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Breastfeeding, breast milk and human immunodeficiency virus (HIV). Statement from the Consultation held in Geneva, 23-25 June, 1987.
WHO REPORT. 1988; 1-2.Recommendations from a consultation on breastfeeding, breast milk and HIV infection held by the Global Programme on AIDS and the Division of Family Health of the WHO in June 1987 are summarized. 20 participants from 15 countries, experts in epidemiology, immunology, virology, pediatrics and nutrition attended. There is a 25-30% chance that HIV will be transmitted from mother to infant during the perinatal period. Whether HIV can be transmitted via breast milk is unknown and risk is thought to be small. While there is 1 report of HIV cultured from breast milk, and a few cases of mothers infected after delivery by blood transfusions who transmitted HIV to their infants by breastfeeding, there are many reports of infected mothers breastfeeding without infecting their infants. Breast milk is still the best food for infants for immunologic, nutritional, psychological and child-spacing benefits. It is recommended that breastfeeding continue to be promoted in both developing and developed countries, regardless of HIV status. The use of pooled human milk is the second best mode of infant feeding. Pasteurization at 56 degrees C. for 30 minutes will inactivate HIV. Wet nurses should be chosen with care.
In: Public policies and the misuse of forest resources, edited by Robert Repetto, Malcolm Gillis. Cambridge, England, Cambridge University Press, 1988. 385-410. (World Resources Institute Book)The World Resources Institute has compiled 12 case studies on public policies from developed and developing countries and the misuse of forest resources into 1 book. All of the studies confirm that 3 key products of population growth and rural poverty in developing countries are responsible for deforestation. These products include shifting cultivation, agricultural conversion, and fuelwood gathering. Large development projects also foster forest destruction. Government policies contribute to and exacerbate these pressures which result in inefficient use of natural forest resources. Such policies directly and indirectly undermine conservation, regional development schemes, and other socioeconomic goals. Forestry policies include timber harvest concessions, levels and structures of royalties and fees, utilization of nonwood forests products, and reforestation. Tax incentives, credit subsidies, and resettlement programs comprise examples of nonforestry policies. Trade barriers established by industrialized countries have somewhat encouraged unsuitable investments and patterns of exploitation in forest industries in developing countries. Negotiations between exporting and importing countries within the confines of the General Agreement on Tariffs and Trade (GATT) and the International Tropical Timber Agreement (ITTA) should strive to reduce tariff escalation and nontariff barriers to processed wood imports from tropical countries and to justify incentives to forest industries in developing countries. These 12 case studies have come to the same conclusion as the UN Food and Agriculture Organization did in 1987: action to conserve forests is needed without delay.
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.
[The controversies over population growth and economic development] Die Kontroversen um Bevolkerungswachstum und wirtschaftliche Entwicklung.
In: Probleme und Chancen demographischer Entwicklung in der dritten Welt, edited by Gunter Steinmann, Klaus F. Zimmermann, and Gerhard Heilig. New York, New York/Berlin, Germany, Federal Republic of, Springer-Verlag, 1988. 19-35.This paper presents a broad review of the major theoretical and political viewpoints concerning population growth and economic development. The western nations represent one side of the controversy; based on their experience with population growth in their former colonies, the western countries attempted to accelerate development by means of population control. The underlying economic reason for this approach is that excess births interfere with public and private savings and thus reduce the amount of capital available for development investment. A parallel assumption on the social side is that families had more children than they actually desired and that it was only proper to furnish families with contraceptives in order to control unwanted pregnancies. The competing point of view maintains that forcing the pace of development would unleash productive forces and stimulate better distribution of wealth by increasing social pressures on governments. The author traces the interaction between these two viewpoints and shows how the Treaty of Bucharest in 1974 marked a compromise between the two population policies and formed the basis for the activities of the population agencies of UN. The author then considers the question of whether European development can serve as a model for the present day 3rd World. The large differences between the sizes of age cohorts and the pressure that these differences exert upon internal population movements and the availability of food and housing is more important than the raw numbers alone.
