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[Unpublished] 1989 Oct 26. 11 p. (UNFPA/CM/89/107; UNFPA/CD/89/103; UNFPA/RR/89/103)In October 1989, UNFPA distributed its Policy Guidelines on UNFPA Support for Population and Environment to its representatives, country directors, and headquarters staff. UNFPA cooperates with other UN agencies on population and environment issues, e.g., UNEP, UNDP, UNICEF, World Food Programme, and International Fund for Agricultural Development. UNFPA assistance in the area of population and environment should be limited to research and analysis, e.g., country case studies; information, education, and communication (IEC) projects that create awareness and that sensitize people to the interrelatedness of population and the environment; policy formulation and planning; and training. UNFPA should seek to provide assistance through interagency cooperation and joint programming projects. UNFPA prefers providing assistance to action-oriented research which examines ways population variables interact with environmental variables in developed and developing countries and improves population/environment linkages at the local level. It favors country case studies because they allow us to study linkages in various settings of hugh differences in natural resources and economic prosperity, political constraints, and different stages of environmental degradation. UNFPA recognizes the need for data collection and analyses at the regional and global levels. To increase awareness and sensitization, UNFPA plans to fund seminars or workshops for parliamentarians, policymakers, planners, representatives of nongovernmental organizations, research and technical institutes, and other relevant people at the global, regional, national, or subnational level. These seminars or workshops should aim for development of proposals for practical action-oriented interventions.
Washington, D.C., Island Press, 1991. lxii, 272 p.In 1988, the World Meteorological Organization and the UN Environment Program established the Intergovernmental Panel on climate Change (IPCC) to consider scientific data on various factors of the climate change issue, e.g., emissions of major greenhouse gases, and to draw up realistic response strategies to manage this issue. Its members have agreed that emissions from human activities are indeed increasing sizably the levels of carbon dioxide, methane, chlorofluorocarbon (CFC), and nitrous oxide in the atmosphere. The major conclusions are that effective responses need a global effort and both developed and developing countries must take responsibility to implement these responses. Industrialized countries must modify their economies to limit emissions because most emissions into the atmosphere come from these countries. They should cooperate with and also provide financial and technical assistance to developing countries to raise their living standards while preventing and managing environmental problems. Concurrently, developing countries must adopt measures to also limit emissions as their economies expand. Environmental protection must be the base for continuing economic development. There must be an education campaign to inform the public about the issue and the needed changes. Strategies and measures to confront rapid population growth must be included in a flexible and progressive approach to sustainable development. Specific short-term actions include improved energy efficiency, cleaner energy sources and technologies, phasing out CFCs, improved forest management and expansion of forests, improved livestock waste management, modified use and formulation of fertilizers, and changes in agricultural land use. Longer term efforts are accelerated and coordinated research programs, development of new technologies, behavioral and structural changes (e.g., transportation), and expansion of global ocean observing and monitoring systems.
In: The global possible: resources, development, and the new century, edited by Robert Repetto. New Haven, Connecticut, Yale University Press, 1985. 491-519. (World Resources Institute Book)Participants at the Global Possible Conference in 1984 concluded that, despite the dismal predictions about the earth, we can still fashion a more secure, prosperous, and sustainable world environmentally and economically. The tools to bring about such a world already exist. The international community and nations must implement new policies, however. Government, science, business, and concerned groups must reach new levels of cooperation. Developed and developing countries must form new partnerships to implement sustained improvements in living standards of the world's poor. Peaceful cooperation is needed to eliminate the threat of nuclear war--the greatest threat to life and the environment. Conference working groups prepared an agenda for action which, even though it is organized along sectoral disciplines, illustrates the complex linkages that unite issues in 1 area with those in several others. For example, problems existing in forests tie in with biological diversity, energy and fuelwood, and management of agricultural lands and watersheds. The agenda emphasizes policies and initiatives that synergistically influence serious problems in several sectors. It also tries to not present solutions that generate as many problems as it tries to solve. The 1st section of the agenda covers population, poverty, and development issues. it provides recommendations for developing and developed countries. It discusses urbanization and issues facing cities. The 3rd section embodies freshwater issues and has 1 list of recommendations for all sectors. The agenda addresses biological diversity, tropical forests, agricultural land, living marine resources, energy, and nonfuel minerals in their own separate sections. It discusses international assistance and the environment in 1 section. Another section highlights the need to assess conditions, trends, and capabilities. The last section comprises business, science, an citizens.
ADVANCES IN CONTRACEPTION. 1994 Jun; 10(2):121-31.The World Health Organization's prospective IUD study at 47 centers in 23 (mostly developing) countries among 22,908 women found an elevated IUD-related risk of pelvic inflammatory disease (PID) during the 1st 20 days after IUD insertion. It also showed that the likely major determinant of PID among IUD users is the risk of exposure to sexually transmitted diseases (STDs). Long-term IUD use is related to a uniformly low PID risk. These findings support measures already practiced by most service providers: aseptic conditions and techniques during IUD insertion, close monitoring of women for signs of infection during the early stage of IUD use, IUDs not recommended for women at risk of STDs, use of long-lasting IUDs, and removal before the end of the IUD's life span. Additional research is recommended to strengthen the validity of the findings, to further reduce IUD-related PID incidence, and to expand indications for IUD use. Cohort IUD studies should ascertain women's sexual behavior at baseline and during the study period. Other cohort studies should examine the natural history of IUD insertion-related PID. Clinical trials should examine the protective effects of antibiotics administered during IUD insertion against PID. IUD use in nulliparous and nulligravid women should be studied. Studies should clarify the link between IUD use and nongonorrheal infections (chlamydial infection, HIV infection, and actinomycosis). Research is needed to examine IUDs that claim to protect against PID (e.g., levonorgestrel-releasing IUDs). After family planning researchers clear IUD use from its alleged association with PID and its sequelae, they can advance to studies on how to improve the quality of life of IUD users (e.g., reducing distressing symptoms such as bleeding) and to increase access to IUDs by removing the programmatic and medical barriers.
