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Journal of Adolescent Health. 2003 Oct; 33(4):240-251.The contemporary health problems of young people occur within the context of the physical, social, cultural, economic, and political realities within which they live. There are commonalities and differences in this context among developed and developing countries, thus differing effects on the individual’s personal as well as national development. Internationally, the origins and evolution of health care for adolescents can be viewed as an unfolding saga taking place particularly over the past 30 years. It is a story of advocacy and subsequent achievement in all corners of the world. This paper reviews the important developments in the international arena, recognizes major pioneers and milestones, and explores some of the current and future issues facing the field. The authors draw heavily on their experiences with the major nongovernmental adolescent health organizations. The special roles of the World Health Organization, Pan American Health Organization, and United Nations Children’s Fund (UNICEF) are highlighted, and special consideration is given to the challenge of inclusion through youth participation. (author's)
International Journal of Gynecology and Obstetrics. 2003 Sep; 82(3):357-367.The International Federation of Gynecology and Obstetrics – FIGO – has been striving hard to carefully attend to women’s well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO’s committees strengthen these objectives and FIGO’s alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands. (author's)
Journal of Viral Hepatitis. 2003 May; 10(3):157-158.Though a potent vaccine represents a powerful preventive tool, the policy of its use is governed by epidemiological and economical factors. Hepatitis A, an enterically trasmitted disease shows distinct association with socio-economic status, populations with improvement experiencing lower exposure to the virus. With the availability of vaccine, it is pertinent to consider its use in the effective control of the disease. However, with the varied epidemiological patterns and economical constraints in different countries it does not seem to be possible to evolve universal policy for immunization. Though, universal immunization may be the most effective way of control, the same is not practical for many countries. It is proposed that irrespective of endemicity of hepatitis A, high-risk groups such as travelers to endemic areas, patients suffering from chronic liver diseases, HBV and HCV carriers, tribal communities with high HBV carrier rates, food handlers, sewage workers, recipients of blood products, troops, and children from day-care centers should be immunized with hepatitis A vaccine. In addition, for populations with intermediate prevalence, infants, children from affordable families may be immunized. As coupling the vaccine with EPI schedule would be beneficial, use of combined A & B or A, B & E vaccine may be an attractive alternative. (author's)
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
In: La population du monde: enjeux et problemes, edited by Jean-Claude Chasteland and Jean-Claude Chesnais. Paris, France, Institut National d'Etudes Demographiques [INED], 1997. 435-60. (Travaux et Documents Cahier No. 139)The author clarifies the conceptual framework of the study of populations health in an attempt to understand the notions of demographic transition and epidemiological transition. World Health Organization (WHO) statistics are then noted, followed by the presentation of WHO data on the global health situation. Estimated numbers of all cases of morbidity and mortality worldwide by cause are presented for 1993. Where possible, the prevalence, incidence, and number of long-term handicaps caused by each ailment are presented in addition to the number of deaths caused. According to data collected by WHO, approximately 51 million people died worldwide in 1993, of which almost 24% were in developed countries and 76% were in developing countries. The most important groups of illnesses were infectious and parasitic diseases, and causes of maternal, perinatal, and neonatal mortality, responsible for about 40% of all mortality during the year. 99% of these latter deaths occurred in the developing world. Then, circulatory system diseases, chronic lower respiratory system illness, and cancer were together responsible for about the same number of deaths, with the numbers of such deaths divided almost equally between developed and developing countries. External causes, such as accidents, suicides, and homicides caused near to 4 million deaths, or 8% of the overall total. These causes of morbidity and mortality are discussed, followed by consideration of likely future trends for the world s predominant ailments.