Mexico City, Mexico, MEXFAM, 1988 Feb. , 10 p.During 1987 the Mexican Federation for Family Planning (MEXFAM) continued developing its programs following the same orientation as in the previous year, but at a slower pace intended to achieve a greater degree of consolidation. A permanent mechanism for qualitative evaluation was arranged with the Mexican Institute for Social Studies, an external organization. Work was initiated in 4 new states, bringing the total to 26 of Mexico's 32 states. Activities were suspended in Yucatan because new information revealed that fertility rates were relatively low. MEXFAM does not seek to provide massive family planning coverage but rather to act as a catalyst for family planning activities. MEXFAM is expanding its program of "community doctors", in which it assists young medical school graduates to establish practices in underserved urban areas. In a similar program, "affiliate doctors", physicians already established in their communities, receive technical assistance and materials to begin offering family planning services. During 1987, MEXFAM initiated the "Young People" program to provide sex and family planning education to young people under 20 in schools, clubs, and recreation centers. Various films were made to provide sex education to the Young People program. They were well received in Mexico and some were broadcast in other countries. In 1987, 382,328 new users were served, compared to 174,634 in 1986. 73% of the new users were in MEXFAM programs and the rest were in collaborative programs. Mexico's deteriorating economic situation in 1987 was reflected in increasing resource scarcities for public health organizations. The broad geographic distribution and remoteness of some MEXFAM programs pose a serious challenge for control and supervision. Programs have been grouped into logistic centers with responsibility for supervision assigned on a regional basis. MEXFAM is making great efforts to improve its record system, adapt it to International Planned Parenthood Federation requirements, and make it compatible with the Ministry of Health record system. A certain amount of confusion is anticipated in 1988 as workers become accustomed to new record formats. User payments are the main source of local revenues for MEXFAM. Given Mexico's poor economic situation, the prospects for an increase in local donations are poor, but efforts to raise funds locally are continuous. 4 new external donors were added in 1987. The International Planned Parenthood Federation continues to be the main source of funds. 87% of MEXFAM funds were directly spent on projects and 13% on administration and general services in 1987.
SIND UNIVERSITY ARTS RESEARCH JOURNAL. 1988; 23:47-58.This paper demonstrates the negative role that multinational corporations play in developing countries by instituting policies and practices that keep them "underdeveloped." It is estimated that there are around 27,300 multinationals worldwide, but of these 200 are the largest (over 1 billion dollars). 8 of these are based in the US accounting for 1/3 of the total number of foreign affiliates which together with those of Britain, France and West Germany account for 3/4 of the total number. Investments by multinational corporations (MC) in developing countries is usually for its own interests and not of the host country; for example, in countries where rural development is a national objective, MC's will invest in the urban areas. When MC's introduce technology into developing countries it is generally designed for large-scale production and reflects the factor prices in developed countries, making such technologies inappropriate to the conditions found in developing countries. In developing countries, social and political development are usually prerequisites for economic development; however this process is hampered by MC's by virtue of their contacts with certain social groups in host countries. There are 4 areas of conflict between MC's and developing host countries: 1) foreign investment is a private venture that often clashes with social and national goals; 2) it is obligopolistic, possessing market powers that can be used against the interest of host countries; 3) it is foreign, serving the interests of foreign countries; and 4) it is western, and may transfer technological know-how not appropriate for developing countries. MC's are actually playing negative roles and preventing the development of Third World countries through exercises in foreign aid. (author's modified)
[Unpublished] 1988. Presented at the Annual Meeting of the Population Association of America, New Orleans, Louisiana, April 21-23, 1988. 18 p.The implications for Canada of the migration recommendations of the Organisation for Economic Co-operation and Development (OECD) are discussed. OECD has 24 member countries in Europe, as well as Japan, U.S.A., Canada, Australia and New Zealand. OECD organized a set of recommendations on migration and foreign manpower in the 1960s, which was updated in 1979 under the title "Migration, growth and development," commonly known as the "Kindleberger report," and focusing on migration of workers from less-developed to developed European OECD member countries. The OECD Kindleberger report deals with subjects such as social implications of migration, trend of South-to-North flows of illegal foreign workers, challenges to sovereignty of nations, macro-economic effects of migration, long-term demographic role of migration, increasing pluralism of societies, responsibility of the sending countries to solve their development problems. The OECD subsequently held a Working Party on Migration Conference on the Future of Migration in May 1986. The Canadian responses to the Conference are listed in a 7-point policy framework. Topics included policy convergence, sovereignty, economic role of migration, demographic impact, and control of immigration as regards tourism, illegal migrants, economic refugees, organized networks for border crossing, penalties on employers, and the effect of regularizing illegal migrants on future flows.
