human Environment acknowledging the basic link between environment and development, the environment has deteriorated even further, especially ozone depletion. Yet some governments did set up environmental agencies or ministries, like the US Environmental Protection Agency, but they were not allowed to influence economic policy or the policies and/or practices of major sectoral agencies. These environmental organizations relied too heavily on regulation. The 1992 conference needs to result in a political commitment to place reduction of poverty worldwide as the 1st priority since poverty and underdevelopment are strongly related to destruction of the environment. It is particularly important that developing countries improve their strengths by developing their human resources and institutional capacities (science, technology, management and professional skills) and reduce their vulnerabilities, such as dependence on foreign experts. This can best be achieved if they have access to technology. Moreover they must reduce population growth and reach population stability quickly. The 1992 conference in Brazil should also result in a global partnership based on common interest, mutual need, and shared responsibility. The world ecoindustrial revolution has already begun in some countries, such as Japan which has reduced energy use 40% since 1975. In fact, Japan has proven that environmental improvement can be accomplished with high rates of economic growth.
[Unpublished] . 100 p. (WHO/MCH/MSM/91.6)The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1991 Nov 22; 66(47):345-8.Recent community studies and better information systems have made it possible for WHO to reassess maternal mortality and calculate new estimates. These new estimates indicate that pregnancy and childbirth are somewhat safer for women in parts of Latin America and most of Asia than they were in 1983. In Sub-Saharan Africa, however, a rise in births have resulted in an equal rise in maternal deaths. Further, it is in Sub-Saharan Africa where the only real increases in maternal mortality occurred since 1983. Thus deteriorating economic and health conditions in Sub-Saharan Africa have resulted in maternal mortality here being the worst in the world. Like in 1983, >500,000 women still die annually from pregnancy related causes and childbirth because there has been about a 7% increase in the number of births, but the risks are around 5% lower than in 1983. In developed countries, maternal mortality and number of maternal death have decreased 13% since 1983. In the Caribbean, the rise in maternal mortality is actually due to better information. In Latin America, maternal mortality in most countries, except Haiti and Bolivia, stand <200/100,000 live births. In fact, the number of maternal deaths has declined by almost 25%. A recent nationwide study in China reveals that the former maternal mortality figure of 50 was inaccurate and was actually almost 100. Except for China, however, declines in risks or pregnancy and number of deaths have occurred in all subregions of Asia. Country specific data, estimates, and explanations of how statisticians arrived at estimations appear in either 1 of 2 WHO reports entitled Maternal Mortality; A Global Factbook (US$45) and Maternal Mortality: A Tabulation of Available Information (free).
The Integration of Population Variables into the Socio-Economic Planning Process. An International Seminar jointly sponsored by the UN Population Division, UNFPA and CICRED, and hosted by the Government of Morocco, Rabat, Morocco, 9-12 March 1987. Integration des Variables Demographiques dans le Processus de Planification Economique et Sociale. Seminaire International organise sous le patronage conjoint de la Division de la Population des Nations Unies, du FNUAP et du CICRED, et tenu a Rabat a l'invitation du Gouvernement du Maroc, Rabat, Maroc, 9-12 mars 1987.
