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WHO / CONRAD Technical Consultation on Nonoxynol-9, World Health Organization, Geneva, 9–10 October 2001. Summary report.
Geneva, Switzerland, WHO, 2003.  p. (PN-ACQ-110)An effective, easy to use vaginal microbicide would provide women with a method under their own control with which to protect themselves against infection with the human immunodeficiency virus (HIV). While many novel compounds are currently being developed and tested, it will be many years before a new product can be fully evaluated and distributed to users. The spermicide Nonoxynol-9 (N-9) has been widely available as a contraceptive for many years and has been shown to be effective against HIV in laboratory studies. If it also provided effective protection against HIV in clinical studies, N-9 could be made rapidly available to women who require protection. The World Health Organization Global Programme on AIDS (GPA) and the Joint United Nations Program on HIV/AIDS (UNAIDS) sponsored a clinical trial of a gel containing N-9 to assess its effectiveness in protecting against HIV. Preliminary results from the study were presented in July 2000 at the 13th International AIDS Conference in Durban, South Africa, and showed, contrary to expectation, that the HIV incidence was higher in women using N-9 than in women using a comparison product. While a disappointment with regard to the rapid deployment of an effective microbicide, these results also raised questions about the safety of N-9 when used for its main indication, protection against unwanted pregnancy. After presentation of the preliminary results from the study in July 2000, the World Health Organization (WHO) was approached to provide an assessment of the scientific information regarding the safety and effectiveness of N-9 when used for family planning purposes. This summary should permit Member States to assess the risks and benefits of N-9 use among women in their country who may be at risk of HIV infection from inadequately protected sexual activity. Accordingly, the WHO Department of Reproductive Health and Research (RHR) convened a Technical Consultation in October 2001, in partnership with the CONRAD Program, Arlington, VA, USA, to review the available evidence and provide advice to member states on the use of N-9. The Consultation included experts from developed and developing countries with experience in product development, safety assessment, and public health and representatives from collaborating agencies (Annex). Reviews of key issues were commissioned prior to the meeting and are summarised in this report. The meeting also considered the submitted manuscripts from recently completed studies directly relevant to the safety and effectiveness of N-9. This report summarises the evidence presented to the meeting on the safety of N-9 and its effectiveness for protection against pregnancy, sexually transmitted infections (STIs) and HIV. The meeting concluded with recommendations on the use of N-9 and identified key areas of uncertainty where more research was urgently required. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], . 39 p.Reduction of maternal mortality has been endorsed as a key development goal by countries and is included in consensus documents emanating from international conferences such as the World Summit for Children in 1990, the International Conference on Population and Development in 1994 and, the Fourth World Conference on Women in 1995, and their respective five-year follow-up evaluations of progress in 1999 and 2000, the Millennium Declaration in 2000 and the United Nations General Assembly Special Session on Children in 2002. In order to monitor progress, efforts have to be made to address the lack of reliable data, particularly in settings where maternal mortality is thought to be most serious. The inclusion of maternal mortality reduction in the Millennium Development Goals (MDGs) stimulates increased attention to the issue and creates additional demands for information.1The first set of global and national estimates for 1990 was developed in order to strengthen the information base2. WHO, UNICEF and UNFPA undertook a second effort to produce global and national estimates for the year 1995.3 Given that a substantial amount of new data has become available since then, it was decided to repeat the exercise. This document presents estimates of maternal mortality by country and region for the year 2000. It describes the background, rationale and history of estimates of maternal mortality and the methodology used in 2000 compared with the approaches used in previous exercises in 1990 and 1995. The document opens by summarising the complexity involved in measuring maternal mortality and the reasons why such measurement is subject to uncertainty, particularly when it comes to monitoring progress. Subsequently, the rationale for the development of estimates of maternal mortality is presented along with a description of the process through which this was accomplished for the year 2000. This is followed by an analysis and interpretation of the results, pointing out some of the pitfalls that may be encountered in attempting to use the estimates to draw conclusions about trends.2,3 The final part of the document presents a summary of the kind of information needed to build a fuller understanding of both the levels and trends in maternal mortality and the interventions needed to achieve sustained reductions in the coming few years. (excerpt)
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)
Perspectives in Health. 2003; 8(2):26-29.More and more, nurses in the Caribbean have been packing their bags and heading for countries with less-than-perfect climates to get better pay and more respect. Now the region is looking for ways to keep them from leaving – and even to lure those abroad back home. (author's)