Development co-operation, 1988 report: efforts and policies of the members of the Development Assistance Committee.
Paris, France, Organisation for Economic Co-operation and Development, 1988. 254 p.The members of the Organisation for Economic Co-operation and Development's (OECD) Development Assistance Committee provided about $41.5 billion in development assistance in 1987, over 80% of world aid, which exceeded $50 billion. In real terms, this is a 1% drop in assistance over 1986. Among the larger countries, Japan's 1987 performance was outstanding; its assistance increased by 13.5%. There has been considerable disappointment with the relatively low priority accorded to development assistance by the US, but the US is in the middle of a period of fiscal and trade policy adjustment seen as important to the well-being of the international economic system. Official development assistance still provides more than half of total net financial flows to developing countries. The DAC has just reached a new consensus of principles of project approval, including 1) a conducive policy environment, 2) clear and realistic goals, 3) project design corresponding to managerial and technical capacity, 4) affordability in terms of initial costs and of operations and maintenance, 5) active involvement of local authorities and target groups including women, 6) choice of appropriate technologies, 7) realistic time frames, 8) adequate maintenance and support systems, 9) compatibility with domestic socio-cultural environments, and 10) environmental sustainability. There is an encouraging convergence in economic thinking with a recognition by OECD and developing countries alike that what happens in each is important to the world economy. Trade is now seen even more clearly than in the past as fundamental to the development process. The worldwide consensus on the importance of private-sector growth suggests that developing countries are likely to be seeking more help for direct assistance to the market economy and for improving government institutions needed to provide vital services and support. There is a renewed interest in looking at aid policy for upper middle-income countries.
Washington, D.C., PAHO, 1988 Jul. v, 117 p. (Official Document No. 221)The global economy continued to adversely affect member countries' health programs and activities in 1987. For example, Latin American and Caribbean countries lost >$US28 billion in 1987 and from 1982-1987 they lost $US130 billion. At the same time, the percentage of adolescents and elderly in the total population increased tremendously, the numbers of people experiencing chronic and disabling diseases also increased while infectious and parasitic diseases still posed challenges for the health community, and the number of urban poor continued to grow. In 1987, to help member countries deal with the everchanging health needs of their populations, PAHO focused on population groups and geographic regions and within these defined areas concentrated on specific diseases. For example, PAHO worked with member governments to formulate, implement, and evaluate policies and programs on the health of adults. Specifically, diseases and conditions emphasized in adult health included cardiovascular diseases, cancer, diabetes mellitus, accident prevention, and the prevention, treatment, and rehabilitation of alcoholism and drug abuse. Other emphases were maternal and child health and family planning and those diseases and conditions associated with the population. Additionally, PAHO continued with special programs and initiatives to maximize its role as a catalyst and to mobilize national and international resources in support of activities aimed at selected health priorities. Some of these initiatives included the Expanded Program on Immunization, the Emergency Preparedness and Disaster Relief Coordination, and the Caribbean Cooperation in Health. In addition, each country's PAHO activities have been summarized.