WORLD HEALTH FORUM. 1997; 18(2):107-15.In 1996, the World Health Organization (WHO) identified the following issues for consideration as it designed its new strategy to achieve "health for all" in the 21st century: the determinants of health, health patterns in the future, intersectoral action, essential public health functions, partnerships in health, human resources for health, and the role of the WHO. Because ethical considerations play a vital role in developing the strategy, the WHO sought the input of the Council for International Organizations of Medical Sciences in this regard. As understanding of the role and nature of medical ethics has deepened in the past decades, new ethical questions are continually being raised by changing patterns of disease and health care and by technological advances. The new health-for-all strategy must, therefore, give prominence to the consideration of equity, utility, equality, and human rights. In order to attain justice, the equilibrium between equity and equality should be maintained. Cultural diversity will also inform notions of equity. The principles of primary health care contained in the WHO's Alma-Ata Declaration also need to be strengthened to place proper emphasis on the need for information systems, decision-making mechanisms, and support systems. The most important activities the WHO is applying to its effort to renew its "health for all" strategy are 1) clarifying the concepts; 2) strengthening links to related fields; 3) working in partnership with countries, regions, and organizations; and 4) promoting the dissemination of information and ideas. The WHO's renewed strategy must bring clarity, practicality, and effectiveness to global health activities while fostering an understanding of the moral issues that contribute to human well-being.
National perspectives on population and development. Synthesis of 168 national reports prepared for the International Conference on Population and Development, 1994.
New York, New York, United Nations Population Fund [UNFPA], 1995. viii, 112 p.This document highlights some of the most interesting and salient features of the 168 national reports prepared for the 1994 International Conference on Population and Development and illustrates the variety and complexity of situations encountered across countries and regions. Part 1 presents insights into changing perspectives on population issues, especially into the recurrent themes of 1) the interrelationships between population, development, and the environment and 2) the role and status of women. The evolution of political commitment to population concerns during the past two decades is also traced, and the challenges ahead are outlined. Part 2 deals with population dynamics issues through a discussion of the implications of population growth and structure, improving health conditions, influencing fertility, and internal and international migration. The statistics used in this document are those found in the national reports and complementary information forms. The UN geographic system of classification of countries is used, and frequent distinctions are made between developing and industrialized countries.
WORLD HEALTH FORUM. 1993; 14(4):333-44.WHO evaluated the implementation of the health-for-all strategy using data from 151 countries. 110 countries still endorsed the strategy. 95 have either completely implemented or further developed community involvement. Just 33 countries had more equitable distribution of resources. The percentage of gross national product (GNP) that the government dedicated to health rose in the least developed countries. Developed countries spent a higher proportion of their GNP on health than did developing countries (3.3% vs. 0.9%, 1991). Maldistribution of health personnel continued to be a major problem. Between 1985 and 1990, the proportion of people in developing countries with access to safe water rose from 68 to 75%. Adequate sewage disposal coverage rose from 46 to 71% (1985-1991). Prenatal care coverage by trained personnel increased from 58 to 67%. Tetanus toxoid coverage of pregnant women only increased from 24 to 34%. Most maternal deaths were a result of inadequate prenatal care, inadequate care during childbirth, pregnancies spaced too closely, multiparity, and poor health and nutritional status before the first pregnancy. Immunization coverage rose considerably in every region (e.g., 47-83% for diphtheria). Nevertheless, substantial differences in coverage existed between countries. A substantial trend towards more integrated primary health care occurred. Child survival rates improved, but the gap in infant mortality rates between developed countries and the least developed countries widened. The gap in health status between the poor and the wealthy had become larger. Developing countries in the process of the epidemiological transition continued to be burdened with both infectious and degenerative diseases. GNP and adult literacy rose, but less so in the least developed countries. These findings suggested that governments must sustain the commitment to reduce inequities, realign health systems, improve health financing systems, improve coordination between health sectors, and improve linkage between health and development.