Paris, France, CICRED, 1988. 159 p.Conference proceedings from an international seminar sponsored by the UN Population Division, the UN Fund for Population Activities (UNFPA), and the Committee for International Cooperation in National Research in Demography (CICRED) are presented in both French and english versions in one volume. Hosted by the government of Morocco, the opening speech is delivered by the Secretary General of the Ministry of Planning of Morocco. The statement from the UNFPA is then presented, followed by a message from the Director of the UN Population Division. The Coordinator of the Project next provides the foreword. Report of the Seminar is made, including annexes of the agenda and list of participating institutions, followed by discussion of possible areas of research and application. Research projects currently implemented or contemplated by participating centers are listed, with closing comments from the Vice-President and Bureau of CICRED. A list of documents prepared by the participants is included.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1987; 40(3):267-78.The primary cause of death in women in the world is cancer. In most developing countries cancer of the cervix is the most prevalent cancer. Breast cancer has this distinction in Latin America and the developed countries of North America, Europe, Australia, and New Zealand. It is also the most prevalent cancer worldwide. The most common cancer in Japan and the Soviet Union is stomach cancer. Effective early detection programs can reduce both breast and cervical cancer mortality and also the degree and duration of treatment required. In Iceland, cervical cancer mortality declined 60% between the periods of 1959-1970 and 1975-1978. Programs consist of mammography, physician breast and self examination, and Pap smear. The sophisticated early detection equipment and techniques are expensive and largely located in urban areas, however, and not accessible to urban poor women and rural women, especially in developing countries. Tobacco smoking attributes to 80-90% of all lung cancer deaths worldwide and 30% of all cancer deaths. Passive smoking increases the risk of lung cancer to 25-35% in nonsmokers who breathe in tobacco smoke. Since smoking rates of women are skyrocketing, health specialists fear that lung cancer will replace cervical and breast cancers as the most common cancer in women worldwide in 20-30 years. Tobacco use also contributes to the high incidence of oral cancer in Southern and South Eastern Asia. For example, in India, incidence of oral cancer in women is 3-7 times higher than in developed countries with the smoking and chewing of tobacco in betel quid contributing. Techniques already exist to prevent 1/3 of all cancers. If cases can be discovered early enough and adequate treatment applied, another 1/3 of the cases can be cured. In those cases where the cancer cannot be cured, drugs can relieve 80-90% of the pain.
INTERNATIONAL MIGRATION REVIEW. 1989 Fall; 23(3):579-98.This article examines the evolution of the current international system for responding to refugee problems and the climate within which the legal and institutional framework has developed. It reviews the background and handling of some of the key refugee movements since World War II and traces the legal and institutional adjustments that have been made to deal with new refugee movements that have occurred predominantly, but not exclusively, in the developing world. Finally, it assesses the adequacy of the present system to meet the challenges ahead. (author's)
POPULI. 1989 Dec; 16(4):4-17.Official Development Assistance (ODA) for population activities rose from US $100 to over US $400 million between 1968-72, again rising to US $500 million in 1985, then declining, representing 2% in the 1970's shrinking to 1.12% by 1982 and rising to 1.3% of all ODA by the mid- 80's. Of the 17 major donor countries, the US provides more than 1/2 of all population assistance, followed by Japan (10%). ODA reaches recipient countries through 3 channels: 1) direct bilateral aid; 2) the UN organizations and 3) non-governmental organizations. Most donors channel their funds to countries through the UN; however, Australia, Canada, Finland, the United Kingdom, the US, Germany and New Zealand use bilateral and NGO channels. The different funding mechanisms used between regions are due to specific political and cultural sensitivities of the region and of individual donors. For example, the UN provided the largest amount of money to Africa in the former years, but NGO contributions and bilateral assistance has now caught up with the UN while NGO's were the original major contributors to Latin America with bilateral funding catching up. From 1982-88 Asia received over 1/2 of all assistance declining from 58 to 42% while assistance to Africa increased from 13 to 27%; Latin America's 20% remained the same and the Middle East and North Africa received less than 10%. The major determinant of a country's population assistance is its population size, with larger countries receiving more money than the smaller, and the age of a country's program. Efforts to measure the impact of assistance has been difficult. For example, aid to India has had modest achievements while China's significant reductions in fertility were achieved before any assistance was provided. In spite of the lack of statistical evidence demonstrating the effects over time to population activities, such assistance is necessary and effective.