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)Breastfeeding is on the decline in most countries, despite the fact it can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. The World Health Organization (WHO) and the UN International Children's Emergency Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding. In the most developed countries, breastfeeding has increased despite generally unsupportive hospital environments, the availability of clean water, and the fact that breastfeeding was virtually a lost practice in these countries 40 years ago. An increased awareness of the benefits, some of which are outlined, coupled with mother-to-mother support are most likely to have influenced this increase. The guidelines developed by WHO/UNICEF seek to put into practice specific recommendations agreed upon by pediatricians, obstetricians and gynecologists, nutritionists, nurses, midwives, and other health care providers in national and international forums. The main points of the guidelines are as follows: every facility providing maternity services should develop a policy on breastfeeding, communicate it to all staff, define specific practices to implement the policy, and ensure that all staff are adequately trained in the skills necessary to ensure implementation of the policy; facilities for 24-hour rooming-in, initiation of breastfeeding immediately after delivery, and demand-feeding are essential in every maternity ward; every pregnant mother should be informed fully about how breast milk is formed, the proper way to nurse a child, and the benefits of breastfeeding; and harmful practices, such as the use of bottles and teats for newborn infants, should be eliminated during this early period and exclusive breastfeeding maintained for at least 4-6 months from birth. These activities, when fully implemented, will ensure that every mother/infant couple reached prenatally, at birth, and postnatally gets off to a good start. Then, other support services will be more effective. These standards have been successful in the field and have had a positive impact on the rates of breastfeeding. A need exists for collaboration and an interdisciplinary approach to the promotion, protection, and support of breastfeeding, and, hopefully, this workshop is the first of a series of technical consultations.
WORLD HEALTH. 1988 Aug-Sep; 10-5.The 1978 International Conference on Primary Health Care (PHC) in Alma-Ata, USSR, sponsored by the World Health Organization (WHO) and by UNICEF, culminated in the Declaration of Alma-Ata. This Declaration, signed by representatives of 134 nations, pledged urgent action for the development of PHC and toward the goal of "Health for All by the Year 2000." Among the most important principles of PHC are these 5: 1) that care should be accessible to all, especially those in greatest need; 2) that health services should promote popular understanding of health issues, and should emphasize preventive as well as curative measures; 3) that health services should be adapted to local economic and cultural circumstances, and be effective; 4) that local communities should be actively involved in the process of defining health problems and developing solutions; and 5) that health development programs should involve cooperation among all the community and national development efforts that have an impact on health. Even before the Declaration 10 years ago, the concepts underlying PHC had been taking root around the world. Progress toward the ideals of PHC has been made. Immunizations rates increased from 5% in 1970 to 40% in 1980. Only 34 countries had under-5 mortality rates of 178/1000 or more in 1985. 1/2 the number of 25 years earlier. However, PHC has in general achieved much better coverage in the developed countries than in the developing ones. The increase in world poverty -- to 1 billion people in absolute poverty today -- is a major setback for PHC. A major cause of health problems in the 3rd World is the too-rapid growth of unwieldy cities. Another common problem is that the training of medical professionals has not prepared them for leadership roles in community-oriented, preventive health programs. The ideals of PHC have been widely accepted throughout the world, and progress has been made, but much remains to be done.