In: Change: threat or opportunity for human progress? Volume V. Ecological change: environment, development and poverty linkages, edited by Uner Kirdar. New York, New York, United Nations, 1992. 154-60.The most common global concerns are the threat to the earth's ecological balance, challenges originating from new technologies, and the ability of developing countries to respond to these changes in a way conducive to sustainable development. Creative learning means that political systems assimilate new information when making policy decisions. pathological learning implies that political systems prevent new information from influencing policies, eventually leading to the system's failure. Policymakers cannot ignore the new technologies and the changing environment. The UN University had identified the most important research gaps with regard to technological development. recommendations from this study are more research on the relationship between the effects of existing trends in the technological revolution and the formation of development strategies and the significance of identifying alternatives of technological development better suited to the actual needs and conditions of developing countries. For example, biotechnology may produce new medications to combat some tropical diseases, but a lack of commercial interest in industrialized countries prevents the needed research. Research in the Himalayas shows the importance of focusing on the linkages between mountains and plains, instead of just the mountains, to resolve environmental degradation. This finding was not expected. The researchers promote a broader, more holistic, critical approach to environmental problem-solving. Humans must realize that we have certain rights and obligations to the earth and to future generations. We must translate these into enforceable standards at the local, national, and international levels to attain intergenerational equity. Policy-makers must do longterm planning and incorporate environmentally sound technologies and the conservation of the ecological balance into development policy. sustainable development must include social, economic, ecologic, geographic, and cultural aspects.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1993; 71(3-4):421-8.Worldwide coverage of measles vaccine is about 80%, but many communities and countries have considerably lower coverage rates. WHO is concerned about measles occurring in infants between 6 and 12 months old, especially in densely populated African cities. Measles rarely occurs in infants under 6 months old, but the measles case fatality rate is greatest in the 1st year of life. WHO aims for an effective measles vaccine to be administered at 6 months old. A high titer vaccine appears to reduce survival among children receiving it. Some countries have reduced measles incidence by as much as 90% by achieving coverage levels greater than 90% with a single dose measles vaccine. Another method to prevent early measles cases and later vaccine failures is administration of the 1st dose around 6 months and a 2nd dose no earlier than 12 months. Measles vaccine policy in the US and some countries in Europe is routine 2-dose measles schedules: 1st dose between 12-19 months and 2nd dose at school entry. This schedule is appropriate in developed countries with good immunization coverage. Other countries schedule the 1st dose anywhere between 6-9 months and the 2nd dose between 12 months and 7 years. All mathematical models of the effects of 2-dose schedules indicate that 2-dose schedule are a great benefit. The literature shows that developing countries with high immunization coverage and well-managed immunization programs can effectively execute and sustain 2-dose measles schedules. Measles vaccination early in life sometimes results in a blunted antibody response. The 2-dose schedules are probably more expensive than 1-dose schedules and require more cold storage space. No field trials have looked at clinical efficacy of 2-dose measles schedules in developing countries. Ideal field trials would be randomized controlled trials. Demonstration projects can evaluate operational issues, e.g., dropout rates, cost, and vaccine usage. Case control studies can address technical and epidemiological issues.
NEW YORK TIMES. 1992 Jun 4; A1, B10.The international AIDS Center at the Harvard School of Public Health led a coalition of AIDS research from around the world in an analysis of more than 100 AIDS programs and discovered that the HIV/AIDS pandemic is more serious than WHO claims. Its findings are in the book called AIDS in the World 1992. AIDS programs do not implement efforts that are known to prevent the spread of HIV. For example, clinicians in developing countries continue to transfuse unscreened blood to many patients, even though HIV serodiagnostic test have existed since 1985. Further, programs do not evaluate what works in other programs. As long as people debate whether or not to distribute condoms, exchange needles, or offer sex education and whether people with AIDS deserve care, the fight against HIV/AIDS is hindered. The report recommends that leader come up with a new strategy to address the AIDS pandemic. WHO claims to have done just that at its May 1992 meeting. An obstacle for WHO is political pressure from member nations. On the other hand, the private Swiss foundation, Association Francois-Xavier Bagnoud, finances the Harvard-based AIDS program, allowing members more freedom to speak out. The head of the Harvard program believes the major impact of AIDS has not yet arrived. Contributing to the continual spread of HIV is the considerable difference of funding for AIDS prevention and control activities between developed and developing countries (e.g., $2.70 per person in the US and $1.18 in Europe vs. $.07 in sub-Saharan Africa and $.03 in Latin America). Even though developed countries provide about $780 million for AIDS prevention and care in developing countries, they do not enter in bilateral agreements with developing countries. 57 countries limit travel and immigration of people with HIV/AIDS. Further, efforts to drop these laws have stopped. Densely populated nations impose travel constraints to prevent an explosive spread of HIV.
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.