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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.
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.
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.
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.
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.