New York, New York, Longman, 1988. xv, 223 p.In 1964 Wilbur Schramm, on a grant from the United Nations Educational, Scientific and Cultural Organization (UNESCO), wrote a book called "Mass Media and National Development." It painted a glowing picture in which the mass media would reveal the way to development and enable the Third World countries to achieve in a few decades the development that had occurred over centuries in the West. By the 1970s it became clear that population growth was overtaking development. The Third World nations began to see the mass media as tools of the conspiracy of transnational corporations in their to keep the Third World a source of cheap labor. The Third World countries began to seek an alternate route to development, without help from either the East or the West. Their ideal and model was China, where the radical alternative had been shown to work. The Third Word countries joined together as the "Non-Aligned MOvement," a organization which had been founded in Indonesia in 1955. By the 1970s the Third Word countries constituted a majority in UNESCO, which they turned into a forum of resentment against the Western mass media, which they perceived as using dominance over world news flow to keep the Third World in a state of cultural dependency on the West. The poverty of the Third World nations, they claimed, was the heritage of colonialism, and the West owed them restitution. The Western news media were identified as the modern day equivalent of the colonial armies of imperialism. The debate over the dominance of Western influence in world news flow was launched in UNESCO by a request from the Soviet Union in 1972 for "a declaration on the fundamental principles governing the use of the mass media with a view to strengthening peace and understanding and combatting war, propaganda, radicalism, and apartheid." The debate in UNESCO took on a new name, the "New World Information Order," in which the Third World nations argued that they had the right to restrict the free flow of news across their borders. UNESCO Director General, Amadou M 'Bow, tabled the resolution and appointed a commission, headed by Sean MacBride, to undertake general review of communications problems in modern society. The report, entitled "Many Voices, One World," was in many ways vague, but it at least endorsed the Western values of free flow of information. The Us offered technological assistance to the Third World under the auspices of the International Program for the Development of Communication. This institution was designed as a world clearinghouse for communication development, but as such it accomplished little. Meanwhile, the Third World countries gave priority to developing their own national news agencies and the Non-Aligned News Agencies Pool, dedicated to the "journalism of national development." What this meant, if effect, was journalism limited to "development news" (which by definition was always good)and to "protocol news," i.e., ribbon-cutting and other ceremonial events. By the time of the US withdrawal from UNESCO at the end of 1984, the issue was becoming, if not resolved, at least quiescent, with some indications of progress. At the 1983 conference at Talloires, the World Press Freedom Committee and the Associated Press put together a list of 300 journalistic exchange, training, and internship programs in 70 countries. The World Bank issued a report on "Telecommunications and Economic Development," and a report by the Organization for Economic Cooperation and Development and the International Telecommunications Union pointed out the cost-benefit relationship of telecommunications to economic development. Finally, a report by an international commission headed by Sir Donald Maitland stressed the importance of shifting existing resources to telecommunications so that basic communications services would be available to everyone on earth by the early 21st century.
Washington, D.C., World Bank, 1988. 29 p.This 21st edition of the Atlas presents economic, social and demographic indicators in the form of tables and charts covering the world. The main yardstick of economic activity in a country is the gross national product. 60 developing countries have had declining gross national product, although for most countries real per capita income has risen. Social indicators show evidence of improved standards of living since the early 1980s. Population estimates and other demographic data are from the UN Population Division; education data are from the United Nations Educational Scientific and Cultural Organization, and calorie data are from the Food and Agriculture Organization. A total of 10 charts and maps show world population; statistics on 185 countries and territories; gross national product, 1987; population growth rate, 1980-87; gross national product per capita growth rate, 1980-87; agriculture in gross domestic product, 1987; daily calorie supply, 1985; life expectancy at birth, 1987; total fertility rate, 1987; and school enrollment ratio, 1985. Throughout the Atlas, data for China do not include Taiwan. The World Bank, a multilateral development institution, consists of 2 distinct entities: the International Bank for Reconstruction and Development, which finances its lending operations from borrowings in the world capital markets, and the International Development Association, which extends assistance to the poorest countries on easier terms.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(3-4):267-73.Because declining mortality from infectious diseases is accompanied by increasing mortality from noncommunicable diseases in both developed and developing countries, the World Health Organization (WHO) has initiated the Integrated Program for Community Health in Noncommunicable Diseases (Interhealth). Interhealth is based on the concepts that 1) noncommunicable diseases are related to a set of risk factors some of which can be controlled; 2) the entire community must be involved; 3) health promotion intervention strategies, such as population control, risk identification, screening and prevention strategies, must be integrated; 4) different categories of intervention (e.g., lifestyle changes, health care reorganization) must be coordinated; 5) social and environmental changes will be necessary; and 6) noncommunicable disease prevention and control strategies will be implemented through existing primary health care systems. The core program of Interhealth addresses heart diseases, stroke, diabetes, cancer, and respiratory diseases from the point of view of their common risk factors: diet, tobacco, physical activity, environment, oral hygiene, blood pressure, lipids, and glucose. The Interhealth program is being developed as a dynamic system, consisting of 4 main activities: experimental testing by means of demonstration projects (of which there are currently 18 in 15 countries); mathematical modeling of disease/risk factor interrelations; training; and research activities. These activities will be supported by organizational, financial and information activities at WHO headquarters and in the WHO Regional Offices.