POPULATION BULLETIN OF THE UNITED NATIONS. 1993; (34-35):102-19.As part of the preparation for the forth-coming UN International Conference on Population and Development, an expert group met in Paris, France, in November 1992 to discuss population growth and demographic structure. As part of the demographic background for the meeting provided by the UN Population Division, participants were informed that although the world population growth rate began to decline in the late 1970s, this decline has not yet resulted in declining absolute numbers, and the annual increment to the world population was not expected to decline to the level that existed in 1985 until the period 2020-25. World population increased from 2.5 billion in 1950 to 5.3 billion in 1990. The medium variant population projection of the UN shows world population at 6.3 billion in 2000 and 8.5 billion in 2025 (the high variant shows 9.4 billion in 2025 and the low variant shows 7.6 billion). Population aging is expected to reach unparalleled levels in 2010-20. The meeting then considered the topics of population growth and socioeconomic development, confronting poverty in developing countries, demographic impacts of development patterns, demographic and health transitions, population growth and employment, social change and the elderly in developing countries, and social development and ageing in developed countries, The expert group meeting then prepared 19 recommendations aimed at governments, social institutions, and the international community. The recommendations call for political commitment to human resources development and population and development programs, especially in least developed countries, alleviation of poverty and social inequality, and equality of access to social and health resources that will lead to reduced mortality and fertility. Governments are urged to place a high priority on education and on increasing women's access to education and to remove barriers to economic independence for women. Health-sector priorities should be reassessed to provide the most cost-effective and efficient means of providing health care, reproductive health-care programs should receive high priority, and efforts should be made to minimize the effects of HIV infection and reduce the spread of AIDS. The needs of the elderly should be met with a "safety net," which should be developed in countries with no social security programs. The elderly should be recognized as an important human resource for development, and intergenerational equity should exist to accommodate their needs, with special efforts made to help them remain in their own homes and communities. Governments should collect accurate, comprehensive, and regular data on population characteristics and trends, and the international community should facilitate the comparative analysis of such data. Training should be provided to professionals in demography and related fields in developing countries.
New York, New York, Oxford University Press, 1993. xii, 329 p.The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.
Geneva, Switzerland, UNCED, Secretariat, 1992 Apr. , 116 p. (E.92.I.15)The UN Conference on Environmental and Development Preparatory Committee (UNCED) agreed on an action plan of global partnership for sustainable development and environmental protection entitled Agenda 21 to be adopted at the June 1992 UNCED in Rio de Janeiro. The priority actions are a call for action to achieve a prospering, just, and habitable world. These actions also promote a fertile, shared, and clean planet via extensive and responsible public participation at local, national, and global levels. Since most environmental problems originate with the failures and inadequacies of the current development process, the 1st action centers around revitalizing growth with sustainability including international policies to accelerate sustainable development in developing countries and integration of environment and development in decision making. The 2nd action is achieving sustainable living by attacking poverty, changing consumption patterns, and recognizing and acting on the links between population dynamics and sustainability, and providing basic health needs to preserve human health. The 3rd action addresses human settlements including urban water supplies, solid wastes management, and urban pollution and health. The 4th and 7th action plans incorporate the most subtopics. The 4th action plan calls for efficient resource use ranging from land resource planning and management to sustainable agriculture and rural development. The 7th plan is a call for individuals and groups to participate and be responsible for sustainable development. The major identified groups are women, children and youth, indigenous people, nongovernmental organizations, farmers, local authorities, trade unions, business and industry, and the scientific and technological community. The 5th plan addresses global and regional resources including protection of the atmosphere, the oceans and seas, and sustainable use of living marine resources. The 6th plan deals with management of toxic and hazardous chemicals and radioactive wastes.
In: The population debate: dimensions and perspectives. Papers of the World Population Conference, Bucharest, 1974. Volume II, compiled by United Nations. Department of Economic and Social Affairs. New York, New York, United Nations, 1975. 105-9. (Population Studies No. 57; ST/ESA/SER.A/57)In 1974 World Population Conference in Bucharest, romania, WHO discusses degradation of the environment and population. In developing countries, poor sanitary conditions and communicable diseases are responsible for most illnesses and deaths. Physical, chemical, and psychosocial factors, as well as pathogenic organisms, cause disease and death in developing countries. Variations in individuals and between individuals present problems in determining universally valid norms relating to environment and health. Researchers must use epidemiological and toxicological methods to identify sensitive indicators of environmental deterioration among vulnerable groups, e.g., children and the aged. Changes in demographics and psychosocial, climatic, geographical, geological, and hydrologic factors may influence the health and welfare of entire populations. Air pollution appears to adversely affect the respiratory tract. In fact, 3 striking events (Meuse valley in France , Donora valley in Pennsylvania [US], and London  show that air pollution can directly cause morbidity, especially bronchitis and heart disease, and mortality. Exposure to lead causes irreparable brain damage. Water pollution has risen with industrialization. Use of agricultural chemicals also contribute to water pollution. Repeated exposure to high noise levels can result in deafness. Occupational diseases occur among people exposed to physical, chemical, or biological pollutants at work which tend to be at higher levels than in the environment. Migrant workers from developing countries in Europe live in unsafe and unhygienic conditions. Further, they do not have access to adequate health services. Nevertheless, life expectancy has increased greatly along with urbanization and industrialization. A longer life span and environmental changes are linked with increased chronic diseases and diseases of the aged.
