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Mortality and health policy: highlights of the issues in the context of the World Population Plan of Action.
In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 37-79. (International Conference on Population, 1984.; ST/ESA/SER.A/91)This paper reviews the major issues that have emerged in the analysis of mortality and health policy since the 1974 World Population Conference. The 1st part summarizes current mortality conditions in the major world regions and evaluates progress toward achieving the goals of the World Population Plan of Action. It is noted that the current mortality situation is characterized by continued wide disparities between the more developed and less developed regions, especially during the 1st year of life. The 2nd part focuses on the synergistic relationship between health and development, including social, economic, and health inequalities. It is asserted that mortality rates in developing countries are a function of the balance governments select between development strategies favoring capital accumulation and concentrated investments on the 1 hand and strategies oriented toward meeting basic needs and reducing inequalities in income and wealth. Data from developed countries suggest that economic development does not necessarily lead to steady gains in life expectancy. Some variations in mortality may reflect changes in family relationships, especially women's status, that are induced by social and economic development, however. The 3rd part of this paper analyzes the effect of health policies on mortality, including curative and preventive programs and primary health care. The lack of community participation is cited as a key factor in the weak performance of primary health care in many developing countries. In addition, there is strong evidence that the concepts and technologies of modern medicine must be adapted to existing systems of disease prevention and care to gain acceptability. The 4th section, on the implementation of health policies, discusses health care management, planning, and financing. It is noted that successful implementation of health policies is often hindered by scarcity, inadequate allocation, and inefficient utilization of health resources. Finally, more effective means to cope with rising costs of health care are needed.
Population and Development Review. 1984 Mar; 10(1):103-26.This paper presents some of the results of projections prepared by the World Bank in 1983 for all the world's countries. The projections (presented against a background of recent demographic trends as estimated by the United Nations) trace the approach of each individual country to a stationary state. Implications of the underlying fertility and mortality assumptions are shown mainly in terms of time trends of total population to the year 2100, annual rates of growth, and absolute annual increments. These indices are shown for the largest individual countries, for world regions, and for country groupings according to economic criteria. The detailed predictive performance of such projections is likely to be poor but the projections indicate orders of magnitude characterizing certain aggregate demographic phenomena whose occurrence is highly probable and set clearly interpretable reference points useful in discussing contemporary issues of policy. (author's)
In: United Nations. Department of International Economic and Social Affairs. Population projections: methodology of the United Nations. New York, N.Y., United Nations, 1984. 60-6. (Population Studies, No. 83; ST/ESA/SER.A/83)This paper offers suggestions for guiding the next projection's exercise at the United Nations in light of third world life tables which, although severely limited, are believed to be relatively reliable. Of prime importance is the suggestion that expectation of life at birth in a number of less developed areas has begun to overtake and surpass the lower levels of such measures among the populations of developed countries. Although this is the 1st such occurrence on record, it is not likely to be reversed. A major implication of these patterns is that the causal linkages which have historically connected levels and patterns of socioeconomic development with those of mortality have become greatly attenuated. It is safe to say that major new causal mechanisms for reducing mortality have come into play which demographers have yet to comprehend adequately for purposes of projection. Another suggestion is to increase attention to the specific status and performance of national public-sector health programs (including water supply and sanitation) key factors affecting the onset and scale of mortality downtrends during the postwar decades. In addition, increasingly close attention needs to be paid to political disturbances, affecting health-care programs financing and associated delivery systems. With few exceptions, differences between female and male life expectancies at birth have been rising in the sample areas under review, implying that the gains over time for females have been higher than those for males. This directional pattern at both ages is remarkably similar to what has been found to hold with notable consistency among developed countries since 1920. Its prevalence suggests a bench-mark for checing the projected longevity differentials between males and females in the next UN exercise; at a minimum, these should be compared with past directions and magnitudes of change. Added or new attention should be given to comparisons between developed country and less developed country mortality measures; to how such measures vary by age at given points of time and shift by age over time; to sex differentials of both mortality levels and changes; and to the rapidly growing stocks of information becoming available on leading correlates of deaths, survival and morbidity rates. Such attention will enhance the quality, relevance and reliability of the future work of the UN on population projections.
In: United Nations. Department of International Economic and Social Affairs. Population projections: methodology of the United Nations. New York, N.Y., United Nations, 1984. 25-32. (Population Studies, No. 83; ST/ESA/SER.A/83)The United Nations population projection assumptions are statements of expected trends in fertility, mortality and migration in the world. In every assessment, each of the 3 demographic components is unambiguously specified at the national level for each of the 5-year periods during the population interval (1950-2025). The approach used by the UN in preparing its projections is briefly summarized. At the general level, the analyst relies on available information of past events and current demographic levels and differentials, the demographic trends and experiences of similar countries in the region and his or her informed interpretations of what is likely to occur in the future. One common feature of the UN population projections that guides the analyst in preparing the assumptions is the general conceptual scheme of the demographic transition, or the socio-economic threshold hypothesis of fertility decline. As can be observed from the projected demographic trends reported in this paper, population stabilization at low levels of fertility, mortality and migration is the expected future for each country, with the only important differences being the timing of the stabilization. Irrespective of whether the country is developed, with very low fertility (for example, the Federal Republic of Germany or Japan), or developing with high fertility (such as, Bangladesh or the Syrian Arab Republic), it is assumed that fertility will arrive at replacement levels in the not too distant future. Serious alternative theories or hypotheses of population change, such as declining population size, are not only very few in number, but they tend to be somewhat more unacceptable and inconvenient to the demographic analyst as well as being considerably less palatable to goverments.