International Migration/Migrations Internationales/Migraciones Internacionales. 1988 Jun; 26(2):187-97.Bilateral and multilateral measures implemented to assist migrants who return to their country of origin have been designed to respond to a number of different but specific situations. 2 bilateral agreements are briefly described: 1) an agreement between the Federal Republic of Germany and the Republic of Turkey signed in the early 1970s, and 2) an agreement between France and Algeria signed in 1980. 3 different types of multilateral activities are described: 1) the operation of the so-called Return of Talent program by the Intergovernmental Committee for Migration, 2) the Transfer of KNow-how Through Expatriate Nationals program of the UN Development Programme, and 3) the elaboration of a model machinery on return migration by the Organization for Economic Cooperation and Development. While the 1st 2 activities are operational programs, by which annually between 1000-2000 professionals are assisted in their permanent return to or temporary sojourn in their developing countries of origin, with the financial support of both the developed and the developing countries concerned, the 3rd initiative is a conceptual effort aimed at assisting governments to implement policy measures designed to make return migration commensurate with national development goals. 3 recent proposals include 1) the proposal for an international labor compensatory facility, 2) an international fund for vocational training, and 3) an international fund for manpower resources. A common factor shared by all these programs is that they have all involved on 1 side industrial receiving countries which feel themselves obliged to observe a number of principles guaranteed by law and which govern employment conditions and working relations. The reintegration measures implemented or proposed in cooperation with them have been adopted in full consideration of the prevailing standards of these countries, as different as they may be from 1 country to another. A common consideration has been that the returning migrant should reintegrate in his country of origin as far as possible in conditions allowing the returnee to attain self-sufficiency and social security coverage. However, this underlying context does not necessarily prevail in all world regions where different forms of labor migration take place. Therefore the measures experienced in the relationship of specific countries cannot be easily copied for implementation in other countries. Multilateral measures benefited a rather limited number of individuals only, in many instances skilled and highly skilled migrants.
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.
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.
New York, New York, United Nations Population Fund, 1988. xi, 477 p. (Population Programmes and Projects Vol. 1.)This is the 5th edition of the GUIDE to be published. A new edition is issued every 3 years. The GUIDE was mandated by the World Population Plan of Action, adopted by consensus at the World Population Conference held in Bucharest, Romania, in August 1974. Each entry for an organization describes its mandates, fields of special interest, program areas in which assistance is provided, types of support activities which can be provided, restrictions on types of assistance, channels of assistance, how to apply for assistance, monitoring and evaluation of programs, reporting requirements, and address, of organization. International population assistance is broadly construed as 1) direct financial grants or loans to governments or national and non-governmental organizations within developing countries; 2) indirect grants for commodities, equipment, or vehicles; and 3) technical assistance training programs, expert and advisory services, and information programs. To gather information for this edition of the GUIDE, a questionnaire was sent to more than 350 multilateral, regional, bilateral, non-governmental, university, research agencies, organizations, and institutions throughout the world.