WORLD HEALTH FORUM. 1992; 13(2-3):232-6.In 1989, the city of Rennes, France created its healthy city committee consisting of people from different sectors to strengthen health and the environment and to encourage public participation. It organized existing activities and integrated the health dimension into municipal decisions at all levels to create joint healthy city projects. For example, over 18 months, the Brittany Youth Information Center, the city of Rennes, the National School of Public Health, representatives of about 60 groups, teenagers, and private citizens organized and implemented an adolescent health week in November 1990. The intersectoral and participative approach of preparation resulted in new working relationships contributing to health for all. Some other healthy city projects included noise abatement actions, family gardens, a health information and documentation center, creation of a sexually transmitted disease/AIDS group, and roof safety campaigns. Organizers of all projects considered the health criteria including quality of the environment, support for the disabled, safety, and access to health care. Rennes became part of national and regional networks in France consisting of 30 cities. It also joined the WHO-European network and the French-speaking network where cities shared information via meetings and symposia. WHO emphasized a different health promotion topic each year such as community participation and equity. Issues discussed at the 1990 symposium in Stockholm were clean cities campaigns, nonpolluting urban transportation, the social and cultural environment, and unique urban problems of eastern European countries. The French-speaking network involved French-speaking areas and countries in Canada, Europe, and Africa. Sharing problems of cities in the developed countries could allow developing countries to avoid some of the same problems. The healthy cities approach cannot be just the responsibility of municipal authorities but also requires the backing of national governments and international groups.
New York, New York, United Nations, 1991. xiv, 120 p. (Social Statistics and Indicators Series K No. 8; ST/ESA/STAT/SER.K/8)5 UN agencies worked together to develop this statistical source book to generate awareness of women's status, to guide policy, to stimulate action, and to monitor progress toward improvements. The data clearly show that obvious differences between the worlds of men and women are women's role as childbearer and their almost complete responsibility for family care and household management. Overall, women have gained more control over their reproduction, but their responsibility to their family's survival and their own increased. Women tend to be the providers of last resort for families and themselves, often in hostile conditions. Women have more access to economic opportunities and accept greater economic roles, yet their economic employment often consists of subsistence agriculture and services with low productivity, is separate from men's work, and unequal to men's work. Economists do not consider much of the work women do as having any economic value so they do not even measure it. The beginning of each chapter states the core messages in 4-5 sentences. Each chapter consists of text accompanied by charts, tables, and/or regional stories. The 1st chapter covers women, families, and households. The 2nd chapter addresses the public life and leadership of women. Education and training dominate chapter 3. Health and childbearing are the topics of chapter 4 while housing, settlements, and the environment comprise chapter 5. The book concludes with a chapter on women's employment and the economy. The annexes include strategies for the advancement of women decided upon in Nairobi, Kenya in 1985, the text of the Convention on the Elimination of All Forms of Discrimination against Women, and geographical groupings of countries and areas. During the 1990s, we must invest in women to realize equitable and sustainable development.
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.