Perspectives in Health. 2003; 8(2):3-7.This year marks the 25th anniversary of the first International Conference on Primary Health Care in Alma- Ata, Kazakhstan, an event of major historical significance. Convened by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), Alma-Ata drew representatives from 134 countries, 67 international organizations and many non-governmental organizations. China, unfortunately, was notably absent. By the end of the three-day event, nearly all of the world's countries had signed on to an ambitious commitment. The meeting itself, the final Declaration of Alma-Ata and its Recommendations mobilized countries worldwide to embark on a process of slow but steady progress toward the social and political goal of "Health for All." Since then, Alma-Ata and primary health care have become inseparable terms. A quarter century later, it is useful to look back on the event and its historical context – particularly on the theme of "Health for All" in its original sense. For one who was a direct witness to these events, it is clear that the concept has been repeatedly misinterpreted and distorted. It has fallen victim to oversimplification and voguishly facile interpretations, as well as to our mental and behavioral conditioning to an obsolete world model that continues to confuse the concepts of health and integral care with curative medical treatment focused almost entirely on disease. (author's)
Public Health Nutrition. 2003 Jun; 6(4):323-325.This report and the subsequent commitment to a global strategy are extremely important for those of us working in Public Health Nutrition. They provide an important opportunity to promote the benefits of an evidence-based approach to solving major public health problems and raise the profile of nutrition. I have asked Este Vorster and Tim Lang to start off a discussion about the expert report. I look forward to other comments from readers. (excerpt)
[Unpublished] 2003 Jul 9. 15 p.How can information and communication technologies (ICT) be used to promote gender equality in developing nations and to empower women? This essay seeks to deal with that issue, and with the gender effects of the “information revolution.” While obvious linkages will be mentioned, the essay seeks to go beyond the obvious to deal with some of the indirect causal paths of the information revolution on the power of women and equality between the sexes. This is the third1 in a series of essays dealing with the Millennium Development Goals (MDGs). As such, it deals specifically with Goal 3: to promote gender equality and to empower women. It is published to coincide with the International Conference on Gender and Science and Technology. The essay will also deal with the specific targets and indicators for Goal 3. (excerpt)
POPLINE. 2003 May-Jun; 25:1, 2.If we are serious about a more equitable balance between population, environment and resources, Fornos said, " the industrialized world must commit itself to the provision of the necessary population assistance to the developing world." He stressed that solving the problem of rapid population growth is "a burden sharing exercise, with all of us - governments, multilateral agencies, the private sector, non-governmental organizations - working together for the common goal of improving the human condition." Fornos pointed out that throughout the world forests are declining, topsoil is eroding, deserts are expanding, temperatures are rising, and there remains the constant threat of unprecedented food and water shortages. (excerpt)
2003 world population data sheet of the Population Reference Bureau. Demographic data and estimates for the countries and regions of the world.
Washington, D.C., PRB, 2003. 13 p.With every passing year, prospects for population growth in the more developed and less developed countries grow more dissimilar. On this year’s Data Sheet, the total fertility rate (TFR) for the more developed countries is a mere 1.5, compared with 3.1 in the less developed countries—3.5 if outlier China’s large statistical effect is removed. But the passage of time, as well as the difference in fertility rates, is ensuring that the two types of countries can expect to continue to have different population sizes in the future. The decline in Europe’s fertility rates is not a recent phenomenon; those rates have been low for quite some time. As a result, there have been long-term changes to age distributions in Europe, and this “youth dearth” is now taking on a more significant role in the near certainty of population decline. (excerpt)
Human Resources for Health. 2003 Jul 22; 1: p..Background: Human resources are an essential element of a health system’s inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, sociodemographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health. Methods: Profiles of the health workforce are drawn for 18 countries with developed market and transitional economies, using data from labour force and income surveys compiled by the Luxembourg Income Study between 1989 and 1997. Further descriptive analyses of the health workforce are conducted for selected countries for which more detailed occupational information was available. Results: Considerable cross-national variations were observed in terms of the share of the health workforce in the total labour market, with little discernible pattern by geographical region or type of economy. Increases in the share were found among most countries for which time-trend data were available. Large gender imbalances were often seen in terms of occupational distribution and earnings. In some cases, health professionals, especially physicians, were overrepresented among the foreign-born compared to the total labour force. Conclusions: While differences across countries in the profile of the health workforce can be linked to the history and role of the health sector, at the same time some common patterns emerge, notably a growing trend of health occupations in the labour market. The evidence also suggests that gender inequity in the workforce remains an important shortcoming of many health systems. Certain unexpected patterns of occupational distribution and educational attainment were found that may be attributable to differences in health care delivery and education systems; however, definitional inconsistencies in the classification of health occupations across surveys were also apparent. (author's)
Working out of poverty. Report of the Director-General. International Labour Conference, 91st Session 2003.