ACTA CARDIOLOGICA. 1988; 43(2):133-9.Age-adjusted mortality trends among men aged 35 to 74 in developed countries are analyzed for the last 35 years using WHO data for seven selected countries. "Mortality from all causes has shown the greatest decrease in Japan and the greatest increase in Hungary. From 1970 on cardiovascular mortality demonstrates a downward trend in all countries, except in Sweden where it remains virtually unchanged and Hungary where it rises markedly. Cancer mortality shows an upward trend which levels off during the last 15 years with the exception of Hungary. Changes in dietary and smoking habits and mass treatment of hypertension offer the most plausible explanation for the observed changes." (EXCERPT)
The contribution of the United Nations to the development of population policy in developing countries.
[Unpublished] 1988. 13 p.The UN has been actively engaged in population questions--including policy issues--from its very beginning. In 1946, the UN's Economic and Social Council established the Population Commission to arrange for studies and advise on the size and structure of populations, the interplay of demographic and socioeconomic factors, and policy. The UN has 3 leading functions that it carries out in relation to population questions: 1) the formulation of population policies and recommendations for action as agreed to by the community of nations, 2) organizing and maintaining a flow of resources and technical assistance, and 3) assembling, analyzing, and disseminating research findings that contribute to effective policy formulation. Although the population policies adopted by the UN are not treaties and lack the force of law, the existence of an international consensus can serve to help legitimate a policy at the national level as well as giving governments an incentive to formulate their own position. International policy formulation can also guide the financial support, technical assistance, and research activities of the UN system. 2 risks that must be overcome for the effective use of intergovernmental fora to arrive at population policies are 1) the risk that population issues may become politicized, and 2) the risk that attempting to define policies acceptable to all nations will result in a policy so general that it loses all impact. The leading role in the promotion of population programs of the UN system was given to the UN Fund for Population Activities in 1967. To implement its broad and flexible mandate, the Fund has developed a core program covering 1) family planning, 2) population education, 3) basic data collection, 4) population dynamics, and 5) population policy. The leading questions facing the UN now as it seeks to continue its contribution to population policy at the national level are 1) the possibility of holding a 3rd international conference on population in 1994, 2) continuing high rates of fertility and growth in Sub-Saharan Africa, 3) near or below replacement fertility in some countries, 4) changes in the structure and the roles of women, 5) the AIDS epidemic, 6) urban growth and rural decline, and 7) the residual effects of past international migration.
WORLD HEALTH FORUM. 1988; 9(2):185-99.This article explains how the concept of health for all developed within the context of the history of the World Health Organization (WHO). By the early 1970s a new idea was taking shape in WHO. Medical services were failing to reach vast numbers. Health would have to emerge from the people themselves. In the heat of discussion the new strategy was clarified and given a name--primary health care (PHC). An ambitious target was set for it--no less than health for all by the year 2000. It was decided that the community itself had to be involved in planning and implementing its own health care. A new type of health worker was called for, chosen by the people from among themselves and responsible to the community but supported by the entire health system. In virtually all countries, the emphasis on curative care would have to be balanced by an equal emphasis on prevention. Almost 90% of WHO's Member States were prepared to share with one another detailed information about the problems facing their health systems. Industrial countries were beginning to realize that sophisticated medical technology was no guarantee of good health and that health for all through PHC offered an alternative. Millions of health workers have been trained, extending services to low-income groups that had no access to modern health care. Among health professionals, lack of understanding of the PHC concept and insufficient concern for social equity remain the principal constraints. Another problem is that expenditure on health care tends to be viewed as a drain on scarce resources rather than as an investment in the nation's future. The mommentum of health for all can be sustained only by governments implementing at home the policies they have collectively agreed on at The World Health Assembly in Geneva.
