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The past, present, and future of reproductive health surveillance in the US-Mexico border region [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A110.This editorial discusses reproductive health surveillance in the US- Mexico border region. It touches on past, present and future projects for that area including the United States- Mexico Border Health Commission (USMBHC) and the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP).
Bulletin of the World Health Organization. 2007 Nov; 85(11):824-825.The most recent report of the Intergovernmental Panel on Climate Change (IPCC) found that there is overwhelming evidence that humans are affecting climate and it highlighted the implications for human health. The World Health Organization (WHO) is helping countries respond to this challenge, primarily by encouraging them to build and reinforce public health systems as the first line of defence against climate-related health risks. (excerpt)
The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
Bulletin of the World Health Organization. 2006 May; 84(5):338.The context for this theme collection is the publication of the report of the Commission on Intellectual Property Rights, Innovation and Public Health. The report of the Commission -- instigated by WHO's World Health Assembly in 2003 -- was an attempt to gather all the stakeholders involved to analyse the relationship between intellectual property rights, innovation and public health, with a particular focus on the question of funding and incentive mechanisms for the creation of new medicines, vaccines and diagnostic tests, to tackle diseases disproportionately affecting developing countries. In reality, generating a common analysis in the face of the divergent perspectives of stakeholders, and indeed of the Commission, presented a challenge. As in many fields -- not least in public health -- the evidence base is insufficient and contested. Even when the evidence is reasonably clear, its significance, or the appropriate conclusions to be drawn from it, may be interpreted very differently according to the viewpoint of the observer. (excerpt)
Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects. [Corporaciones multinacionales y atención de la salud en Estados Unidos y América Latina: estrategias, acciones y efectos]
Journal of Health and Social Behavior. 2004; 45 Suppl:136-157.In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institution and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector. (author's)
Forced Migration Review. 2005 Jul; (Spec No):12-14.The tsunami was a tragic reminder that some people are always more vulnerable than others. The vast majority who lost their lives were people living in poverty, forced to live in inadequate housing along the shoreline. In the Maldives – which had only been removed from the UN’s least developed country category six days before the disaster – it was the poor, who do not have bank accounts and so keep money at home, who lost the most. Damage to the island republic has been estimated at 62% of GDP and is expected to reduce the country’s economic growth rate from the pre-tsunami forecast of 7.5% pa to only 1%. In all affected states initial responses to the tsunami were shaped by fears that the accumulation of dead bodies would represent a major threat to public health. Human bodies are indeed a source of emotional stress and their collection is important from a psychosocial perspective. However, efforts to explain to people that corpses do not represent an immediate health threat were half-hearted. In the general rush to dispose of bodies many traditional ritual practices were set aside, leading to a lingering sense of guilt that will need to be addressed through counselling. (excerpt)
Boston, Massachusetts, Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights, 2000. 10 p.Before human rights, there was altruism and after human rights there is altruism—the unselfish concern for the welfare of others. Altruism has been and remains an integral part of the beliefs, behaviors and practices of public health practitioners. But altruism means different things to different people. What human rights does for public health is to provide an internationally agreed upon framework for setting out the responsibilities of governments under human rights law as these relate to people’s health and welfare. Human rights as they connect to health should be understood, in the first instance, with reference to the description of health set forth in the preamble of the WHO Constitution, and repeated in many subsequent documents and currently adopted by the 191 WHO Member States: Health is a “state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” This definition has important conceptual and practical implications, as it illustrates the indivisibility and interdependence of rights as they relate to health. Rights relating to autonomy, information, education, food and nutrition, association, equality, participation and non-discrimination are integral and indivisible parts of the achievement of the highest attainable standard of health, just as the enjoyment of the right to health is inseparable from other rights, whether categorized as civil and political, economic, social or cultural. Thus, the right to the highest attainable standard of health builds on, but is by no means limited to, Article 12 of the International Covenant on Economic, Social and Cultural Rights. It transcends virtually every single other right. This paper highlights the long evolution that has brought health and human rights together in mutually reinforcing ways. It will summarize key dimensions of public health and of human rights and will suggest a manner in which these dimensions intersect in a framework of analysis and action. It will address these issues against the background of the progress being made by the World Health Organization towards defining its roles and functions from a health and human rights perspective. (excerpt)