POPULATION BULLETIN OF THE UNITED NATIONS. 1989; (27):108-24.This paper reviews recent new trends in population structure in the world and its major regions in order to access the determinants of those trends and explore issues regarding the recent and projected changes in the age structure of population and the relationships of those changes to social and economic development. In particular, the paper compares the change in age structure projected by the Population Division of the UN Secretariat in its most recent 3 series--namely, those completed in 1984, 1986, and 1988. By and large, the most recent UN assessment projects that a larger proportion of the world population will be aged 60 and over in 2000 and 2025 than was previously estimated. Those changes in projections can be observed for the world and for the more developed countries as a whole, and for the regions of Africa, Latin America, Northern America, East Asia, Europe, and Oceania. While the recommendations of the International Conference on Population called attention to the importance of changes in population structure, this paper recommends urgent government action in planning social programs for the aged because of the greater eminence of population aging in many settings. The case of Japan is used to illustrate the growing importance of increases in life expectancy as a determinant of age structure changes (in relation to fertility decline), a point that is reinforced through a cruder decomposition of UN estimates and projections for several European countries. (author's)
In: State of the world 1988. A Worldwatch Institute report on progress toward a sustainable society. New York, New York, W.W. Norton, 1988. 3-21.Most of the recognized threats to the world environment, such as the destruction of forests by acid rain, the ozone hole, population growth, energy use, and the greenhouse effect, have moved from hypothetical projections to present-day realities which can be solved only by international efforts. The Montreal accords of 1987 to limit the production of chlorofluorocarbons and the UN call for a cease-fire in the Iran-Iraq war were steps in this direction. But a look at the "vital signs" of the earth as expressed by environmental crises will show how much more is needed. Deforestation for agriculture and logging causes as estimated loss of 11 million hectares of forest each year. Deforestation means erosion. The topsoil layer, once 6-10 inches deep over the globe is being blown or washed away at the rate of 26 billion tons a year. The soil is not only being depleted, it is being contaminated by agricultural pesticides and toxic wastes. In Poland, for example, 1/4 of the soil is unfit for food production, and only 1% of the water is safe for drinking due to chemical contamination. The depletion of the ozone layer is no longer observed only in Antarctica; it has dropped up to 9% in North Dakota, Maine, and Switzerland. The loss of forests and the acidification of lakes and soil are causing whole species to become extinct. World population continues to grow, as each year 80 million more people are born than die. But the real problem is not population growth per se; it is the relationship between population size and the sustainable yield of local forests, grasslands, and croplands. In 1982 India's forests could sustain an annual harvest of 30 million tons of wood; the estimated demand was 133 million tons. In 9 Southern African countries the number of cattle exceed the carrying capacity of the grasslands by 50% to 100%. In India enough fodder is raised to supply only 50% to 80% of the needs of cattle. The results of deforestation, overgrazing and overplowing is desertification, which compounded by drought, brings famine. The relationship between population growth and land degradation is reflected in per capita food production. In China it has risen by 1/3 since 1970, but in Africa it has fallen by 1/5; and India, despite the Green Revolution, will have to import grain if there is another failure of the monsoons. Another indicator of environmental ill-health is energy consumption, which is again on the rise. Industrial use of oil and coal, especially in the US, the USSR, and China, has resulted in air pollution and acid rain, which by September 1987 had damaged 30.7 million hectares of forests in Europe. But by far the most serious result of the burning of fossil fuels and wood is the 7 billion tons of carbon discharged annually into the atmosphere, causing the greenhouse effect, which will raise the global temperature between 1.5 and 4.5 degrees Celsius by year 2050. Patterns of World settlement and agriculture will change drastically; irrigation and drainage systems will have to be adjusted; and a rise in sea levels between 1.4 and 2.2 meters by year 2100 could inundate coastal cities. In view of these deteriorating "vital signs" of the planet, nations must work together to turn one earth into one world. The Montreal accord on ozone protection and the 1987 US-Soviet arms limitation were a good beginning. The greenhouse effect and the changing climate are logical candidates for the next round of world environmental deliberations.