WORLD HEALTH FORUM. 1988; 9(2):143-6.This article summarizes the activities and the philosophy of WHO in its effort to improve worldwide health care since its inception some 40 years ago. At the 1st World Health Assembly in 1948 it was pointed out that little could be achieved by medical services unless the existing economic, social and other relations among peoples have been improved. The immediate priorities of the new Organization were more limited: to build up health services in the areas destroyed by the war, and to fignt the spread of the big infectious killer diseases. It took almost 30 years before the WHO really got down to trying to do something about the economic, social and other conditions which lie at the heart of most health problems. The Alma-Ata Declaration in 1978 heralded a new era in health. The concept of primary health care and the global health-for-all strategy to implement it are now rapidly gaining ground. In villages, towns and districts, people are waking up to the fact that they can contribute to their own health destiny. As WHO embarks on its 5th decade, there are grounds for optimism: health is moving in the right direction in spite of major obstacles.
INTERNATIONAL HEALTH NEWS. 1988 Feb; 9(2):7.At a panel on Acquired Immune Deficiency Syndrome (AIDS) and the 3rd world in January 1988, experts focused on the profound problems generated by the AIDS pandemic. The World Health Organization (WHO) estimates that 3-5 million people in at least 127 countries now suffer from AIDS and that this figure will reach 10-30 million by 2000. The disease represents a highly debilitating force, both socially and economically, even in nations able to afford the approximately $6000/patient cost per year of treating AIDS patients. Panelists suggested that this could prove devastating for the poorer nations. WHO's AIDS program, launched in February 1987, focuses on the development and support of national AIDS control programs. It now operates in 93 countries, and 34 more countries are scheduled to join in 1988. WHO has assisted another 58 countries with shortterm AIDS action plans. The US Agency for International Development has developed a 2-pronged strategy for curbing the pandemic with prevention-emphasis programs operating under WHO.
WORLD HEALTH. 1987 Oct; 23-5.The World Health Assembly of 1977 determined that all member governments should have as their primary goal--to achieve by the year 2000--a level of health that would allow their citizens to enjoy an economically and socially productive life. The goal is now known as "Health for All by the Year 2000" (HFA/2000). Problems directly related to health, grouped under personal health services, can be differentiated from infrastructure development, including methods and proceedures to improve health. The former encompasses maternal and child health, nutrition, treating infectious and chronic diseases, and environmental factors. The latter covers human, technical, and auxiliary resources, administration, planning, evaluation, information, legislation and regulation, basic and applied research, and financing. Almost all Latin American and Carribean countries are looking at 3 main strategies. The 1st is finding new ways to interconnect health sector institutions and to mesh goals and operations of institutions with overall policy and national objectives. Here, health ministries take on the broad task of guiding, leading, and mobilizing national and international resources and analyzing progress. 2nd, all the countries have tried hard to offer better alternatives for service financing for better and fuller health coverage, including equitable access by all people to the care level required by each case, and to eliminate unnecessary proceedures that raise costs without helping to solve real health problems. A 3rd route is implementing efficacious methods of planning, administration, and health service evaluation.
WORLD HEALTH. 1987 Oct; 4-6.3 years ago, the Central American countries of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama began a subregional initiative with PAHO/AMRO named "Health as a Bridge to Peace." Formally called "Priority Health Needs in Central America and Panama," this initiative has included: 1) A temporary cease-fire in El Salvador each year between government and guerrillas, permitting a 3-day nationwide immunization campaign throughout the country; 2) Belize's inclusion for the 1st time in an annual meeting of the Ministers of Health in Central America and Panama. The directors of the Social Security Institutions also participated. Although recent conflicts had strained international dialog, the initiative spurred cooperation between all countries of the region, including formal agreement between the Ministers of Health of Honduras and Nicaragua to conduct joint border monitoring to prevent the spread of malaria and other tropical diseases, mutual spraying in malaria endemic areas by Nicaragua and Costa Rica, and training and technical cooperation exchanges between the countries and their neighbors. Last year, in the 1st joint purchase from a revolving fund for essential drugs, the countries obtained some 17 drugs more than 300% cheaper than each had purchased them seperately the previous year. Priorities of the initiative are health services, human resources, essential drugs, food and nutrition, tropical diseases, and child survival. It concentrates on mothers and on children under 5, on refugees and displaced persons, and on the urban and rural poor.