American Journal of Public Health. 2005 Jan; 95(1):8.The term global as applied to human development emerged in the 1960s at the time of the green revolution, when the World Bank advocated the need to “think globally, act locally.” The terms global, international, and intergovernmental have different roots and translate differently in policy; institutional functions; and level of analysis, action, and accountability. They are not mutually exclusive. While the term international has framed much of the work in health across countries over the past decades, the term global has become more politically viable in that it elevates the vision of health to the whole planet, moving beyond geopolitical boundaries and including not only governments but nongovernmental stakeholders and actors. The World Health Organization (WHO), created shortly after World War II as a specialized, intergovernmental agency, is intended to lead and coordinate the health actions of governments worldwide. The work of WHO is facilitated when consensus is reached among countries on global priorities, as was the case for malaria and smallpox eradication in the 1960s, primary health care and immunization in the 1970s, and the Global Program on HIV/AIDS in the 1980s. (excerpt)
Perspectives in Health. 2003; 8(2):23-25.Today the Pedro Kourí Institute for Tropical Medicine comprises 52,000 square meters and 700 employees and is Cuba's leading research and training center in infectious diseases, as well as a major player in international efforts to control tropical diseases. Many of the national laboratories of Cuba are housed at the institute, along with the island's only tertiary AIDS clinic and research center. It continues to receive support from TDR as well as Canada, France, Spain, Belgium, the European Union and the Wellcome Trust, among others. (excerpt)
[Unpublished] 1993 Dec. xii, 217,  p. (Report No. 12577-AFR)The World Bank has recommended a blueprint for health improvement in sub-Saharan Africa. African countries and their external partners need to reconsider current health strategies. The underlying message is that many African countries can achieve great improvements in health despite financial pressure. The document focuses on the significance of enhancing the ability of households and communities to identify and respond to health problems. Promotion of poverty-centered development strategies, more educational opportunities for females, strengthening of community monitoring and supervision of health services, and provision of information on health conditions and services to the public are also important. Community-based action is vital. The report greatly encourages African governments to reform their health care systems. It advocates basic packages of health services available to everyone through health centers and first referral hospitals. Health care system reform also includes improving management of health care inputs (e.g., drugs) and new partnerships between public agencies and nongovernmental health care providers. Ministries of Health should concentrate more on policy formulation and public health activities, encourage private voluntary organizations, and establish an environment conducive to the private sector. African countries need more efficient allocation and management of public financial resources for health to boost their effect on critical health indicators (e.g., child mortality). Public resources should also be reallocated from less productive activities to health activities. More commitment from governments and domestic sources and an increase of external assistance are needed for low income African countries. The first action step should be a national agenda for health followed by action planning and setting goals to measure progress.
Bulletin of the World Health Organization. 2001; 79(1):69-70.This article reviews the 1991 paper by Arata Kochi on the strategy of WHO to control tuberculosis. It notes that Kochi's paper did not report a new scientific discovery, rather it depicted the devastating impact of tuberculosis around the world in a clear and forceful manner. Consequently, it changed the public health focus of WHO, national governments and leading voluntary organizations. Kochi's paper pinpointed three major programmatic deficiencies that had to be overcome: inadequate treatment services; high rates of failure to complete therapy; and the worldwide absence of adequate governmental surveillance and monitoring systems. Furthermore, the paper gave attention to the role of public health in addressing the tuberculosis issue. To address the problem, Kochi emphasized that it would take strong, directive leadership by national government to implement systems for an effective prevention and control program for tuberculosis.
Washington, D.C., World Bank, 1993. vi, 23 p.This World Bank annual report gauges the progress made in improving health for all in 1993, diagnoses deficits in government operations, and identifies the roles of government and the market in reforming health systems. This report offers policy recommendations for developing country governments for improving the health status of people, improving the health status of the poor, and helping to control health care spending. Tables and charts for major countries of the world provide 1990 data on population structure and dynamics, as well as health expenditures and total flows from external assistance. Health service failures have been due to misallocation, inequity, inefficiency, and exploding costs. The poor in low income countries lose out in health due to public spending that favors high cost hospital services benefiting the affluent. In middle income countries, governments subsidize insurance that benefits the affluent. In the formerly socialist countries, the aim is equity, but the affluent still make informal out-of-pocket payments for better care. The government's role in health care delivery should be guided by increased provision of the supply of goods and increased encouragement of positive health behaviors. Government should provide cost effective health services to the poor and should compensate for problems associated with uncertainty and insurance market failure. A three-pronged approach to government policies for improving health should focus on fostering an environment that enables households to improve health, improving government spending on health, and promoting diversity and competition.
New York, New York, Oxford University Press, 1993. xii, 329 p.The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.