POPULATION BULLETIN OF THE UNITED NATIONS. 1989; (27):30-41.During the 2nd half of the 20th century, there has been a marked growth in awareness of the problems associated with population growth. The compromise consensus reached at Bucharest and reaffirmed at Mexico City set limited goals against which progress can be partially measured. Acceptance of the need to formulate population goals and policies grew, especially in the less developed countries. Progress was made in reducing mortality, but the goals set by the international community were not fully met. Results in the area of fertility were markedly heterogenous between regions. Rather more was accomplished in restraining the rapid growth of the urban agglomerations, and in some countries there is greater freedom of internal migration, although coercive resettlement policies are still found in a few countries. For policies to succeed, it is essential to reach a national consensus on population issues. Research and debate on population issues in international forums such as the conferences at Bucharest and Mexico City can contribute to the attainment of a national consensus. (author's)
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
[Vaccination, the right of each child, World Day of Health 1987] Vacunacion: derecho de cada nino, Dia Mundial de la Salud 1987.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1987 Mar; 102(3):263-80.In the 10 years since the Panamerican Health Organization (PAHO) and the World Health Organization initiated the Extended Immunization Program in the Americas (PAI), coverage has increased from less than 1/3 to over 1/2 of children immunized in their first year against 6 major childhood diseases. Due mainly to the PAI, the incidence of measles, tetanus, and diptheria has been reduced by 1/2, that of whooping cough by 75%, and that of tuberculosis by about 5% annually. About 75% of children are immunized against polio, which has 1/10 as many victims today as 10 years ago. PAHO and several other organizations have targeted 1990 for eradication of polio from the South American continent. Since the PAI was established in 1977, more than 15,000 health workers have been trained, cold chains have been established to preserve vaccines, and more than 250 technicians have been trained to maintain and repair the needed equipment. The cost of the campaign to eradicate polio is estimated at US $ 24 million per year for the entire region--a low total compared to the costs of hospitalization and rehabilitation of the victims in the absence of such a program. The goal of immunizing all the world's children by 1990 proposed by the World Health Assembly in 1977 is achievable, but much remains to be done. The number of children immunized in the largest Third World countries ranges from 20-90% owing in part to national immunization days but also to assumption by local communities of the goal of universal immunization by 1990. All deaths produced by these 6 killer diseases are not registered, but the World Health Organization estimates that measles takes 2.1 million lives annually, neonatal tetanus 800,000, and whooping cough 600,000. Governmental and nongovernmental international organizations have made financial help available to countries needing it for their immunization programs. Most developing countries are expected to achieve the goal of universal immunization by 1990, but the 10 poorst countries of Africa and the Eastern Mediterranean may not be able to do so. At the worldwide level, 41% of the 118 million children who survive their first year have been vaccinated against measles and 46% against tuberculosis. 47% have received the full course of vaccine against diptheria, whooping cough, tetanus, and polio. The cost of these immunization is $5-15 per child and 80% is assumed by local countries. The World Health Organization recommends that all children, even the undernourished or slightly ill, be vaccinated, and that all health services vaccinate. Parents should be urged to return for the 2nd and 3rd doses of polio and DPT vaccines. Vaccination programs should pay more attention to impoverished urban populations. Several countries of the region have added innovations such as vaccination against other illnesses, house to house searches for unvaccinated children, or use of mass media to publicize national vaccination programs.
World Health. 1985 Nov; 13-15.In November 1980, Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), and James Grant, head of the UN Children's Fund (UNICEF), drafted a joint program to improve the nutritional status of children and women through developmental measures based on primary health care. The government of Italy agreed to fund in full the estimated cost of US$85.3 million. When a tripartite agreement was signed in Rome in April 1982, the WHO/UNICEF Joint Nutrition Support Program (JNSP) came into being. It was agreed that resources would be concentrated in a number of countries to develop both demonstrable and replicable ways to improve nutrition. Thus far, projects are underway or are just starting in 17 countries in Africa, Asia, Latin America, and the Caribbean. In most of these countries, infant and toddler mortality rates are considerably higher than the 3rd world averages. Program objectives include reducing infant and young child diseases and deaths and at the same time improving child health, growth, and development as well as maternal nutrition. These objectives require attention to be directed to the other causes of malnutrition as well as diet and food. JNSP includes nutrition and many other activities, such as control of diarrhea. The aim of all activities is better nutritional status leading to better health and growth and lower mortality. Feeding habits and family patterns differ from 1 country to another as do the JNSP country projects. Most JNSP projects adopt a multisectoral approach, incorporating varied activities that directly improve nutritional status. Activities involve agriculture and education as well as health but are only included if they can be expected to lead directly to improved nutrition. A multisectoral program calls for multisectoral management and involves coordination at all levels -- district, provincial, and national. This has been one of the most difficult things to get moving in many JNSP projects, yet it is one of the most important. Community participation is vital to all projects. Its success can only be judged as the projects unfold, but early experiences from several countries are encouraging.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
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.