Geneva, Switzerland, International Labour Office, 2003. ix, 106 p.Chapter 1 crystallizes my thoughts, commitments and ideas on this vital issue. We have a rich historic mandate that calls us to the challenge of fighting poverty. Our experience on the ground is bringing that mandate to life throughout the world. And we face common challenges as we join with others to provide women and men with the tools and support to work out of poverty. Chapter 1 is my personal exploration of these key issues. The subsequent chapters are more technical in nature, providing an in-depth and detailed account of the various dimensions of ILO efforts to eradicate poverty. Chapter 2 focuses on the complexity of poverty and the cycle of disadvantage that it creates. Chapter 3 describes ILO action on the ground and tools in the fight against poverty. Chapter 4 examines how rights at work and the institutional structure of the informal and formal labour market relate to employment creation, poverty reduction and competitiveness in a global economy. Finally, Chapter 5 discusses the need for a coordination of policies that focus on different dimensions of the life of people living in poverty. (excerpt)
Medical Hypotheses. 2003 Jul; 61(1):21-22.According to the United Nations, global fertility has declined in the last century as reflected by a decline in birth rates. The earth’s surface air temperature has increased considerably and is referred to as global warming. Since changes in temperature are well known to influence fertility we sought to determine if a statistical relationship exists between long-term changes in global air temperatures and birth rates. The most complete and reliable birth rate data in the 20th century was available in 19 industrialized countries. Using bivariate and multiple regression analysis, we compared yearly birth rates from these countries to global air temperatures from 1900 to 1994. A common pattern of change in birth rates was noted for the 19 industrialized countries studied. In general, birth rates declined markedly throughout the century except during the baby boom period of approximately 1940 to 1964. An inverse relationship was found between changes in global temperatures and birth rates in all 19 countries. Controlling for the linear yearly decline in birth rates over time, this relationship remained statistically significant for all the 19 countries in aggregate and in seven countries individually (p <0:05). Conclusions. The results of our analyses are consistent with the underlying premise that temperature change affects fertility and suggests that human fertility may have been influenced by change in environmental temperatures. (author's)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
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)
New York, New York, United Nations, 2003. iv, 37 p. (ESA/P/WP.182)Governments’ views and policies with regard to the use of contraceptives have changed considerably during the second half of the 20th century. At the same time, many developing countries have experienced a transition from high to low fertility with a speed and magnitude that far exceeds the earlier fertility transition in European countries. Government policies on access to contraceptives have played an important role in the shift in reproductive behaviour. Low fertility now prevails in some developing countries, as well as in most developed countries. The use of contraception is currently widespread throughout the world. The highest prevalence rates at present are found in more developed countries and in China. This chapter begins with a global overview of the current situation with regard to Governments’ views and policies on contraception. It then briefly summarizes the five phases in the evolution of population policies, from the founding of the United Nations to the beginning of the 21st century. It examines the various policy recommendations concerning contraception adopted at the three United Nations international population conferences, and it discusses the role of regional population conferences in shaping the policies of developed and developing countries. As part of its work programme, the Population Division of the United Nations Secretariat is responsible for the global monitoring of the implementation of the Programme of Action of the 1994 International Conference on Population and Development (ICPD). To this end, the Population Division maintains a Population Policy Data Bank, which includes information from many sources. Among these sources are official Government responses to the United Nations Population Inquiries; Government and inter-governmental publications, documents and other sources; and non-governmental publications and related materials. (excerpt)