Who Chronicle. 1984; 38(3):109-15.The theme of the 1984 World Health Day--children's health, tomorrow's wealth--provides an occasion to convey to a worldwide audience the message that children are a priceless resource, and that any nation which neglects them does so at its peril. World Health Day 1984 spotlights the basic truth that the healthy minds and bodies of the world's children must be safeguard, not only as a key factor in attaining health for all by 2000, but also as a major part of each nation's health in the 21st century. An investment in child health is a direct entry point to improved social development, productivity, and quality of life. Care of child health starts before conception, through postponement of the 1st pregnancy until the mother herself has reached full physical maturity, and through spacing of births. It continues from conception on, through suitable care during pregnancy, childbirth, and childhood. In the developing countries the child must be protected by all available means, particularly from the killer diseases. What happens in the immediate family and community around the mother and child, and even far away in the world, can have a direct impact on the health and security of both of them. The mother and child need to be placed in an environment that will ensure their health by protecting the overall setting in which they live. This means providing clean water, disposing of waste, and helping to improve shelter. Nothing can diminish the importance of good food, enough food, and proper nutrition for children and their mothers. Beyond the immediate physical needs are the equally important needs for love and understanding which stimulate the healthy development of the child. The emergence of new health problems of mothers and children in developing and developed countries should be kept in mind. Better health services must be made available to all who need them. The World Health Organization (WHO) provided resource material on World Health Day issues for dissemination throughout the world. Extracts from 4 articles on this year's theme are reproduced. The articles report on the success of the Rural Health Center in Ballabhgarh (India) in reducing maternal and infant mortality, the value of breastfeeding as 1 of the simplest and safest ways of ensuring adequate spacing of births, Tunisia's integration of a program of immunization into the routine activities of the health care system, and the needs of the healthy child.
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.
New York, UNICEF, 1984 May. 280 p.The data in this set of 135 country profiles for 1981 are made up from 9 major sources and cover the countries and territories with which the UN International Children's Emergency Fund (UNICEF) cooperates. In terms of infant morttality, countries are divided into 5 infant mortality groups: a very high infant mortality (a) group of countries, with a 1981 infant mortality rate (IMR) estimate of 150 (rounded) or more deaths per 1000 live births; a very high infant mortality (b) group of countries with a 1981 IMR estimate between 110 (rounded) and 140 (rounded); a high infant mortality group of a middle infant mortality group of countries, with a 1981 IMR estimate of between 26 and 50 (rounded); and a low infnat mortality group of countries, with a 1981 IMR estimate of 25 or less. For each country data are also presented on nutrition, demographic, education, and economic indicators.
Populi. 1983; 10(1):13-35.Levels and trends of fertility throughout the world during the 1970s are assessed in an effort to show how certain factors, modifications of which are directly or indirectly specified in the World Population Plan of Action as development goals, affected fertility and conditions of the family during the past decade. The demographic factors considered include age structure, marriage age, marital status, types of marital unions, and infant and early childhood mortality. The social, economic, and other factors include rural-urban residence, women's work, familial roles and family structure, social development, and health and contraceptive practice. Recent data indicate that the rate at which children are born into the world as a whole has continued its slow decline. During 1975-80 there were, on the average, 29 live births/1000 population at mid year. During the preceding 5-year period, there occurred annually about 32 live births/1000 population. This change represents a decline of 3 births/1000 population worldwide and approximately 14 million fewer births over a period of 5 years. This change in the global picture largely reflects the precipitous downward course that appears to have characterized China's crude birthrate. There are marked differences in fertility levels between developing and developed regions. In developing countries, births occurred on the average at the rate of 33/1000 population during 1975-80, compared with only about 16/1000 in the developed nations. Levels of the crude birthrate varied even more among individual countries. The changes in levels and trends of fertility may be attributed to many of the factors noted in the Plan of Action as requiring national and international efforts at improvement. The populations of the less developed and more developed regions as a whole aged somewhat during the decade of the 1970s. In both regions, the number of women in the reproductive ages increased relative to the size of the total population, but the change was more marked in the less developed regions. Recommendations in the Plan of Action as to establishment of an appropriate minimum age at 1st marriage subsume existence of too low an age at 1st marriage mainly in certain developing countries. The Plan of Action calls for the reduction of infant mortality as a goal in itself using a variety of means. Achievement of this goal might also affect fertility. Recent findings concerning the influence of social, economic, and other factors upon fertility levels and change are summarized, with focus on topics highlighted in the World Population Plan of Action.